Bob Edlin: Maori Health Authority Segregation Bill

Maori Health Authority must engage with “relevant” groups under new Bill – but guess who gets to define “relevant”?

As we expected when we last reported news from the Beehive, Health Minister Andrew Little has introduced his health reform bill to Parliament to abolish the country’s district health boards and centralise the provision of health services.  Most notably, the Bill segregates the country’s health services by establishing a Māori Health Authority and formalising the role of iwi-Māori partnerships.

Compared with the existing legislation, moreover, it significantly expands on the place of the Treaty of Waitangi in health legislation.

There is plenty to digest in the Bill – the Pae Ora (Healthy Futures) Bill –  and your Point of Order team has not thoroughly examined it. But we were fascinated by some of the accountability provisions for the new Māori Health Authority.

This authority must

… have systems in place for the purpose of engaging with Māori in relation to their aspirations and needs for the health system; enabling the responses from that engagement to inform the performance of its functions; and

 “engage with relevant Māori organisations” when—

• • jointly developing the New Zealand Health Plan with Health New Zealand; and
  • advising on the GPS and any health strategy; and 
  • preparing its statement of intent and statement of performance expectations.

A GPS is a Government Policy Statement.

But what is a “relevant” Māori organisation?

The bill answers this question:

Māori organisation includes (without limitation) iwi-Māori partnership boards, iwi and hapū authorities, rūnanga, trust boards, Māori health professionals’ organisations, and representatives of whānau and hapū

 Relevant Māori organisation means a Māori organisation that the Māori Health Authority considers relevant for the purpose of the engagement.

Doesn’t this mean the authority must engage only with the organisations it chooses to engage with?

The Ardern government’s unabashed politicising of the “principles of the Treaty of Waitangi” can be gauged by checking out the existing legislation.

The New Zealand Public Health and Disability Act 2000 says:

Treaty of Waitangi

In order to recognise and respect the principles of the Treaty of Waitangi, and with a view to improving health outcomes for Maori, Part 3 provides for mechanisms to enable Maori to contribute to decision-making on, and to participate in the delivery of, health and disability services.

Little’s Bill is much more specific about what he contends the Treaty (a document with just three short articles) demands from our health system:

Te Tiriti o Waitangi (the Treaty of Waitangi)

In order to provide for the Crown’s intention to give effect to the principles of te Tiriti o Waitangi (the Treaty of Waitangi), this Act—

• • requires health entities to be guided by the health system principles, which, among other things, are aimed at improving the health system for Māori and raising hauora Māori outcomes; and
  • establishes the Māori Health Authority and sets out its objectives and functions; and
  • requires the Minister to—
    • • establish a permanent committee, the Hauora Māori advisory committee, to advise the Minister; and
      • seek the advice or agreement of the committee before exercising certain powers; and
  • gives recognition to iwi-Māori partnership boards to enable Māori to participate in and contribute to decision making on local health priorities; and
  • requires Health New Zealand and the Māori Health Authority to engage with iwi-Māori partnership boards; and  
  • requires Health New Zealand and the Māori Health Authority to jointly develop and implement a New Zealand Health Plan and to work together in the performance of specified functions of Health New Zealand; and
  • requires the boards of Health New Zealand and the Māori Health Authority to have knowledge of, and experience and expertise in relation to, giving effect to te Tiriti o Waitangi (the Treaty of Waitangi) and tikanga Māori; and
  • requires the Māori Health Authority to have systems in place for the purpose of engaging with Māori and enabling the responses from that engagement to inform the performance of its functions; and  
  • requires the Māori Health Authority to report back to Māori on how the engagement under section 20(1)(c)has informed the performance of its functions

Perhaps we shouldn’t blame the influence of the Treaty, but it does seem Maori are being given preferential treatment and entitlements, compared with other ethnic groups in this country.

According to the Beehive press statement, the Pae Ora Healthy Futures Bill replaces the 20 District Health Boards with a new Crown organisation, Health New Zealand, providing a national health service with a strong focus on primary health care.

In other words, the public will lose the district health boards whose members are elected by local citizens under current legislation. It will be replaced by the new Health Authority.

But the press statement also says:

“These changes recognise the role of Iwi-Māori Partnership Boards and that Māori should be able to exercise tino rangatiratanga and mana motuhake when it comes to planning and decision-making for health services at a local levels,” Peeni Henare said.

This suggests – at first blush – that for the great bulk of the population, local control of or influence on health services will be abolished and the system will be centralised.

Maori, in contrast, are being enabled to influence decision-making at the local level through the statutory entrenchment of a role for Iwi-Maori partnerships …

But then Andrew Little says:

“Giving people a real say in the type of services they have is critical, and the bill provides for communities to come together in locality networks, which can work with Health New Zealand and the Māori Health Authority to develop services that work for local people.”

Trouble is, there is no formal structure for non-Maori citizens (or consumers) to be consulted. At least, not that we can find.

We checked the bill and learned:

Determination of localities

(1) Health New Zealand must determine, with the agreement of the Māori Health Authority, geographically defined areas (localities) for the purpose of arranging services.

(2) Health New Zealand must ensure that—

(a) all of New Zealand is covered by a locality; and

(b) the boundary of a locality is consistent with any regional arrangement specified in regulations made under section 97; and

(c ) a list of all localities (including their geographical areas) is made publicly available.

(3)  Health New Zealand may, with the agreement of the Māori Health Authority, amend the number or boundaries of any localities at any time, as long as the requirements in subsection (2)are met.

But how does the public get to have a say in the development of these localities?

Through the procedure whereby locality plans are developed, perhaps.

Health New Zealand must develop a locality plan for each locality.

A locality plan must—

(a) set out the priority outcomes and services for the locality; and

(b)   state the plan’s duration, which must, as a minimum, be 3 consecutive financial years; and

(c)  give effect to the relevant requirements of the New Zealand Health Plan.

In developing a locality plan for a locality, Health New Zealand must—

(a) consult consumers or communities within the locality; and

(b) consult social sector agencies and other entities that contribute to relevant population outcomes within the locality; and

(c) consult—

(i) the Māori Health Authority; and

(ii) iwi-Māori partnership boards for the area covered by the plan; and

(iii) any other individual or group that Health New Zealand considers appropriate.

Our impression that Iwi-Maori Partnership boards have a special place in shaping future health and disability services is reinforced by information found on the Department of the Prime Minister’s website:

Iwi-Māori Partnership Boards, which currently work with DHBs, will have an explicit, formal role – including agreeing local priorities with Health NZ

These reforms are designed to give Māori rangatiratanga over hauora Māori and greater influence throughout the system. This is not only because it is central to Te Tiriti o Waitangi, but also to ensure everyone has the same access to good health outcomes.

The website then explains what’s changing.

The Ministry of Health and each of our 20 District Health Boards (DHBs) currently share responsibility for ensuring equity for Māori. In the future, it will remain the responsibility of all organisations to improve Māori health outcomes, with significant changes to ensure that this is embedded and driven through the system:

• • a new, autonomous Māori Health Authority will be responsible for ensuring the health system is performing for Māori through:

(1) partnering with the Ministry to advise Ministers on hauora Māori 

(2) directly funding innovative health services targeted at Māori (including kaupapa Māori services) 

(3) working with Health New Zealand to plan and monitor the delivery of all health services.

• • Iwi-Māori Partnership Boards, which currently work with DHBs, will have an explicit, formal role – including agreeing local priorities with Health NZ Health NZ will be responsible for improving Māori health outcomes and equity through all of its operational functions at national, regional and local levels

• • the Ministry of Health will continue to monitor how the system is delivering for Māori overall, partnering with the Māori Health Authority.

Let’s repeat that bit about Iwi-Māori Partnership Boards. They will have an explicit, formal role – including agreeing local priorities with Health NZ Health.

In response to Andrew Little’s media briefing, ACT deputy leader and health spokesperson Brooke van Velden said the Minister had left more questions than answers.

Indeed.

Van Velden focused on the issue of community involvement:

“The Minister couldn’t answer how many new localities would be set up under Health NZ, pointing to drawing on the health services available to different areas.

“Could it be that we spend hundreds of millions of dollars and see 20 DHBs re-established under a different name ‘localities’?”

Van Velden then spelled out what ACT would do to reform our health system.

Great.  But right now the Ardern government is in the driving seat and Opposition parties would do well to do something the news media probably won’t do and highlight measures in Little’s Bill that look likely to widen racial divisions in our society.

UPDATE:  The original text has been updated to provide a link to the Pae Ora (Healthy Futures) Bill and explain that a GPS is a Government Policy Statement.

Bob Edlin is a veteran journalist and editor for the Point of Order blog HERE.