Government's health reforms review committee divided over Māori role in new system

Health Minister Andrew Little is in charge of the reforms. Photo / NZME

The special committee examining the Government's health reforms has completed its final report, which shows MPs divided on the efficacy of the proposed reforms and the place of Māori in the reorganised health system.

The Labour and Green majority on the committee recommended extending measures designed to give effect to the principles to the Treaty of Waitangi to drug-buying agency Pharmac, despite the Pae Ora [Healthy Futures] Bill, which will give effect to the health reforms, excluding Pharmac from having to give effect to the principles of the Treaty.

Pharmac itself was supportive of this. In a submission, Pharmac said it was already committed to "upholding the articles of Te Tiriti, advancing Māori health and aspirations: tino rangatiratanga; partnership; active protection; options and equity".

Pharmac also said it was informed that officials had excluded it from a clause recognising the principles of the Treaty in the bill because of "concern about potential unintended consequences" in light of Pharmac's specific decision-making framework, which includes looking at which medicines to fund and how much to pay for them.

Pharmac said it did not ask to be exempted from the Treaty provisions, and a majority of the committee recommended changing the bill to bring Pharmac under the Bill's provisions that provide for the "Crown's intention to give effect to te Tiriti o Waitangi" across the health system.

The legislation will establish two new entities that will sit at the heart of the Health System, Health NZ, the super agency that will manage the way health services are delivered for most New Zealanders, and the Māori Health Authority, which will have a specific focus on Māori health, and which will be allowed to commission health services for Māori.

The majority on the committee recommended clarifying the legislation to "make it clear" that despite the existence of the Māori Health Authority, Health NZ was obliged to improve the Health of all New Zealanders, not just non-Māori. There was a fear Māori would fall in the crack between Health NZ and the Māori Health Authority.

"We believe our proposed amendment would prevent perceptions that HNZ [Health NZ] would not be responsible for improving service delivery for Māori due to the existence of the MHA [Māori Health Authority]," the committee majority wrote.

Health NZ will be the main part of Government responsible for delivering on the needs of New Zealanders' health. The Ministry of Health will still exist, and will become a policy shop, advising the minister on health policy.

At least once every three years, the Minister of Health is obliged to deliver a Government Policy Statement (GPS) on Health, which will act as a road map for what areas the minister would like the health system to focus on.

This is a system borrowed from the transport sector, where the Minister of Transport draws up a GPS, which sets out minimum and maximum levels of spending in areas like state highways and public transport, as well as directions on areas of policy focus, for Waka Kotahi-NZTA to then deliver on independently of day-to-day ministerial control.

The committee majority recommended the final bill included priorities that were "defined by specific outcome metrics" and that these should be stated "more explicitly".

They also recommended the GPS be written up so that priorities were "expressed in terms of measurable outcomes".

The original wording of the bill required the GPS to include strategies for improving the health of Pacific people, disabled people, rural communities, and other populations. The committee suggested the bill add "women" to that list.

The report noted submitters had wanted the legislation to force the Government to publish strategies for "Asian people, children and infants, digital infrastructure, medicines, mental health and substance abuse, the rainbow community, refugee communities, rare diseases, rural communities, women, and workforce".

The committee ultimately decided against recommending further strategies be included in the legislation, saying it was advised that specifying "further strategies based on particular population groups or conditions could result in certain populations having too much or too little focus on them".

The report warned this could also lead to a "lack of flexibility" and an "overemphasis on producing specific plans" and not enough focus on "innovative service design and provision".

National and Act both produced dissenting views from the Labour-Green majority.

National said it recognised Māori health inequities but the party did not believe Māori Health Authority would reduce them.

The party warned there was an "inherent conflict of interest" in the fact the Māori Health Authority would both monitor Māori health and commission services for Māori. The party also complained the Māori Health Authority's financials had not been disclosed, undermining the committee's scrutiny.

Act admitted the "status quo" in health was "not acceptable", but said the bill did not address the real crisis in health, which was Pharmac and drug buying.

"It is not possible to truly reform the healthcare system without considering the role medicines play in the lives of New Zealanders," Act said.

"There is a need for better accountability, more hospital beds, a stronger workforce and better access to life-saving medicines so more New Zealanders can live longer, healthier lives. But that is not what this bill delivers," Act said.

Act warned the bill focused on co-governance rather than healthcare.

"By focusing on co-governance, it does not address any of those [health] issues. Worse, it risks being divisive and ineffective.

"The newly established health system principles say the health system should 'provide opportunities for Māori to exercise decision-making authority on matters of importance to Māori', but there is no requirement for the same decision-making authority on matters of importance to anyone else," Act said.

The bill will shortly return to the House. It is intended to come into force on July 1, after district health boards have been disestablished. It is not clear whether the Labour-Green majority's recommendations will be acted upon, but Labour will face little trouble passing the bill because of its Parliamentary majority.