Pae Ora (Healthy Futures) Bill

I present a legislative statement on the Pae Ora (Healthy Futures) Bill.

ASSISTANT SPEAKER (Hon Jenny Salesa): That legislative statement is published under the authority of the House and can be found on the parliamentary website.

Hon ANDREW LITTLE: I move, That the Pae Ora (Healthy Futures) Bill be now read a second time.

This bill was introduced on 20 October last year. It was returned to the Pae Ora Legislation Committee, which was set up specifically to consider it. I want to thank the members of that committee for their work over the last six months. They considered 4,665 submissions and they heard in person from nearly 200 individuals and organisations. Now, that’s both a testament to the public’s deep interest in the state of our health system and an enormous credit to the committee for its hard work over that time. I want to particularly think its chair, Dr Deborah Russell, and deputy chair, Tāmati Coffey, for their incredible work in those roles.

Submitters made some very important points and these are reflected in the changes that the committee has recommended. I want to thank the many people who shared their personal experiences and their trust by disclosing their personal stories when they presented to the committee and made their submissions. The committee also heard perspectives from across the health sector, including workforce organisations, non-Government organisations, regulatory bodies, and individuals who assist in the provision of health services. There is strong support for the need to change our health system. It is particularly welcome that so many of those who spoke to the committee supported the general approach taken in the bill and commented favourably on the creation of Health New Zealand, the Māori Health Authority, and the recognition of iwi-Māori partnership boards.

As members will be aware, not everyone is in favour of the proposed approach, and I’d like to firstly address the concerns raised by many submitters and in media comment that the reforms are separatist and create a two-tier system. This is completely untrue. I absolutely and wholeheartedly agree that this should not be a two-tier health system. But sadly, that is exactly what we have at the moment, in practice, and that is exactly why we are reforming it. People experience unjustifiable differences in access to services and health outcomes because of where they live, their ethnicity, or other circumstances. We need to create a system that, at its core, recognises and addresses that inequity so that not just some but all New Zealanders have the opportunity and support to live healthy and full lives.

I’ve previously spoken about the reasons why we need to reform our health system, not the least of which is that Māori die seven years earlier than Pākehā. And it’s not just Māori that experience poor health outcomes that the system needs to address: Pacific people, rural people, and disabled people are just some of the New Zealanders for whom the health system needs to perform better. The system has failed too many people for too long, and that needs to change now. If we don’t begin to invest in the future of the health system, we will never see change. That would mean tolerating more inequity, more ill health, and more premature deaths. We need to make change for reasons of equity—we’ve established that. We need to make change in order to properly fulfil our obligations under the Treaty of Waitangi. The essence of the Treaty is an agreement for Kāwanatanga—Government—which also respects the rangatiratanga—leadership by Māori of their people. We’ve started to see, when we govern on the basis of acknowledging rangatiratanga, such as when we handed responsibility to Māori to lead a COVID vaccination programme for their people last year, then we can make a real difference. I reject utterly the argument by some that enabling Māori to lead their people on health in their own way and to express their rangatiratanga is biased or separatist or in conflict with principles of good governance.

Clause 3 of the bill is clear that the purpose of it is to protect, promote, and improve the health of all New Zealanders. The health sector principles in clause 7 confirm the need for the system to be equitable, which is in clause 7(1)(a), and to protect and promote people’s health and wellbeing through a number of means, clause 7(1)(e). The scheme of the bill makes it clear: Health New Zealand and the Māori Health Authority need to work closely together—and I can tell the House that during this establishment phase that is exactly what has been happening. The committee has recommended important changes that will strengthen the bill to help achieve the purpose of the reforms. I welcome these recommendations. They will ensure the bill succeeds in laying the foundations for a transformed health system to tackle inequities and improve health outcomes for all New Zealanders.

I’d like to touch briefly on just some of the main areas that the committee spoke to. The bill makes the important step of formally recognising iwi-Māori partnership boards in the legislation. At introduction, the bill didn’t include functions or powers for the boards because we wanted to take time to engage with Māori about what they wanted in it. That engagement has happened and we now have functions and powers for iwi-Māori partnership boards in the bill. An updated process to recognise these boards is also recommended by the committee and ensures boards are representative of the whole Māori community in the area, while leaving flexibility and discretion for Māori to adopt a tikanga-based approach to boards.

Many submissions asked for a stronger accountability of the Māori Health Authority to Māori. I want to be very clear that the Māori Health Authority is accountable to the Minister of Health who is accountable to Parliament. This has always been the case in the bill and there’s been no change in that position. However, as a responsible Tiriti partner, the Crown must recognise the disproportionately poor health outcomes that Māori face under the current system and work to make that right. The bill ensures Māori voices are at all levels of the system to address these longstanding unacceptable outcomes. One of those voices is the Hauora Māori Advisory Committee. The select committee has recommended it be appointed directly by Māori through iwi-Māori partnership boards and hauora Māori organisations. The Minister has to consult the committee when appointing members to the board of the Māori Health Authority and when exercising other ministerial powers. In making a decision, the Minister would not need to necessarily agree with the committee’s advice, but would have to clearly state where it had not been followed. This strikes the right balance of accountability to Māori and to Parliament. It means an entity appointed by Māori for Māori is involved in key accountability functions, leaving no doubt as to the Government’s intention to give effect to Tiriti partnership at the highest level of the system.

It will be no surprise to members that the committee also heard from users of health services and from the workforce about the need for culture change. We know workforce cultural development will be critical, but these cannot be easily legislated for. What we can legislate for, and as the bill requires, is for workforce development to be included in the health strategies and the New Zealand health plan, as well as the creation of a New Zealand health charter. One change that came out of the committee process is a technical one: the change to the ordering of precedence for the Government policy statement (GPS) on health. The change makes the Government policy statement appear secondary to the health strategies, but the GPS is not secondary to the strategies; it is the basis on which the strategies should be developed. So I do not agree with this change and there will be a Supplementary Order Paper to change it back.

The committee heard loud and clear that people want their voices to be heard in the system. Current planning, commissioning, and delivery of primary and community care is disjointed and does not routinely seek or respond to the voices of consumers. I’ve also heard comment that in the pursuit of centralisation, these reforms take power away from voices at the local level. We currently have 20 separate systems operating in 20 different ways in a country of 5 million people. It doesn’t work. Hearing the voices of New Zealanders is a key pillar of the single New Zealand health system, one that is centrally coordinated but locally delivered with health services genuinely informed by the needs and the priorities of the people it is serving. The bill puts consumer voices at the heart of the new structure. There are active engagement requirements at all levels, so services are designed for people’s needs. I agree with the committee’s recommendations to strengthen these engagement requirements. In particular, I strongly support the inclusion of annual progress reporting for locality plans. These will complete the feedback loop to local communities on the priorities and outcomes agreed with them.

Some submitters ask, “Why now?”, and I say because every week of inaction means another week of tolerating inequity, of tolerating Māori dying younger than Pākehā, of disabled people being seven times more likely to report psychological distress, of Pacific people dying six years younger, of people in our rural communities continuing to miss out. This is the status quo and it is completely unacceptable. We are changing that. The transition is already well under way. Interim Health New Zealand and the interim Māori Health Authority are set up and are working together. They have chief executives, key leaders in place, and recruitment under way. They have confirmed the prototype sites. The first nine localities are building their organisational structures and are working closely on the interim New Zealand health plan that will set priorities for service improvements in the first two years. They are ready to go.

Pae Ora for everyone in New Zealand means that our health system should be refocused to keeping everybody well for longer. We need a law to lay the foundation of our new health system, a system for all 5 million New Zealanders, with equity at its core. This bill does that, and on that basis I commend this bill to the House.

The question is that motion be agreed to.

In this contribution, I will speak firstly to the Health reforms generally, and then to the Māori Health Authority. The trail of Pae Ora through the select committee process is a story that starts with disrespect and ends with deception. The creation of a special select committee to discuss a purely health bill disrespected the standing Health Committee. The Labour members’ majority was an early signal of the deceit that would follow, which I will describe in detail here. The warning signs for a poll-driven watering down of the bill were there when the very first part of the bill was changed by the Labour-majority select committee. The very purpose of the bill—the purpose of the bill—was changed from reducing health disparities to striving to eliminate health disparities—a tragic reduction in ambition and a clear indication of a poll-driven watering down of this bill. These health reforms will fail, and they will fail on a number of grounds. I will describe six areas of failure.

Number one: “Labour knows best” centralisation. Retrenching of local health voices to Wellington under the ideology of “Government knows best” is the same sort of disenfranchising that we have seen with polytechnics and three waters. This is all about control and not about health services. Wellington does not know what is best for the people in North Hokianga. Local people know what is best for them, and they want this Government’s heavy hands out of their lives and out of their pockets. We despair the loss of local autonomy under these reforms.

Number two: timing in the middle of a pandemic. We had a Government official tell the select committee that the timing of the reforms in the middle of a pandemic was optimal—this timing is far from optimal. If the Government hadn’t noticed, the sector is exhausted because Andrew Little failed to build a health workforce. The waiting lists are as big as they have ever been in history because Andrew Little didn’t build enough ICU beds to protect the health system during COVID. Nurses are burnt out because Andrew Little didn’t keep his promise to fully implement the Safe Staffing Accord, a promise made in June last year. Critical care nurses are in short supply because after announcing the botched Kiwi Health Jobs recruiting programme in November last year, Andrew Little wasted four months before starting it, and it only employed three nurses to last month. Infrastructure hasn’t kept up because Official Information Act documents show that last year, Grant Robertson told Andrew Little to cut the health budget to a “minimum viable package” so that he could fund the health reforms. People are, therefore, rightfully devastated with wasted spending when Andrew Little let more than $21 million of vaccines expire, while also botching measles, shingles, and flu vaccination campaigns. The timing of these reforms is terrible.

Three: no rural voice. Where is the rural voice in the health reforms? What about the half-million people who live in rural areas with less access to GPs, laboratories, and after-hours services? Where is their voice and recognition of their unique needs in these reforms? Rural people are invisible. The Labour-majority select committee didn’t even want to include or contemplate rural people in this bill. What about exhausted rural GPs? GPs and, in fact, primary care don’t even have a representative on the Health New Zealand board. Despite the fact key solutions in the reforms are keeping more people at home, that’s primary care. Kicking people out of hospital earlier—also known as reducing length of stay—that’s primary care also; that’s where they go to. Yet primary care doesn’t even deserve a place on the Health New Zealand board. The rural voice is invisible.

The last Budget actually signalled the hidden agenda for how this Labour Government will deal with rural communities. In a terrible mistake last February, the Ministry of Health released to me an unredacted copy of a Budget briefing from Ashley Bloomfield to Andrew Little. In that unredacted briefing, one of the options to manage cost pressures was “rationalising specialist services—example: consider the scope and function of provincial hospitals.” That is code for removing rural and provincial services. This is the hidden agenda of these reforms for rural areas—decentralised decision-making and reducing provincial hospitals—and this Government got caught out by their own mistake.

Four: a track record of more money, more bureaucracy, worse outcomes. The evidence to date is that this Government has spent more money on health, but got worse health outcomes. All of the national health targets are worse now than when we handed over in 2017, and COVID cannot be used as an excuse because they were getting worse even before COVID. What we are seeing with these reforms is layers and layers of bureaucracy that are being built. Two weeks ago, Andrew Little made an announcement hailing the start of the bureaucracy—locality commissioners, locality coordinators, and 80 locality networks. The real message was that nowhere in his announcements was a single, targeted health outcome. It was all about bureaucracy—more money, more bureaucracy, worse outcomes. How could one possibly believe that these reforms will be financially viable when, in March last year, Cabinet documents showed the benefits projected to be $1.5 billion over 15 years and yet, barely six months later, the benefits had ballooned to $3.8 billion over 10 years. This is simply not credible; no one believes it.

Number five: inability to deliver the reforms. Even if the reforms did have some merit, it is not possible for a ministry and a Minister who gets a D from the Treasury for investor confidence rating to deliver these sorts of reforms.

And number six: no outcomes. Show me the outcomes, Minister. Five years before any benefits from the Māori Health Authority, and I challenge you to shout at me again like you did in select committee when I asked you to name a single health outcome that will happen in the first year. No one cares about your layers and layers of bureaucracy; they just want their hips, knees, and cataracts done. National is interested in health outcomes. New Zealanders are interested in health outcomes. Show me the outcomes.

In their entirety, then, we reject these reforms as a centralised command-and-control grab that diminishes the local voice and completely misses the vital democratic utility of health systems, which is health need. The changed financials are not credible, and this Government cannot and will not be able to deliver anything other than layers of bureaucracy, which New Zealanders will pay for.

I will now turn to the Māori Health Authority. National does not support a Māori Health Authority as a separate health system. I will set some context around the Māori Health Authority before seeking to detail three key reasons why a Māori Health Authority will fail, and conclude with 10 signals why, under this Māori Health Authority, Māori are being thrown under the bus.

Firstly, Labour did not campaign on a Māori Health Authority of this type and context; they did campaign on a Māori Health Authority, but under the Simpson review, it did not have veto rights, it was not commissioning, and it was not in the context of a complete removal of all DHBs. The comment that nothing has been done for Māori health for 180 years, those that say that a Māori Health Authority is needed because Māori Health has failed—how dare you disrespect the work of those Māori doctors who along with others took Māori from a life expectancy of 30 years in 1840 to the 73.4 years today. Māui Pōmare, Peter Buck, Tūtere Wī Repa, Edward Ellison, Richard Grace, Louis Potaka, Golan Maaka, Henry Bennett, Nītama Paewai, and Tom Kawe—we stand on the shoulders of these 10 Māori doctors, the first Māori doctors, and many others who have followed. Do not disrespect their work by saying nothing has been done for Māori. Shame on you for demeaning their memory. The better question to ask is not why Māori health hasn’t improved over the past 180 years but why there is a difference today in health outcomes for Māori and non-Māori. This is the problem we must solve.

A Māori Health Authority will fail; it will fail for several reasons. Firstly, it is based on a Treaty response and not health need. A health system that does not place health need as its core principle will fail; it will fail as it is corroded by conflicts of interest and distributive justice. A commissioning Māori health system will fail. Heather Simpson has said that she did not envisage the architect of the reforms, did not envisage a Māori Health Authority as a separate health system, which it will be if it is commissioning, and it will cause a lack of cohesion in the system. There will be competition for scarce resources. There will be provider complexity. Parliamentary questions demonstrate that a GP can hold two contracts: one with the Māori Health Authority; and one with Health New Zealand. That will definitely increase complexity. There is a terrible conflict of interest. The Māori Health Authority not only is a monitor of health inequities but a provider of health services. It is marking its own exam, and that eventually will corrode the Māori Health Authority.

There are 10 signals that Labour are throwing Māori under the House with this Pae Ora bill. The Māori Health Authority veto has gone, the veto that Andrew Little said in this House was vital for inequities—gone. The only redaction in all of the Government papers is in the Māori Health Authority in the financial statements. The Māori Health Authority is not a Treaty partner. Treaty principles are not included in the Pae Ora bill. The Māori Health Authority can be dissolved easier than Health New Zealand. No benefits to the Māori Health Authority in the first five years. The commissioning part has an unfixable conflict of interest. The role of iwi-Māori partnership boards has been watered down. You have been vacated; you are deleted with a red line by this Labour Government, and you will now apply. And, finally, there are deleted powers to undertake functions. The Māori Health Authority no longer has complete powers; there are many holes in this bill.

Thank you, Madam Speaker, for the opportunity to contribute in the second reading of this bill.

I’ve got a number of notes here but I do want to address a number of the matters that the previous speaker Dr Shane Reti has just presented to this House. It was drawn a parallel that commissioning would fail. Actually, commissioning was established under that Government, the National-led Government. It was established through Whānau Ora, and the same model for commissioning that is being implemented here through the Pae Ora legislation in enabling the Māori Health Authority to be able to deliver is the same commission model that was established and supported by the National-led Government. Now, I’m really excited about that, also as the Minister for Whānau Ora, because we’ve seen the results that can be achieved through commissioning for outcomes, a very different way of doing things. We know that when we commission for outcomes, what we’re allowing is actually a certain kind of outcome that allows flexibility for providers to be able to cater for the needs of whānau. Now, that’s exciting because why? Whānau Ora actually was born with a health lens. It was born out of health. However, the National-led Government established Whānau Ora, as we know it today, and the commissioning that will be enabled through the Pae Ora legislation.

So I’m really quite proud of that particular fact. It was something that was asked for by Māori to the tribunal, in the health claim to the tribunal, in the hauora claim, the hauora report. It’s something that we were quite clear on actually. The member gets it wrong. He says that this party, the Labour Party, didn’t—what do you call it—campaign on a Māori health authority. We were quite clear. We were campaigning on a Māori health authority, no ifs or buts about it. What we were quite clear on though was that we needed to work through what would be a once-in-a-lifetime change in the health sector. That’s something that we’ve afforded the committee to do, this House to do, and I’m proud now to stand here in this House in support of this bill in its second reading.

In supporting my colleague the Hon Andrew Little I do want to acknowledge the Pae Ora Legislation Committee for the work that they did. We know that it was a huge piece of work. Minister Little has already outlined the large number of submissions on the bill. They sat through extended sittings and hearings to make sure that they could work through as many of those submissions as possible. No mean feat. I want to acknowledge them.

Of course, I also want to acknowledge the leadership of the Hon Andrew Little on this particular bill. What he has said is true. When we’ve been around the country to promote the Pae Ora legislation and to talk about the health reforms, it has been overwhelmingly positive. If one wants to listen to the speech from Dr Reti, they would think it’s all doom and gloom. But I can tell you that, actually, the optimism and the positivity from the health sector, I have never, ever seen it before. This is in the face of a pandemic, in the face of a health sector pivoting to respond to that pandemic. There is still huge optimism for what we are going to achieve in the Pae Ora legislation.

Of course, the Pae Ora (Healthy Futures) Bill provides for the essential foundations for that reform. I want to touch on a number of those, as have speakers before me. The Māori Health Authority will work with iwi-Māori partnership boards, Māori health providers, professionals, iwi, hapū, and Māori communities to understand and deliver Māori health needs and aspirations across New Zealand. Now, just reading that one sentence there, when I heard the previous speaker who said, “Health in Wellington is different to health in Hokianga.” Well, guess what! There are iwi, hapū, whānau, and health providers in Hokianga, which this legislation enables their voice to be heard. It enables their voice to be heard so that we can make sure they receive the support that they need to meet the health aspirations in those regions.

Also, this will help build a stronger Māori workforce, support the growth and capability and capacity of hauora Māori healthcare providers, and encourage more innovation and services that deliver better outcomes for Māori. That innovation we speak of, we saw it at the forefront of our COVID pandemic response from our Māori health providers. What better way to acknowledge and reward them for the work that they did in the pandemic than enabling them to make sure that this continues into a reimagined health future for our country? The reform presents us with, as I’ve already mentioned, that once-in-a-lifetime opportunity to reset our thinking, and, in particular, the challenges with Te Tiriti o Waitangi.

Dr Reti names luminaries and leaders in the health sector and the Māori health sector, in particular, over centuries. The same Māori doctors and Māori health providers presented to the Waitangi Tribunal on the hauora claim—a very clear voice. That voice said that change needed to come, and this legislation does it. They went on further to make sure that as we match the clinical expertise of those doctors with actual public health services on the ground, that they were in a match that would suit that particular region. I want to acknowledge that, because the tribunal was quite clear and continues to guide much of the work that we’re doing in the reform work now.

The other part that’s been much spoken about, basically, since the start of this reform work is the iwi-Māori partnership boards. The iwi-Māori partnership boards, through this legislation, are an important part. Now, it was quite clear through the submissions that the iwi-Māori partnership boards needed to be put into legislation to make sure that it has form and function. It also has the powers to make sure that the aspirations that are led through those particular iwi-Māori partnership boards are met.

I want to go back to what Mr Reti said when he said, “What happens in Wellington is different to Hokianga.” The iwi-Māori Partnership boards will allow those voices to come to the fore for health aspirations at a local level, and even another local level, because guess what! Hokianga is part of Tai Tokerau. When the Tai Tokerau finds its voice on these reforms, which is what this legislation does, so too will Hokianga through the iwi-Māori partnership boards. Because the same thing is true, actually—what’s right for Ngāpuhi isn’t necessarily the aspirations and health for Te Arawa. Now, what the iwi-Māori partnership board does is it enables that voice and it enables that aspiration to come to the fore in all of what we’re trying to achieve here.

It also looks towards engaging with more Māori. Sir Mason Durie, a luminary in Māori health who created the Whare Tapawhā model, which I know many in this House are familiar with, made it very clear that through the engagement, the accountability structures needed to be in place so that it wasn’t simply an accountability structure in Health back to the centre—in other words, to central government—but also from the provider to the whānau. We’re quite clear in our work with iwi-Māori partnership boards that that is an expectation that we have that accountability structures between whānau and health providers are also measured and also accounted for in this reform work.

We also want to, through these iwi-Māori Partnership boards, assess the current state of hauora Māori and determine those priorities with them, not for them. Monitoring the performance is, of course, the duty of the Crown as we move forward. But as I said, the accountability structures must be throughout the entire system and not simply to the centre. The engagement with the Māori Health Authority and the support from the Māori Health Authority is crucial to make sure the iwi-Māori partnership boards are a success. My recent meetings with the Māori Health Authority board and its management and leadership is quite clear that they too are excited. They are fully engaged with the iwi-Māori partnership boards that have already come to the fore in recent times. Ngāti Toa and Te Āti Awa here in Wellington have come together to create an iwi-Māori partnership board, which is hugely exciting, and they are already engaged in the health aspirations from their local perspective with the Māori Health Authority.

What it’ll also do is agree local priorities and locality plans with Health New Zealand and the Māori Health Authority. Well, we hear from the other side of the House this loss of democracy. Actually, it’s the opposite. What this bill does is it strengthens local voices. It strengthens local delivery to make sure that we can—

Matt Doocey: Define what a locality is. What’s a locality?

Hon PEENI HENARE: If Mr Doocey was listening, he might ask his colleague where Hokianga is. That is a locality, Mr Doocey. Hapū and iwi, through iwi-Māori partnership boards and a locality plan, are quite clear that we can deliver localised outcomes to meet the health aspirations of our people. So I dispute the assertions from the other side that it is a failure in democracy. In fact, I think it is a strengthening of democracy. We see it in our health work. We see it in our three waters reform. We see it in all of the work that we’re doing in the regions, and I’m proud to be on this side of the House to support that.

The Minister has already spoken about the Hauora Māori Advisory Committee. Once again, another local voice adding to central decision-making and being a part of what will meet Māori health aspirations. The Minister made it clear the people who are appointed to that board come from the regions. And guess what! Those are rural regions too, Mr Reti.

Finally, I support this in the second reading of this bill. I’m proud of the progress we have made. These reforms present a once-in-a-lifetime opportunity to make significant changes to our health sector, and I commend this bill to the House.

Thanks very much, Madam Speaker. I think, hopefully, I can give the House a challenge tonight and all those watching this debate to see if by the end of it they’ll actually know what a locality is, because this bill does not describe what a locality is and that, in fact, is the issue. The last speaker, Peeni Henare, spoke of the optimism in the health workforce. I disagree. I think it’s apathy, because at a time when the health workforce is preoccupied, quite rightly, responding to the impacts of COVID—and not only that, they’ve accepted change irrespective of whether they agree with it or not. But the biggest concern I think the health workforce has, as many New Zealanders have, is when you look at the bill in front of us—and I don’t think the select committee process has really helped it—there’s no real definition. There’s no detail. People don’t actually know what it’s going to do. So that’s why I set the challenge: if we can find out by the end of this debate what actually a locality is going to be.

What’s really concerning on this side of the House is here we have a Labour Government that’s got a track record of failure to deliver, of absolute incompetence. They cannot plan for anything. And now they’re saying, “Trust us. In the middle of the pandemic, we’ll blow half a billion dollars on a health restructure.” It doesn’t add up. And then tonight, the context of this—the worst poll this Government’s had in five years. And we’ve got rural and regional government MPs who are sitting there going, “I’m going to have to go back to the electorate when I didn’t even stand on a platform of disestablishing their local DHB at the last election. And now I’ve got to defend rural not even being mentioned as a rural strategy, as a priority group.” Who would have thought in a country like New Zealand, when you listed the strategies and the population priority groups, rural would not be there. Because remember that term, the Hon—well, whatever the primary industries Minister is—Damien O’Connor had, that term rural proofing? Oh yep, remember that. Well, where’s the rural proofing in this bill? It’s not there, and I look forward to those Government members going back and explaining that in their electorate.

The second reading is talking about submitters. I want to raise the submission of the New Zealand Rural General Practice Network. They have over 1,800 members across 90 percent of all rural general practices. They, quite rightly, point out that rural and remote New Zealand encapsulates about 700,000 New Zealanders—700,000 New Zealanders. And I know, as our agricultural spokesperson Barbara Kuriger will know, that those 700,000 people deliver 50 percent of this country’s GDP—and they don’t even get a look-in in this bill. The Government members did not want to listen to those submissions and here they are championing equity—equity when it suits them. Why not put a rural strategy in place?

This bill was championed around addressing the postcode lottery. Not including rural is going to entrench the postcode lottery. And I just want to put a quote on the record from the general practice chair, Dr Fiona Bolden. She says, “We wish you luck if you have a medical emergency or an accident on a remote rural road and are waiting for a response from an under-funded and overworked rural GP or nurse who is on a 24/7 call roster, or wait for an ambulance that has to be dispatched from a depot 3 hours away.” People affected by that are not just rural people; because urban people will be out using those roads in rural New Zealand, going on holiday, going about their work. And that’s why this is about all New Zealanders being sold short when this Government chose not to include a rural strategy and rural people as a priority group.

Another priority group I want to flag up that wasn’t listened to in the submissions in the select committee process was people with mental health issues. The Mental Health and Wellbeing Commission said, “The issue of mental health is almost invisible within this bill.” They’re not listed. There’s no mental health and wellbeing strategy. Who would have thought, with a Government that came in on the pledge of transforming the mental health system, that the mental health commission would be saying it’s invisible in this bill. And of course, the mental health commission are the ones who’ve released their recent report that said: with the Government’s announcement of $1.9 billion, no material improvements. And then they’ve got the nerve to bring the bill to the House that doesn’t even prioritise people with mental health needs. Who would have thought of it?

It says when they look at the Government policy statement, in preparing a health strategy they’re required to consult—this is the Minister—with health entities or groups considered as reasonably likely to be affected, and the Mental Health and Wellbeing Commission is not one of those groups. The mental health sector watchdog is not someone the Minister has to consult. And the reason why that’s important is: let’s not forget last year’s debacle with the Ministry of Health when ministry officials were caught running a risk lens over negative statistics as to not embarrass the Government. That’s why we need the independent Crown entity, the mental health watchdog, included in this bill, but they’re not.

You really have got to scratch your head as to why the mental health commission has to come in with a submission pleading to be included in this bill, especially when setting up the mental health commission was a recommendation of this Government’s own inquiry and they spent huge cost and time of this House passing legislation to establish it. And now not only do they not want to include it in this bill, but, as we know, they’re actually blocking its first reports at select committee.

Then we have had the true advocate I believe in mental health in New Zealand, which is the Mental Health Foundation. And they’re saying that this bill does not demonstrate the Government’s commitment to improving mental health and wellbeing outcomes. They’re saying it shows no leadership and ownership. People with mental health issues in New Zealand can have a life expectancy shorter by 20 years of the average Kiwi. This bill was built around equity. Yet when we look at the strategies within this bill, the health strategies that this bill will need to respond to, mental health is not one of them.

And you’ve got NGOs like Emerge Aotearoa, who are really concerned about mental health being invisible in this bill. They’re pointing out in their submission the impacts they see around COVID-19. We know other mental health systems around the world are calling the impacts of COVID-19 on youth mental health a shadow pandemic. Why would you not include a mental health and wellbeing strategy to inform this new health restructure?

Of course, the World Health Organization said that mental health needs to be a key plank in any country’s COVID recovery management plan. This Government is tone deaf to the submitters that have taken their time to raise genuine concerns about what is going to be a once-in-a-generation restructure of the health system. Why would we not get this right? Why would we not include mental health as a strategy? Why would we not include our rural communities? Because when you start to become stubborn like this, it starts to sound more and more ideological. Is the true point of this to be equitable? If it is, put those two population groups in. Or is the point of this bill to be simply, like the other bills coming through this Parliament, ideological, of taking away local people’s views, centralising it, running everything from Wellington? The bureaucrats in Wellington do not know how to deliver health services in my electorate of Waimakariri. We have been waiting for after-hours healthcare services promised for a few years ago, now. We’ve got a rural health hospital that’s been closed down. Taking rural out of this bill—

Order! Order! The member’s time is up.

As chair of the Pae Ora Legislation Committee, I’d like to report on some of the submissions that we received in the process of hearing the Pae Ora (Healthy Futures) Bill. We received 4,665 submissions, of which 178 were from groups rather than from individuals. On a straight numerical basis, most of the submissions were opposed to the bill, but the great majority of those submissions opposed to the bill came from individuals, and they were single-issue submissions—I’ll refer to those later on. But professional bodies; medics; lobby groups; population groups; the Asian, the Māori, the Pasifika groups; the rainbow groups; the disability groups; and so on expressed support for the bill. There was overwhelming support for the bill from professional groups, from medical groups, and from the workers in the health system. They see the need for change, and they know that the time for change has come and they support this bill.

Members opposing this bill opposite have worried about what a locality is, and said, “We don’t know what it is”. I invite them to raise that in the committee stage, but the Minister Andrew Little has already been quite clear about what a locality is—it’s a place- and people-based approach for improving the health of populations. There are three characteristics: it’s a partnership with mana whenua, it supports locally led solutions that take a holistic approach to wellbeing, and the locality approach joins up care across communities. It is a very localised approach, rather than a top-down approach.

I want to just read some of what people said about the bill, some of the submissions that came in. General Practice New Zealand said, “GPNZ is supportive of the overall reform direction that the legislation is designed to enable. We endorse the principles set out in the Bill, specifically the requirement to give effect to Te Tiriti o Waitangi. The Te Tiriti section clarifies that the whole health system, and not just the Māori Health Authority, will be responsible and accountable for health equity and upholding the principles of Te Tiriti. We support the new structures and the intent to achieve a consistent and unified health system”. That’s from General Practice New Zealand.

The National Council of Women said, “NCWNZ welcomes and strongly supports the purpose of this Bill to fundamentally change the structure and accountability of the publicly funded health system” and they “particularly welcome the establishment of the Māori Health Authority”.

The National Hauora Coalition, drawing on their decades of experiences of running a Māori primary health organisation, say, “The NHC supports the intention behind the Bill to create a fairer, more equitable health system that is effective for Māori and honours te Tiriti o Waitangi.” They sought a stronger Te Tiriti clause in the legislation, and they emphatically supported the establishment of a Māori Health Authority.

The Health and Disability Commissioner said, “I acknowledge the Government’s ambitious reform efforts and endorse the vision of an equitable and cohesive public health and disability system which gives effect to the principles of Te Tiriti o Waitangi, and is designed in partnership with the people it serves.”

The New Zealand Health Group said, “We want to be part of the story that stops the decline in Māori and Pasifika health and for those living with disabilities or injuries for our current and future generations.” Then it goes on to say, “The Pae Ora (Healthy Futures) Bill lays the foundation for the transformation of our health system to better achieve equity by reducing health disparities among [the] population groups in Aotearoa, and particularly for Māori, Pasifika and those living with disabilities [and] injuries.”

New Zealand Rural General Practice Network (RPNG) said, “[The] RPNG is supportive of the overall reform direction that the legislation is designed to enable. We support the new structures and the intent to achieve a consistent and unified health system. This support includes the requirement to give greater effect to Te Tiriti o Waitangi. We endorse the intent that the whole health system, and not just the Māori Health Authority, will be responsible and accountable for health equity and upholding the principles of Te Tiriti.”

The support for this bill was overwhelming from people who know what they’re talking about within the health system. Now, of course, there were many areas where people asked us to go further, and particularly it was with respect to health strategies. The bill already has a New Zealand health strategy, a Māori health strategy, a Pacific health strategy, and a health of disabled people strategy. We were also asked to put in place strategies for Asian peoples, for women, for rainbow people, for mental health and addiction services, for rural communities, for refugee communities, for rare diseases, for children, infants, and a strategy for medicines. So those were a lot of strategies we were asked to put in place as part of the legislation.

Now, we’ve already heard from Mr Matt Doocey, his concern about whether or not there is something in place for mental health services, and then saying that mental health was overlooked in the bill. But I request Mr Doocey to look at clause 7(1)(e)(iii) of the bill, where the health system principles specifically say that it should promote health and wellbeing by “working to improve mental and physical health and diagnose and treat mental and physical health problems equitably”. It’s sitting there in the bill already. We have, as a committee, endorsed the inclusion of a women’s health strategy in the legislation. That seemed to be something that was really important to do in the legislation itself. But just because a strategy is not in the legislation does not mean it cannot be elsewhere in the system, and Health New Zealand will be able to develop its strategies for all those other groups as needed—as needed—and they certainly are needed, but that will certainly be part of the work that Health New Zealand and the Māori Health Authority are enabled to do.

The people who were opposed to the bill were overwhelmingly opposed on a couple of grounds. I’m going to read just the one submission, but there were huge numbers of submissions that said basically this, and this person has said, “No public mandate has been sought for segregating our health system. I support health services based on clinical need, not race.” Indeed. Indeed, we should support health systems based on clinical need. A report on Radio New Zealand from earlier this year talking about research that was conducted at the University of Otago says that Māori are more likely to get cancer, will get it younger, are diagnosed later, have poorer access to treatment, and are much more likely to die from cancer than non-Māori because of inequity in the health system. People told us that in order to have equal access to the health system, we should have access that is not based on the colour of one’s skin. Indeed, it should not be, but that has been the case for far too many years now, that Māori have simply not had equitable access to our health system and neither have Pasifika peoples. This bill sets about changing that.

As the Minister said, it is not just a matter of need. And this goes back to the mandate. Was there a mandate? Yes. Health reform, and it was firmly on the table. Ensuring that we better meet our Treaty obligations was firmly on the table. Part of the ethos of this Government is to ensure that we are continually talking with our treaty partners, with our Māori Treaty partners, that we are continually revising and re-understanding and reorganising the way we do treaty in this country. That the Treaty is a conversation, that constitution is a verb, not a noun. We are continually working to ensure that we are doing governance as Treaty partners—and that is, part of what is happening was the establishment of the Māori Health Authority. We are working to make the Treaty a real part of the constitution, and I am proud to be part of that.

Finally, I wish to conclude with some thanks to the people who worked so very hard on this bill. My thanks to the officials in the Department of the Prime Minister and Cabinet who helped to get us through this bill and worked so hard on it, and to our clerks in the select committee who helped us to run a very effective and efficient process. I would also like to give my thanks to the committee members, especially my deputy chair, Tāmati Coffey, but also to all the members of the committee. It was a very efficient and effective process. We disagreed strongly about issues, but everyone worked hard to make sure that the process went very smoothly, and I’m very grateful for that. I am very grateful to the submitters who put in submissions and helped us to improve this bill immeasurably. And finally, I wish to acknowledge the extraordinary work done by the Minister of Health and by the Associate Minister for Māori health, and for the people who have been involved in this legislation. This is transformative change, and I thank the Ministers for bringing it to the House.

Kia ora koutou. I rise on behalf of the Greens to support the Pae Ora (Healthy Futures) Bill. Tēnā koe e te Minita mō tēnei mahi taumaha.

[I acknowledge you, the Minister, for this demanding work.]

And thank you to my colleagues on the Pae Ora Legislation Committee, particularly our very able chair, Deborah Russell, and deputy chair, Tāmati Coffey. I join other speakers in acknowledging all of those people who made submissions. It was worth the effort—dozens and dozens of changes were made to this legislation because of it. Special thanks to our Te Mātāwaka staff and the Rainbow Greens, who supported many submitters to take part in this democratic part of our society. I note that the Greens did campaign on an independent Māori health authority, and until it’s actually established it remains one of our Māori priorities.

Based on Te Whare Tapawhā, the Māori health model created by Tā Mason Durie, the Māori Health Strategy, He Korowai Oranga was launched in 2002. It set a new direction, an overarching framework that would guide the Government and the health and disability sector to achieve the best health outcomes for Māori. It was updated in 2014 to the Pae Ora (Healthy Futures) Strategy. That strategy has had no impact on the grim statistics for Māori, because it did not address the institutional racism built into the health system that accounts for the horrifying health statistics for Māori and Pasifika people.

This legislation aims to address this by acknowledging Māori leadership in the form of the Māori Health Authority, the creation of iwi partnership boards, and the Hauora Māori Advisory Committee. It acknowledges mātauranga Māori and it makes systemic the need to engage with experts in the field, especially our Māori, Pasifika, and community health providers, who turned the tide on COVID-19 through their vaccination efforts and personal support for their people.

This new structure does not disrespect Māori doctors from the past or the current day, as my learned colleague Shane Reti has suggested. I think it just acknowledges that a handful of them has never been enough to go up against the force of the settler colonialism that has formed the health system we’re trying to change today. Also, anything that has been designed by Tā Mason Durie we know is based soundly in kaupapa Māori. But, most importantly, instead of the usual goal of reducing health disparities, Pae Ora firmly states that it will eliminate them. Now, that’s a big ask. It was always going to be difficult, complicated, and messy. However, transformational change can only happen with a vision, and the Greens certainly envisage a health system that is based on Te Tiriti o Waitangi, but it ensures that no matter the ethnicity or cultural background of a person, no matter their age or address, no matter their disability, no matter their sexuality, gender, or sex characteristics, they have access to the healthcare they need when they need it and where they need it.

During the many times I’ve spoken in this House on COVID-19 orders and bills, I expressed concerns that people who died of COVID seemed to be more important than people who died for any other reason. There’s still daily reporting in the national news, but only for COVID people, not for cancer, not for rare diseases, not for family violence, and not for suicide. In the year ended December 2020, there were 32,613 deaths in this country, an average of over 89 people every single day. In 2021, 34,932 more, an average of 96 people every day. A few made the news, but most went unremarked, mourned by their family and friends but not the nation. Some of those deaths were because the treatment they needed was not available in this country or not funded by Pharmac. Some were because their treatment was delayed and appointments were missed to make way for COVID, because of the chronic shortage of nurses and specialist healthcare professionals. Some were because they lived rurally or had disabilities that meant that healthcare was not accessible for them. We can do better, and we absolutely should, because not dying is a very low bar in developed countries such as ours. Many people would just like to live without pain, with access to the diagnosis, healthcare, and medication they need.

We support the locality plans because they enable local voices that operate within communities in a way that works for them. I totally agree with my colleagues who’ve said people in Wellington should not be telling anybody else in the country what to do. However, for me, I’ve always had a concern that it’s very easy to just duplicate the way that things have operated, because we still have the same hospitals in the same places. We are still going to have mostly the same staff offering pretty similar services to what we have, in the regions and locally.

So for me, the national strategies then have to be key. We support the production of the hauora Māori, the Pacific health and disability outreach strategies that were already in the original legislation. We shout out to the Gender Justice Collective, who advocated for years and have successfully achieved a women’s strategy being included with those. And as my colleague Deborah Russell has said, and my colleague Matt Doocey, there were many, many other strategies that several of us advocated for that came out of the submissions. So I reiterate: the mental health, rural, rare diseases, rainbow medicines, and there were many more. My concern, and what is not in the legislation at all, is how do those connect together? It doesn’t exist yet, because we cannot get rid of the postcode lottery until those things are woven together, and until that happens, we can’t make any of this vision come true.

To conclude, I want to just acknowledge that there’s two terms that are appearing in New Zealand legislation for the first time, in the Pae Ora bill. The first is “lived experience”. It puts into law and acknowledges that people who have experience are actually critical for officials to listen to when decisions are being made. This is a core part of how our health system should be working. They should not be discounted because they don’t have a degree. They certainly have a degree in what’s wrong with them or what’s going on with their own health, and it’s such a huge resource in the generosity of all those people that have to, through their own experience, educate everybody around them. The fact that it’s baked into this, I’m very, very, very, very pleased with.

The second—and, although I’ve failed so far, I’m going to keep trying to get a rainbow strategy added to the list. The second term that’s been added is “takatāpui”. I’m particularly proud of that because it’s saying, again, that there are particular experiences that people have in different communities in this country that are not experienced by anyone else, and so they have particular expertise and particular knowledge that is essential for the decisions that are being made about them. In the Greens, we call that appropriate decision-making, both of those terms.

We have high hopes for this restructure. We are also realising that there is a lot more work to do. I would like to see much greater clarity on how those locality plans work with the national strategies, and how many aspects of this will roll out to actually get to that vision that we’re talking about. However, thank you again for all the work that has gone into this and all of the officials who make us look good on these committees. We commend this bill to the House. Kia ora.

Thank you, Madam Speaker. I rise tonight on the Pae Ora (Healthy Futures) Bill in opposition to the second reading. I want to start by acknowledging the submitters who took the time to submit to the Pae Ora Legislation Committee. I also want to acknowledge the select committee’s staff—many of whom worked on the Health Committee as well; who were doing enormous roles of not only sitting in the morning with the Health Committee but also sitting throughout the afternoon with the Pae Ora Legislation Committee too. I want to commend them for all of the work that they did to help bring it to the House today.

It is a mammoth task to reform the health system, and there were many people working behind the scenes. But I want to make a very clear point, that is: it’s still not clear what the different outcome is from having this bill seen to under the Pae Ora Legislation Committee than would have been the outcome from having it seen to under the Health Committee. Because we have a Health Committee; this is a health reform, and yet there is no better place to look at health reform than in the Health Committee. But the Government felt the need to make the Health and Māori Affairs Committees merge for the purposes of this bill.

The Minister at the time said, “This bill is about meeting Treaty obligations.”, and implied that somehow it is not possible for the current Health Committee to do that. And it’s because of a belief system that has crept into Parliament that says that membership to a group should be based on race and that is more important than what unites us as our common humanity. He essentially said that people on the Health Committee can’t do an adequate job at looking at health reform because of our ethnicity. He set an ugly precedent in this Parliament that says that even though elected officials and elected representatives might have the ability to analyse, to debate, and to reason, that doesn’t matter. What matters more, and what is more important, is what identity group you subscribe to, what group that you belong to. He put administration over outcomes. All of that shows you that it’s a symbol of what’s wrong with this Government.

The administrative reform of Parliament’s select committees was important—in the same way that we’re seeing governance and administration change but not as much focus on outcomes in the Pae Ora legislation. There is the same fundamental problem in this bill. I spoke to mental health workers about the Pae Ora legislation, and I asked, “How will this actually change the job that you do on the day to day?” And they said, “We have no idea. We cannot point to a single thing that we think might actually change.”

I talked to doctors who laughed when I asked whether they thought that this would actually make their jobs easier, whether they’d see more patients, whether there’d be any change in patient outcomes, because they’re still not clear what this change will actually effect in real people’s lives. I talked to patient groups who said they don’t know how this will change, in any way, the types of drugs that we have access to in New Zealand, because it doesn’t—medicines access is completely outside of the scope of this bill. I’ve talked to rural doctors who say, “We have no idea how this makes it better for access to care in rural areas.”, because what is a locality that they fall under, under this bill?

This bill changes administration, but it doesn’t answer the basic questions of whether we’ll get better treatments, faster, and for more people. So what does this bill actually do? Well, it removes the 20 district health boards and it replaces it with Health New Zealand and the Māori Health Authority, and there’ll be five to eight board members on both. One of those board members sitting on the Māori Health Authority will also be able to be a member of Health New Zealand. Now, these two separate entities will be able to come together to create and carve up New Zealand into locality plans, but there is an issue here that iwi-Māori partnership boards must also be consulted on these plans. It says that a locality plan is made when it’s agreed to by Health New Zealand, the Māori Health Authority, and the relevant iwi-Māori partnership board.

Now, the real difficulty is that last week, the Minister of Health stood up and said there could be up to 80 different localities. He said there might be nine now, and it’s so up in the air what that actually is. Now, the iwi-Māori partnership boards will be able to help design the delivery of services. This is a huge issue, because we have three Ngāpuhi members in our caucus, and it’s very unfortunate that when it comes to the issue of Treaty settlements, Ngāpuhi have been unable to come together to negotiate who will be in charge of Treaty settlements. Are we saying to the vulnerable people of Northland that their locality plans—the service, the design, the delivery of their services in Northland—could be in jeopardy because they have to have the Māori Health Authority, Health New Zealand, and the relevant iwi-Māori partnership board, whoever that is to be established, all agree to a locality plan? This risks being ineffective and divisive.

Now, the real issue here is that when they can’t come together on a locality plan, they have to be arbitrated by a Minister who is also in charge of the health strategy, the Pacific health, the disabled people, women’s health strategies, and it’s not clear that getting rid of any of these DHBs and putting in place this mess of a system is going to create anything that’s not simply bureaucratic and a nightmare to deal with.

Now, ACT has multiple solutions that we are putting forward in three Supplementary Order Papers (SOPs) to make sure that we can have an effective, modern healthcare system that acknowledges that all people are equal in New Zealand and they all deserve good health outcomes under the law. Now, we have created, firstly, a rural health strategy, because it’s ridiculous that under this entire bill the rural populations of New Zealand have been forgotten. There are 700,000 people living in rural and remote areas of New Zealand. They were mentioned 80 times in the health and disability system review that brought this bill to Parliament, and yet they’ve been completely forgotten—forgotten. The rural populations of New Zealand are quite often forgotten completely by this Government, and the ACT Party is here to bring them back into the fore. So we would like to see a rural health strategy for the people who provide so much for us in New Zealand.

We also have a medicines strategy, because we cannot truly reform the healthcare system if we don’t discuss medicines, and medicines has been completely removed from this bill. We need to know that if we’re truly having a once-in-a-generation reform, we’re discussing how medicines can help keep people healthy as well. So we are putting in place a medicines strategy. The third that we are bringing to the House is an SOP to completely remove the Māori Health Authority from this bill, because, quite frankly, it is divisive. We need to make sure that people get the healthcare that they truly need and deserve, not a system that increases bureaucracy and red tape through division. This amendment would remove the Māori Health Authority, because we want to strengthen the healthcare system and not divide it.

I would ask my colleagues in the National Party to support us on all three of these amendments so that we can actually make sure we have real change. I would also ask my colleagues in Labour to question the errors of their ways, to make sure that we don’t divide our country, that we make sure that we acknowledge the inherent dignity and humanity of all New Zealanders, that we make sure that we’re reforming the healthcare system in a way that puts health at the centre of healthcare and not an exercise in co-governance. It is a divisive bill. We oppose it, but we hope that we could make it some bit better. Thank you, Madam Speaker.

Thank you, Mr Speaker. That last one; that was an interesting one—“The errors of our ways,” Brooke van Velden says. Take out the Māori Health Authority and you will see the light, you’ll see the errors of your ways. Well, I absolutely, fundamentally disagree with that member. I absolutely, fundamentally agree—not just us over here on this side of the House, though, not just the Green Party of Aotearoa, not just the Māori Party as well. Actually, there’s a lot of organisations that think that the Māori Health Authority is good, and they penned an open letter—and they penned an open letter. And these aren’t necessarily Māori organisations. We’re talking about the Lung Foundation NZ, Kidney Health New Zealand, Stroke Foundation NZ, the breast cancer coalition, the gynaecological health foundation, and Cancer Society New Zealand who have all penned an open letter to be able to convince those people on that side of the House that want to take the Māori Health Authority away and plead with them to be able to say, “Let it happen, let this happen.” The Māori Health Authority is a really great innovation here.

I want to start by talking about the commitment that we have, in this House, to be able to realise our Te Tiriti partnership. We, as lawmakers in this House, must have a serious commitment. We cannot keep going with the system that we’ve got—we cannot keep going with the system that we’ve got. The system is broken; the system does not work for Māori. And we did hear it in our submission hearings. We did hear people come forward, and they did say to us that they wanted to see improvements. They were asked—in fact, it was Matt Doocey who sits on the committee as well. He asked the question to GPNZ, General Practice New Zealand: does your organisation have a view on the disestablishment of DHBs? They said, “Yes, this was signalled early, and we’re very comfortable with this.” He talked about Starship; one of his questions: “Are we going to see an equivalent Starship for young Māori or the same organisation?” And the response was: we actually need to earn the trust of all people in Aotearoa, including Māori. We have to earn the right and the trust to have a single service. Health New Zealand and the Māori Health Authority need to work together on a partnership level to be able to make those decisions.

And I keep hearing it, in speeches coming from the Opposition: “What’s the outcomes, where are the outcomes? We want to know the outcomes.” Well, let’s start with this outcome: by Māori, for Māori. Let’s start with that as an outcome, as something that we’re doing this whole reform for, which is a health system where, actually, the Māori voice is heard through the system—[Interruption] Oh, we’ve got them fired up. Kia ora, welcome. Good morning, welcome. What we’ve got here is the opportunity for Māori to be able to input into a health system like we’ve never done before—like we’ve never done before—in an honest and meaningful way. We want to bring Māori into that conversation, which is why we’ve set up and refreshed, in some parts of Aotearoa, the iwi-Māori partnership boards. I know that our one back home—it had been in a bit of an abeyance because, actually, and that’s a sign of the politics, because, as much as they’ve wanted to participate in the health system in the past, they haven’t been able to because they haven’t had legislation to back their voice.

So what do we get? We get what we’ve currently got, which is a health system which isn’t working for Māori. So the iwi-Māori partnership boards, as well as other hauora Māori organisations, are going to be able to give advice to the Minister of Health and, through that, the Minister of Health will be charged with the job of appointing the Hauora Māori Advisory Committee. And what will that committee do? They will appoint the members on the Māori Health Authority. Why have we gone to those lengths? Because it came through really clearly in the submissions that, actually, a Māori Health Authority should not be appointed and dismissed by the Minister, who sits within the Government of the day.

Māori submitters, notably the Māori Women’s Welfare League, came forward and said to us, “If you’re going to tell us that this is an independent and arm’s-length organisation from you guys in Government, then you need to create a process whereby we have faith in the system.” The iwi-Māori partnership boards, the hauora Māori organisations will contribute to that. The Hauora Māori Advisory Committee will contribute to that. We will have Māori making decisions for Māori.

I want to tell one very small story which sums this up. There is a health and social service provider in the beautiful Waiariki region. This is a Māori health provider that goes into our very small communities—and they are rural communities as well—and it is their job to fight for contracts. They have to go in and they have to fight within the health system for those contracts. When they do that, it’s actually a really, really long line. Every time that they do that, they have to say, “We’re doing this because we are able to deliver on the equity that our communities deserve, but you need to have faith with us.” That hasn’t happened. Sometimes they’re successful; sometimes they’re not.

The fact is that if we’re creating a partnership, if we, in this House, are committed to a Te Tiriti partnership, then we need to be able to give organisations like them the mana to be able to make their decisions by Māori, for Māori. That’s the outcome that we’re looking for here. That’s the outcome that came through in some of the submissions that we heard. The hauora Māori organisations were incredibly passionate about the reform that we’re undertaking here. It’s got their support. They see the vision. It’s terrible for the Opposition to actually bag it without giving it a chance. That’s what these organisations have asked for. They’ve said, “Take a leap of faith. We can’t do any worse than the Government has done over successive Governments. Take a chance on us.” That’s what I heard in the submissions. That’s what I’m here to support in the second reading, and that’s what I’ll be supporting in the third reading as well. I commend this bill to the House.

This is a split call. I call Simon Watts—five minutes.

Well, thank you very much, Mr Speaker. It is a pleasure to rise on the second reading of the Pae Ora (Healthy Futures) Bill—a bill that National oppose. And I rise on behalf of the National Party and as a member of North Shore. And what I haven’t heard this evening is any acknowledgment of those hard-working clinicians who are currently working around the country, such as those in my local hospital of North Shore Hospital in the emergency department there, looking after people around the place, or those ambulance officers, such as those working on North Shore one this evening, based in Takapuna, who are dealing with the significant reality of delivering healthcare services in this country at the moment, which has been a very difficult period post-COVID, but fundamentally will not be supported by this bill and this legislation. We have heard a number of speakers on the other side promising a lot of hope and ambition in terms of what the future may look like, but they will not be able to deal with the underlying issues that are within our health system this evening or tomorrow. I’m going to talk this evening in my short call around some of those key drivers.

There is never a good time to blow up the health system. I quote there an important point to note that this Government has decided to undertake reform of a monumental scale in the middle of one of the largest impacts on our health system that we have seen in generations. The challenges around the timing shows that there is absolutely no understanding in terms of how to actually implement change within what is a very complex, complicated, and not integrated system, which is the health system. No one is standing here this evening saying that the health system is absolutely perfect and there cannot be any improvements, but the way in which this system needs to be reformed needs to be done in co-development with those people at the front lines; those that understand the issues, and we need to deal with the significant aspects that are facing our individuals in our health system today. And that key issue is around workforce.

I looked through my notes when I got up in this House last June and July and asked the Minister of Health what he was doing around the significant healthcare workforce crisis in this country and what were his plans around solving that. That was June and July of 2021. Where are we now? What has changed? Well, I can tell you what: things have got worse, and we are nearly a year down the track of a lot of talk from that other side of the House, and Kiwis have clicked on that these guys are good at talk but have a complete inability on delivery.

They cannot implement and do not have a plan, and we are seeing this coming through in this legislation. We are not going to see any improvement in health outcomes, we are not going to see any improvement in our rural and our suburban communities as a result of this, and we’re going to continue to see the issues around health workforce crisis continue to get worse and worse as the borders reopen and our workforce move across to Australia, which 70 percent already do at the moment.

The centralisation of bureaucracy behind this reform is mirrored in other aspects of reform by this Government across a number of other areas. The increasing of bureaucracy and the centralisation—this mind-set that Government knows best—is endemic in the way in which this Government is trying to implement change. The challenge and the reality is that this change will not deliver the outcomes that Kiwis require in this country, and that is a great shame, because the opportunity cost of failure to deliver will be felt by our communities and our most vulnerable. There are those members of my community of the North Shore who are struggling to get access to healthcare services, who are struggling to get their next elective operation, and who are not getting the Pharmac drugs that they require, but, instead, you’re going to see half a billion dollars of taxpayers’ funds—hard-earned taxpayers’ funds—going on more bureaucracy and not the actual factors that are going to help improve those health outcomes.

Māori health outcomes have been noted as one of the drivers of this. This Government could take one action this evening to change that. It was a National Party policy around the introduction of lung cancer screening for ex-smokers in the Māori population. There is an eight-year differential between Māori and non-Māori around mortality. That initiative in itself would take one year off that eight-year differential, yet this Government are not even focusing on the examples right in front of them. National oppose this legislation because it will not deliver health outcomes for our community.

Tēnā tātou e te Whare. The Māori Health Authority is based on the needs of tangata whenua, and it is us as tangata whenua, our whānau, who have been underserved for generations; not all Kiwis. Te Pae Ora legislation is a step in the right direction to actually addressing and fixing some of those wrongs we’ve experienced, as was addressed in Wai claim 2575.

This policy was championed by many, including Te Paati Māori, and adopted by this House. I want to thank those in the House who know it is the right thing to do. It’s taken 180 years to address our health inequities, which are a breach of our constitutional entitlement—that constitutional contract, which some on my left and right conveniently forget, which guaranteed our rights and interests. A reminder: article 2 said it’s about acknowledging pre-existing rights we had before colonisation. Article 3 of the Tiriti is about equal rights as tangata whenua, addressing equality and equity. Te Pae Ora legislation is an attempt to the realignment and a step towards honouring this country’s obligation.

So Te Paati Māori is pleased to be standing here, advancing this on the promise to let us stand on our own two feet; to be well; to be reaching our true potential; to assert our tino rangatiratanga; to do by Māori, for Māori, after desperately waiting for those in power to admit there has been a two-tier health system which has failed us. You would think those that are anti this would be supporting us standing on our own two feet. But no, we stand here under our own constitutional right, upholding our Tiriti rights and treatment, and they’re still not happy. Let’s remember: our democracy exists on that very Tiriti o Waitangi, when 100,000 Māori were here and 100 settlers; we could have retained 100 percent but our tūpuna generously determined to partner fifty-fifty equally—which still creates issues. The descendants of those tangata Tiriti have forgotten their place.

Non-Māori are here based on our Tiriti, even the right for this Parliament to be here is based on our Tiriti. This great democracy many of you fight for and talk about in Aotearoa is founded on Te Tiriti. The rule of law, and all rules of law—contract of Te Tiriti—is to be reminded the Māori Health Authority is about finally honouring that contract. There is no separatist, special treatment going on here. The duplicity of those opposing the Māori Health Authority—the 2 percent of New Zealand that own 40 percent of our wealth—this minority who donate to this democracy, these are a cohort who buy our democracy as a minority. Therein lies the problem of this House as certain people use their might to suit their minority, who then become a majority voice within this nation.

Te Paati Māori are here by our constitutional right and obligations; therein lies the difference. We are not the 2 percent minority who escape tax by will, who don’t have to live amongst those who the system fails; we are tangata whenua and we are holding you to account for the contract you broke. Why would they want us to be part of a separatist health system that kills us seven years sooner than themselves? Why would they want us to maintain a system that takes our money, spends it all on us, fails us, then tell us as Māori that we’re the failure? We have a constitutional right and entitlement to self-development and self-management, a desire to break away from systemic failings so that we can be well—well enough to learn, well enough to earn, and unshackled from welfare dependency systems.

I also want to take umbrage at those who are either deeply confused or deeply misleading groups of people. Te Paati Māori believe they know exactly what they’re doing: they are playing race baiting politics. We can no longer trust a Luxon solution or Seymour solution; they say they will scrap the Māori Health Authority if they get in. But this queenmaker is saying it’s a deal-breaker. The more strongly that National and ACT subjugate our people, the more distance Te Paati Māori must take. As typical of those not affected, those funded by the 2 percent take issue, so we take pride and we’re happy to be here today to support this, and wish you to continue on. Kia ora rā.

Members, this debate is interrupted and set down for resumption next sitting day. The House stands adjourned until 2 p.m. tomorrow.

Debate interrupted.

The House adjourned at 9.56 p.m.