Point of Order: Shane Reit worried - But Peeni Henare sanquine

Independent examination of the Maori Health Authority finds plenty to worry Shane Reti, but Peeni Henare is sanguine

Having found no fresh news on the government’s official website this morning, Point of Order turned its attentions elsewhere and…

Well, we were steered by National’s Health spokesman, Shane Reti, to an independent report on the Maori Health Authority which must be a different independent report from the one that Associate Health Minister Peeni Henare was spruiking yesterday.

Among other things, the report referenced by Reti draws critical attention to the new authority hiring staff based on their ethnicity, not on their skills and talents.

Hmm. The government’s aim – presumably – is to promote Maoriness rather than competence, merit or eminence in the people hired to improve the health of Maori people.

Reti’ statement, headed Damning Māori Health Authority Report Released, opens:

An independent report into the Māori Health Authority clearly shows the failures of more bureaucracy, National’s Health spokesperson Dr Shane Reti says.

Reti fixes on these failures:

“Since the creation of the Māori Health Authority over a year ago, the report found no overarching plan for activities, timeframes, resources, accountability or performance.

“Labour’s bureaucratic health restructure has cost taxpayers half a billion dollars, and for there to be no plans or details for a whole year on how to better improve Māori health is shocking. No other public service would be allowed to operate like this.

“A further revelation is that the Māori Health Authority was transferring staff from Health NZ because of their ethnicity, instead of staff with the necessary skills and expertise.

“No one disputes that Māori health outcomes need to improve, but to take staff based on their ethnicity and not on the skills and talent they could bring to actually improve Māori health outcomes is quite simply appalling”.

Reti says almost every page of the report contains a damning indictment of flawed processes, faulty management and failure to deliver – and not one Māori health outcome has improved and further delays are predicted.

His statement includes a link to the Māori Health Authority report (https://www.health.govt.nz/system/files/documents/pages/230505i-hmac-report-final.pdf).

Point of Order has yet to read all of the report and hence can’t verify that almost every page contains the damning indictments that rankle Reti.

But we did read a section of the report which presents key findings in a nutshell, identifying focus areas, then providing an “overall assessment”.

Ministerial focus areas

Commissioning and co-commissioning

This is an area of significant concern for both the Board and executive and needs a high level of prioritisation. Commissioning activity and Māori provider service provision is tracking behind Government commitments. Te Aka Whai Ora leadership is working through a plan to ensure this is resolved in FY23/24.

IMPBs* and localities planning

This is an area requiring effort and resource. While 11 IMPBs have been established, the activation of IMPBs to deliver their functions as outlined in the legislation varies across the country and support is required to clarify and operationalise their ways of working with the system.

Monitoring

Monitoring is an area that is currently underdeveloped. While a theoretical framework has been developed, implementation and independence issues continue to be worked through.

Implementation plan

Organisation-wide planning and prioritisation work for FY22/23 is evident, but below the level of the SOI and SPE, it has not been sufficient to effectively deliver on government commitments. This is an area for significant improvement to drive future performance.

Budget 22

Projected underspend from finance of approximately $66m means the highly anticipated boost in services for Māori will not be fully realised in FY22/23. It is acknowledged that this is due to a myriad of factors outlined throughout the assessment. More focus and prioritisation is required on Budget 24 bid process going forward.

Hauora Māori Strategy

The interim Hauora Māori Strategy is expected to be delivered by June 2023. However, tensions described between Manatū Hauora and Te Aka Whai Ora teams working on this require an intentional reset of the ways of working.

Other matters of significance

Governance

The Te Aka Whai Ora Board is passionate and committed but may need to re-balance its delivery priorities in the context of its operating environment and establishment imperatives.

People and capability

This is an area that is lacking overall and requires concerted effort and attention to ensure Te Aka Whai Ora has the capacity and capability to deliver on its core functions.

Ministerial requests

There is an opportunity to streamline requests from the four health Ministers in order to assist Te Aka Whai Ora to deliver on its urgent priorities.

The Executive Summary expands on those judgements:

The passion and urgency of the Board to inject deep transformative thinking and te ao Māori approaches into the Te Aka Whai Ora strategic and operational functions, while understandable, has at times needed balancing with the pressing need to keep things simple in order to rapidly establish the set of core foundations and systems required for key functions.

Additionally, discretionary choices made by the Board and/or executive have occasionally detracted from Te Aka Whai Ora’s delivery of its core functions. A key example raised in interviews related to staff transfers from Te Whatu Ora to Te Aka Whai Ora (an agreed process as part of building Te Aka Whai Ora capability), whereby the Te Aka Whai Ora prime focus (choice) was on acquiring Māori personnel / teams instead of strategic targeting core capability requirements and staff with the necessary skills and experience to deliver these (e.g. commissioning and contract management expertise, given the volume of Māori provider contracts being transferred).

Other decisions related to monitoring, commissioning, recruitment, and executive focus were raised.

Peeni Henare’s press statement was headed Te Aka Whai Ora and Pae Ora Act reforms on track to deliver real change for Māori.

He thanked the Hauora Māori Advisory Committee for undertaking the report at a key time in the health system reform process.

Preferring to give the new authority its Maori name, he recalled that the Government had established Te Aka Whai Ora under the Pae Ora (Healthy Futures) Act 2022 “to strengthen Māori leadership in the health system and initiate a serious change in the health system’s performance for Māori”.

He seems pleased with what is happening:

Te Aka Whai Ora has made some good progress in challenging circumstances.

“The uncomfortable fact is that the current deeply entrenched disparities for Māori in the health system are decades in the making and will take more than a year to fix.

”I don’t think anyone doubts that there are significant underlying equity issues continuing to prevent Māori from accessing quality health care, especially in rural areas, which is why Te Aka Whai Ora will ensure Māori have a strong, independent voice at the provider level,” Peeni Henare said.

Henare said a key delivery for Te Aka Whai Ora has been establishing 15 Iwi Māori Partnership Boards to provide key insights, direction and advice to government agencies on the provision of health services to Māori communities.

Mixing English and te reo, he said he has supported the establishment of Te Aka Whai Ora mai rāno (from the beginning) because it was the right thing to do, then and now.

And he is encouraging the Board and Chief Executive to focus on ways to improve how the health system serves Māori.

“The Committee’s report is a helpful way to confirm those priority areas.”

He also credited Te Aka Whai Ora with playing a critical role in the development of the recently released Pae Tū –Hauora Māori Strategy.

He was pleased that the report recognised the support Te Aka Whai Ora provided local communities affected by Cyclone Gabrielle in Te Tai Rāwhiti and flooding in Tāmaki Makaurau.

But didn’t everyone pitch in to help after that calamity?

Henare said he has sought and received assurance from the Board Chair that Te Aka Whai Ora will continue to demonstrate progress to retain the confidence of the health sector, the Government, and most of all, whānau right across the motu who depend on the health system.

“I’ll be excited to see Te Aka Whai Ora’s positive impact on health outcomes for Māori as I continue to visit and learn from providers around Aotearoa New Zealand,” Peeni Henare said.

He, too, provided a link to the Hauora Māori Advisory Committee report.

The report, by the way, is dated 5 May 2023.

Reti picked up on this to say:

“There was a reason the Health Minister Dr Ayesha Verrall left the damning Māori Health Authority report sitting on her desk for months and silently released it late yesterday – it’s revealed failure from all corners of this third health entity. “

But maybe she has been much too busy to get around to it, because she has research, science and innovation responsibilities and must get to grips with the incorporation of matauranga Maori in the country’s science system.

* Iwi-Māori partnership boards

Point of Order is a blog focused on politics and the economy run by veteran newspaper reporters Bob Edlin and Ian Templeton