Māori health authority a 'once in a generation opportunity'

By Rukuwai Tipene-Allen

It comes with a promise to address inequities in the health system but there is no real detail released about what the newly announced Māori health authority will do and how it will do it. Form and funding are yet to be decided.

“These reforms are about a smarter, fairer, national health system – they’re not about cutting spending or reducing the workforce. We need greater investment in health, not less, and more, not fewer, people working in the future health system,” Health Minister Andrew Little said this morning.

National Urban Māori Authority chair Lady Tureiti Moxon and CEO John Tamihere have called it a  “once-in-a-generation opportunity” but questions about the detail of the changes are still being raised.

“The devil will be in the detail and the money must follow the Māori. It cannot be a ‘by Pākehā to Māori’ model,” Tamihere said.

“But this is a once-in-a-generation opportunity and Minister Little must be congratulated for leading this historic piece of work.”

Still, Tamihere noted: "Once we get a look under the hood, we will have a much clearer understanding of how this will operate.” 

Radical changes

The plan released today intends to improve the way in which the health system is overseen and how it reports. It also includes strengthening the current advisory role the Ministry of Health holds with the government.  When it comes to the money, it won’t be directly funding or commissioning health services.

The second part of the plan looks at the yet-to-be-established Health New Zealand, which will be responsible for hospitals and commissioning primary and community health services. The new entity will replace  20 district health boards.

As for the Māori Health Authority, that will "directly commission health services for Māori and partner with Health NZ in other aspects of the health system."

A public health agency will also be established and located inside the Ministry of Health. The agency will be responsible for public health strategy, policy, and analysis and monitoring.

Decades-long claim

Minister of Health Andrew Little said to an enthusiastic audience today: “And by making these changes, we can start giving true effect to tino rangatiratanga and our obligations under Te Tiriti o Waitangi.”

National Urban Māori Authority chair Lady Tureiti Moxon has been an advocate for the establishment of a Māori health authority and says this is a step in the right direction. “The Māori health authority was born out of our decades-long Waitangi Tribunal claim, thanks to the pluck of those who chose to stand up for our people against the might of the district health boards and the Ministry of Health,” she said.

The changes will include

  • all district health boards will be replaced by one national organisation;
  • a new Māori health authority will have the power to commission health services, monitor the state of Māori health and develop policy;
  •  a new public health agency will be created; and
  • a strengthened Ministry of Health will monitor performance and advise the government.

And the reforms will see

  • All 20 district health boards replaced with a new Crown entity, Health New Zealand, which will be responsible for running hospitals and commissioning primary and community health services. It will have four regional divisions.
  • Responsibility for public health issues will rest with a new public health authority, and a new Māori health authority will monitor the state of Māori health and have the ability to commission services directly.

“The reforms herald a change in focus for the health system – we will treat people before they get sick so they don’t need to go to hospital, thereby taking the pressure off hospitals,” Andrew Little said.

Associate Health Minister (Māori), Peeni Henare says “we talk a lot about being a transformational government. Some imagine this statement means big infrastructural builds, massive policy commitments all leading up to a grand reveal. But this is what I see as transformation, something quite simple and yet so very complex. It's Māori feeling comfortable and able to go to the doctor when they get sick.”

National, however, is calling the restructure reckless. The party’s health spokesperson, Shane Reti, has challenged the government on its health outcomes, saying “The government needs to own its track record in health. In the past four years every single national health target is worse than when National was in government. Labour has spent money but hasn’t seen the outcomes.”

He says it’s not the time for race-based policy.

“National believes whoever has the greatest needs should receive the appropriate resources. We know Māori have the greatest inequity across health, and therefore greater needs across many health metrics.

“But we do not support a separate Māori health authority as it runs the risk of a fragmented two-tier system. On one hand Health Minister Andrew Little claims he’s trying to create a single, harmonious, joined-up health system and, on the other, he’s creating a two-tiered funding system based on race."

“This radical restructure couldn’t have come at a worse time. New Zealand is undergoing three critical mass vaccination programmes, including our Covid-19 vaccine rollout. What the health sector needs right now is certainty and stability.”

Interim agencies are to be set up later in 2021 to support the establishment of Health NZ and the Māori Health Authority.