By Wednesday, 24 September 2025, 7:17 Am Opinion: Ian Powell
Copyright scoop
It is difficult to characterise the bill in the name of
Minister of Health Simeon Brown which is going through the
parliamentary process. It seeks to several varying
amendments to the Pae Ora (Healthy Futures) Act.
Act came into force on 1 July 2022 under the former Labour
government. Currently in its select committee phase, the
amending bill is required to be reported back to Parliament
by 24 November. These amendments
legislating for arbitrary ‘health
targets’ (which only cover part of what the health system
actually does and focus on both what can be counted and what
is politically convenient to count); andnegatively
removing the requirement to have a charter based on valuing
and constructively engaging with the health
In part, these amendments are petty
and immature. In part, they reflect a reductionist approach
to a health system that of necessity is characterised by
complexity. In greater part, they are based on simplistic
and misplaced ideology.
The narrow mindset that sits
behind the amendments also involves a negative attitude
towards addressing Māori healthcare
Simplistically this is implicit in seeking to
change the name of the Act from ‘Pae Ora (Healthy
Futures)’ to ‘Healthy Futures (Pae
Reversing the order seems more consistent
with a spiteful negative narrative towards Māori healthcare
than any other logic. Pettiness is the kindest
descriptor.
Māori Health Authority
The coalition government’s negative
attitude towards a focus on Māori healthcare came to the
fore during the 2023 general election campaign.
accelerated once in government with its decision to use
parliamentary urgency to disestablish the Māori Health
Authority (Te Aka Whai Ora) which had been a major feature
of the 2022 Act.
When the former Labour government
moved to establish the Authority I welcomed it in an article
published in BusinessDesk (12 June 2022): A
good call but not a magic bullet.
Back then I
observed that:
When the Pae Ora (Healthy Futures)
Act takes force on July 1, the Māori Health Authority will
have the power to:
Co-commission and plan
Māori healthcare services with the new Health New Zealand
structure which replaces the district health
boardsCommission kaupapa Māori
services.Monitor the performance of the
system for Māori.
This makes the
authority a potentially influential organisation to help
turn around the largely accepted health inequities Māori
face. Recognising kaupapa alone is significant, given that
it comprises principles and ideas which act as a base or
foundation for action. This could be powerful for ensuring
that Māori access to quality community healthcare is
improved, which also improves access to hospital diagnosis
and treatment.
However, I also warned against the
hyping up of expectations over what it might achieve simply
by establishing the new structure. This hype ignored
powerful external constraints on the new organisation which
were beyond its control.
Primarily these were the
impact of social determinants of health as the biggest
driver of health demand and inequities and the wider
‘command and control’ leadership culture of the health
system brought about vertical centralisation (replacing
district health boards with Health New Zealand – Te Whatu
Then Health Minister Shane Reti argued
forcefully in Parliament for the disestablishment of the
Māori Health Authority because he wanted to put function
before structure.
In other words, while the structure
of the Authority was being abolished, its functions were
Instead, Reti advocated, they would be
transferred to both Health New Zealand and empowered Iwi
Māori Partnership Boards (IMPBs) which were being
established under the Pae Ora Act.
There was logic
behind Reti’s position. Excluding political leadership and
business consultants, putting function before structure is
well-established health system wisdom.
However, in
this case there were two key factors which undermined
Reti’s argument. First, the Authority never had a chance
to prove itself barely lasting two years. It deserved to
have that chance.
Second, contrary to his more
respectful position, the dominant narrative for abolishing
the Authority was not only false; it was negatively
destructive.
Essentially, with Prime Minister
Christopher Luxon at the forefront, this narrative claimed
that the Authority signified separatism in the health
Complete nonsense but why should the truth be
allowed to get in the way of negative ideology!
changing structure to changing functions
amendments proposed by Dr Reti’s successor, however, are
about undermining the functions that had been transferred
from the disestablished Authority.
Whereas Reti
focussed on changing the structure but retaining the
function, Brown has gone in the opposite direction in
respect of function.
This is discussed by NZ
Doctor journalist Alan Perrott in a recent paywalled
article (15 September): Reducing
IMPBs functions.
Perrott draws on the insights of
Rakihia Tau, Chair of the Te Tauraki IMPB covering much of
the South Island (plus the Chatham Islands).
describes the amendments as silencing a “powerful voice”
for the very communities experiencing the greatest health
inequities. He calls the means of achieving this objective
“disruptive reform”.
Perrott also covers the
national response to the amendments by the 15 IMPBs in a
collective submission. They dismiss the proposed changes
because they “…are not simply technical or
administrative; they will directly harm Māori
communities.”
As reported by Perrott they say
The repeal of sections requiring engagement,
cultural responsiveness, and ongoing monitoring of Māori
health outcomes, according to the submission, will result in
more Māori disengaging from health services, inequities
going unreported, and a return to one-size-fits-all policies
that fail to meet the needs of Māori.
effective change in function is seeking to reduce IMPBs from
being “genuine partners in health system design to mere
advisory voices…”
Māori healthcare deserves much
more than soundbites
Te Puna Ora o Mataatua is a
charitable trust based in Whakatane which works to support
whānau to achieve better long-term health and
It delivers a range of homebase, community,
medical and social services across the Eastern Bay of Plenty
As reported in the above-mentioned NZ
Doctor article, its chief executive Dr Chris Tooley is
forthright:
There is nothing at all for Māori
here. Even when you think about their core role of producing
community plans, there is no funding for research, nothing
for modelling, nothing for co-design and nothing for
engagement.
Simeon Brown needs to listen to and
act on this concern. His argument for reducing the function
of the Iwi Māori Partnership Boards amounts to little more
than simplistic soundbites.
Māori healthcare deserves
much better than this. So does the whole Aotearoa New
Zealand health
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