Pae Ora changes are bad news

Health Minister takes aim at Māori, governance, and health workers in latest changes to the Act

Health Minister Simeon Brown has released his usual propaganda style statements on the changes to the Pae Ora Act. You can read much of his press release here, on RNZ, which seems to have taken to publishing press releases from National and ACT MP’s verbatim, with limited critical thinking or critique. (Note - RNZ don’t seem to be doing the same for Labour or the Greens, whose press releases are usually accompanied by critique and a comment from NACT MPs, just an observation and something to think about).

In it, Simeon takes direct aim at the NZ Health Charter (Te Mauri o Rongo) and the associated values and principles. A great deal of work has been done previously to apply these values and principles to the workplace in practical ways, across organisations, collective practices, and individual behaviours.

A quick read of the Te Whatu Ora website, particularly the Frequently Asked Questions (pasted in full at the end of this post) makes it clear why Simeon is targeting this piece of legislation; this government is actively seeking to erase Māori and partnerships with Māori from any and all policy and legislation.

Alongside Repealing the Health Charter and Sector Principles, Simeon wants to embed and legislate his health targets, simplify board appointments but have stronger governance and financial oversight, and hobble iwi-Māori Partnership Boards so that they no longer have input into local service design and delivery but rather now merely “engage with communities on local perspectives and Māori health outcomes”.

These are all terrible ideas that will do little to improve access to healthcare or achieve better outcomes.

Past experience with health targets under the National Government (2008–2017) clearly showed how targets lead to gaming of data, marginalisation of complex patients, and increased staff burnout. They achieved little, as DHBs rejigged wait lists, moved funding from non-targeted areas, and/or changed their reporting practices. Targets that fail to come with additional funding and staff simply drive worse health outcomes across the board. Without the financial and workforce investment needed, health systems end up treating to the provided KPIs rather than meeting community need. It is austerity thinking in practice.

Having fewer board members who are more closely aligned with the government means health is no longer independent, but becomes partisan and driven by the government agenda of the day. This proposal inserts the Health Minister more deeply into operational health governance, undermining the independence of what should be a publicly accountable but politically neutral health service. Again, this does little to ensure positive health outcomes across the country - it just makes it easier for the government to spin and control the narrative.

Lastly, Simeon, in this legislation, is actively working to remove iwi partnerships from decision making roles that ensure local service design is relevant, appropriate, and meets local health needs. This is just one more way that National are targeting the involvement of Māori and removing mechanisms for accountability. It is a very clear, intentional breach of Te Tiriti o Waitangi, and a naked attempt to strip decision-making power from Māori when it comes to health and wellbeing.

Overall, these changes to Pae Ora consolidate government control over health, undermine the independence of Te Whatu Ora/Health NZ, strip out accountability measures for organisations and individuals regarding implementation of decent health care, and severely limit opportunities for meaningful changes by and for Māori.

a nice calming photo of the heart shaped leaves of a kawakawa bush

Taken together, these changes mean that most of the population will experience a decrease in quality of care, a decrease in access to the healthcare we need (especially if that healthcare is not included in government targets), and increased wait times in real terms (not the manipulated wait list times - we’ll end up on a wait list for the wait list or simply bumped back to the GP).

They also mean that healthcare provision will suffer, as employees are no longer required to provide culturally competent care within a New Zealand context. This opens the door for Health NZ to employ large numbers of overseas trained workers -who will then not receive the level of mandatory training needed regarding cultural safety, or the necessary introduction to our sociocultural contexts required, leading to compromised service quality and exacerbating health inequities.

Bear in mind that this legislation change is occurring alongside a targeted attack on regulatory standards of health professionals. Brown has already signalled, via his polemic and partisan consultation document Putting Patients First: Modernising Health Workforce Regulation, that he intends to reduce barriers for overseas-trained health professionals to work in New Zealand. This necessitates undermining clinical standards, removing cultural competencies, and unwinding best practice approaches that are currently required by New Zealand’s regulatory authorities.

Rather than the current approach of training Māori health professionals, developing evidence based, localised, culturally-specific health programmes, and partnering with Māori - an approach that has been shown to improve both Māori and non-Māori health outcomes - we will get cheap and shoddy quick fixes that fail to meaningfully or adequately provide they type of public healthcare all New Zealanders deserve.

What can we do?

I feel like a broken record here, but honestly, make a submission when it goes to Select Committee, write to your local MP, post on social media/raise awareness, organise with friends, join your local leftie political branch, attend protests and events.

It is clear that this National government are actively unpicking a raft of public institutions that act for social good. Partnerships with Māori, funding for Māori-owned and directed initiatives, and anything where Māori are in decision making positions are being targeted and removed. There’s only one reason to so heavily target Māori control, and that is to make it easier to exploit land and people. It is worth considering, who benefits from this? Who benefits from land being easier to exploit and extract profit from? Who benefits from workers being easier to exploit and cheaper to employ?

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Where has Te Mauri o Rongo come from?

Te Mauri o Rongo is required by the Pae Ora (Healthy Futures) Act 2022 and applies to organisations and workers throughout the health sector. It is underpinned by Te Tiriti o Waitangi principles identified by the Waitangi Tribunal in its Hauora Inquiry: tino rangatiratanga (self-determination); ōritetanga (equity); whakamaru (active protection); kōwhiringa (options); and pātuitanga (partnership).

What is the purpose of Te Mauri o Rongo?

The purpose of Te Mauri o Rongo is to ensure that health and care workers are supported and empowered by shared values in workplaces that value their contribution. This enables us to best serve whānau and communities and to continually improve their health outcomes and contribute to Pae Ora for all.

What does it contain?

Te Mauri o Rongo is a statement of values, principles, and behaviours that health entities and health workers are expected to demonstrate at a collective, organisational, and an individual level.

Who does it apply to?

Te Mauri o Rongo is for all of us. It applies to the health entities named in the Act, organisations and workers involved in delivering publicly funded services.

Te Mauri o Rongo sits alongside the Te Tāhū Hauora (Health Quality and Safety Commission, HQSC) ‘Code of expectations for health entities(external link)’ engagement with consumers and whānau’ and the ‘Code of Health and Disability Services Consumers’ Rights(external link)’ (Code of Rights).

How has it been created?

Te Mauri o Rongo has been created through consultation and engagement with a wide range of organisations including Iwi Māori providers, workers and their unions, and organisations that promote the interests of the health workforce.