There has been an outcry in recent weeks about the race-based differentiation of access to, and allocation of, health services. The spotlight on health came from the confirmation that identifying as Maori is a factor in determining a patient’s position on surgical waiting lists.
This discrimination is not new but has been escalated by the establishment of the Maori Health Authority.
The severing of our health system into two was opposed and challenged by academics, health professionals, and those of us who believe all New Zealanders should be treated equally and that allocation of services should be based on need, not race.
And wouldn't you know it, all of our concerns, fears, and submissions have come to fruition in a review of the Maori Health Authority released by the Ministry of Health at the end of last week.
I won't bore you with all 36 pages of review, but there are some excerpts of interest. In particular, the document reveals multiple pressure points where the views of Te Aka Whai Ora (Maori Health Authority), Te Whatu Ora (Health NZ), and Manatū Hauora (Ministry of Health) have tensions and disagreements. Despite splitting our health system in two there are concerns that the existence of the MHA might take away from Health NZ's "Māori capability".
"...challenges arose in the relationship between those Te Aka Whai Ora and Manatū Hauora managers due to differing views on how the strategy development process should run. This has yet to be resolved."
"Tension surfaced between Te Aka Whai Ora and Manatū Hauora with regard to their respective roles of monitoring in the system...
"The interim Hauora Māori Strategy is expected to be delivered by June 2023. However, tensions described between Manatū Hauora and Te Aka Whai Ora teams working on this require an intentional reset of the ways of working."
"Concerns were raised about staff transfers not being focused on the critical skills and expertise needed, and on the potential for the focus on Māori personnel / team transfers to diminish Te Whatu Ora’s own Māori capability."
Additionally, the review found that the promised gains in outcomes were not going to eventuate due to a number of issues:
"The Board appears to have made little progress in establishing a governance level risk monitoring and management framework, despite repeated requests."
"Te Aka Whai Ora staff have significant workloads and are struggling with forward planning."
"Projected underspend from finance of approximately $66m means the highly anticipated boost in services for Māori will not be fully realised in FY22/23."
"Organisation-wide planning and prioritisation work for FY22/23 is evident, but below the level of the SOI and SPE..."
"...discretionary choices made by the Board and/or executive have occasionally detracted from Te Aka Whai Ora’s delivery of its core functions."
"...there have been delays in the development of the monitoring framework due to insufficient deployment of resource (capacity) and capability to date, and this area not being sufficiently prioritised."
"...we tried to source a Board-approved implementation plan that outlined the Year One priorities for Te Aka Whai Ora and set out the detail on how these will be planned, delivered, managed and monitored...There appears to be no such overarching plan."
David Seymour called it “a damning assessment of the Maori Health Authority that shows that it has failed on every level." While, National's Dr Shane Reti said:
“Labour’s bureaucratic health restructure has cost taxpayers half a billion dollars, and for there to be no plans or details for a whole year on how to better improve Maori health is shocking. No other public service would be allowed to operate like this.”
The defence that it is early days for the Authority should be rejected outright as the criticism is not limited to outcomes but also notes failure to even establish targets and performance indicators.
Of course, the Maori Health Authority is doomed to fail as there is simply no empirical evidence that outcomes are impacted due to systemic racism or, more fundamentally, because they are Maori.
The New Zealand Initiative completed a detailed review on the matter and made the case for equal treatment.
In the foreword of the Initiative's report, Emeritus Professor Des Gorman, professor of medicine at the University of Auckland, says:
“We can all agree that the time to address the underlying causes of this [health outcome] inequality is well overdue. However, what is needed are objective data about what leads to improved outcomes rather than political rhetoric."
Another report, produced last month by Tailrisk Economics’ Ian Harrison, highlights the same lack of evidence.
The research report concludes with an extract from the 'Waitangi Tribunal 2000 Napier Hospital Report' which states:
“The chief difficulty with the claimants’ position is not the goal of equal health outcomes but the one-track focus on healthcare services as the means to achieve it. More ambulances under the cliff cannot remove the factors causing people to fall off.”
This Government has staunchly held their position that racism is the cause of all failure to improve Maori outcomes and have refused to listen to medical professionals and academics with evidence to the contrary.
In April 2022, co-leader of the Maori Party, Debbie Ngarewa-Packer also promoted the idea that the MHA would be a fix-all:
“With the establishment of the Māori Health Authority a new era in Māori health is arriving. It’s crucial that this is done right, and there is no other way of guaranteeing that than letting Māori lead. We must not have a situation where the Māori Health Authority can be vetoed or underfunded by Pākehā bureaucrats.”
Despite the establishment of this Maori Health Authority, in the general health system wait-listing has become race-based, grocery vouchers have been offered to Maori women in exchange for getting mammograms, and, most recently, $100 worth of Prezzy cards to entice pregnant Maori women to attend two prenatal appointments.
Maybe Minister of Maori Development, Willie Jackson was correct when he stated in May:
“Most Maori are not attached to a lot of our Maori organisations.”
And yet, the Government is ploughing on with these separatist systems.
As a nation, we were sold the importance of co-governance as being THE solution for resolving inequity.
Friday’s MHA report demonstrates everything we have criticised in co-governance – added cost, increased bureaucracy, lack of accountability – and NO IMPROVEMENT IN OUTCOME.
For better outcomes, and for New Zealand, we must end co-governance.