Abandon the silos!

Chief Executive of the Cancer Society, Dalton Kelly, today challenged stakeholders at a PHARMAC forum whether the time hasn’t come to abandon the silo approach to delivery of disease prevention and treatment, as is apparent in the public sector.

“Our worry has long been the silo approach where different health groups and divisions get on with their objectives and roles – whether it be buying drugs or running a public health promotion. But I wonder whether the revolution in technologies, and the understanding of the holistic approach, shouldn’t be leading us to think about the spectrum as a whole.

Dalton Kelly had a work of praise for the country’s drug purchasing agency. “PHARMAC, along with its siblings that deal with vaccines, Maori health, smoking cessation and so on, has worked well for New Zealand. Until relatively recently PHARMAC had to deal with a dwindling allocation of funds, while on the other hand new and very expensive drugs became available.

“The paradigm has shifted further. New blockbuster drugs are increasingly few and far between. And while these drugs come at an enormous cost, I have two comments. The first is ‘thank goodness we still have researchers looking for new cures and resolutions, and secondly the cancer community does understand how much R&D trials, particularly failed trials, cost in a commercial world.

“And anecdotally, we find that many of our acceptable day to day drugs, like aspirin, would never have made it through today’s rigorous testing as the side effects, such as bleeding, would have been regarded as unacceptable.”

In closing Dalton noted that one of the reasons he had raised the issue of the silo mentality was because, “being based in Wellington I hear a lot about the ‘joined-up government approach for many policy issues, ranging from infrastructure development to delivery of welfare services. But this-joined up idea still has to come to fruition in the health sector. I know efforts are being made, but suggest we need to do better.

“It is not just deciding what drugs will or won’t be funded, whether provincial cities continue to retain maternity services or if breakfast will be served at low decile schools somehow we need to get a hand on the big picture, the helicopter approach, which draws all these threads together.

“A great example just this is the work currently being done to enhance the Cancer Registry. This is a great initiative that will capture information about every one of the 20,000 cancer cases diagnosed every year. The work enhances the existing registry and will ultimately provide a brilliant planning tool so that DHBs will really know if trends indicate they need new equipment, staffing and resources, it will allow researchers and clinicians to know what treatments have been applied and what outcomes have occurred.”