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OPINIONPoliticsNovember 2, 2023

How fees-free prescriptions changed my patients’ lives for the better

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The removal of prescription charges has been transformational for many of those coming through the doors of Te Awamutu pharmacist Gemma Perry. But now the new government is planning to reinstate fees, and she’s dreading the impact.

At Sanders Pharmacy in Te Awamutu, Clive, aged 88, has been coming to us for 70 years. He’s been a patient at the pharmacy since it was founded in 1953 by pharmacist Bill Sanders, who described himself as “mad keen on helping people”.

We have a long history of looking after Clive. Our whole team has built relationships with him over decades. As a result, he says he has a “special spot” in his heart for me and my team.

This is what pharmacy is all about. Getting to know our patients and their needs. Helping them to understand their medical conditions and the often complex medicines they require. Supporting our patients to navigate the health system, with an increasing focus on preventative medicine.

All this work was boosted by the removal of “patient co-payment” prescription charges in July of $5 per item. It happened after long years of health sector advocacy and in the wake of compelling new University of Otago research about the benefits of removing prescription charges, such as people spending fewer days in hospital.

We’ve already seen the difference that’s been made by fees-free prescriptions. As pharmacists, we’re keeping people out of hospitals. We’re getting people through our doors again: Young parents who just didn’t have the money for an unexpected bill on the day. Families with teenage children needing asthma inhalers. People dealing with anxiety, for whom the stress of a potential Eftpos decline had been too much. Low-wage workers – some literally crying with relief. Patients with high health needs, who had been driving long distances and waiting long times to get their various medications from discounters, often served without vital medication advice. We no longer have the heartbreak of patients asking which of their list of important medicines they can leave until payday. We no longer see the upsetting consequences of patients with chronic conditions and pain trying to eke out their medicines by taking less than the prescribed daily dose.

And we’re having more face-to-face conversations, allowing everyone the chance of having a meaningful relationship with their healthcare provider. That’s where the magic of pharmacy happens.

A lot of that magic is at risk. National plans to reinstate the $5 prescription charge for most people over 13 years old; Act wants to reinstate it for everyone. We’re pleased New Zealand First have promised to keep prescriptions fees-free; as their MP Jenny Marcroft has said, “Access to medicines is not only about increased funding of medicines but removing and keeping barriers to access down.”

But even if it turns out on November 3 that the National-led government does not need NZ First’s votes, we urge the government not to bring back prescription fees.

Increasing fees for medicines for most people will be a step backward – for patients, for pharmacists, and for our community. Pharmacists’ conversations with patients will be taken up with concerns about cost, rather than care – even for those who can pay. People, even on reasonable incomes, are struggling. Medicines add up: an unexpected bill of $40 or more, if the whole family gets sick, or if someone is dealing with multiple health issues, can put people off dealing with health issues until they get worse. It’s the shame, the embarrassment of not being able to pay.

a $5 note on a blue background, with blue and white capsules dotted around
National wants to bring back the $5 charge for adult prescriptions. Act is pushing for everyone to pay. (Image: Archi Banal)

Prior to the fees removal, a group of pharmacists, the Prescription Access Initiative, carried out a survey on the fallout of the fees, and one responding pharmacist summed up the problem well: “I spend more time managing patients fiscally than medically.” We’ll be back in that position if the new government follows through on its plans – particularly during the current cost-of-living crisis. At a time when people are facing high food prices, steep petrol costs, and rising rents, it doesn’t seem sensible or fair to ask people to pay for medications they need. There are plenty of people without Community Services Cards or SuperGold Cards (National’s proposed exemptions) who are still in need. Anytime we add in layers of targeting, there will be vulnerable people who will fall through the cracks.

Putting prescription charges back on the table also turns pharmacists into tax collectors for the government. The fees don’t go to us. This wastes our time and it’s not our role. It risks putting more strain on pharmacists when we’re already having trouble filling our workforce.

National put out a whole policy on cutting red tape. But asking pharmacists to deal with targeted exemptions, requesting proof of eligibility, and then collecting tax for the government all creates more red tape for small businesses that are part of the beating heart of our communities.

National and Act have also promised tax relief. But putting fees on vital medications is essentially putting a tax on sick people.

National’s also refused to rule out loosening the rules on ownership of pharmacies – and Act has definitively said they want to loosen these rules. Removing the requirement for pharmacies to be majority-owned and effectively controlled by pharmacists would open up more pharmacies to corporate control, including in supermarkets, and risk closure of independently-owned pharmacies. We know the corporate focus is keeping costs down to provide shareholder returns, rather than building relationships and going the extra mile to support patients.

These kinds of political footballs wear down and demoralise the community pharmacy sector. They make us feel like the forgotten profession.

A rural Northland pharmacist wrote in our survey: “It’s free to go to hospital, why can’t it be free to come collect medicines from the pharmacy that can keep you well and out of hospital?”

Pharmacists in New Zealand have a clear message for our new government leaders: we ask that they at least delay reintroducing prescription fees during a cost-of-living crisis. We ask that they stop and consult the sector that has to implement their policies before storming ahead. Giving us all some time to share what we do, and why fees should stay off medicines, would give us breathing space – and time for the new government to pause and reflect on the best way forward.

I think that’s the sort of thing that 88 year-old Clive would really appreciate.

Gemma Perry is a pharmacist and founding member of advocacy group Prescription Access Initiative.

National’s Rima Nakhle (Image: Archi Banal)
National’s Rima Nakhle (Image: Archi Banal)

PoliticsNovember 2, 2023

Meet Rima Nakhle, the new National MP who almost overshadowed Luxon’s big night

National’s Rima Nakhle (Image: Archi Banal)
National’s Rima Nakhle (Image: Archi Banal)

She had a surprise moment in the spotlight when her supporters briefly drowned out the incoming prime minister’s victory speech on election night. Stewart Sowman-Lund meets the newly-elected Takanini MP (and her husband) to find out what happened, and why.

It’s election night at Auckland’s Shed 10 and National Party supporters are celebrating a better-than-expected result. Every time the television cuts to a result showing a seat has been flipped to blue, there’s a loud cheer. While the biggest applause of the night is reserved for the new prime minister, one of the most popular faces in the packed room is a political rookie largely ignored by the political journalists already waiting at the door for Christopher Luxon to arrive. “Rima, Rima, Rima!” fans chant, waving flags emblazoned with her face and creating a makeshift guard of honour at the entrance to the venue.

Later in the night, another round of “Rima, Rima, Rima” briefly interrupts Luxon’s victory speech. You would have heard it if you were watching at home, too. 

The Rima they are chanting for is Rima Nakhle, the second-time National candidate, and now new MP, for the South Auckland seat of Takanini. 

“When that happened, I was like ‘no, stop’.” It’s two weeks later and I’m sitting opposite Nakhle, smartly dressed in a party-blue blazer and a silky scarf, and her husband Roger in a corner booth at the Coffee Club in Takanini. She’s ordered a tea and insists that we get some food. “This isn’t just any Coffee Club,” she says, pointing out the owner whom she knows personally and telling me about the awards the cafe has won. 

She sounds slightly embarrassed recalling her colourful election night entrance. “The flags were organised by Roger. He’s like ‘Rima, imagine! Us at the party waving a flag’ and I was like ‘you know what, that would be cute’.” Some of Nakhle’s family from Australia, including an uncle and sister, had visited to help in the final moments of the campaign. On election night, alongside a handful of volunteers, they were responsible for starting off the chant. 

Rima Nakhle arrives at National HQ on election night
Rima Nakhle arrives at National HQ on election night (Photo: Fiona Goodall/Getty Images)

“Rima’s a darling of the party, everyone loves her,” interjects Roger, her husband of almost 12 years. “Everyone rallies around her.”

It might be true. During the hour we spend chatting over coffee, we’re interrupted no less than five times by well-wishers, including a local councillor. It isn’t a set-up, insists Nakhle, laughing. “That’s the scary thing,” Roger says. “It’s not.”

Australian-born Nakhle moved to this side of the ditch in 2012, following her marriage to New Zealander Roger. Both their families are Lebanese, and the Nakhles have been a prominent family in South Auckland since the 1960s. She completed a law degree in Sydney and was later admitted to the bar in Auckland, though she never practised. 

There were two unsuccessful local body political campaigns before she was invited, in late 2019, to consider running for the new Takanini seat for National the following year. The selection process was “brutal” and Nakhle ultimately beat sitting MPs Parmjeet Parmar and Agnes Loheni for the Takanini candidacy in 2020.

In that year, she lost to Labour’s Neru Leavasa. It was hardly an unexpected result given the widespread move towards Labour during the Covid-19 pandemic. “Trust me, I felt it on the doorsteps,” says Nakhle. “Their minds were made up… they were scared.” 

But things felt different this time. People were more open, she says; even their body language was more welcoming. Where once people would reluctantly take a pamphlet but say their mind was already made up, now they enthusiastically listened to what she had to say. “We didn’t do any polling this time around. For months I have been door knocking and I knew what we were seeing,” explains Nakhle. “I’m the type of person that goes hard until the last moment. At school when I had exams, I’d study until the early morning. I want to use every moment.”

The Takanini electorate was formed in the lead-up to the 2020 election as a result of population growth in South Auckland, pulling from parts of neighbouring Manurewa (a Labour stronghold) and Papukura and Port Waikato (safe National seats). Nakhle rejects the suggestion that Takanini would naturally fall to National simply because of the areas it encompasses. Some parts of it are “deep red”, she says. Either way, Nakhle almost completely reversed the result from 2020. That year, Leavasa won with a majority of almost 8,000. This time around, Nakhle came in 7,000 votes ahead.

Takanini is also a very diverse area – the 2018 census showed that more than 50% of locals were born overseas – and it’s the second fastest growing electorate in the country. People are often shocked at how multicultural National Party events are in the seat, says Nakhle. She pushes back when asked whether such comments demonstrate a broader issue within the party. “I say if I felt our party was actively trying to be that way, I wouldn’t be part of the party. If I felt our party was racist, I wouldn’t be part of the party.”

Her campaign formally started in March this year, later than some of her colleagues who were selected as candidates in late 2022. Nakhle says it didn’t really change anything for her as she’d been in campaign mode “since October 18, 2020” – the day after the last election. “I didn’t know if I was going to be the candidate, but I thought maybe I would,” she says. “I had to assess how much heartache I could take if I lose again.” She laughs, saying she didn’t want to be a “loserrr” (that’s “just a joke”, she insists).

Over the past few years, people would ask why she was still turning up to events that she didn’t have to be at. “How could I not?” she says. “I was campaigning from last time. I didn’t stop.”

Nakhle’s interest in politics started young. “I’ve always been drawn towards advocacy. When I was 12-years-old I asked one of my teachers, ‘what does a lawyer do?’. He said, in very rudimentary terms, ‘a lawyer sticks up for people’. I thought, ‘I stick up for people’.” 

Now, she says her passion for helping people encompasses a range of topics. When asked if there’s a particular portfolio she’d like to get her teeth into in parliament, she names several including justice, children, seniors and ethnic communities. Housing would also be a natural option, given her role as executive manager of Te Mahia Community Village, a Nakhle family business that provides emergency accommodation in Takanini.

Nakhle’s reticent when asked where her politics fit within National, a party that likes to describe itself as a “broad church”. Still, she says the diversity of her views can surprise people. “I can be very conservative on certain subjects but very progressive on others,” she says. She voted against both 2020 referendums – cannabis legalisation and euthanasia – but says that doesn’t mean she’s consistently conservative on conscience issues. “When I made the decision to put my name forward [as a candidate] it took months of thinking and part of the thought was that question. I thought, if I am not prepared to understand on what basis my party is making up policy, then I shouldn’t be part of it,” she says. 

“Whatever I’m socially conservative on, it’s done in a way where I understand the other point of view and I don’t ever want to judge. Whatever my view is, I’m in no way judging other people for their views that will be very different to mine.”

Rima Nakhle and her campaign car
Rima Nakhle and her campaign car (Photo: Stewart Sowman-Lund)

Given that it’s near-impossible that the special votes will change the outcome in Takanini, Nakhle is already throwing herself into her new job. She’s in Wellington most days now, learning the ropes and preparing for what will be a busy three years. Apparently included in that crash course is that any substantive question about coalitions or the shape of the next government should be met with words to the effect of “no comment”. It’s a smart move. 

But one thing she won’t need to learn is what type of MP she wants to be. She tells me about an event she attended in Papakura early in her political career. A lot of “people in suits” were arriving and someone turned to her and said they were there because an election was coming up.

“That sticks with me, like it was tattooed in my memory. It made me feel sick that this person noticed that there are people that only show up when it’s election time. I thought if I continue with this, I’m never going to be like that.”

If the number of people stopping for a chat in the Coffee Club is representative of anything, it’s that she’s off to a good start.