Te Tai Tokerau is set to be a major winner as a result of the recently announced reforms to Aotearoa's failing health system, as long as the resources are allocated where needed, according to health experts.
"There are certain ways you can measure whether or not there is fair equity ... What this highlights is that there is inequity for Māori in the current health system," said chief executive officer of Te Hau Ora O Ngā Puhi Te Rōpu Poa (Ngāpuhi, Ngāti Te Rino, Ngāti Hine, Ngāti Kahu).
Health Minister Andrew Little announced the reforms alongside Associate Minister of Health (Māori Health) Peeni Henare (Ngāti Hine, Ngāpuhi) and Associate Minister of Health Dr Ayesha Verrall yesterday morning.
The reforms are set to radically reshape the way the country's health system operates, scrapping the 20 existing District Health Boards (DHBs) in favour of a single united national entity called Health NZ.
"The health system is fragmented and under strain. I acknowledge there are criticisms of the funding formula for GPs (capitation) specifically that it doesn't take account of population factors such as ethnicity and socio-economic status, or take in to account the increasing complexity of a growing number of patients," Minister Little recently told 'The Advocate'.
Health NZ will be responsible for the day-to-day running of the country's entire health system, including a unified public health service, bringing together 12 Public Health Units.
Alongside Health NZ will be the Māori Health Authority, charged with ensuring the system has a strong focus on health outcomes and care for Māori. The Māori Health Authority will also have the ability to commission services in partnership with Health NZ.
"It's trailblazing in terms of tangata whenua being able to decide what is best for us, with the resources there to act accordingly," said Poa.
There will also be a new Public Health Agency formed, aimed at providing national leadership on public health policy, strategy, and intelligence. The hope is that this new agency will help the country to better understand and respond to threats to public health and place scientific evidence at the heart of policymaking.
The above changes are being made in order to allow the Ministry of Health to focus on stewardship, strategy, and policy, as commissioning and operational roles are moved into the Māori Health Authority and Health NZ.
"I'm excited about the Māori Health Authority and the Public Health Authority ... The devil is in the detail in terms of how it's going to be implemented over the next few years. What I hope to see is greater control of health services from Māori," said Equity Lead for Mahitahi Hauora and Board Member of the Northland DHB Dr Mataroria Lyndon (Ngāpuhi, Ngātiwai, Ngāti Whātua).
"One important detail is around the pūtea (money). The Māori Health Authority is going to be commissioning but how much resources will they have?" said Lyndon.
While many have been receptive to the changes, there are concerns from some about the effects of scrapping the nation's 20 DHBs will have on local representation, especially in large rural areas such as Northland.
Deputy leader of the New Zealand National Party and the party's health spokesman Dr Shane Reti (Ngāpuhi, Ngātiwai, Ngāti Hine, Ngāti Kura) has called for Te Tai Tokerau to retain its DHB.
"I am gravely concerned for the loss of local voice. Northlanders know best what their health needs are," Dr Reti said.
"Removing DHBs is similar to when Regional Health Authorities were centralised, it didn't work then and it won't work now. The Government should be looking to maintain regional identities and exploring the consolidation of some functions across DHBs, like asset management, not getting rid of them entirely," said Reti in a press release.
Despite Reti's concerns, the Northland DHB (NDHB) has come out in support of the changes, stating it will empower primary and community health organisations to provide better care and focus on prevention, rather than being reactive.
"We believe that these are positive changes for Northland. Having one central entity means that the challenges and issues currently facing all DHBs will be shared, and health services will be better connected both regionally and nationally," said NDHB CEO Dr Nick Chamberlain.
"A revamped, and hopefully better funded primary and community sector will have a greater focus on our local communities and what happens to them, and we will retain our local voice through Health NZ at our local district and locality level," he said.
Reti - a GP and former NDHB member - also said National did not support the establishment of a separate Māori Health Authority as "it runs the risk of a fragmented two-tier system".
However, experts on the ground in Te Tai Tokerau such as Poa welcomed the devolution of power and resources to Māori. She said Māori Health Providers already have the networks and trust in place with local communities.
Poa claimed a dedicated Māori Health Authority would enable more effective resourcing and stronger accountability to Māori from those at a decision-making level.
"We have intel and we can get into the nooks and crannies of our areas. There's a high level of trust with our whānau," said Poa.
Meanwhile, Lyndon said he hoped inequities in-terms of resourcing for DHBs would be addressed through the changes. He said some DHBs currently offer more services than others.
Poa said that these inequities created mistrust in the health system from Māori and prevented them from seeking help before it was too late.
"Our whānau don't go to the doctors unless they really need to, unless they're ready to be admitted to hospital ... They can't afford to go to the doctors so they go to Accident and Emergency and then get admitted," said Poa.
Ngāti Hine Health chief executive Geoff Milner (Ngāti Pōrou) welcomed the changes and was particularly excited about the inclusion of Te Tiriti in the framework. He said the partnership would allow patients and whānau to be at the centre of the nation's health system.
"The Government has heard the cry of Māori who are feeling disabled and disenfranchised in our current system," Milner said.
"Te Tai Tokerau now has a brand-new opportunity to build a greater cohesiveness as everyone contributing to the region's health care can come together. The elevation of Te Tiriti of Māori at levels of decision-making means there is a responsibility of all Northlanders to better understand what that means and what does partnership really look like," Milner said.