Despite $3.44 billion for hospital and specialty services, $2.12bn for primary care and public health, a budget boost of $1.77bn over four years for Pharmac, plus tax relief for inflation-hit businesses, critics of New Zealand’s 2024 Budget said it fails cancer patients, Māori and “kicks the medicines crisis down the road”.

The total spend on health was $29.6bn, up slightly from $26.5bn in last year’s budget, with health minister Dr Shane Reti promising an overall increase in health funding of $16.68bn over this government’s three budgets. National’s election promise to fund 13 specific cancer treatments – including nivolumab (Opdivo) and pembrolizumab (Keytruda), adjuvant treatments for uveal melanoma – whose $280m cost was to be funded by reinstating the $5 prescription fee, was, however, dropped. “Our hearts go out to those living with cancer and their whānau who had their hopes raised by National’s election promise last August, only to see them crushed today,” said Cancer Society chief executive Dr Rachael Hart.

Responding to post-budget criticism from cancer specialists and patients, finance minister Nicola Willis said her government was committed to expanding access to cancer drugs, while prime minister Christopher Luxon agreed it was still a priority and he hoped to make an announcement before the end of the year.

Pharmac’s $1.77bn boost will bring its total budget to $6.3bn over the next four years, said associate health minister David Seymour. However, Dr Ayesha Verrall, the former minister of health, countered that just over $1bn of this is related to increased costs at Pharmac and the new funding will do little more than maintain Pharmac’s status quo. "Hopeful patients and advocates will welcome this funding – but David Seymour needs to be upfront with them about how far it will go," she said.

Other casualties

On the surface, Budget 2024’s $2.12bn for primary care and public health over the next four years sounds impressive, said Bindi Norwell, chief executive of ProCare, a cooperative supporting 850,000 of the country’s healthcare professionals. But that’s roughly $530m per annum and it’s not just for primary care, she said. “It’s shared across mental health, community providers, ambulance services and aged care… which means that figure is spread extremely thin.” Natural population growth and our ageing population will soak up most of that $530m because of the way our health contracts are written, she said. “This doesn’t make the financial pressures primary care is facing go away. Nor does it address the fact that workforce costs and other inflationary pressures continue to outpace the funding practices are receiving.”

It is a step in the right direction, said Royal New Zealand College of General Practitioners president and Wellington GP Dr Samantha Murton. “But it is disappointing to once again see the biggest slice of funding going to hospital services, instead of being reprioritised into primary care. You cannot prevent someone from being hospitalised once they are already in hospital – it needs to be prevented in the community and in primary care.”

As part of the Budget, the government said it was also “prepared to make fair and reasonable contributions to supporting non-government healthcare providers to deliver ongoing services” but would not commit to specific funding amounts in advance of settlements being reached. Norwell welcomed the news, saying that while primary care practices are extremely supportive of paying their nurses more money, the reality is that they cannot afford to carry these costs without additional funding. “It is imperative that the government takes this into account,” she said.

Health Informatics New Zealand confirmed more than $330m originally earmarked for data and digital health initiatives at Te Whatu Ora over the next four to five years will be returned to the Treasury. The ‘unspent’ money was identified as part of savings initiatives.

As well as any mention of eyecare being absent in Budget 2024, so were Māori, said Te Pati Māori co-leader Debbie Ngarewa-Packer, who called it ‘‘a privileged budget’’. ‘‘There is not any eye on Māori – you can’t even see the word. It’s like we don’t exist and we’re seeing the dismantling of kaupapa that actually fought for Māori solutions. Whānau Ora has got the best social return on investment, but it has absolutely no increase in funding. Why?”