Measurable targets for the Māori Health Authority will be announced when the lights go on at the new entity in July next year. But how the authority will actually address Māori inequality has been lost in recent weeks to a debate about whether it’s separatist, writes political editor Jo Moir.
Finance Minister Grant Robertson has already decided how much money the new Māori Health Authority will get to establish itself over the next year.
That amount will be delivered in the Budget on Thursday.
Once the group set up to design the authority is in place – for now only the head, Tā (Sir) Mason Durie has been appointed – the full extent of how much money is required to run it will be discussed and signed off by Cabinet.
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Associate Health Minister Peeni Henare, who is responsible for Māori health, told Newsroom in the coming weeks the rest of the advisory group members will be announced, and a more detailed timeframe will be set out.
“Loosely speaking over the next six months my expectation, and indeed Minister (Andrew) Little’s as we’ve talked about this, is that a lot of the grunt work in terms of the establishment of the Māori Health Authority will be up and running.
“In a slightly longer timeframe my estimates are that the iwi/Māori partnership boards at a regional and local level will start to take shape with the hope that – and this is my hope and budget pending – that there will be some opportunities for the Māori Health Authority to get some early runs on the board within the next 12 to 15 months,’’ Henare said.
“If we’ve set a timeframe for July 1 to be lights on at the Māori Health Authority – and Minister Little set those ambitious timeframes for us – then the expectation is that around then we’ll be having discussions about what exactly targets look like and the key areas we want to focus on early.’’
As part of the monumental health reforms announced by Health Minister Andrew Little and Henare last month, District Health Boards will be scrapped and replaced by a central agency, Health NZ.
Henare says some of the early work that will be done is working out the “influence” the Māori Health Authority will have over the “policy and strategic direction” of Health NZ.
The iwi/Māori partnership boards operating at a regional level will also need to establish themselves and “find their space’’ alongside the regional arms of Health NZ.
Henare says actual health outcomes will be set by the authority, not him, but his expectation is that “we should be able to see significant public health targeting’’.
He pushes back strongly on any suggestion the Māori Health Authority and Health NZ will be competing.
“Nor is it about, dare I use the word, segregation.
“We’re not saying Māori health providers can only go to the Māori Health Authority to deliver services for whānau and communities.’’
Henare describes the two structures as needing to “co-decide’’ on the best initiatives and innovations to help communities – in some cases they might be kaupapa Māori initiatives while more mainstream services will be more appropriate at other times.
“It isn’t a separate segregation kind of a model, it’s an and-and.’’
For that reason, he says National Party MP Simon Bridges is wrong when he says as a Māori he will have access to health services that Pākehā won’t.
“If you take where I come from, Ngāti Hine. The Ngāti Hine Health Trust are funded through multiple contract schemes to deliver for Māori and Pākehā.
“They don’t kick anyone out that presents with immediate health needs, because they know the health accessibility for people in general across the mid-North is really difficult, and not just for Māori,’’ Henare said.
“It just so happens that Māori are a large part of that population, but they certainly don’t distinguish between Māori and Pākehā – they deliver the service regardless.’’
The race relations debate
In the past month a debate about Māori tino rangatiratanga has broken out in Parliament over Māori co-governance, equity and partnership, and what is an accepted level under the Treaty of Waitangi.
National Party leader Judith Collins is calling for a national conversation, arguing on a daily basis that the Government is pushing ahead with “separatism’’ without public consultation.
On the Māori Health Authority, the Opposition says its establishment will tear regional New Zealand apart and create a two-tiered system.
The debate led to Te Paati Māori walking out of the House last week, after accusing Collins of emboldening racists with her rhetoric.
Asked how Collins’ language sits with him personally as a Māori MP, Henare responded “there are multiple ways to skin a racist cat and I’m in for the fight’’.
“I prefer to sit there and be confronted by it and have my chance to be able to respond to it on behalf of not just my iwi and me, but my constituents in Tāmaki Makaurau.’’
He said Te Paati Māori walking out of the House was a “tactic used rather frequently by them’’.
“We all know the rules. We all accept that when we come into a place like this it’s a Pākehā place.
“We all know that, whether you run in a Māori seat or are a Māori running in a general seat – we all accept there are rules with this institution.’’
Henare says those rules have changed and evolved over the years but ultimately the House “isn’t a marae’’.
“That’s one of the points that’s been reiterated with me, and as someone who grew up on a marae, if you stand up to make your point – regardless of how harsh it is or whether or not people accept it – you still get given the opportunity to speak.
“But you must also be willing to accept the response from the people who hear it, not simply deliver my speech then walk off the marae,’’ he said.
National’s water worries
On Sunday National continued its attack on the Government over race-based policies being implemented without consultation.
At the party’s regional conference in Queenstown, Collins alleged the Government was planning to give Ngāi Tahu partial ownership of the South Island’s water.
Ngāi Tahu has strongly rejected the claim and on Tuesday, Prime Minister Jacinda Ardern told the House Collins’ comments were based on a document the Government hadn’t commissioned.
In a statement shortly after the story hit headlines, Ngāi Tahu said the claims by Collins were “deceptive and wrong”.
Henare told Newsroom it was clear National was ignoring iwi and the relationship was “under strain or simply didn’t exist’’.
“I recall in my first term we were being punished as Labour members for not meeting with the Iwi Chairs Forum. I’ve been to a number of meetings recently and not seen any National Party members there or any comment from the National caucus around its role or function or how it might work with the forum.’’
On Tuesday Collins told Newsroom she hadn’t approached Ngāi Tahu ahead of her speech on Sunday, nor had she or anyone in her caucus made contact with the iwi since the fallout.
Asked if she thought her comments would have put a strain on iwi relations, Collins said: “I’ve always had good relations with Ngāi Tahu, as I feel I have with most New Zealanders.”
Her deputy, Shane Reti, said the door was always open to iwi to discuss any issues.
Reti, a GP in Whangārei before entering politics, said on Tuesday that he continues to stand by the party’s position that a Māori Health Authority would create a two-tiered system.
“Clearly [the health system] hasn’t been as effective as we’d like but that doesn’t mean you chuck the baby out with the bathwater and just start with something that I believe won’t be as effective.
“I would suggest we look at fixing the one system and doing a better job with that,’’ he said.
Henare and Reti both hapū to Ngāti Hine in the North, but Henare says he and others within the tribe are disappointed Reti hasn’t allowed for a “more mature debate, rather than race-baiting’’.
“I respect his medical expertise, he’s been my family doctor, but I am surprised he’s not pushing back harder on his colleagues in respect to a Māori Health Authority,’’ Henare said.