Health Minister to reveal Māori Health Authority replacement details during debate

Health Minister Shane Reti has refused to answer questions about how his replacement for Te Aka Whai Ora, the Māori Health Authority, will work - saying he prefers to explain that in Parliament.

With Parliament sitting under urgency in part to introduce and pass the bill through all stages, Dr Reti says he does not expect he will be able to speak to reporters about it until after the bill has gone through.

The government has been facing criticism over its plan to abolish the authority, particularly as this is expected to be done ahead of an urgent claim at the Waitangi Tribunal.

Reti, however, would not provide details about the replacement for the authority until the bill's first reading.

"I think you'll be pleased ... I'd actually prefer to portray it into the House in the first reading, where I can give it depth and volume and lustre around what the alternative plan is," he said.

"I like oratory, I like adding context and contour to the statements I'm going to make. So I'd rather deliver all of that in the first reading."

Despite that, he did offer some hints.

"You'll see this, through the legislation, that there are parts of the pae ora which I have retained - like the Hauora Māori Advisory Committee, whose counsel I have found wise to date, already, actually, and in fact I'll be powering them up to do even more."

Reti said he could not commit to speaking to reporters about it after the bill was introduced, as he expected to pass it through all stages in the same sitting.

"I can't make a commitment to that, I envisage being in the House all of the time through until when the third reading is completed so we'll just have to see how that goes."

However, he said the funding for Māori health would remain the same, "and how that's distributed - through clinical or non-clinical frontline, backline, that's what's under discussion".

"With the frailties in pae ora that we've seen over the past year or so - maybe even longer - that opportunity to craft and create something different, a different journey - yeah, that's a privilege and I respect the privilege that I have, doing this."

The coalition's 100-day plan promised to introduce a bill dismantling the authority, but did not include a requirement to pass that legislation within the timeframe. The paper Reti took to Cabinet in December even suggested the full bill "should be passed no later than June, so that the Māori Health Authority can be disestablished in line with the financial year".

Reti had earlier released a statement confirming the bill would transfer all remaining roles and functions from Te Aka Whai Ora to Health NZ Te Whatu Ora, and the Ministry of Health, by the end of March.

"The narrow focus on disestablishment doesn't mean an end to our focus on Māori health for those who need it. We know the solutions for Māori communities come from Māori communities - not a centralised Wellington hub," the statement said.

"We are committed to finding more efficient ways to work together to deliver those solutions, as well as savings which can go back into better health outcomes."

It confirmed Iwi Māori Partnership Boards and the Hauora Māori Advisory Committee would remain, and that the government "intends to shift decision-making closer to communities to allow the people who know their communities best to guide service design and commissioning".

It said the government would "chart a new direction for Māori health" - but confirmed official documents relating to the bill would not be available until 4pm - and gave no further details about what would replace Te Aka Whai Ora.

Te Pāti Māori in an earlier statement said it had requested with the Speaker a debate about the "use and abuse of urgency", including about the disestablishment of the Māori Health Authority.

"The governments use and abuse of urgency has created a dictatorship in what should be a Tiriti-led democratic state," the statement in the name of co-leader Debbie Ngarewa-Packer said.

"Urgency deprives both legislators and the public of adequate time for scrutiny and deliberation on significant legislative measures such as the disestablishment of the Māori Health Authority and abolishment of Smokefree legislation."

Co-leader Rawiri Waititi - ahead of the bill's introduction - moved for such a debate to take place, and moved that the bill not be read because of the Tribunal hearing.

However, the Speaker ruled against those as a matter of procedure.

Legislation revealed

After repeated attempts by opposition MPs to prevent it, the bill was tabled in Parliament for debate.

Reti's first reading speech was about six minutes long.

"While the particular version of the dream that the Māori Health Authority laid out is coming to an end today, I want to paint a different dream, one that will be outcomes-driven, providing greater devolved decision-making that will deliver care as close to the home and the hapū as possible," he said.

He pointed to "organisational expertise" at the authority that he wanted to retain, and "I say to Māori Health Authority staff to please join me, guide me, and help us together to row a different waka towards better health outcomes".

For the most part, the bill replaces mentions of the Māori Health Authority and transfers most of the staff and responsibilities to Health NZ Te Whatu Ora, with a few also going to the Ministry of Health.

It also:

• Introduces a requirement for the minister to set up a Hauora Māori Advisory Committee - with members to now be appointed directly by the minister, instead of being nominated by the partnership boards and a list of specific organisations.
• Removes a requirement for Health NZ to provide information to Iwi-Māori Partnership Boards, watering this down to a requirement to "take reasonable steps" to support the boards and "engage" with them when determining priorities for kaupapa Māori investment.
• Extends the timeframe for "localities" planning, which aim to set out the health service needs of 60-80 geographical areas after consultation. Reti in his Cabinet paper said he planned not to progress these.
• Removes the need for Health NZ to get agreement from the local iwi-Māori Partnership board before making a locality plan and secure the board's consent to the annual report.
• Requires Health NZ to have "the capacity and capability to understand kaupapa Māori services and cultural safety and responsiveness of services", and to have systems for engaging with Māori about their aspirations and needs to inform its functions.

Advice provided alongside the bill noted Māori had seen gains in life expectancy in recent years - faster than for other ethnicities - but the "pace of change is gradual, and it will be some time before rates match those of the general population.

It highlighted the importance of confirming the scope and approach to the repeal quickly, "implementing the preferred changes transparently with emphasis on minimising disruption".

The advice also noted the changes to the health system were "ongoing and are expected to take time before their intended benefits are realised", but pointed to some "early indications" of improvements from Labour's reforms.

"The national approach to reducing waiting lists for planned care to manage demand is something that would not have been practicable under the former structure."

The paper Reti took to Cabinet also noted the Crown had accepted obligations to engage with Māori to improve health outcomes.

It also pointed to the existence of the Waitangi Tribunal claim, saying it "may make recommendations to the Crown to address any prejudice to Māori arising from a Treaty breach arising from disestablishment".