Health and disability system reforms

On 21 April 2021, the Government confirmed the details of the health system reforms in response to the Health and Disability System Review.

The Ministry works in partnership with the Transition Unit within the Department of Prime Minister and Cabinet (DPMC) on a range of work programme areas. The Transition Unit was set up to lead the response to the Health and Disability System Review.

Online hui

The first online hui in a series of four on the reforms was held on April 26, focusing on how the new system uphold Te Tiriti o Waitangi principles and the Crown’s obligations to address historic inequity.

The panel included Minister of Health Andrew Little, Chief Executive of interim Māori Health Authority Riana Manuel, and Director-General of Health Ashley Bloomfield.

The Ministry of Health’s Deputy Director-General Māori Health John Whaanga moderated the hui.

Speakers:

  • Dr Ashley Bloomfield – Director General of Health
  • Andrew Little – Minister of Health
  • Riana Manuel – Chief Executive of the Interim Māori Health Authority
  • John Whaanga – Deputy Director-General, Māori Health

>> (Speaks Māori language) Kia ora everybody and welcome, welcome to the first of our information sessions on the health and disability reforms. And particularly to the Te Tiriti o Waitangi and our system.

Just to let you know, I acknowledge from a generation ago, the people who have helped shape the Te Tiriti o Waitangi and acknowledging that if they were here today, the excitement I’m sure they would feel as we are about to engage and embark on our next journey and embracing and incorporating Te Tiriti o Waitangi into our system. I also acknowledge the work of the professor, and his seminal work in reviewing and encapsulating the key direction for all of us that led to work that came later on by the Waitangi Tribunal. The development of the health action plan, and most important, and the basis of our discussion today, the new legislation. I would like to welcome today The Hon. Andrew Little, Dr Ashley Bloomfield, and Riana Manuel, who come along today to share their insights and observations and aspirations as we move towards an exciting development in the development of Te Tiriti o Waitangi. For those of you who are online, you will be able to participate and provide questions into this process through Slido and I invite you to do so. Also if there are questions that we aren’t able to respond to today, we will gather those together and provide online responses after this was that further ado, I would like to head over to Dr Ashley Bloomfield.

>> Thank you very much John.

Great pleasure to be here alongside you.

Welcome to you Minister Little, and my colleague Riana Manuel was the Chief Executive of the interim Māori Health Authority. Is a pleasure to be here today.

 I know that many of you will be aware that whilst I’m finishing up as the Director-General, I still have three months in the role and the global pandemic, that can be a long time, and it means I’m very excited about continuing to be involved in the implementation of these reforms to the system and of course they are not starting now, nor in July 1, but they are already well underway. I have always been a strong proponent of New Zealand’s health and disability system. It is by no means perfect but it is one that delivers very good outcomes for many New Zealanders.

However, like many, if not all people working in that system, and indeed New Zealanders, we have aspirations to do even better. And these reforms offer an opportunity to do just that, to achieve healthy futures for all New Zealanders. A system that is responsive to people and their needs, whatever their circumstances. The reforms underpinning them have this special relationship between Māori and the Crown, which we know exists under Te Tiriti o Waitangi. Embedding this will help us achieve and I know this will be the subject of some of your questions and we will hear more on this so we look forward to receiving those. There is a clear responsibility and commitment to continuing the good work that John has outlined that has been done in the past and laid down by some of those great names in Māori health development in Aotearoa New Zealand. And more recently the development of the Māori health action plan. That lays out some of the key actions that are aiming to improve services, services for groups that currently don’t get the access they should, like Pacific people, disabled people. Where this reform provides an opportunity for us to not just reconnect to but to make substantial progress in those areas. We are not starting with nothing. There has been a lot of great work happening already within the healthcare system and in particular, over the last two years and our response to the pandemic, I believe we have seen some step changes in the way our system has responded to inequities and the idea of course is that we build on those gains that have been made. But it is an opportunity for us to revisit how our system can better ensure equitable access to experience of and outcomes from care. Our role as the Ministry of Health is the key strategic advisor to government, is a key Guardian for the system is to ensure that the system is delivering for New Zealanders in the future. One of our most important roles will be monitoring overall system outcomes and we are working actively on how that will look different in the future, as we move, on one July, to that new system. Believe me, we will make sure we remain steadfast in the government’s health priorities are being met and that the system delivers a for the longer term health needs for all New Zealanders. One of the key documents that underpins the Health Minister’s priorities for the future system is the interim government policy statement. And that lays out, really, the government’s priorities as we journey towards. I would like to hand over to Minister Little to explain about the government’s goals and priorities for the new system, and then after Minister Little, will be over to my colleague Riana Manuel, to offer some insights. Kia ora Minister.

>> Good afternoon. It’s a great pleasure to be here to talk about the process of bringing the policy statement and as we head towards 1 July, the introduction of the new operating model for our health system. When the government reviewed the report of the health and disability system review, it looked very closely at what that reporter told us. Is indeed many others have told us about the performance of our health system, which is done very well, but has also seen a growing share of our population continue to miss out on frontline healthcare, particularly primary health care and a system that has been built up over many years to do a number of very important things, but still not addressing some of the fundamental aspects of broader well-being that we would expect a country of our size in the 21st-century. One of the other things that became apparent was for a country that understanding its history, and coming to terms in the last 30 or 40 years with the Te Tiriti o Waitangi and the founding role that that document plays in this country and us as a nation state, is to make sure that the Crown is truly honouring its obligations under the Treaty. We set is one of the first priorities of the reforms is that we must ensure that the way our health system operates truly honours and embeds the obligations of the Crown under the Treaty. Of the range of recommendations that the government picked up, which was establishing the Māori Health Authority to reflect the set of priorities about that. Is the job we are giving the Māori Health Authority that I think gives us the opportunity for a much more powerful response to lift health and health services and access to health services for Māori. As Dr Bloomfield acknowledged too, we have population groups within Aotearoa New Zealand, for whom there needs to be read emphasis, more work, greater priority. To make sure the health system is delivering. Pacific peoples, ethnic minorities, and others. But for Māori, to whom we have an obligation under the treaty, it’s not just a question about providing more or better health services, it’s also about a voice in the system. A way to express and the way we have set up the system. This is one of the things that we want to ensure that the reforms do. Have an opportunity now to, I think with a strengthened health New Zealand, with a Māori authority to decisions about health to really address some of the long-standing inequities in health care and health outcomes that we have seen in this country. As Dr Bloomfield also acknowledged, we have a number of what we might call accountability documents, we have the government policy statement which we are in the process of putting together and we will talk about that in the weeks to come. But that is the document that sets out the government of the day’s objectives and aims for the health system. To the structure and the entities that we have in place. In addition to health New Zealand and the Māori Health Authority, of course one of the new dimensions of the operating model will be public health agency, supported by the ministry, and providing leadership in our public health endeavours through the consolidation of the public health units within health New Zealand. And all of that under the stewardship of the Ministry of Health whose role will become very much a leader of the system, providing a policy support, and advice to ministers, providing that system stewardship, and enabling the Māori Health Authority and health NZ to get on with their task and their mission of running excellent health services and improving health outcomes for all of Aotearoa New Zealand. Within that system, there must be clear decision-making roles in place for married which will be expressed not only through the Māori Health Authority but through Māori partnership boards and drawing on the wisdom and strength from Māori. All of the entities must work closely together. From my position as Minister, from what I was served in the establishment phase, what I see as the Māori Health Authority and Health NZ, working incredibly closely together, is indeed a must for both organisations to succeed in working closely with the Ministry of Health. Because as I said, almost work with shared objectives and common goals and work closely together, the strength of those relationships is going to be absolutely vital to changing what we do. We do the first two weeks when we head towards 5 July, subject to the passage of legislation to cut over to the operating model, there are hugely exciting opportunities for all of Aotearoa New Zealand, think about their health sell visitors, the needs, those omit and unmet, and how we address long-standing concerns in that regard stop I look forward to the ongoing discussions as to how we continue to achieve the best health system to achieve Pae Ora.

>> (Speaks Te Reo Māori) My name is Riana, and I will start by first acknowledging the amazing work that has been undertaken over these last four years by all of the sector, workforce, communities, and in general. We are absolutely aware that there is so much going on in the communities. We are excited, given rise to excellent models out in the community is. Which uphold Tate to read the . One of the challenging aspects, as a Crown partnership, we are not part of the treaty, but between the partnership with the Crown will be what myself and the College of health New Zealand will have, including partnerships that we have with the Ministry of Health as well. I’d like to acknowledge that (Unknown name) passes her apologies, she is on holiday, and said everyone her well- wishers as well. So, the thing that is important to me, when we acknowledge that we historically have a health system that has not met the obligations for Māori under the treaty, it’s important we see the reform as an action to take and moving forward. And creating system that honours the treaty, upholds the rights of Māori and gives effect to the treaty principles by the Waitangi tribunal. That means sharing resources, tackling, sharing power and resources, and tackling racism within the system to ensure that we remove bias, make sure there is adequate access to health services, particularly for Māori in the relationship, but other parts of the community, who also have experienced in equities, and exist to these services as well. We want to have effective treaty partnerships, and have Māori principles for the time ahead of us. To make sure, when we develop a system based on understanding the relationship, and the inequities, that it has a massive benefit for all of us here in Aotearoa, health system that acknowledges and serves everyone, by acknowledging the special relationship between both the Crown and here we -- Iwi that’s the main thing I want to embed in. We will work on documents, as the Minister outlined, we will work hard with organisations to ensure that we uphold our responsibilities as a good treaty partner as well. We will give for not just exist in the system, but looking at innovative examples from the last couple of years, that we reach into communities, that we get services more locally exposed, and making sure the good partnerships such as localities will be explored, invested in, and create opportunities to ensure people, no matter which immunity you live in, be rural, urban, whether it is a person with disability, whether it is Māori, Pasifika, these are people who have better access and consult with the collective result with the health system. (Speaks Te Reo Māori).

>> (Speaks Te Reo Māori). Thank you very much for sharing preliminary insights and aspirations. And thank you all for putting your questions on Slido. I will take a bit of latitude, because there are a number of questions which are doubling up amongst people. But I will ask, in reverse order, the three guests today a question starting with Riana and then Minister Little. How can help ministers help embed the principles of Te Tiriti o Waitangi in the health system.

>> I think that is something that I alluded to previously. The approach we need to take now is not just one for health, we need to actively embed Te Tiriti o Waitangi across the health system. And that is working collaboratively across the sector, not just the Public Service Act, but taking opportunities to work collectively with opportunities -- communities, community leaders. If we look at rural and isolated communities, that we work collectively and collaboratively with people making decisions, and those decisions with those people. So, I think it can be embedded across all parts of the sector. We must make a collective effort to do so, and of course, like a semaphore, the opportunities for all of us will improve the health system overall. It’s one way to affect the health system with the most might is to bring all of the sectors, housing, (Speaks Te Reo Māori) all of us together so that when we go on the voyage and we reach Hauora for all of us.

>> With the question of how to embed Te Tiriti o Waitangi. We need to have a deep understanding of what it is, and what the articles are. Of what they actually mean for and a personal leadership level, an organisation level, the system level. Is incumbent on us to not just understand that, but to translate that into specific actions. And also, what delivery on those articles and treaty means, and particularly in the health sector, what it means for what the health sector is structured. From mainstream services, and Hauora Māori services. For my part, I am constantly thinking about how to embed the treaty articles, and leadership and a personal, organisation and system level. Kia ora.

>> Minister, thank you. A couple of points that I would make, the treaty is we have seen models for Māori, and support, is not just about boys, it is about voice, but it’s also about decision-making and rights. For Māori to lead their people, as contemplated by the treaty. My expectation, with the operating model that we have got, that the Māori authority and with the engagement reflecting their voice, and with the government of the day makes. the other aspect is that we talk about co-government as recognising that. The treaty always was a shared objective for the Crown and for Māori, and that doesn’t change, doesn’t change in the public sector. But the way the government through the agency conducts itself, can properly reflect what the vision of the treaty was. Māori empowered to make decisions for Māori, and Riana talked about sharing power and resources, that’s what it’s about, and the progress of our nationstate, Aotearoa New Zealand, and how they sit comfortably together. Which is what the treaty was always about.

>> Kia ora Minister. I will ask a similar question in reverse order starting with you, minister. What are you looking for as your measure for success, with 2 to 3 years into the reforms. One of the things that you expect to see in the New Zealand health system? Over to you, first minister.

>> What I expect to see 2 to 3 years from now is a level of confidence, and other parts of the health sector, a confidence of understanding the needs of Māori, and fulfilling building services that help to fulfil the needs. Bearing mind that the Māori health services does not stand apart from health New Zealand and the Ministry of Health. As I said before, they are all integrally involved, and they have to be for the total system to work. But the Māori Health Authority brings a strength that we have long lacked in terms of lifting the performance of the system, and providing access to health services for Māori. I would expect to see data that shows more Māori getting greater access to services. And in order to do that, and therefore what I expect to see is different types of services, and frontline health models providing those services, compared to what we have today.

>> Kia ora, Minister. Ashley?

>> So, the key thing is in three years, and one year, it is already seeing an improvement across the system, the more equitable access to experience outcomes. And we are actively monitoring that. Is a constant approach to improvement. We are looking at new ways to deliver services, and been very responsive at what the constant desire to learn and improve. And we have seen this a lot over the last couple of years, with the response to COVID. The need to respond to Māori and other communities to improve outcomes and deliver vaccines to Māori and other communities, the systems can learn and respond quickly. That’s a strong feature of the system. Finally, this is important, for the Ministry of Health and its stewardship function, it is a strong future view, not just here now, we are securing the system for the future in terms of workforce. In terms of infrastructure. And in terms of the way that services are delivered so that they are more accessible to the community. Kia ora.

>> (Speaks Te Reo Māori) when we talk about better access, we want people to be encouraged to get involved in the development of the services, health and well-being services, and I think that is the transformational part that we want to invest ourselves in over a longer period of time. We want to accept that there is one part, what we do right here and now, and the reforms and transition to reform, and the work that we do to make sure we transform the system over a longer period of time. Making sure, at a local level, people are able to influence the way services will be set up, and this will encourage different funding models for Māori providers, so they are resilient, they do the work we know they can do, and collaborate with ministry health, and other ministries at the same time. It has really been an investment style model, because we see the whole community wraparound, we see a lot of good outcomes for the communities, and that’s what we would want to see over a longer period of time as well.

>> I have a question to ask you Ashley. How can it marry become better partners in the regularly and public space with opposite the new Ministry and public health agency?

>> This is a good question. The agency will be sitting within the Ministry of Health, and I think about it, because I’m in a public health position, but I think about it as being in the heart of the future ministry and some of its functions will be fundamental to us to be able to deliver on our stewardship role, our monitoring of outcomes, and the system performance. Those public health regulatory functions are determined in effect by the Ministry of Health, but they are delivered largely by our public health units and our public health units will be coming together into a single national public health service within Health New Zealand, and so there is an exciting opportunity here for that national approach to our public health service delivery, including the regulatory aspects, the health protection aspects of this, to be much more connected to the local communities, including Māori communities, and in fact we’ve seen some very good examples of this and I talked earlier on about the need for the COVID response to respond immediately to what community needs were. When we saw our public health units having to develop new ways, new relationships with (Speaks Māori language) communities and indeed other communities in the delivery of that health protection function. To have a really strong base to build off here and in a way, this is one of the most exciting developments just to see that while those regulatory functions are prescribed legislatively, they determined by the mistreatment, the way in which they are delivered can be managed by partners.

>> I have a question here, particularly the question has asked will the audit approach be used to assist in embedding the treaty into the new system?

>> I would say that there is always an opportunity to embed whānau ora and the approach it is taken, because again that speaks to that whole collaborative network of providers, community, groups that come together to make sure that they create solutions and establish networks if you like for all whānau to be able to access. The order is so that whānau have a voice and that is an important part of this reform and how we operate moving forward. Not only do we want to lean into the final order outcomes that have been very successful to date, we also want to make sure we can establish finite voice and build on what they are telling us so it is a system that is cognizant of all of those factors.

>> Minister, I have a question here around the future for PHOs and general practice but I also think there is an interesting locality planning and I’m aware that there has been announcements quite recently around that. I wondered if you want to comment a bit on how you see that moving ahead, particularly with Māori health in mind.

>> I think a really important question. When it comes to PHOs, they’re not a creation of statute, the government hasn’t created them to establish, they arose out of the system as it is at the moment, there were some benefits to offer support across general practices in a particular area or region. I think the offering from PHOs was to assist with back-office functions, supports and innovation. And there are some PHOs that have done a great job in doing just that. There are some other PHOs who I would say haven’t actually risen to the occasion what PHOs do is really going to be entirely up to them and the practices that they represent. For me and for the new system, I think the locality planning network process is going to be absolutely critical. The way that process operates is to bring together different health providers in an area as well as iwi, as well as community leaders, To talk about the health needs in a particular locality, look at the profile of the population, see whether there are things that are distinct to that population, and for that to form the basis of what then Health New Zealand and the Māori Health Authority will fund. From that process, I expect, and if we don’t see this, it means it won’t be working, but I do expect to see a lot more innovation, a lot more collaboration and coordination. I think one of the challenges for primary and community care, not for all of it before some parts of it, is to examine the business models that they are operating under at the moment and then to think about what might be better ways of ensuring the full range of primary care services that we expect to be in communities can be offered. Bearing in mind that outside the big metropolitan areas, and provincial urban areas, we’ve got a large rural population whose health needs had often frankly sort of been secondary to what practices might want to do in those more populated sorts of various. Through locality planning, we have a much greater opportunity to think carefully about how we provide services at a more consistent sort of way, and reach into communities that I think for a long time have missed out. If there are PHOs you want to provide the leadership to do that, then that is a good thing, and that opportunity is there for them. But what is critical, I think, is through the way that Health New Zealand and the Māori Health Authority ends up funding services, and activities, it drives services to be offered in a way that meets a population’s needs, not that meets the service provider’s needs.

>> I have a question here around where we see, in any change process, particularly one as significant as this, which I think would easily be the most significant health changes we’ve ever had. But there is a question there around where we see the bumps in the road in the next six to 12 months. Obviously as we channel and move towards a change, it is important we know the destination, but also where some of those bumps might be. So might start with Riana and then Ashley and then yourself Minister about where you think those bumps on the road might be.

>> Getting today one, ensuring we have the organisations established, and ready to go, it’s going to be not so much a bump on the road, but it is certainly one of the things that we are really focused on prioritising at the moment to stop making sure we get the right documents, dress those priorities, and making sure that we partner up well both with Health NZ and with the Ministry of Health to make sure that we are able to roll out those key functions post 1 July. Partnership is always about having those good, high trust relationships, working together collectively, and working wider with the rest of the sector, that will be part of our key priorities. I think the potential for bumps in the road in any of those spaces, but what I would say is we are really committed to making sure that these reforms are extremely well. It is a priority for all of us because at the end of the day, we really want to address pae ora, we want to see it regain for our people, and that means being really good treaty partners.

>> I am very conscious as we come to just over two years in a pandemic, we’ve been asking a lot of our health workforce, in its broadest sense, the public sector workforce as well. And so it is very important that we make sure we are engaging our people who work in this system and that they have a sense of excitement about the future system and its purpose in the direction and that they can see the opportunities there and that they can see the aspirations they have, I know they have, for the system able to be realised. And of course that goes in particular in terms of our discussion today about our shared aspirations for improving Māori health and for delivering on our treaty obligations. It’ll be very important that we create the space for people, even as they are busy and no doubt tired after an amazing effort and amazing work in responding to the pandemic. And also it’s important that we are able to articulate to communities, to whānau, and others exactly what reforms mean for them and we are able to demonstrate as we go along the way the benefits of it. But rest assured, of course there will be bumps in the road was that we’ve seen that in a pandemic response. The important thing is that we are constantly articulating that really clear vision and that people are given the opportunity to respond to that and to engage with the changes that are on the way.

>> Thanks again, I agree, I think for health, the critical element in delivering health services is our health workforce, and we have an absolutely tremendous health workforce that has really delivered in a way that I think it really struggle to see just over the last couple of years and really risen to the occasion. That means we have a health workforce too that is really feeling it, has felt the pressure, and is feeling tired as a result. And it’s a health workforce that was under pressure anyway. We are in a system that still carries a lot of vacancies. So we need to address those issues. They won’t be fixed in the next few weeks, but we need to do that. We also need to continue a measured response to the COVID pandemic as well as facing what this winter might present to us as well. In terms of when you are setting up the new structure and a new operating model, there is risk establishing new relationships, those reforming old relationships. Those things can happen unevenly. I think as others have acknowledged, there’s no such thing as the perfect process. No change happens in a straight line. Think what’s important as we understand the magnitude of the task, we understand the state that the system is in, that the workforces in, there are still some outstanding issues that I think many in the public and private health workforce would wish were fixed, fixed some time ago, but fixed sooner rather than later. And we are determined to do everything we can to do that. Think equally as I get in, thing people do see the opportunity of the changes and also want to get on with that. So I think as long as we understand that there are still challenges to rise to, some important tasks to get stuck into that we support each other to get there, and we accept that it won’t be perfect but it will be headed in the right direction, for all the right reasons.

>> Kia ora Minister. One question that I am going to ask, start with you and then Ashley and then Riana, is what happens if there’s a change in the policy in the future? In recent weeks in the newspaper that something that has been posited. Do you have any reviews on that before a hand on to others?

>> I think is the legislation, the pae ora healthy futures legislation goes department, I think the be more of a public debate then perhaps we have seen up until now. And we should embrace that debate, it’s an opportunity to really layout what we’re trying to do. I’m confident that for those particularly in the health sector who know that we can do differently and we can do differently well, and we can do better, that they are willing to seize the opportunity that the changes present and I also think there are plenty in the community who see that opportunity and want to make the changes well. So I wouldn’t get too fussed about what is said in the political arena. I’m not trying to criticise legitimate criticism and legitimate opposition, of course there is. And as we know it health, nothing is ever going to be perfect. Let’s let the debate unfold, but I think the organisations, Health NZ, and the Māori Health Authority, and the revamped Ministry of Health, they will stand for themselves, and I’m confident that even after a year, 18 months operation, we will start to see change and difference and improvement and that is what will strengthen the organisations in the new operating model. I detect there is a willingness to embrace the change and as long as that is there, we will make that change and that will sell itself.

>> The area of reforms that tend to get the most debate and our time is around the structures, the organisational elements of the new reforms. But at the end of the day, the thing that our whānau and our communities really need and want of that system remains quite concert. In the structural reforms, the organisational forms, they are designed to set up the system to be able to better deliver for whānau and communities. And that is the thing that certainly is the stewards will remain focused on is the Ministry of Health, that actually what we’re looking for is what are the outcomes we are trying to achieve in making sure the system is delivering those outcomes, and certainly my experience having spent my career in the health system, is that ultimately, structures are important but they are not everything, and Relationships people have that lead to those outcomes. So, the approach that we will take being focused on the outcomes that we all aspire to achieve. Kia ora.

>> Kia ora.

>> I couldn’t have said it better myself. Rather than focus on the structures, I know that structures are one part of the reform, remembering why we have come into these reforms, it has been really cognisant Lee aware as to what C in the first place. We know, for Māori, we are not accessing services in the same way. Are not getting the same outcomes. We have mortality rates that are so different to other New Zealanders, and this is about exploring and making sure that we start working on the solutions. And that is something we should all get interested in. We all want the right response around. To make sure we look after all the people of Aotearoa. And if we get to the bottom of the long-term chronic diseases, mortality rates, and other issues for Māori, it will be a benefit to the health system overall. A bit like Ashley in that case, a job is to make sure the relationships are sound, we are working collaboratively, reaching across sectors, and we make sure we go back to communities who most want to be able to stand up these systems to themselves, and recognise there are other ways that people get the best services. As they define them, and as they aspire to be able to access them. Kia ora.

>> Kia ora. There is a golden opportunity with the reforms, amongst other things, to increase visibility and awareness, respect for and utilisation of mātauranga Māori and te ao Māori. How might they engage, Minister?

>> It’s a good point, Minister. The reason the system is set up, the Māori Health Authority is not just confined to health services, to cross the system. The whole system needs to be able to respond effectively to Māori, and address the needs. One of the jobs that the Māori Health Authority have as part of the workforce development mandate is engaging with the training institutions that have courses. One of the jobs is that we examine closely the training, not just to all health workers, that they get qualifications, and providing basic knowledge and understanding for all those who enter the health force, with qualifications, to understand what the expectations are, what the needs are for Māori when they engage with the health system.

>> Kia ora, Minister. Ashley, there are a bit of questions with the big letter R word, racism. Do you have the best way to go about this, given that we need to keep the health sector in a purposeful direction?

>> Kia ora, John to stop this is a important public, and the Māori action plan is addressing racism across the system. Going back to earlier comments about leadership and the responsibility of leaders on a personal and organisation and assistant level, we need to be open to and looking at what other drivers of poorer outcomes for Māori for the system. It’s no doubt, it is well documented in New Zealand and other countries and health systems, racism, conscious or unconscious, plays a role. Therefore it needs to be actively called and addressed. I have been very encouraged over the last two or three years in particular, to see a much more mature, systemwide response to acknowledging racism and the impact it can have. I acknowledge, it can be a tricky subject, can be something that I feel quite strongly about, and I will have a mature response to it, making specific actions in tackling it is a deliberate action. Kia ora.

>> Kia ora, Ashley. Riana there has been questions about the health system and the Māori Health Authority, how do you see that partnership being expressed between the two organisations?

>> I would expect to see it expressed in so many different ways. We should always look at our priorities, develop plans that will see better access to services, remembering that Health NZ will bring together the district health boards and services that are within there, but there are also community services, and I see as having a productive relationship could partnership around how we hold ourselves accountable in the system. The Māori Health Authority, we will not be trumped, we will make sure that my people have their voices heard, that we rely the information to our partners, and that is not just Health NZ, but the partnership with the ministry as well as those stewards. The Māori Health Authority has a big job ahead of it, and of course, making sure that we behave in a way that has partnership full, enhancing, that shows respect to all parties and people, and will result in good outcomes. I want to add to my comment, to take initiative, John, last question before, I think it’s the exciting aspect of the reform, we are having these discussions. If you wanted to see, in real- time, what change looks like, it is the fact that we are having conversations about Indigenous models of care, introducing concepts, people understand their history, that it leads them to well-being in their own right. Good health is not just the absence of disease, it is making sure that we have good housing for our people, that we are conscious of those that are without, and that we make sure we join together to pull all the levers to get a healthy nation for all people in Aotearoa. Kia ora.

>> Kia ora. We are coming to the end of time, but I want to leave a final question for you before we close. And that is where we see our particular roles in leading the change. I’ll mix it up, have Ashley, Riana and then you, John.

>> One is being leader of Ministry of Health, it really has a strong stewardship role. Stewardship role is even stronger and enhanced, we have a clear obligation to monitor and ensure that the system is performing for all of New Zealanders. So, it’s a key part of the Minister’s role in the future, and the Director-General has got a system leadership role that goes beyond being the head of the Ministry of Health. And worse in the importance of the role, through the pandemic. Whilst I have been moving on from it, I’m just one Director-General, in a long line of Directors-General, and another person coming into the role will bring you vision and energy, and a sense of deep commitment as well to continuing the leadership role across the system. I’m also confident going back to my early comments about the maturity of the system in terms of treaty responsiveness, in terms of its focus on equity, and the partnership with Māori, and the Director-General will carry on that important work. Kia ora.

>> Kia ora, Ashley.

>> I see my role as being a really good partner. And working collaboratively with all parts of the sector to embed all of these Te Tiriti, that we create better plans and that we make sure photo voices is at the centre of everything we do. That the Māori Health Authority is the voice for Māori, because people just won’t have that. But making sure that Iwi all have the opportunity to have their voice, and that the messages for people are adhered to will be a big part of my role. The last thing that I will say is (Speaks Te Reo Māori), and simply put that means it is not by the might of one, it is the collective that will get us the result we look for. Kia ora.

>> Kia ora. Minister?

>> I could say that we have the easy job, I received the reports, make decisions. No, it’s not. The important role that I will continue to play in this role is what I have done so far, to look closely at the reports, evidence, and recommendations, and work with other ministry and colleagues to get good decisions up, that are practical, ambitious, and that actually seek to do justice, particularly to Te Tiriti . We will send the milestones for the decisions, and the other milestones as well. That is what we have been doing. And the other thing is, to make sure that we continue, we have enjoyed so long to get people in the right roles to provide that leadership. So, Ashley in your leadership in the timer Director-General, what you’ve done to advance and improve Māori health. John, the work you have done with the Māori action health plan, and Riana your work as a health leader, I cannot feel like the Māori Health Authority is more blessed by having your leadership, working with the ministry, and Māori partnership boards, and your people to drive the change in Māori that we know we need to see. And we feel like we are truly honouring the treaty. I will continue to drive towards those aspirations.

>> Kia ora, Minister. (Speaks Te Reo Māori) Just on your behalf, thanking again, our minister the Honourable Andrew Little, Dr Ashley Bloomfield, and Riana Manuel, for the expectations we have and continuing to improve the health system, get the best out of it. On your behalf, I want to mihi to them for their time today, and their kōrero, and the questions that you put to the session. I want to close on the point that Riana made that it takes many of us to have our goals come forth. And I will end with (Speaks Te Reo Māori)

Themes from the Online Hui session

Te Tiriti will be embedded in the health system

Aotearoa New Zealand’s health and disability system is being transformed so all New Zealanders have better access to, and outcomes from, health services - no matter who they are or where they live.

The reforms acknowledge the special relationship with iwi and Māori communities under Te Tiriti o Waitangi.

One of the five priority outcomes for the reforms is partnerships with Māori in how healthcare is designed and delivered and empowering everyone to help design systems that work for them, guided by the special relationship under Te Tiriti o Waitangi.

At a local level people will be able to influence the way services are set up. This will encourage different funding models for kaupapa Māori providers to make sure they are there, are resilient and able to work with other partners. It really is a Whanau Ora design.

The success of embedding Te Tiriti into the system will be monitored

The Minister of Health sets his strategic priorities through the interim Government Policy Statement (iGPS), which the Ministry of Health is developing on his behalf to cover the first two years of the reformed health and disability system 2022-2024.

The interim GPS is a stepping stone towards the ‘full’ future statement. It sets a clear expectation of what is important for health entities in the next two years.

It will outline how progress will be measured and reporting requirements.

The Ministry of Health in its role as steward of the health system will remain focused on the outcomes the reforms are trying to achieve and making sure the system is delivering those outcomes.

How the reforms will address the needs of Māori who are disabled

There is a clear responsibility to improving hauora Māori, and other groups, such as Pasifika and the disability community, who may not have had equitable care in the past.

The Government has announced the establishment of the Ministry for Disabled People, to deliver and transform Disability Support Services as part of broader Disability System Transformation.

Disabled people will now have a dedicated agency that will support a whole-of-life approach to disability, rather than considering the community’s needs through a health lens alone.

The new Ministry has a mandate to lead a whole-of-government approach to disability, and to develop policies that support partnership with and employment of disabled people, families and whānau using a strengths-based approach.

Māori will be enabled to better partner in the regulatory public health space without it being locked up in the public health agency and services

Regulatory functions, currently delivered largely by PHUs, will come together into a single national service within Health New Zealand that aims to be much more connected to their local communities, including Māori communities.

The Māori Health Authority will work with Health New Zealand to jointly develop plans, commission primary and community services and kaupapa Māori services.

The Māori Health Authority will partner with the Ministry to develop strategies and policies that work for Māori.

The Māori Health Authority will have joint decision-making rights to agree national strategies, policies and plans that affect Māori at all levels of the system.

The Māori Health Authority will directly fund health services grounded in kaupapa Māori and work with Health New Zealand to plan and monitor the delivery of health services.

Iwi-Māori Partnership Boards will enable Māori to exercise tino rangatiratanga and mana motuhake when it comes to local planning and decision-making for health services.

Iwi Māori Partnership Boards will act for the communities they represent and bring the voice of whānau to planning and decision making of health services to improve hauora Māori.

How the partnership between Health New Zealand and the Māori Health Authority will work

The Māori Health Authority will work with Health New Zealand to jointly develop plans, commission primary and community services and kaupapa Māori services.

The Māori Health Authority will also partner with the Ministry to develop strategies and policies that work for Māori.

The Māori Health Authority will have joint decision-making rights to agree national strategies, policies and plans that affect Māori at all levels of the system.

The Māori Health Authority will directly fund health services grounded in kaupapa Māori and work with Health New Zealand to plan and monitor the delivery of health services.

Iwi-Māori Partnership Boards will enable Māori to exercise tino rangatiratanga and mana motuhake when it comes to local planning and decision-making for health services.

Iwi Māori Partnership Boards will act for the communities they represent and bring the voice of whānau to planning and decision making of health services to improve hauora Māori.


What the Ministry will look like in the future

The Ministry will continue in its enduring role as chief steward and kaitiaki for the system and some of the things it does will change.

The Ministry’s role will remain focused on strategy, policy, regulation and monitoring the outcomes achieved by the system as a whole. The Ministry will lead the system in its role as kaitiaki, ensuring good evidence informs strategy and policy development, and will work with the other organisations within the system to enable effective delivery of services.

The role of Director-General of Health will continue – the role remains the head of the health system. Statutory roles such as the Director of Public Health and Director of Mental Health will also remain within the Ministry.

A new Public Health Agency within the Ministry will lead population and public health policy, strategy, regulatory, intelligence, surveillance and monitoring functions across the system.

This will see more emphasis on the determinants of health such as employment and housing which will mean working more closely with relevant government agencies and community partners and using intelligence and monitoring to strengthen the system to enable New Zealanders to live longer, healthier lives.

Public Health Advisory Committee

E ngā mātanga, e ngā māngai, tēnei te karanga ki a koutou kia tono mai ki tēnei kaupapa, hei āwhina i tā mātou whai atu i te pae ora mō ngā hapori katoa o te motu.

Expressions of interest are open for members to the Public Health Advisory Committee. This new committee of up to seven members will provide independent advice to Ministers, reflecting the perspectives of Māori, Pacifica and the wider community. The Committee will prioritise equity-based approaches, including considering underlying factors that affect the health of people and communities. Members will be informed by and reflect the perspectives of Māori and Pacific peoples and the wider community as they employ creative solutions to drive better health outcomes.

The Committee will report directly to the Minister of Health and Associates, but will also engage with the Director General of Health, the Director of Public Health and Deputy Director General of the Public Health Agency (which will provide secretariat support to the committee).   

Members’ collective expertise will include an understanding of population health needs, and equity issues. All members are expected to understand the obligations of the Crown under the Te Tiriti o Waitangi, pae ora (healthy futures) and of Māori expectations and aspirations. Crucially, members must think creatively to provide solutions that are not constrained by traditional health and disability sector professional boundaries.

Expressions of interest are invited before 6 May 2022 and can be made here Careers at Ministry of Health NZ.

Disability support system transformation

In October 2021 the Government announced the creation of a new Ministry for Disabled People from July 2022, and a nationwide implementation of a transformed disability support system.

Ministry appoints Establishment Director of the Public Health Agency

Simon Everitt has joined the Ministry of Health as Establishment Director of the interim Public Health Agency. The interim Agency is the first component of the Ministry to be designed as part of the wider health and disability system reforms. See more information.

Recruitment for Deputy Director-General to lead Public Health Agency underway

Advertising is now underway to find an outstanding leader for the new Public Health Agency. The Public Health Agency (PHA) will be a stand-alone business unit at the heart of Manatū Hauora|the Ministry of Health with a renewed focus on population and public health to address inequity and to enable all New Zealanders to live longer and healthier lives. View the job advertisement.

Pae Ora (Healthy Futures) Bill introduced to Parliament

The Pae Ora (Healthy Futures) Bill, which sets up the legal platform for the reformed health and disability system, was introduced to Parliament on 19 October 2021.

The Bill will legally establish Health New Zealand as the national organisation to lead and coordinate delivery of health services across the country and the Māori Health Authority as an independent statutory authority to drive improvement in hauora Māori. 

The Bill also recognises the role of Iwi-Māori Partnership Boards to act as a vehicle for Māori to exercise tino rangatiratanga and mana motuhake with respect to planning and decision-making for health services at the local level.

The Ministry of Health will continue to act as chief steward of the health system with a focus on strategy, policy, regulation and monitoring, and the role of the Director of Public Health will be strengthened.

The Bill also sets out the requirement for the establishment of a Public Health Agency within the Ministry of Health.

It is anticipated that the Bill will be passed in the first half of 2022.

View the Bill

Māori Health Authority and Health New Zealand Board appointments

Health Minister Hon Andrew Little and Associate Health Minister Hon Peeni Henare have announced the appointment of the Boards to lead the Māori Health Authority and Health New Zealand. This a significant step in progressing the Health and Disability System Reform programme. Read more on the Future of Health website.

About the Health and Disability System Review

In 2018 the Government announced a wide-ranging review of the Health and Disability system in New Zealand, designed to future-proof our health and disability services.

The Review looked at the overall function of the health and disability system and whether the system is balanced towards wellness, access, equity, and sustainability. Ms Heather Simpson was appointed as Chair of the review.

The final report on the findings of the Review was released on 16 June 2020.

Visit the Health and Disability System Review website for more information.

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