A.E. Thompson: Saving Money and Sense at Health New Zealand

Health NZ's governing board was replaced with a commissioner to rein in budget overruns. One might wonder where savings can be made. Unfortunately, some of the savings will be at the expense of 'front line' health services if critics are correct in alleging that the percentage increased funding for health fell well short the percentage increase in population due to immigration and the increased proportion of aging baby boomers placing greater demands on health services.

However, publications from Health NZ point to considerable race-based ideological investment of dubious benefit. For example, a communication last week stated:

Restraint and Seclusion-free Care

(Name withheld here), a registered nurse from Hawke's Bay, is one of six Master Trainers in New Zealand working to eliminate restraint and seclusion in healthcare. She educates clinicians on the importance of consent, understanding cultural values, and using de-escalation strategies to ensure care aligns with the Nga Paerewa Standard and Te Tiriti O Waitangi principles.

So Health NZ employs six Master Trainers who use up clinicians’ time to educate them about the importance of consent, cultural values, de-escalation and how to ensure care aligns with Nga Paerewa and alleged principles of Te Tiriti. De-escalation skills would appear to be worthwhile and a focus on that would justify investment in some training. However, any trained healthcare professional will know about the importance of consent. As for cultural values, three guesses about which culture this refers to. Further, any time taken to perform the mental gymnastics required to align healthcare practitioners' behaviour with principles of Te Tiriti will always be a fool's errand, as will convincing most practitioners of the justification for this. Apart from the very general provision for everyone being equal subjects under the British Crown, nothing in the wording of Te Tiriti provides any guidance for healthcare practice. Even the recently-invented, contentious 'principles' would require a great deal of extrapolation to make them relevant. It seems there will be cost savings to be made here.

The Master Trainers are working to ensure care aligns with the Nga Paerewa Standard. That document, actually a set of standards, came into force in February 2022 as a replacement for previous healthcare standards. An incidental issue here is that the standard for restraint is not elimination but for restraint to be used only as a last resort. So the Master Trainers are pushing a standard that doesn't exist; here’s some more time and money that could be saved. Their goal to eliminate restraint is also ideological nonsense. If a patient is behaving in a dangerous, violent way it's important that caregivers are trained to use restraint when they believe this is necessary to protect the patient and/or others. It's important that anyone who is capable of restraining any person anywhere presenting serious danger is able to do so confidently and effectively, knowing it's the right thing to do and that (s)he won't be hauled over the coals for doing so. Moreover, the implication that Maori cultural values might be contravened by using restraint on a dangerous person is clearly poppycock. Maori traditionally will have used considerably more intense versions of 'restraint' to pacify an out-of-control, dangerous or even disobedient iwi member.

Nga Paerewa Standards

The Nga Paerewa document is worth a look at and most New Zealanders will be shocked. The 83-page document focused almost entirely on Maori and Pacific priorities and appeared to assume that those priorities would do for everyone else. Its full title is ‘Nga Paerewa Health and Disability Services Standard' which, thankfully, indicates something of its purpose. It was prepared by a committee of 24 members over a two-year period including 8 from organisations with Maori names and one from a Pacific People's community organisation, but none that appeared to be from groups representing Asian or other immigrant populations. No information was provided about the qualifications of committee members, only the names of organisations they represented. Aside from midwives and nurses, no other healthcare practitioners' groups were listed as being represented; however, the committee claimed to have consulted with numerous individuals representing various other groups and professions.

The preface by Dr Ashley Bloomfield (who wasn't on the committee) claims that the revised standard would assure safe services of care for all ‘while also improving outcomes for those traditionally underserved by our health system - for Maori, Pacific, disabled, rural, and rainbow communities, among others’. No evidence was provided for the claim that these groups had been 'underserved'. If there was anything in the document aimed at improving outcomes for anyone except Maori and to a lesser extent Pacific People, this was not evident in a brief look through.

Throughout the document all headings were made first in bold te reo with an English version printed second and not in bold. Each standard was described firstly in te reo then in English, under three columns called (in the English translations) 'The people', 'Te Tiriti' and 'As service providers'. Some excerpts give an idea of the document's nature:

Under 'Outcome 1: Our Rights':

Maori flourish and thrive in an environment that enables good health and wellbeing

(No other ethnicity was referred to as having rights!)

1.1.1 My service provider shall embed and enact Te Tiriti O Waitangi within all its work, recognising Maori, and supporting Maori in their aspirations, whatever they are (that is, recognising mana motuhake)...

1.1.3 My service provider shall actively recruit and retain a Maori health workforce across all organisational roles.

1.1.4 To facilitate equity approaches, my service provider shall be Maori centred.

1.1.5 My service provider shall work in partnership with iwi and Maori organisations within and beyond the health sector to allow for better service integration, planning, and support for Maori

 

Remember, this document is meant to specify standards for all health and disability services to all people in NZ, but the document suggests that only standards suiting Maori and (to a lesser extent) Pacific people are necessary.

Why would healthcare providers be required to support Maori (and only Maori it seems) in their aspirations, whatever they are? The mind boggles at the ridiculous situations this could lead to. 

Under '1.3 My Rights During Service Delivery':

Service providers recognise Maori mana motuhake (self-determination)

Under '1.4 I Am Treated With Respect'

Service providers commit to Maori mana motuhake

1.4.4 Te reo Maori and tikanga Maori shall be actively promoted throughout organisations and incorporated through all their activities.

 

No consideration of how this might impact on patients other than Maori who, for example, might not like to be treated under 'tikanga' (traditional Maori rules) in whatever form that is interpreted by some healthcare provider.

1.4.5 Services shall ensure health care and support workers receive Te Tiriti O Waitangi training and that this is reflected in day-to-day service delivery.

 

Te Tiriti training training is always indoctrination based on questionable interpretations of the document and huge extrapolation from its wording and possible meaning to those present in 1840. Healthcare staff attending such training know that their careers will be in jeopardy if they question the trainers' claims. Reflecting Te Tiriti in day-to-day service delivery can only rely on make-believe and makes about as much sense as reflecting the Road Code in one's architecture.

1.4.6 Service providers shall respond to tangata whaikaha needs and enable their participation in te ao Maori

 

Tangata whaikaha refers to people with a disability. Te Ao Maori means The Maori World. Never mind those who wish to participate in anything other than the Maori world.

In the Foreword, a section on 'Principles' features as the number one principle:

Achieving Maori health equity - Te Tiriti principles (kawanatanga, tino rangatiratanga, oritetanga) underpin the standards.

Also in the Foreword, a section on ‘Te Tiriti O Waitangi’ states:

With regard to the text of Te Tiriti and declarations made during its signing - the Ministry of Health (the Ministry), as the kaitiaki and steward of the health and disability system (under article 1 of Te Tiriti), has the responsibility to enable Maori to exercise authority over their health and wellbeing (under article 2) and achieve equitable health outcomes for Maori (under article 3) in ways that enable Maori to live, thrive, and flourish as Maori (Ritenga Maori declaration, under article 4).

 

Article 4? I kid you not. Even if one were to accept that the verbal agreement called the Ritenga Maori Declaration that was made at the time of signing Te Tiriti amounts to a 4th Article that wasn't actually in the document, that verbal agreement was that all people in NZ would be free to practise whichever religion they chose, including traditional Maori beliefs or different forms of Christianity. Nothing about living, thriving and flourishing as Maori.

 

How on earth can Article 1 of Te Tiriti be seen to make the Ministry the guardian and steward of our health and disability system? Nothing of the sort is mentioned or alluded to in Article 1.

 

The Ministry of Health has many more responsibilities than enabling Maori to exercise authority over their health and wellbeing. Actually, that's not even what most taxpayers would see as the Ministry's responsibility at all. Surely its responsibility is to ensure that health services are provided adequately, based on good scientific justification and are in line with government directions? Enabling Maori to exercise authority over anything is a political and ideological goal with little or no research to suggest it will improve health. 

The section on Te Tiriti continues (herein abbreviated as summary):

The principles of Te Tiriti, as articulated by the courts and the Waitangi Tribunal, underpin the Ministry's commitment to Te Tiriti…

(a) Tino rangatiratanga...Maori self determination (in the design, delivery, and monitoring of health and disability services…

(b) Equity...equitable health outcomes for Maori..

(c) Active protection...equitable health outcomes for Maori…

(d) Options...resourcing kaupapa Maori health and disability services...ensure that all health and disability services are provided in a culturally appropriate way that recognises and supports the expression hauora Maori models of care…

(e) Partnership...Maori must be co-designers, with the Crown, of the primary health system for Maori.

 

This particular way of describing the recently invented Treaty principles is just more imaginative thinking. What principle was there requiring taxpayers to fund Maori ways of providing healthcare, possibly including spiritual treatment interventions from pre-European Maori culture?

 

What does 'equitable health outcomes' mean? Equity with whom? Is it the average health of the whole population? Or the average health of White people? Or is it the average health of members of the richest family in the country? And does it refer to lifespan or some other marker? Even if one were to accept ‘equality of health outcomes’ as a worthwhile or morally sound goal (which I wouldn’t), it’s likely to be a very expensive pursuit compared with ‘equality of health opportunities’. In this case, the desired health outcomes are not even clear and pursuing such an ambiguous goal is likely to be even more expensive.

 

No consideration is evident regarding whether Maori-designed health and disability services would be suitable for non-Maori. There is also an assumption that all or even many Maori would want something other than scientifically-based western medical interventions. 

The remainder of the document follows the same, racist pattern. Most New Zealanders would be surprised about the extent to which this rot so quickly spread through the state services we all pay for. It's difficult to believe that so many seemingly intelligent people would collude with this ideological indoctrination and falsehood, but I guess the consequences for failing to do so provided a strong incentive.

So this kind of thing is what a good proportion of our healthcare taxes are being used for. Producing racist documents and/or straining to make perfectly adequate documents appear to conform to imaginative interpretations of an 1840 agreement appears to be what a lot of ‘back room’ Health NZ employees do. The new commissioner won’t be able to recoup the obviously huge cost for producing the Nga Paerewa Standards but considerable savings (in addition to equality and fairness) will be available by ensuring healthcare providers don’t waste any more time on most of those standards, as well of course by ensuring that no further documents are produced to extend taxpayer-funded racism. That will require enough bravery to challenge the existing, bizarre Te Tiriti ideology. Are the Commissioner and our current government up to it?

A.E. Thompson is a working, tax-paying New Zealander who speaks up about threats to our hard-fought rights, liberties, egalitarian values, rational thinking and fair treatment by the state.