How does the operation of PHARMAC's 'Community Exceptional ...

challenges are multiple: to identify what research and knowledge is
needed; to identify appropriate sources of that knowledge; to ascertain the
validity, quality and relevance of the knowledge obtained; and to
understand how that knowledge informs a range of potential policy
options. As science has become more complex and impacts on every
aspect of our lives, offering solutions to many of the problems the world
confronts, these issues become more urgent”. (Gluckman, 2011)
The problem with Gluckman’s approach to policy making is deciding which
knowledge base should be used. It cannot simply be assumed that, as is often
suggested in science, there is a clear, commanding and reproducibly derived
evidence base for the knowledge required to solve social problems. My research
has given two examples (those concerning King and Ryall) demonstrating that
Gluckman’s suggested approach is not universally accepted. There are other
characteristics to policy formation and decision making such as societal values,
financial constraints, public opinion and the all important process of elections
(and election manifestos) which are the centre of New Zealand’s democracy and
constitutional arrangements 77 .
When politicians react to intense lobbying and lay aside the analytical approach
to which PHARMAC’s utilitarian model appeals, they undermine the cost
containing processes of their own agent. Gillon (2006) suggests that under these
conditions Ministers who override PHARMAC’s decision making have a
concomitant responsibility to provide PHARMAC with extra resources to meet the
election promises which were made(R Gillon, 2006). Minister Annette King
directed PHARMAC to fund Beta-Interferon out of its resources and did not
provide extra funding for the commitment. Minister Tony Ryall funded the
Herceptin election promise with extra funding provided through the Ministry of
Health to PHARMAC and the DHBs.
In this chapter, I have used the test-questions as a framework for examining the
results of the thematic analysis of PHARMAC’s operation of the Community
77 New Zealand does not have a written constitution. New Zealand’s legal and democratic framework is considered to be the
existence of a collection of statutes and regulations passed by the Parliament (including the Constitution Act 1986, The Bill of Rights
1990 and The Electoral Act 1993), signed treaties including the Treaty of Waitangi, Orders in Council, International Treaties and
Charters, Letters Patent, the Royal Assent for new legislation. The Cabinet Manual and the common law made by decisions of the
Courts. Taken together, all these laws and constitutional traditions are described as New Zealand’s ‘constitutional arrangements’.
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