MPs have been getting down and dirty in the critical mud-wrestling phase of legislation to reform the public health system.
The Pae Ora (Healthy futures) Bill repeals the New Zealand Public Health and Disability Act 2000, disestablishing the 20 District Health Boards and replacing them with a single national health system Health New Zealand while also establishing the Māori Health Authority.
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Labour MP Andrew Little debating in the House Photo: ©VNP / Phil Smith
The Bill is at the committee stage where Health Minister Andrew Little said the guiding principles of the legislation relate to commitments made by the Crown under the Treaty of Waitangi.
“The opening—the kind of starting point for this bill—is that we have a health system that is based on health need, but we also have a country where we know that health need is met inequitably across different population groups, principally Māori and also Pacific. So this is about setting up a set of commitments and principles upon which our health system will be based that better drives towards greater equity. So the combination of the Te Tiriti o Waitangi principles and the health sector principles are a vital underpinning to the way decisions are made in the provision of health services from here on, or at least from the enactment of the bill.”
Rawiri Waititi of Te Paati Māori said his party supported the Bill and the establishment of a Māori Health Authority, but warned that without being funded adequately for what it is supposed to do, it is set to fail.
“The Minister has said he wants the authority to really make a difference for Māori, but how can it when it only receives 0.6 percent of the Vote Health budget, despite Māori making up more than 17 to 19 percent of Aotearoa's population? How can it, when it doesn't have the same functions and powers as Health New Zealand? I've just heard the Minister talk about the importance of Te Tiriti o Waitangi going hand in hand in the whole development of what is supposed to be the biggest health reforms in nearly a century. But Te Tiriti o Waitangi promises parity, and promises equality, and we're not seeing any of that in this particular bill.”
Rawiri Waititi addresses iwi members in the Debating Chamber gallery for debate of a treaty settlement bill Photo: Phil Smith
At the committee stage of a Bill’s passage, speeches by MPs are often more about getting their party’s narrative out there than zeroing in on little details.
For the ACT party’s Brooke Van Velden, it was a chance to reflect on race and a request for the Government to remove the Māori Health Authority.
“Now, we believe that behind this health reform there are no better outcomes. All that this health reform is is an exercise in co-governance rather than in healthcare. We think that we need to get back to basics and understand what our healthcare is supposed to deliver. Will this legislation actually lead to better treatments, faster, for more patients, or will it simply deliver a co-governed system that will divide New Zealanders based on their race rather than on their health needs? That goes far—too far—away from the understanding that all New Zealanders have equal rights under the law, and that's what the ACT Party proposes: that we consider healthcare as part of healthcare, rather than co-governance and race-based healthcare.”
Sometimes to get that message out there requires close attention to the details. National’s health spokesman Dr Shane Reti submitted several Supplementary Order Papers, seeking tweaks to the strategies legislated in this Bill particularly around providing for rural communities.
“Rural health is different and needs to be recognised and future-proofed in this bill. The New Zealand Rural General Practice Network said this after the second reading of the bill: "The Minister was unwilling to define rural communities as a priority population in the legislation.
ACT MP Brooke van Velden Photo: ©VNP / Phil Smith
"Parts 2 and 3 of my SOP demand equitable services to achieve equitable outcomes. National, in health, wants to talk the language of outcomes, not the language of bureaucracy. We understand the unique needs of rural communities. The strategic priorities for rural-health providers are: (1) to improve rural Māori health outcomes; and (2) to grow the rural-health workforce from within the heart of rural New Zealand. And the three principles in our SOP serve all those agendas. I note, today, that late in the piece, an SOP has appeared on the table from the Minister that seeks to recognise—surprise, surprise—a rural-health strategy in amongst, I believe, clause 40A—very late in the piece on the day. I think he's recognised the pain from rural communities in excluding them and having them invisible in this bill.”
Regarding the rural strategy that National wants in the Bill, Andrew Little indicated that the legislation directs the Ministry to develop location-based strategies.
“The other thing this part of the legislation does is to establish the requirement for localities and for the development of locality plans, and although there's only a small number of provisions in the bill for this, this is an absolutely crucial part of the machinery of the health system of establishing health need and engaging with both health providers and communities about how health need can be met and what health services should be put in place. So these are significant changes that will make a significant difference over time when it comes to health provision across Aotearoa New Zealand.”
Regarding ACT’s desire for the Māori Health Authority to be removed, the minister was never going to change Brooke Van Velden’s mind, but he did point out that “equity isn't about everybody being treated the same; it's about everybody being treated according to their needs”.
The Pae Ora Bill is likely to have its third reading next week.