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Report Calls for Reform of a Non-Treaty Compliant System


Waitangi Tribunal Report Calls for Structural Reform of a Non-Treaty Compliant Health System

1 July 2019

The Waitangi Tribunal has released its stage one report today for the three-staged approach, Wai 2575 Health Inquiry. The stage one report addresses claims concerning the way the primary health care system in New Zealand has been legislated, administered, funded and monitored by the Crown since the passing of the New Zealand Public Health and Disability Act 2000.

The Tribunal has made an interim recommendation that the Crown review and redesign its current partnership arrangements across all levels of the primary health sector and that a review process be co-designed with Māori health experts.

The NZ Nurses Organisation represents 49,000 members including nurses, midwives, support staff and students. Kaiwhakahāere of the orgnanisation Kerri Nuku, lodged a claim on behalf of the 3,500 Māori members in the organisation in stage one of the Inquiry, arguing that institutional racism inherent in the health system is to the detriment of Māori and to themselves as Māori nurses, and accordingly sought recommendations relating to workforce issues such as pay parity and cultural competency of staff in mainstream health entities.

Counsel for the Māori nurses claim, argued that Te Puni Kōkiri’s relinquishing of its monitoring responsibility was alarming given the poor state of Māori health and the Tribunal agreed. The report states that Te Puni Kōkiri has not undertaken any formal monitoring of the health sector since the commencement of the New Zealand Public Health and Disability Act 2000 and the Tribunal has stated that this is ‘wholly inadequate’, and goes further to say that

the Ministry of Māori Development Act 1991 places a firm responsibility on Te Puni Kōkiri to monitor the health sector in its delivery of achievement of improved Māori health outcomes, which it has failed to do. Furthermore, we found that Te Puni Kōkiri has failed to carry out its statutory duty to monitor the health sector by failing to conduct agency reviews.”

Mrs Nuku states, “We are content with the report and the findings made by this Tribunal. They have recommended that the Crown ensure that the legislative and policy framework of the New Zealand primary health care system recognizes and provides for the Treaty of Waitangi and its principles and that the Crown’s ‘three P’s’ articulation of Treaty principles is outdated and needs to be reformed”

“As for Māori nurses, pay parity and pay equity is a major issue for us which we have been engaging directly with the Ministry of Health for the past year, however we were disappointed to see that the Wellbeing Budget 2019 does not reflect any changes at all. Now this report validates all our concerns”

“So we are glad to see that the Tribunal has found that the primary health care framework has failed Māori, the Treaty in the Act is a reductionist effort and not Treaty-compliant and that the funding regimes by the Crown in the health sector have failed to improve Māori health outcomes across the board. It’s everything we have been saying all along” says Mrs Nuku.

As a population group, Māori have on average the poorest health status of any ethnic group in New Zealand. The Tribunal states it also received uncontested statistical evidence demonstrating that, despite reform and readjustments, Māori health inequities have persisted in the nearly two decades since the Act was introduced.

According to the report, in the 2017-2018 financial year, the appropriation for Vote Health was $15.910 billion. Based on the recorded number of Māori enrolees in the primary health organisaitons, $167 million was allocated for Māori patients with $28.7 million of funding going to Māori primary health organisations.

“The amount of money spent in the health sector is enormous. Such large scale public funding invites the question of what accountability measures exist in the system” states Judge Clark.

Research for Stage Two of the Inquiry has already begun with hearings set to begin possibly next year. Stage Two intends to focus on other emergent nationally significant systems issues and themes such as mental health, alcohol and substance abuse including tobacco use, and Māori with lived experience of disabilities.


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