DHBs look set to have some of their autonomy taken away when it comes to treating cancer.
More than 80,000 Kiwis have signed a petition asking for the Government to set up a national cancer agency, with growing concerns the level of care here has slipped behind what's on offer overseas.
The Government has so far resisted pressure to tell Pharmac to spend-up on cancer drugs that Australians and Canadians have subsidised access to, respecting its independence.
"The gap between New Zealand and comparative countries like Canada, Australia and the UK is just getting bigger and bigger," oncologist Chris Jackson told The AM Show on Friday.
"We need a national cancer agency which takes things out of the hands of politicians, and makes it into an independent agency that makes sure all New Zealanders get access to best cancer care, no matter who you are or where you live."
Health Minister David Clark next week will unveil a national cancer plan, six months after promising to put one together at a conference in Wellington.
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Dr Jackson says if it's going to work, it'll need to centralise much of the decision-making on cancer issues to end the "cacophony of inequality" which currently plagues the health sector.
"We have got 20 different DHBs each doing their own thing... it's like having a rugby team with no coach - no one to hold the DHBs to account, no one to set standards or anything like that, and that's desperately what we need. Currently, the quality of care you get varies depending on which hospital you're at."
Labour MP Kris Faafoi told The AM Show there would be a focus on centralised leadership in the plan.
"The details in it matter. For far too long, depending on what DHB that you live in, you get a different service. I don't think any New Zealander finds that acceptable."
Dr Jackson said next week's plan will be the first serious effort at improving New Zealand's approach to treating cancer since 2003. He said a separate agency is needed for cancer, which is responsible for about a third of all deaths in New Zealand, like they have in Canada and Australia - rather than a separate unit within the Ministry of Health, which has been rumoured.
"Our worry is that even if it is a good short-term solution to have something within the ministry, in the longer-term when the winds of political fortune change, it might get run down again. Politicians aren't best-placed to make these complex technical decisions."
When Pharmac started funding Keytruda, Dr Jackson says the lack of a dedicated agency to manage it resulted in a lack of doctors and nurses who had the training to deliver it to patients.
Whose to blame?
As the present major Government coalition partner, Labour has taken the brunt of the criticism - but Dr Jackson says National is just culpable.
"Successive Governments have dropped the ball on cancer care. We saw the last National Government get rid of the cancer leadership group, the Cancer Control Council; we saw this Government promise big and so far we haven't quite seen that manifest."
National MP Judith Collins defended her party's record, pointing to the funding of breast cancer drug Herceptin, despite the usual reluctance for politicians to interfere in Pharmac's independence.
"Some people would say 'you shouldn't have done that' but actually, it was the right thing to do. It saved a lot of women."
Then-Health Minister Jonathan Coleman in 2015 said it was a mistake to promise funding for Herceptin, as it weakened the drug-buying agency's negotiating power.
Collins disagreed with Dr Jackson about the need for a separate cancer agency.
"The money you spend on setting up agencies, take some of that money and just put it into the drugs. Give it to Pharmac and [ask for] a big focus on cancer."