Lady Tureiti Moxon and Janice Kuka presenting to the Health Select Committee on changes to the Pae Ora (Healthy Futures) Act 2022. Photo: RNZ/Pokere Paewai
Māori health providers have told a select committee changes to health laws would further sideline Māori in the health sector.
A suite of amendments to the Pae Ora (Healthy Futures) Act 2022 were announced by the government in June and passed first reading in July.
All public submitters to the Health Select Committee on Wednesday were opposed to the amendment bill either in its entirety or to certain sections of the bill.
Te Kōhao Health managing director Lady Tureiti Moxon said a great deal of time and effort went in to the design of the Pae Ora Act and the establishment of Te Aka Whai Ora.
The Act was the best example of what a Treaty partnership between the Crown and iwi could be, she said.
"But instead the Crown has done what it often does when they think iwi Māori are getting too big for our boots, they take back the power and control in the name of one health system for all."
This amendment bill builds on the harm of disestablishing Te Aka Whai Ora, she said.
When the legislation was announced Minister of Health Simeon Brown said the legislation would strengthen the Hauora Māori Advisory Committee (HMAC) and clarify the role of Iwi-Māori Partnership Boards (IMPBs).
Under the proposed changes the Hauora Māori Advisory Committee would provide advice to the minister and the board of Health New Zealand.
And IMPBs focus would be shifted away from local service design and delivery, to engaging with communities on local perspectives and Māori health outcomes.
Former Labour MP Louisa Wall and chair of the Tūwharetoa Iwi Māori Partnership Board said IMPBs were mandated by their hapū and iwi to act as katiaki for all whānau within their region.
Their responsibility is to work in partnership with Health NZ with the Ministry of Health, but she said IMPBs were not agents of the Crown and did not serve government departments, their accountability was to hapū and iwi.
Wall said IMPBs were best placed to identify and address the needs of the communities they served, not simply to advise but design, deliver and monitor health services alongside the Crown.
"This government made a deliberate decision to disestablish Te Aka Whai Ora in doing so ministers were clear Iwi Māori Partnership Boards would step into that space, that we would be supported with commissioning resources to carry out that role."
Former minister of health Dr Shane Reti had given assurances that would be the case, she said.
"Instead of strengthening Iwi Māori Partnership Boards with commissioning powers the bill reduces us to advisory bodies reporting to HMAC, that is a backwards step it breaks faith with iwi and hapū."
If passed as drafted the bill would remove IMPBs from direct partnership with Health NZ and narrow their role to community engagement only, she said.
Wall called advisory bodies like HMAC "toothless" as members of the committee are appointed by the Minister of Health. A sentiment echoed by Lady Moxon.
"What we've got now is an advisory group advising another advisory group to a minister," she said.
Lady Tureiti Moxon (right) and Janice Kuka (left) presenting to the Health Select Committee on changes to the Pae Ora (Healthy Futures) Act 2022. Photo: RNZ/Pokere Paewai
Janice Kuka told the committee the Bill takes Māori health backwards, it distances IMPB's from decision makers - instead of working directly with Health NZ their advice would go through HMAC.
"This further reduces Māori influence over services that affect our people. What we are seeing on the ground is deeply concerning since Te Aka Whai Ora was closed by this government Māori leadership in health has been slashed, the hauora Māori team at Health New Zealand has been cut to a third of its size, the Māori Directorate in the Ministry of Health is sidelined, the Hauora Māori Advisory Committee has no staff, no budget and only meets the minister a handful of times a year."
Kuka said she and Lady Moxon have emphasised over the years Māori must be supported to design their own whare hauora, or health system, through a properly resourced Māori-led health body.
"We've repeated that for the last 20 years but we repeat it again."
In response to a question from Labour MP Dr Ayesha Verrall about how IMPB's can make positive health gains for Māori Lady Moxon said under the original law the IMPBs would have been able to commission services - an ability they would lose under the amendment bill.
"So what we had in Hauraki for example was all the councils coming together, all the various community groups coming together alongside of Māori and iwi and that to me was the greatest thing we could have done in our communities."
Te Rūnanga o Toa Rangatira director of health Michael Rongo told the committee there was an active participation between the iwi and their local IMPB, Āti Awa Toa Hauora, with the two groups meeting monthly.
"There's a real cohesion... or activeness around planning, focus, priorities and we meet really regularly," he said.
Carra Hamon - Pou Rautaki at Te Rūnanga - added that the IMPB had produced data and insights which were invaluable to their work.
"We've recently become a Whānau Ora Commissioning Agency and so being able to leverage that information and data has been invaluable and will be invaluable going forward across all of the mahi that we do in the social services space for our community."
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