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OPINION
In another apparent leak from the government, the email attached was made available to Kahu. We sought confirmation from former Health NZ chair Rob Campbell as to its authenticity and his response was: “As you are aware, I respect public service procedures and could not possibly comment.”
Dear Minister Reti
I appreciate the opportunity to comment on the plans you have been discussing publicly about Māori health services. The intention you express to apply real focus to improving Māori health service access and outcomes and to devolve control, funding and delivery to iwi and hapū is very much in line with what is required.
The first point I must make is a note of caution about advice you will be getting from Manatū Hauora/Ministry of Health. While the ministry has many good and knowledgeable people on matters of health policy, its record on operational matters is quite another matter.
You are very aware of the repeated failures of the ministry to effectively oversee and direct health service operations over many years, which is a significant cause of current deficits in Māori health experience. This was compounded by its failure to properly direct the development of the Pae Ora legislation and its implementation, leaving that to external business consultants and, with too limited if any involvement of, iwi, hapū and Māori health services in the process. Subsequently, the ministry has failed to be adequately supportive of Te Aka Whai Ora (Māori Health Authority) in terms of its funding and authority to act.
Whānau Ora Commissioning Agency chairwoman Merepeka Raukawa-Tait. Photo / Andrew Warner
You must consider carefully to what extent you can rely on advice from a source with this record to deliver on your expressed intent. The faults which do exist are as much their responsibility as anyone’s.
You have clearly identified a fault in the Pae Ora structure, which has been a major challenge. It does not properly take into account and involve the deep and broad experience and expertise in health service funding and delivery which has been built up within Whānau Ora. This valuable resource is also better integrated with the other social agency support which is essential to a holistic view of healthy whānau than a specialist health agency with limited funding and authority. Any future improvements in Māori health services should build on the demonstrable success of Whānau Ora.
There is no reason why Te Aka Whai Ora cannot act in this way if it has a greater degree of independence to forge those relationships. Further structural reform of health administration will be costly and diverting when some simple adjustments could take advantage of what has been put in place.
Despite some excessively early review conclusions, Te Aka Whai Ora has established a highly skilled and motivated independent team which will be wasted if it is integrated with ministry and Te Whatu Ora structures with wider mandates. It needs further strength and independence both for its own service delivery and for its vital monitoring of both wider agencies. This will be lost if integrated with those agencies.
You are rightly drawing attention to the devolution of health service delivery for the wider populations. This is the right direction for all and equally for Māori.
In practice, the Iwi Māori Partnership Boards which Te Aka Whai Ora has put enormous effort into establishing are an ideal mechanism for this. These have been specifically designed for this purpose not only for kaupapa Māori health services, but also to guide the wider health service delivery system. They must be retained but have the additional funding and support they need to be effective and must have the autonomy to develop their own relationships with Whānau Ora and associated central and local government agencies involved in the wider determinants of health. There is no need to break these Partnership Boards up but simply to make them more powerful and effective.
This same view applies the the “localities” which are being developed by Te Whatu Ora.
Rob Campbell, former chairman of Te Whatu Ora. Photo / Michael Craig
It is notable that in all such cases, and especially in localities with large Māori populations, these are showing signs of integrating health services across Māori and other populations. The big risk to these is that they do not get the funding and authority they need to be effective. Working with the Partnership Boards the localities are well placed to have not only “by Māori for Māori” health services operating effectively, but also having a much wider influence. Similar opportunities abound for Pacific peoples and migrant community health services.
My general point is that you are right in the view that current structures especially for primary health services are too centralised and cumbersome even though they are still in evolution. The best option will be to supercharge that evolution alongside of a similar supercharge of Te Aka Whai Ora and its Partnership Boards working alongside Whānau Ora.
You do not have to repeat the mistake of your predecessors in being too cautious and in relying on previous administrations to reconstruct themselves. But neither do you have to de-construct again – just support the great people currently trying to make things work. They know what is needed and how to do it.
The big problems for Māori health remain in the mainstream health agencies, not in Te Aka Whai Ora.
Rob Campbell is a professional director and investor. He is chancellor at AUT, chairman of Ara Ake, chairman of NZ Rural Land, and an adviser for Dave Letele’s BBM charity. He is also the former chairman of Te Whatu Ora (Health New Zealand).
