Pae Ora (Healthy Futures) Bill

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

💬 SPEAKER: That legislative statement is published under the authority of the House and can be found on the Parliament website.

I move, That the Pae Ora (Healthy Futures) Bill be now read a first time. I nominate the Pae Ora Legislation Committee to consider the bill.

Today is a pretty momentous day for this House as it commences its work in a pretty fundamental reform of our health system. I found the last debate instructive, really, about the understanding about not so much the health system but the health outcomes in our country. The reality is that there is an extraordinary disparity of health outcome in this country, depending not only on who you are—and if you are Māori, you are much more likely to have worse health outcomes than pretty much anybody else in the population—but also about where you live. Where you live will also determine what access you get to many forms of healthcare and, therefore, what happens to you.

The system we have at the moment, which is the DHB system conceived, roughly 20 years ago, was an attempt to make sure that we have a health system that was as responsive as it could be to local needs but completely funded by the Government of the day. It is a system that has done OK, actually, in some respects and it has allowed hospitals to develop what they perceive as their needs for their community.

But, actually, over time, a problem has emerged: differences between DHBs, difference in performances, and also it is a system that has simply been incapable of keeping up with developments in technology. So we are now able, through good data and digital systems, to provide a lot of coordination, a lot of analysis, and a lot of understanding about what is happening in different parts of the country, and, indeed, across the population as a whole. But when you disaggregate decision making for a system for 5 million people into 20 different organisations, then we shouldn’t be surprised that disparities emerge and differences emerge and differentiation emerges and, then, people suffer the problem of access to different health services and, therefore, different health outcomes, depending on where you are in the country. So, in many respects, the way we live, what we do, and technology—all those things—have conspired to make the current system obsolete. It is no criticism of anybody in our current system that those circumstances have emerged, but that is what it is.

So it was important that we took the opportunity to reflect on that, and we did that with the Health and Disability System Review, which was chaired by Heather Simpson, and they reported. We’ve also had the benefit of the Waitangi Tribunal and the claim by Māori who took their claim to the tribunal, and what is known as the Wai 2575 claim, and we’ve had the benefit of the interim report of the Waitangi Tribunal reflecting on the health system and the extent to which it has served, or not served, the interests of Māori, and the extent, most importantly, to which it has been consistent with the Crown’s obligations under Te Tiriti o Waitangi.

What was very interesting in the members who spoke opposite—with the exception of Elizabeth Kerekere—was the singular failure of any of those members who spoke to refer to the Treaty of Waitangi. The Crown has obligations under the Treaty of Waitangi and they are very clear. This was part of the examination of the Waitangi Tribunal. It said very clearly that it is a system that has simply failed Māori in that the most kind of standout measure that you can see is life expectancy. On average, Māori men can expect to live seven years shorter than anybody else in the population. That tells you that there is something seriously wrong. The health system has not kept up with the needs of Māori, but, actually, we know it hasn’t kept up with the needs of much of the rest of the population either, but in other respects.

If ever there was any evidence about the problems and the challenges we have with the current health system, you’ve only got to look at the current COVID pandemic and, actually, the roll-out of the vaccination campaign to vaccinate as many as possible of the population. Why is it that for Māori there has been such a lag in the uptake of the vaccine? It is because of a whole bunch of factors that we know have always been there, but they have been exposed for all to see. We’ve had kaupapa Māori health services pressed into action, finally now getting the traction that the rest of the system couldn’t get, because we said—and with the leadership of my colleague the Hon Peeni Henare, with whom I have worked very closely on these reforms and on this bill. Finally, when Peeni Henare worked with those Māori health leaders, it actually started to get traction and it demonstrated something very important to us: that, actually, Māori health leaders know what is needed to make the gains and to make the difference.

So this legislation does some very important things. It takes the 20 DHBs that we have at the moment and puts them into one organisation. It has the benefits of coordination across the system as a whole; not 20 different decision makers in different parts of the country, but one decision maker that can plan across the system as whole, and that takes into account the fact that there is increased mobility of the population. Where you go to get your health treatment should not be significantly different depending on where you are in the country. This reform and this bill will allow us to do that with the establishment of Health New Zealand.

We will also establish the Māori Health Authority, not because, as some members have argued—and I get the culture wars that members like the Hon Simon Bridges want us to buy into, and David Seymour. They want these culture wars, and they’ll try some division and what have you. The Māori Health Authority does not set up a separate system; it is an independent statutory body that works hand in glove with Health New Zealand to make sure that their advocacy—that is to say the Māori Health Authority’s advocacy but also commissioning powers—makes sure that the needs of Māori are met in a way that they simply have not been for many, many years, and that we are seeing demonstrated time and again just in the last 20 months. That is why that is important.

The bill also gives statutory recognition to the iwi-Māori partnership boards, which have been around and have worked to varying degrees of efficacy in the time they’ve been around. They will be powered up through the leadership of the Māori Health Authority to make sure that that local iwi-Māori voice is heard so that when the commissioning decisions are made jointly between the Māori Health Authority and Health New Zealand that we have commissioned primary community care services that are relevant to the local population.

The bill provides for and requires Health New Zealand and the Māori Health Authority to support the locality planning process. I know that many people have held on to the DHB boards and the elected boards and those boards to have been providing the ability to get local input to get great decisions made, but, actually, the evidence tells us the opposite. It hasn’t worked. We are not getting local voices making meaningful differences in local communities. Now, through the locality planning process, we would draw together the health providers in an area, the community representatives, and we can actually start to get health plans in locality areas that are relevant to those communities. That is what the bill will do.

So this bill is a very important reform and evolution of our health system. And then it will ensure greater accountability and transparency through things like the Government policy statement on health, the New Zealand Health Strategy, the New Zealand Health Charter that will govern the values of the workforce and the institutions in our health system. There will be some transparency. We will have a national public health agency; a discreet body within the ministry that will provide the nationwide leadership in public health that the ministry has through its director of public health, but, actually, a discreet agency providing that, because the other thing that the pandemic has shown is that we need nationwide and consistent coordination and a powering up of our public and population health approach to our health system.

I am confident that the changes that will be brought about because of this legislation will make a significant difference through the structure under which we make health decisions, resource allocation decisions, and policy decisions. It will help not only the hospital system and health policy but it will give greater emphasis and support to our primary and community care sector as well, which is so vital. If we are really going to change health outcomes, if we are really going to improve access for all New Zealanders, and improve health outcomes, actually we have to really beef up our primary community healthcare sector. This bill will allow us to do that through the establishment of Health New Zealand, through the stewardship and leadership of the Māori Health Authority, and the commissioning decisions that they have got to do through those bodies. I commend this bill to the House.

The question is that the motion be agreed to.

Thank you very much, Madam Speaker. I rise on behalf of the National Party in opposition to the first reading of the Pae Ora (Healthy Futures) Bill. I am speaking on behalf of our health spokesperson, Dr Shane Reti, a good friend and colleague who’s up at the moment in the Far North vaccinating his people, and we wish him well.

I want to start off with two questions for Government MPs, and this is what I want to hear in their contributions today: which Labour MP went to their constituency in the election last year and said to their constituents “I’m standing to disestablish your DHB.” Which MP went to their constituency and said that? Oh good, two! OK, well I’m interested to hear what the others did. Only about 10 percent said they did—what did the other 90 percent do? I don’t think they knew, or I don’t think they told their constituents. [Laughter.]

The second question—and they’re laughing, because laughing is a good way of hiding fear. The second question is: what health outcome will be increased in the first year of this restructure? Every Labour MP, I want you to answer that question: name one health outcome metric that will be increased in the first year. Because I’ll tell you what, the health Minister Andrew Little still hasn’t answered that question, and questioning, for months. Because what’s interesting today, is we had the Hon Nanaia Mahuta with her steamroller going over the top of local authorities. And now we have Andrew Little on his wrecking ball, wreaking through DHBs. And they will tell the public it is because of the findings of the Health and Disability System Review. Let’s be very clear, the Heather Simpson review recommended reducing DHBs from five to 12, leaving five to 12 DHBs. It never found that they should take a wrecking ball to our DHBs.

Let’s be honest, who would believe this lot can deliver? Their track record—all I need to say is KiwiBuild, light rail, the Auckland Harbour Bridge, mental health. These guys do not have a track record. Now they’re saying to the public, “Let’s take a wrecking ball to the DHB system in the middle of a pandemic.” They’re saying to the public, “Trust us, we know what I’m doing.” And I’ll tell you what, the irony was not lost on the New Zealand public last Friday, when they announced the new COVID traffic light system premised on each DHB getting 90 percent vaccination coverage. The irony. I had several people reach out to me and say, “Here they are with a straight face talking about DHB jurisdictions when the following week they’re taking a wrecking ball to it.”

Because what we need to be—let’s be very clear here, this is ideological. This is centralised. This is socialist central planning. These guys fundamentally believe the country should be run out of Wellington. Running the country out of Wellington, running roughshod over local people’s views. Labour takes “local” out of “local people’s views”. Because what National believes in is strong communities. What we know about strong communities, our strong communities, they are our local economies. They employ our family, our neighbours, and our friends. Strong communities are the heart of local democracy and strong communities deliver local public services to our loved ones. These guys are taking a wrecking ball to the DHBs and to our local communities.

I want to share a story that some people might say actually validates the restructure, it is a story about the postcode lottery. I had a constituent reach out to me, a solo mother who was having a tumour taken out of her jaw. The Canterbury District Health Board (CDHB) declined her jaw reconstruction. She was going to be left having to eat out of a straw and drooling. I made a representation to the CDHB because if she’d lived in other jurisdictions, she would have had it covered. The CDHB took that representation from their local MP and reversed their decision. That is what DHBs provide: local decision making. Labour is ripping that away.

Every New Zealander—rural, provincial, metropolitan—deserves the best world-class health services on their doorsteps. And you know what’s going to happen when they strip away the DHBs to a centralised national health service that localised control, that localised needs won’t be there. And how do I know? I actually worked for the British National Health Service (NHS) for 15 years. If you want to see an inefficient health system, go to the UK. And what’s interesting about the UK model is actually they’re moving away from a centralised model, they’re actually moving to foundation trust. I’ll quote what they say, the UK moving from a centralised National Health Service to NHS foundation trust, “The reform of NHS Trust is an important part of the United Kingdom Government’s programme to create a patient-led NHS with an internal market.” The stated purpose—and this is moving away from centralised to devolved into foundation trusts—is to devolve decision making from a centralised NHS to local communities in an effort to be more responsive to their needs and wishes. So here you have the UK with a centralised healthcare system moving away from that because they know it doesn’t provide a responsive health service.

Yet we are going the way, the other way, and you can see that in the language. Look at the regulatory impact system, “Government intervention is necessary to address these long standing issues,”—and indeed, “only Government”—it says “only Government can take the steps needed to reform the structure and operating model of the publicly-funded health system.” “Only Government.” And that’s where we differ, on this side of the House, because it’s not only Government, it’s the people that we represent—the local and strong communities and partnerships making those decisions. That’s what this reform will strip away. And what’s really concerning, if you look at the cost-benefit analysis, it’s basically bureaucrats before nurses. What they’re planning to do is reduce acute, unplanned admissions; reduce readmissions; and reduce length of stay—so in a nutshell, stop people coming into hospital and kick them out quicker.

Now, in some ways, you know, we can understand that assumption. It is expensive to have people in hospitals. But for all the cost of the reforms, hundreds of millions of dollars in a time of a pandemic when we could be putting that money into ICU beds, into ICU staff—Middlemore is sending people home at the moment who have got COVID because they’ve got no room—and here we are, embarking on the biggest health restructure probably in a generation. Timing. What’s interesting—when you look at the hundreds of millions of dollars they’re going to focus on this restructure in the middle of a pandemic—the benefits are evaluated at 1 percent of Vote Health. Even that, they’re not sure they’ll get there, they said probably “low to medium certainty.” Low to medium certainty of the biggest restructure, taking a wrecking ball to DHBs. Local people are going to lose local representation purely out of ideology. And what we’re finding out is that, potentially, down the track we might get a 1 percent return.

The Māori Health Authority. Māori, having a lower life expectancy in New Zealand is a blight on New Zealand. We should hang our heads in shame. But I would point out, what about people with mental health illness? Their life expectancy is 20 years shorter than the average New Zealander’s life expectancy. Where is the “Mental Health Authority”?

We’ve clearly outlined this restructure is not for New Zealanders. Thank you.

I’m sure my childhood family doctor would be bitterly disappointed with that representation in the House. Dr Reti was a good family doctor, but I can tell you that what I’ve just heard today would be a poor representation of what’s actually happening in the health system and what needs to change.

I stand in support of the Pae Ora (Healthy Futures) Bill. I stand in support of the actions taken by the Hon Andrew Little to make systemic changes to make sure that the health system delivers equity to our country, to make sure that the poor statistics that are impacting upon our people—when I say “our people”, yes, Māori people; yes, Pacific people; yes, disabled peoples; yes, people in rural communities. They need to change and the action being taken by this Government hasn’t started today; in fact it started a long time ago. Minister Little already talked about the Simpson review and the huge consultation that went on around the country. It became clear and evidenced in all of the submissions that the system needed to change and that’s what we’re proposing to do here today.

I’m excited. I’m excited because despite the assertions from that side of the House and the tip-toeing around Te Tiriti o Waitangi, that this bill actually delivers something that Māori communities and that Te Tiriti o Waitangi partner can look to with hope and aspiration. I find it interesting that on the other side of the House the National Party crow about their record for Treaty settlements but aren’t prepared to deal with the fact that Te Tiriti o Waitangi has not been met and the obligations within it, and that’s why we have the poor health outcomes for Māori people today.

This bill looks to address that. This bill looks to make sure that not only is equity in the system but accountability is too. It’s no good just being accountable to each other here in this House. It is important that the system that serves our communities is accountable to the communities. So the mere notion from that side of the House that we are taking away that local representation, I can tell you, is not true. In fact the iwi Māori partnership boards that are being proposed in this bill look to strengthen the way that we deliver those health outcomes and meet the health aspirations for our people locally is all in this bill. What it also does too is it makes sure that not only are those organisations accountable to Wellington and to the leaders in the health sector, they’re accountable ultimately to whānau. That’s ultimately what this is all about. It is about whānau and it is about wellbeing.

What we also saw is in Wai 2575 the evidence became clear that in order for us to make the changes in health, it had to be a fundamental shift and a systemic change, and that’s what this is offering us here today. But let me be clear that this is only the first reading of the bill. Under the process that was proposed by Minister Little, it is going to go through more debate, more rigour. We’re going to get our whānau and our community speaking up on this bill, and that’s important. We need to hear their voice. We want them to be engaged in this process so that the bill at the end of the process is the strongest bill it can be.

To answer the member’s question from the other side of the House, I stood on the election platform and said to those DHBs and to my health community and Māori health community in Tāmaki Makaurau: this has to change; it’s no longer good enough. That’s what we’re doing here and I’m excited that one year after the election, this bill is being introduced into the House and real change is under way.

We’ve already heard about the statistics that impact on Māori, and we can all, I’m sure, tell a story of a whānau member who has suffered those inequities through the health system, whether it was early testing for identification or whether or not it was falling through the cracks on the pathway to treatment or simply by the way they were treated by their health providers or by the health system. I won’t go into any of those stories, but I will encourage anyone who doubts that what’s happening in this bill and the proposed changes in this bill will make change and important change and positive change for our people to read the submissions to the Wai 2575 claim. In those submissions there are harrowing stories of inequity and the bad treatment of communities and people right across Aotearoa.

I’ve already spoken about Te Tiriti o Waitangi and strengthening Te Tiriti o Waitangi. I’m positive that we can find more equitable outcomes as it will hold not only Health New Zealand but also the Māori Health Authority to account, and that’s important. Our people have asked for this. And what I find interesting from the other side of the House is the health sector, despite all the pressures—and I want to thank them for the work that they do every day—even they’re calling for this change. The nurses, the kaimahi, the doctors, the GP clinics, all of them, the Māori health providers are calling for these changes. They acknowledge they’re working hard and they’re doing the mahi with respect to the COVID-19 response and the roll-out of our vaccination plan. But even they are hugely optimistic about this particular bill and the work that’s being done to restructure our health system.

I want to come to the Māori Health Authority. What was clear from our discussions with the community around the country on the Māori Health Authority was it couldn’t be an ivory tower in Wellington. They were quite clear with us on that. So too is the interim board that we’ve actually announced for the Māori Health Authority. So in order for us to make sure that the Māori Health Authority can continue to have its strong influence into our communities, the iwi Māori partnership boards are the way to do that. And I’ll tell you why. Because on a number of occasions in this House, I’ve stood up and if there’s one thing I can say about iwi Māori is they’re all different. Every iwi will say Ngāpuhi is different to us here in Te Arawa, or they’ll say Ngāti Kuri do things differently to Te Aupōuri, even though they’re neighbours. And what we’re hoping to do here with the iwi Māori partnership boards is to make sure that those local nuances are driven locally.

But in order to give them the most impactful plan in moving forward to meet Māori health aspirations, we must make sure that the Māori Health Authority can use all its levers and powers to make sure that the entire health system is delivering for our people. Because it’s no good just doing it there in the community, or it’s no good just doing it at GP clinics. It’s no good just doing it here in Wellington. What we also need is a Māori Health Authority to influence and engage with the systems that our people are engaging with.

It’s interesting that approximately 84 percent of the Māori population, when they are unwell, they go straight to the hospital. They don’t go to their primary GP, they don’t go to their primary health organisation. What they do is they go directly to the hospital. Therefore, we require a Māori Health Authority and iwi Māori partnership boards to have the most influence they can over that hospital to deliver the service for our people, to make sure it is equitable, to make sure that the service they receive when they go into that hospital is one that will see them get well and get better sooner rather than later.

Just in the last couple of minutes that I have, I want to encourage everybody who has already contributed to the passage for health reform to date, and for those who choose to or might choose to in the coming weeks and months—to make sure that your voice is heard, there are more engagement hui to be held right across the country. Minister Andrew Little is already on the road talking to our communities to make sure that they can continue to keep up to date and find their voice in this important process. I will be doing the same, and in order to do that to, have a kanohi ki te kanohi discussion, it’s important that colleagues, in particular my Government colleagues, do that in their communities so that their voices are heard.

Just finally, I find it interesting when Mr Doocey talked about DHBs and then going towards the traffic light system, and I’ll tell you why. Because what we’re saying is if they cared that much, then why haven’t the DHBs put their hand up to be held to account? They are publicly elected, many of them, and I want to encourage Mr Bridges to go back to the Bay of Plenty and ask them why their vaccination rates aren’t high enough. That’s just a clear example that the DHBs in this particular instance have tried their best—some of them haven’t tried their best. But ultimately the vaccination rates are a sign that what needs to change is the health system fundamentally and I’m proud that this particular bill will do that. I look forward to its passage, and I look forward to rigorous debate throughout its passage here in the House, and I commend this bill to the House.

Thank you, Madam Speaker. Well, here we go again. Twenty years ago, Labour came in, in 1999, and they had a great big new reform which was going to make the New Zealand health system the envy of the world. They said the National Government had run down the health system and underinvested, blah-blah-blah, you’ve heard it all before. Their great big, big bang reform was a structural change to the health system, and it’s called district health boards. We had 16 district health boards established round the country, and we had elections. It was Annette King’s—she was the Minister of Health—it was her big reform. We were going to elect locals to the district health boards. Unfortunately, we then saddled it with the single transferable vote election system, and I took great pride and pleasure in my time as Wellington City district health board resident, every—

💬 Hon Simon Bridges: I was hoping you were about to tell me you’ve been on one of the boards.

No, no, no. It was not my privilege, sadly, Simon Bridges. But every DHB election would come around, and I would go through the little booklet which gives you 250 words of meaningless nothing. I would always make sure that Sue Kedgley was ranked last in the district health board elections, and Helene Ritchie, who was, at various points, a Wellington City councillor—always made sure Helene Richie was ranked number 28. I then tried to find the competent people and I put them at one, two, and three—people with some sort of accountancy skills and things like that. I didn’t get to vote for you, sorry, Dr Verrall, because I’m in the Hutt Valley DHB now, obviously. But I tried to vote for competent people, and anyone who seemed nuts, like an anti-vaxxer or anti-fluoride or anything, they went last, but the person who always came last was Helene Richie.

Anyway, I digress away from the bill, which is to say we’ve sort of been here before, because 20 years ago, the answer was DHBs, and yet here we go again. Labour’s back in and their big bang reform now they’re unshackled from New Zealand First—and I have no time for Winston Peters, but it is true to say that the last Labour Government was stopped from doing some dumb stuff by New Zealand First. I mean, one thing they stopped them doing was this stupid retrospective property law changes, which we’re going to consider in the next bill before the House, but I don’t think they would have agreed to this. But anyway, here we are, unshackled by any essential governing party—and I don’t count the Greens as part of that governing arrangement because, as was demonstrated last week, in the bipartisan deal done between National and Labour over housing, no one cares what the Greens think anymore, actually, about much at all, frankly. No one really has any interest in what they have to say. So they’re there, but let’s face it, this is Labour’s ideological bill. So we’re going to get rid of DHBs and go back to the future.

💬 Hon Member: They’ll bring them back in about another 15 years.

Yeah, in 30 years’ time, after the long next National Government’s finished its time and Matt Doocey and Harete Hipango and Nicola Willis and Simon Bridges and Maureen Pugh have been long-serving senior Ministers—

💬 Hon Member: Government of excellence.

—a Government of excellence—after Labour finally come back around the mulberry bush, they’ll probably bring it back again. Who knows? That’s the way these things tend to go.

But the reason I make that point—it sounds frivolous, and I’m being slightly frivolous, but it’s a serious point, which is that the health system endures this constant churn of reform, and Dr Verrall, who is a Minister, knows this all too well. Actually, reform is OK, as long as it meets the hurdle rate. The reason I say hurdle rate, or the threshold rate, is that it takes up an inordinate amount of time and money. In relation to these reforms, the Government has put forward on the table it’s going to cost $478 million. Now, let’s be generous and say that that’s an underestimate, and say it’s probably double. So let’s round up—I don’t think it’s being unfair—let’s say it’s the thick end of $1 billion. Now, you might say: what’s a $1 billion between me and some friends? Well 1 billion bucks is a lot of money. That is a lot of ICU beds. It’s a lot of hip operations. It’s a lot of GP surgeries. It’s a lot of primary care. It’s a lot of money in the health system. So you don’t just go throwing away a billion dollars—likely—but, sadly, that is the dead-weight cost of these reforms. That is literally money vaporised. It’s productivity, and it’s efficiency, and it’s the cost vaporised. That’s something we get nothing for.

Now, the Government would say, in the long term, the medium to long term, we do get more efficiencies and more reforms out of it. But I for one do not accept that is necessarily true. Actually, the analysis underlying the reforms says that as well, because if you read the cost-benefit analysis, this is prepared by the officials, no way to evaluate whether these reforms will deliver this outcome. Low to medium certainty. So these are reforms that are not based on a sound foundation.

I make the point that I’m not opposed to reform, and neither is the National Party—we’re not opposed to reforms. In fact, I would like to be part of a reforming administration, because, ultimately, I got into Parliament and into politics to improve things and make things better. That often means changing the status quo; that’s part and parcel of being here. But I’d simply say, in relation to structural reform of a major part of our economy and a major part of our society, the threshold rate for change is a high one; you have to be able to make the case. You just know what’s going to happen, anyone with any experience in the Wellington public sector knows what’s going to happen, because if I could be a little bit provocative and maybe a little bit pejorative towards the last National Government—and a guy I have a lot of time for, Steven Joyce—the Ministry of Business, Innovation and Employment (MBIE).

Now, you know, MBIE was brought together, the Department of Building and Housing; department—I can’t even remember the names—oh, the Ministry of Economic Development, the old MED—

💬 Hon Member: Housing. Building.

Housing. Building and housing. They brought all the agencies together, and lots of grand proclamations about what a great job it would do and it would be more efficient and it would join up Government and all the rest of it. All the things that, frankly, if you read the bureaucratic documents underlying these reforms, you’ll find, and nine years later, has it delivered on its promise? I don’t know, I think that’s probably an open question.

I’ll tell you what has happened though. Lots of rebranding, new buildings, new letterheads, new email addresses, new sector teams, lots of whiteboard meetings, lots of afternoon and morning teas, lots of—

💬 Hon Member: Brainstorming.

—blue-sky thinking sessions. Brainstorming sessions. Lots of that. That’s all fine, keeps people employed and occupied. But that’s actually not why we have MBIE. So I make the point: we’re going to get rid of all these DHBs, and you could already see it coming through in stories from the health system, which is morale. That’s the other big thing about change and managing change is that it affects people’s morale. So all of a sudden, everyone who works in the health system is always looking over their shoulder going, “What’s coming up behind me? What’s this next change the Government’s doing? Do I have a secure job in the next 12 months? What’s my pay going to be like? Who am I going to work for? Who’s my boss?”

Now, again, those changes can be justified, but that can be worth it, but you have to be really sure that, at the end of the day, in five years’ time or 10 years’ time, you’re going to get a health system where morale has been improved and you get efficiencies and get all the outcomes you want out of it. It’s not just me saying this. If you read any—or many—theories of business change management and structural reform in the business world, all of these problems are well known around morale from restructuring having a big effect around the efficiencies of change and restructured organisations often never really materialising. It’s not just me saying this; this is based on theory and evidence from the business world, as well.

So you can make a case for change, but you have to be really sure that we’re going to get the benefits, and I just simply say—in the final minute of my speech—will these reforms deliver more hip operations or less? It is not clear to me that we will get more operations out of it. Will these reforms mean better primary care in our communities? I do not believe the case has been made that they will. Will it mean more connected health resources, for Māori and Pasifika communities and harder to reach communities where there are health inequities and inequalities? I do not believe that that case has been made. It’s going to a committee, you never quite know, we are pretty firm in our opposition to this, but we’ll wait and see what the evidence shows. But at a time of a global pandemic, with very scant evidence for reform, the Government’s belief in this bill seems, frankly, heroically optimistic at best, and naively incompetent at worst. Sadly, I think it is more of the naively incompetent than the heroically optimistic.

Thank you, Madam Speaker. It’s an absolute pleasure to be speaking on the first reading of the Pae Ora (Healthy Futures) Bill, but also to acknowledge the huge amount of work that’s gone into bringing the bill to the House to date. I just want to look back at the Health and Disability System Review, which we undertook in our first term, and just the huge and compelling need for change that it highlighted. So what it highlighted was just the significant amount of duplication of effort that was happening in the system. It talked about the postcode lottery in health. It talked about the huge inequities for different groups within the community for Māori and Pacific peoples, for those in rural communities, for those with disabilities, and those living in poorer areas. And it, basically, suggested that there was a compelling need for change.

I just think back to my own work, when I was working as a public health doctor, monitoring the health of our country’s children and young people before becoming an MP. I think one of the tasks I had to do was develop a consistent national framework for monitoring child and youth health around the country. What we really had to take a look at is what can you do centrally once and well versus what needs to happen at the local community level. I think, just an example, thinking through, you didn’t need 20 DHBs all doing an evidence-based review on what works in childhood obesity prevention, but you certainly did need to make sure that if you were going to implement anything on the ground, then you had local input, local engagement, and those that knew what was happening. So I think, basically, this bill gets the tension right about what we need to do centrally to provide that strategic direction, but also making sure that we get local input at the community level.

And just thinking also about some of the other examples of the need for change, drawing back to my previous work in monitoring child health. At one point we were just really grappling with a lack of information on children with chronic conditions and disabilities, so basically things like autism, epilepsy, and cerebral palsy. The problem was, if you don’t have information, then the DHBs can’t look at developing decent health services and plans for meeting the needs of those children and young people because there’s not any data there. The issue we were having was that most of the children with those chronic conditions were actually accessing their care either through their GP or in the outpatient setting. And in the outpatient setting, there was no coding of the diagnoses for people as they came in; so unlike hospital admission data, where you could look at thousands of children coming in for asthma and then think asthma’s a really important issue, therefore we need to plan services for children with asthma. Because there was a lack of information, these children were falling below the radar.

So what we went and did is had a talk to the DHBs and said, “Look, what are you doing to improve information access for these children and young people so that you can actually meet their health needs?” And one of the DHBs said, “Well, we’ve actually created this nice little system for coding in outpatients and we’ve got a couple of different broad, high-level diagnoses that we use.” Another DHB said, “We’ve got this amazing system we’ve developed over the last few years. We’ve got about 20 to 30 of the most common codes that we’ve looked at and we consistently can monitor that over a period of time.” Another one said, “Well, we actually use ICD-10, and so we’ve got access to thousands of codes.” And that was fine, they could get all their own information, but then when they went to actually talk to their neighbours and say, “Well, how do we do some joint planning here?”, there was no common information, there was no common language. And I think the other problem is then you couldn’t aggregate that up at the national level to actually figure out what was going on.

So the issue we’ve got is that’s just one little example, but it’s also happening across workforce planning; it’s also happening across how DHBs are planning that they manage the flow of patients with different conditions. And so there’s just this huge duplication of effort. And yet, all the time that DHBs are putting into that, they’re also grappling with, in the DHBs we were working with, thousands of kids coming in with potentially preventable conditions: asthma, pneumonia. They were working with workforce shortages—very big shortages—in terms of things like mental health staff, paediatric pathology, rheumatology, because there was no central, strategic direction. And so what we need is a health system that does things once and well where it’s efficient to do so centrally, but also incorporates that local level community involvement where you implement things on the ground. And I think this is where this bill achieves both and it creates that really great balance.

So what does this bill do? Well, firstly, what it does is it does disestablish our 20 existing DHBs, but it creates some new entities. So it creates Health New Zealand and the Māori Health Authority. And, basically, Health New Zealand and the Māori Health Authority will work in partnership to plan, commission, and deliver health services across the country. So that common approach means we’re getting rid of a lot of the complexity and duplication in the system. Basically, the issue though is that in addition to that central approach, we’re also looking at localities and local communities. And so, basically, what it also develops is localities. So, basically, the Māori Health Authority and Health New Zealand will work together to define particular localities where we want to look at specific local planning. I think of my own DHB, the Southern DHB, and if you think about the health needs of those living in Dunedin, they’re very, very different to those living in Queenstown, to those living in Invercargill, and to those in rural Southland. I think that’s that ability to think through how do we look at different localities and plans for those communities and how we engage our local communities in that planning, and this bill takes that into account.

I think one of the other important things this bill does is it creates a public health agency within the Ministry of Health. And I think, when you look at the incredible significance of our public health response to COVID-19 and the way we’ve had that national-level planning, and also just acknowledging the huge input of our health professionals in the public health workforce, having a single public health agency within the Ministry of Health to coordinate that strategic leadership and approach is going to be incredible valuable moving forward.

The other thing I think is that what this bill will do is create a whole lot of strategic documents, which are going to be essential for making sure that we’ve got a consistent approach and that the priorities that we’ve got as a Government are implemented well across the country. So we’ve got a new Government policy statement in health, and that’s going to set out the Government’s overall direction, priorities, and objectives across the health system over three years. But it’s not just about the strategy, it also sets out the funding envelope as well and how the system’s actually going to deliver the outcomes and how that’s going to be monitored. Again, just doing a review, I remember during my public health days thinking through the approach we had previously where we had strategies, but none of them were actually funded, and so thinking through how effective they could be. So linking that in with funding, I think, is incredibly important.

It’s also got a New Zealand health plan. And what that will do is it provides a three-year costed plan that talks about and sets out those health services, how they’re going to be delivered within the Government across that three years. So again, just looking at that practical implementation.

And then also—I’ve already mentioned—locality plans, where we’re going to be looking at different localities and what those area’s health needs are and having some engagement with the local communities about what local communities see is their priority. Certainly where I’m based down in Invercargill, after-hours access to GP services, particularly free access for children after hours, is incredibly important as a local priority—so being able to have those conversations about how do we have the best configuration of health services in local communities.

Also there’s the New Zealand Health Charter, and what that’s going to be looking at is the common values, principles, and behaviours for the entities within the new system and also the people employed by them—so making sure that that’s very, very clear from the outset.

But also there are a range of things that won’t be changing. And so within the legislation, there are provisions to ensure that the New Zealand Blood and Organ Service and the Health Quality and Safety Commission can just continue on with their current functions, although making sure that they are subject to the accountability and monitoring requirements within the system.

So I think this is a substantial reform. I mean it’s obviously the most substantial reform that’s happened since DHBs were created back in the early 2000s. I think it’s going to continue to shape the health and access to health services for New Zealanders for years and years to come. But I also think, as I said before, it gets that balance right. So what it makes sure is that we’ve got a common strategic approach and we’re not spending a lot of time reinventing everything from the ground up 20 different times around the country; we’ve got a common approach, we do things once and well where we need to. The Māori Health Authority will provide the ability to work in partnership with Māori and to think about how health services for Māori communities are commissioned and delivered. And we’ve also got the capacity to make sure, within our localities, that there’s a level of local input into service delivery and planning. So I’m very, very happy to commend this bill to the House.

Kia ora. Thank you for this opportunity to support the Pae Ora (Healthy Futures) Bill. The restructure of our health system is a huge step forward, making the wellbeing of all New Zealanders a reality. It was 1985 when the Whare Tapa Whā model of Māori health was first published by Tā Mason Durie. It was a simple yet profound framework, four sides of a meeting house, each representing one aspect of health: taha wairua—our spirituality, our connectedness with all things; our hinengaro—our psychological, our mental health; our taha tinana—our physical selves, our bodily integrity; and taha whānau—our family health, because we are never just individuals. It was a holistic and intergenerational view of health. And, of course, it’s not the only Māori health model that’s been developed. A shout-out to the late Dr Rangimārie Turuki Rose Pere for the Te Wheke model, which I discovered as a young person and I used for many, many years. Te Whare Tapa Whā, though, is the most enduring model and the most well-known. Many have adapted it for use—and certainly I have as well in my creation of “Te Whare Takatāpui” model, which is a place of wellbeing for takatāpui people of diverse genders, sexualities, and sex characteristics.

So Te Whare Tapa Whā was an integral part of He Korowai Oranga, the Māori Health Strategy, when that was first launched in November 2002. It set a new direction back then, new and shiny, an overarching framework to guide the Government and the health and disability sector on creating better health outcomes for Māori. The initial aim was Whānau Ora—that Māori families would be supported to achieve their maximum health and wellbeing. It was updated in 2014 with “Pae ora – healthy futures”. And, as they refreshed that strategy, so with the foundation of “Whānau ora – healthy families”, they added “Mauri ora – healthy individuals” and “Wai ora – healthy environments”. And so, for us, working in the health sector and working in our different ways in the community, around health and wellbeing, it felt like we had such high hopes, but we had so many crushing disappointments. Many of the people in this House have got health backgrounds, but you don’t need that to know about the huge disparities in Māori health.

During the annual review of the DHBs, when I was a baby member of the Health Committee and we were inundated with reports from around the country, I was horrified to see that in every health condition, in every DHB Māori were at the bottom. It was even worse to see that, when we were looking at the budgets those DHBs were spending, and despite most of them having dedicated strategies, in all manner of things going on with a Māori name, per health condition per person more money was spent on non-Māori than Māori. And this is the foundation of the struggle to get the last lot of our people vaccinated: that absolute core distrust of a health system that does not look after our people.

However—however—this new health system, we very much support it. We support its aim to give effect to Te Tiriti o Waitangi, the most important evidence of which is the establishment of the Māori Health Authority. It was one of our priorities—Te Mātāwaka, our Māori caucus of the Greens—we announced at Waitangi this year, because in our consultations with tangata whenua they absolutely confirmed the need for this change but also to make sure that that authority was independent and adequately resourced. It was a stroke of genius to appoint Tā Mason Durie to come back and lead that development of that authority, as one of the most trusted Māori leaders we have ever had. But it must be really strange for him to create something 36 years ago—actually created 37, probably before—coming back in the hope that that vision might actually be closer at hand.

We note that the Māori Health Authority will commission kaupapa Māori services. So this a big deal alone. As one of many, many Māori who have sat on advisory boards in a range of different sectors, we know that usually there is no power and there is no money; so this here is a great start. We know that the Māori Health Authority will also co-commission with Health New Zealand, and this is important because most Māori don’t go to Māori providers. Partly, that’s because there are so few of them and they are not all over the country, but sometimes they choose for different reasons to support their local clinic. And so it really matters how the bulk of the health system is operating and what say the new Māori Health Authority will have over it. Being able to monitor the performance of a system for Māori is one thing, but being able to have actual power when you point out that something is wrong—that it actually gets fixed.

We note that the new agency will lead systems operations, planning, commissioning. Together with the Māori Health Authority, of course, they’re going to develop all manner of strategies and plans, which is how it should be. We want to make sure that those lead to direct work and that we’re not still, in a couple of years, writing plans and we haven’t actually made a change in people’s lives. We note that Health New Zealand will also establish localities to plan and commission primary community health services and engage with communities at the appropriate level. Now, you could say that locality seems to be very geographically termed. I have suggested to the Minister of Health and the Director-General of Health that we could have a rainbow locality—that even though it would be nationally based, it would enable a consistent approach to gender-affirming healthcare, for example, and to ensure that the things like the atrocious practice of gender normalising surgery on intersex infants never happens in this country again.

But we do support, also, the progressive expansion of the roles and functions of what is now the public health agency to enable it to advise, plan, and fund evidence-based health promotion services. We support those kinds of services that create supportive physical and social environments and empower communities to identify their own needs and be part of the solution. For this to be a transformational and visionary health system, it cannot be that you’re just telling people what to do; it is not going to work. People need to be empowered to take control of their own lives and their own bodies, and how they look after themselves, and given support when they need it.

💬 Nicola Willis: Come join the centre right!

Ha, ha! So we think that inside that, though, there must be a major focus on prevention. We can’t just always be dealing with people who are sick and need help right now—we must look after them, but let’s create a society that emphasises our wellbeing to such a degree that we can rely less and less on a publicly funded health system.

Now, local democracy is a core value for the Green Party. Our policy is that healthcare professionals, service users, our communities should be involved in planning and decision making on the issues that affect them. So the proposed replacement of DHB elections with appointed boards—we would still like to learn more about how that will work, but we prioritise those population groups with the greatest health needs, of course: Māori, elderly, women, children, Pasifika, refugee and asylum seekers, rainbow communities, of course people with low economic status, people with disabilities and rare disorders. All of this is part of ensuring better health outcomes for all of us. So community engagement, particularly as those localities are established and those locality plans are developed, the health and disability strategies are created, and the code of consumer participation is developed—we want to make sure that those consumer voices are heard.

Finally, I’ll conclude where I started, with a vision of health that is holistic and intergenerational, because the health sector cannot do it by itself. We note the stated objective of Health New Zealand: to encourage and maintain community participation in health improvement and service planning; to promote health and prevent, reduce, and delay ill health, including by collaborating with other social sector agencies to address the determinants of health. We hope this is indicative of a broader, collaborative approach. Whilst this needs to be defined and clarified, it’s very clear that our people cannot have good health unless they have a warm, dry home, a safe place to sleep, and enough money to live on.

Nā reira, kua eke te wā kia mārama me whakamana anō hoki te Kāwanatanga ki te tūāpapa o ngā tikanga Māori te tino rangatira me te manaakitanga i raro i te mana o Te Tiriti o Waitangi,

[Therefore, we have come to the time that the Government should be clear and give authority to foundational Māori protocols; self-management and care under the authority of the Treaty of Waitangi.]

Accordingly, we commend this bill to the House. Kia ora.

Members, the time has come for me to leave the Chair for the dinner break. The House will resume at 7 o’clock this evening.

Sitting suspended from 5.57 p.m. to 7 p.m.

The House is resumed. Members, when the House broke for dinner we were considering the first reading of the Pae Ora (Healthy Futures) Bill and I call Brooke van Velden.

Thank you, Madam Speaker It’s my pleasure to rise tonight on behalf of the ACT Party in opposition to the Pae Ora (Healthy Futures) Bill. I want to take some time to acknowledge the health workers who have been working as our essential workers under the COVID crisis. You know, we have had so many months of nurses and doctors, GPs, people working in our hospitals and in our community care who have worn full personal protective equipment, who have sometimes left their families aside, and who have been wearing masks that have started to cut into their faces so that we can have healthcare and that we can have the essential services that we need under COVID. But I also want to take some time to acknowledge the hard work of people who weren’t considered our essential workers under COVID—and there are many people who are in our health workforce who aren’t considered essential workers. I think that’s wrong and I’m glad that the Government under alert level 3 has changed some of the rules so people can have their osteos and their physios, for example. We have a huge workforce of healthcare workers in New Zealand and I want to acknowledge all the hard work that they do.

But I want to come back to the Pae Ora (Healthy Futures) Bill and the reason why we’re having this discussion—and it’s because the Government has decided that we need a health reform. That’s coming after the health and disability review, which said that the system was fragmented and complex. We have unclear roles and misalignment of strategy, and it’s what we quite often refer to as the postcode lottery. You know, I constantly hear examples of people who are living in Southland who can’t get access to midwives, who travel for hours to try and get to the hospital, and who are giving birth on the sides of roads because they don’t have the facilities that they need in their areas for healthcare. We hear of farmers who can’t get mental health care in the areas that they live. We do have a very fragmented approach to healthcare in our country.

So the ACT Party also believes that the status quo isn’t acceptable. We have hospitals that are very run down. We have, essentially, Third World conditions, quite frankly, in some of our hospitals and people are languishing on waiting lists just for elective surgeries. It’s hard now under COVID but it was terrible even before that. We need a modern healthcare system that empowers people to get the healthcare that they truly need and deserve and we can do that by reducing bureaucracy and having a stronger focus on patient outcomes but it needs to be a greater collaboration between the public healthcare system and private provision. We would be happy if the Government adopted some of the ACT Party’s policies and ideas that I truly believe would help the healthcare system. We have publicly subsidised common elective surgeries—that’s a good idea. A national, fully integrated IT system across public healthcare for patient management—that’s another very good system. We need better security, if you see what’s happened under the Waikato data breach. We also need new hospitals. We need to allow for building arrangements for construction of new facilities under public-private partnerships. We also need a new mental health and addiction agency that is a centralised agency for all mental health and addiction across New Zealand.

The ACT Party opposes the Pae Ora (Healthy Futures) Bill because it doesn’t actually address any of those issues. We are the party of reform and of ideas, and I’ve stated the issues that I believe would actually create good reform and good ideas. So this bill, in particular, speaks to wanting to reduce the number of DHBs from 20 down to one. Now the ACT Party’s position was always that we should reduce from 20 to six and it’s because we believe that we do need to reduce bureaucracy. We do want to have a streamlined healthcare system and that’s a positive step forward but we cannot support this bill in good faith and that’s for two main reasons. One is it’s divisive—unnecessarily so for a healthcare system—and, two, is when it’s happening. So not only do we have set up under one entity, Health New Zealand, there is a separate entity that is being set up called the Māori Health Authority.

I want to acknowledge that New Zealand has a very complex arrangement with families. You know, there are a whole range of different structures and ethnicities and cultures, and there are over 260 different cultures and ethnicities within New Zealand. It shouldn’t be that we are dividing people based on their race; we should be giving people the healthcare they need based on their needs. I want to raise one particularly salient example and that’s that of my colleague Karen Chhour. I am talking about this with her permission, of course. You know, Karen is Māori. Her husband is Cambodian. She has four wonderful Cambodian/Māori/New Zealand children. Why should it be that her children are put in a position where they are pitting their different racial heritages against each other and having to pick which one of their heritages they place more weight on? We should be basing those children’s needs on their needs, not based on which race they particularly want to identify with.

There are inequities in our healthcare system that have to be addressed but there are vulnerabilities that exist in all communities. You can cut and slice and dice New Zealand in so many different ways but I do not believe it is helpful to try and slice and dice it based on our race. Whether you are Māori, whether you are a Pākehā New Zealander, Pasifika, Indian - New Zealand, Chinese - New Zealand—any form of New Zealand—everybody deserves good healthcare. But a racially-based and separate parallel Māori Health Authority is not the right way forward.

I acknowledge that when this announcement was made, the ACT Party said, “We have more than two races in New Zealand. What about the separate authority for Chinese New Zealanders? What about the separate one for Indian New Zealanders? What about the separate one for Pasifika New Zealanders?” And I was very happy to see that the Minister for Pacific Peoples, Aupito William Sio, very quickly pointed out: where was any indication of Pasifika in the Government’s announcement? So, you know, he’s echoed our concerns, too. We oppose co-governance. It is divisive. It represents a serious departure from the idea that all New Zealanders have equal rights.

But the second reason that we oppose this bill is because we’re currently in a COVID crisis. Our DHBs have just been tasked with dealing with the pandemic, and we see the weight that the Government places on them because the new traffic light system specifically talks about the need for each DHB to get to 90 percent. We do not need more uncertainty at this time and we certainly don’t need more uncertainty in our healthcare system. That is the whole reason why we had lockdowns in the first place. We cannot in good faith agree with disestablishing the healthcare system in the middle of a pandemic. We’re talking about a weary and tired workforce, telling them that we’re going to disestablish their roles but we’re going to then replace them into new roles at a time when we’re asking them to be stable, certain, and show leadership in the community. I don’t think it’s right to give them that form of uncertainty at this time.

But this is also a little bit about implementation. When COVID came along, the Government forgot about community care. When Health New Zealand was started up with the interim board, the Government didn’t even put anybody from community care on it. It completely forgot it existed. I hope that these reforms go well because we do need a good functioning healthcare system going forward in New Zealand, but I certainly did not see that in the Government’s implementation of COVID response, and I hope that this is not what happens to the Health NZ and Māori Health Authority. Thank you, Madam Speaker.

Thank you, Madam Speaker. It’s a great pleasure and a really good opportunity tonight to take a call and to stand to speak in support of Pae Ora (Healthy Futures) Bill tonight. I say this for a number of reasons, and I’m going to work my way through a couple of salient ones and, hopefully, make a couple of good points.

I think, at the moment, health is at the forefront of everybody’s mind. You know, everybody can understand that that’s rightly so. It’s something that’s particularly topical. We’ve just been through a series of events over the last 18 months which make that quite salient. The COVID-19 pandemic has highlighted, I think, just how critical public health is, and this bill, in particular, gives it the attention and the resources that it needs. A robust public health system is essential to the wellbeing of all New Zealanders, and a robust public health system is one which, I think, we can or should or would all agree is one that leaves no one behind.

Health outcomes have, for far too long, been an accident of birth and geography, a so-called postcode lottery that I’ve heard several members refer to. I think it’s really important that while we coin phrases like that, we make sure that we don’t trivialise or that we don’t gloss over what that actually means. It’s a postcode lottery: it means, quite simply, that for some individuals, depending on where they’re born and depending on who they are, they can have quite drastically different outcomes. And that’s not good enough.

So this Government is dedicated to creating a fair and equitable system, and a fair and equitable system that reflects and respects Aotearoa’s diversity. This bill will go a long way to ensuring that we have a health system that is fit for purpose in today’s expectations. Earlier on, we heard some prior contributions talk about the cyclical nature of reform, as if that was a bad thing or something that was there for derision. It’s just a matter of fact that the world changes and things do change, and sometimes we need to revisit and sometimes the right time for reform is now.

So this bill will go a long way to ensuring that we have a health system that is fit for purpose for today’s expectations, and one that achieves equity by raising standards for all. I think it’s particularly important to note that it’s raising standards for all, particularly those who have been disadvantaged in the past. To address the inequality in our health system, it was essential that we scrutinised existing arrangements. And, as has been spoken on several occasions tonight, we have 20 district health boards (DHBs), each one with a highly skilled—and I really want to emphasise this—highly dedicated workforce.

Over the years, I’ve had the pleasure and the opportunity, I suppose, to work with various kinds of groups within our very dedicated and very skilled health workforce—most recently, our amazing nurses, not only within the DHB system but within other aspects of our health sector. I greatly admire what they do. I’ve also had the opportunity to work with other groups within our health system, like our doctors, both clinical, research, medical scientists, our healthcare assistants, and our auxiliary workforce and our clerical, and various other people that support our amazing health system.

So I want to be really clear when I say that it’s the structural realities and the duplications inherent in our system that cause the impediments, not our highly skilled workforce. Due to that, we see a situation now where it’s just simply not resulted in a cohesive and consistent healthcare. And cohesion and consistency comes through unity, which is why the DHBs need to be replaced with Health New Zealand, a centralised authority that will take control and responsibility for our health system. This, of course, is entirely congruent with the key recommendations of the Simpson report released last year.

One thing I want to make very clear, also because of previous comments, is that communities will remain at the heart of the system. This is something that this side of the House knows only too well. We understand communities. Most of us come from a grassroots, organising, activist base. We understand what that means and what it actually means in reality. With the additions of locality networks, which the Minister of Health has described earlier on, each of which will be within the health sectors for regional divisions, that’s the means by which to ensure local voices are effectively heard. If anybody thinks that having a triennial election—and I think, as a member on the other side of the House mentioned earlier on, with the misfortunes of an STV system and all of the name recognition sort of criteria that almost certainly guarantees election—if that accounts for local representation, then we’re not doing things correctly.

Another key pillar of reform proposed by this bill that we’re discussing tonight is the establishment of a Māori Health Authority, which will ensure we give a strong voice and provide a vehicle for change for those many New Zealanders that are disadvantaged by the current arrangements. And despite earlier contributions, which I think tended to trivialise lived experience and tended to trivialise all of the planning, the governance, and the strategy—all of the work that goes into making sure that when a member, any particular member, rocks up to their GP and may not care who that GP is—it’s not indicative of all of the reality that goes into making sure a system is fair and equitable.

Who better to commission Māori health services, who better to monitor Māori health outcomes, and who better to develop Māori health policy, than Māori? Detractors will of course say that we’re creating some sort of two-tier system and favouring one group of people over another, but that’s trivial, it’s silly, and it’s simply not true. In fact, the opposite is true. The Māori Health Authority is a distinct entity, but it is one that will work in partnership with the other relevant entities as we take a much needed, more robust, holistic approach to health. Equality in health achieved by raising healthcare standards and accessibility to all New Zealanders is the intended outcome, and it’s the intended outcome of this bill. Indeed, it will be how this aspect of the bill will ultimately be judged.

This bill has significant ramifications for the Ministry of Health as well, as it now will focus and pivot towards more policy and performance monitoring. The ministry, I’m glad to see and feel very reassured by the Minister, will be appropriately resourced and strengthened to facilitate the implementation of these changes, and, you know, as other people have talked about, there were various other additions to the public health agencies and to make sure that we boosted those resources as well.

Even from my very brief outline, this is a significant piece of legislation with wide-reaching impacts on society. It has, accordingly, been prepared with a great deal of care, incorporating extremely valuable contributions from a wealth of experts, including Heather Simpson, as we’ve discussed previously, and the rest of her team; including the Waitangi Tribunal and a raft of primary- and community-based services and medical specialists. The Labour Party manifesto recognised that, over the last three years, we have made record investment in health, playing catch-up after years of neglect. This bill also supports to build us back better as we learn from our strong COVID-19 response and inculcate all of those lessons into the design of this new national health system; something to be really proud of.

I’d like to acknowledge the work of Minister Little, Minister Henare, Minister Verrall on this particularly really exciting piece of legislation. They’ve obviously consulted widely, they’ve listened to the key stakeholders, and they’ve considered a variety of viewpoints in the preparation of this bill, and it’s really evident in the quality of this bill. I said on numerous occasions—in response to a question earlier on in the night—I said on numerous occasions during the election campaign that we can’t keep doing health the same way as we have done and keep hoping for better outcomes. Something needs to change. So I will follow with great interest the progress of this bill through the House and through the select committee process. I have no hesitation at all and am in fact quite excited to commend this bill to the House.

Penny Simmonds—five minutes.

Well, you have to admire the previous speaker Tracey McLellan’s optimism—like lambs to the slaughter. I rise to speak in opposition of the Pae Ora (Healthy Futures) Bill. I spoke earlier today about the review of the vocational education sector, and you might say—and I’m sure Dr Webb will say—“Why is that relevant to the disestablishment of the DHBs and the setup of Health New Zealand and the Māori Health Authority?” It is relevant because it is an absolute prelude to what we are going to see in the health sector, and because actions speak much louder than words.

Three years ago, we heard exactly the same arguments from the Minister of Education about the vocational education sector, and then he gave exactly the same solutions. We heard that the lack of equity of performance for Māori was an issue in the vocational education sector, and it was. We heard that geographic location prevented equity of access. We heard about lack of equity of the disabled. And then we heard the same solutions: centralise, put it into a head office in the centre that can be controlled by the Government, because only the Government can solve these problems! We heard economies of scale would fix everything. Well, here we are.

Here is the review so far of what happened in the vocational education sector. It didn’t save money; it cost more and we are doing less with more. It is less efficient. It won’t be nimble; it will be bloated, cumbersome, slow, heavy, and bureaucratic—and so will the health sector be. It won’t address pockets where there are viability issues, because, quite frankly, there won’t be any accountability for anyone to be held accountable to do that. It won’t involve local community consultation. It will have some window-dressing local consultation but it won’t have any power. And here’s the big one: it won’t address equity issues for Māori. It hasn’t done it in the education sector and it won’t do it in the health sector.

I don’t know when this Government is going to understand that changing the packaging doesn’t change the content; different wrapping won’t change anything. It will cost lots of money, and that money will go to consultants. It won’t go to doctors or nurses. It won’t go to better care for patients. The only winners in this will be the consultants, just as they were in the vocational education sector. Now, it’s sad, but we have seen this little prelude of what is going to happen. We’ve seen lots of money being spent, lots of change around the packaging and the wrapping of it, but we haven’t seen anything substantial that helps the students—and we won’t see anything substantial that helps the patients.

I heard my colleague Matt Doocey say, earlier on today, speaking on this, that he challenged each Labour speaker to come up with what was going to be better and improved for patients, and they couldn’t come up with anything. I’ve waited and I’ve waited. There’s been lovely, theoretical “It’s going to make it so much more wonderful because it’s going to be centralised, and we’re all going to be so happy that it’s all being driven from the middle.”, but I didn’t hear one example of what will be better for the patients.

So you might say that it is not an exact replica of what is going to happen in the health sector. You might say that the mistakes that have been made with, say, KiwiBuild or light rail or bridges for walking and cycling are just a bit of a blip or a mistake; this one is the example of what happened when this Government actually made a change and centralised and it didn’t improve things for the students one little bit. It will do exactly the same thing for the health sector. We’ll be—

Order! Order! Sarah Pallett—five minutes.

Thank you, Madam Speaker. It gives me great pleasure to rise in support of Pae Ora (Healthy Futures) Bill, a bill which, as we’ve heard, will protect, promote, and improve the health of New Zealanders, and will help to achieve equity by reducing health disparities among New Zealand population groups and, in particular, for Māori. Because, you know, we are only as healthy as the least healthy of our communities. It benefits us all to improve access to health services and to iron out the inequities experienced by Māori, by disabled, by Pasifika, and by rural communities, among others.

I heard Mr Doocey earlier refer to pae ora, this wonderful bill, as a wrecking ball, which was hyperbolic in the extreme. But actually, as an analogy, I can go with it, because coming from Christchurch, I know what you do with a building that’s munted. I know what you do with a building that has botched repairs, where we’ve tried our best over the years, where it’s old, it’s falling to bits, it’s not fit for purpose, sewage might be seeping through the walls. Do you know what we do? We dismantle it carefully. We save what we can save, those kauri doors and floors, those lovely window frames, and we build back better. That’s exactly what we intend to do here.

I’m going to speak here for a minute or two on the Māori Health Authority, and forgive me as a Pākehā woman who has come from the United Kingdom. But I’d like to address a few remarks to those few correspondents who feel that Māori somehow are being given special treatment. Because, quite frankly, you don’t want the health outcomes of our Māori whānau. Māori life expectancy is considerably lower than that of non-Māori. Mortality rates are higher for Māori than for non-Māori, at nearly all ages, and Māori health status remains unequal with non-Māori across all chronic infectious diseases, as well as injuries and including suicide. Now, the Treaty of Waitangi guarantees Māori equal access to national resources, and the Government has an obligation to ensure that Māori have at least the same level of health as non-Māori. Now, the Māori Health Authority will work, as my colleague Dr McLellan said, in partnership with Health New Zealand. But it’s not just Māori, Pasifika, disabled people, and rural people who will benefit.

A little bit about me: you probably know by now that I was a midwife before I entered Parliament and a midwifery lecturer. I’ve worked both in rural and remote rural communities as a community-based lead maternity carer, as well as in a busy central city hospital. I’ve seen the direct result of having multiple DHBs of various competencies that are unable to communicate with each other. I’ve seen the effects of having 20 DHBs all trying to do the same thing and using resources that should be better centralised. My colleague earlier, Dr Liz Craig, spoke of do it once, do it right. Don’t do it 20 times. Don’t use 20 times the resources. Let’s do it properly. In practice, for me, what it meant was that I could have a client in Canterbury and I could use the computer systems to input all their data into Canterbury District Health Board’s system. But if they headed to Southland for a holiday or a break and they needed urgent care, the systems were unable to communicate with each other. That’s just one really, really small piece of information and how we are negatively affected by the system that we have at the moment, and why it is that building that just has botched repairs once too many times.

So the DHBs, as we’ve heard, are going to be replaced by one national organisation. We’re going to have a new Māori Health Authority. We’re going to have a new public health agency. But this is all going to be done with a robust select committee process. I really look forward to hearing from the community and from the public about how we can make this piece of legislation the best possible legislation that we can because, quite frankly, that’s what we do, and we do it really well. I am personally extremely grateful for the forward thinking of these Ministers, Minister Little, Minister Henare, and Minister Verrall, who’s obviously involved too. They have been courageous enough to face up to the inefficiencies of the current system and the inequities that it produces. They are facing up to our Treaty obligations and creating a health system that will serve us all now and in the future. I commend this bill to the House.

Kia orana, Madam Speaker. It’s a pleasure to rise and take a call in support of the Pae Ora (Healthy Futures) Bill and very much a pleasure to follow my colleague Sarah Pallett and the optimism that I hear from her in terms of what this change will mean for our country.

I want to start by acknowledging the Minister of Health, who effectively has introduced this bill to the House today and has set this on a particular path of reform that is really exciting. So to the Hon Andrew Little, I acknowledge him and his work. Can I also acknowledge the Associate Ministers, Minister Henare, Minister Verrall, and Minister Sio as well for the work that they have undertaken, because at the core and at their heart is really for the betterment and the good of our people, and I do want to acknowledge that.

What we’ve heard from members opposite is essentially—you know, we have Mr Doocey, we’ve had Miss Simmonds talk about how members on this side, and I’ll speak for myself, haven’t answered their questions. Well, I’ve got news for them. I’m not here to answer their questions. I’m here to answer the questions that my constituents and my communities have elected me to this Parliament to represent on their behalf, and the questions that they ask me are: what we are going to do as a Government to ensure that members of our Pasifika community are not dying younger, are not getting sicker, are not having illnesses that, quite frankly, can be set aside. Those are the questions. Those are the issues. That is the heart of the problem and what we are providing as a Government to our community, to our Māori, to our Pasifika, and to our disability communities are answers—answers that are long overdue.

This will provide an opportunity in—what?—20 years to reform the health sector in Aotearoa New Zealand. It is something that certainly my communities have been calling out for, for quite some time, and even though this is at an early stage they thank me and the Labour Government for wanting to do something about it, for wanting to act, for wanting to make sure that not another Pasifika person dies younger than they should. That’s the bottom line, that’s the reality of this bill, and that’s why I am absolutely proud to be part of a Government that seeks to deliver in that particular space.

We’ve heard a lot about the issues. Now, as members of this House we all experience those issues at a community roots level. In the conversations that we have out and about in our community, we hear about the inequity, we hear about those significant concerns that exist, we hear about the concerns for our Māori community, for our Pasifika community, for our rural community, and for our members of the disability community as well. Colleagues have referred to this postcode lottery. And when I think about number 4412, which is my local postcode, for Palmerston North, or 9481, which is the postcode as I understand it, for Palmerston in the South Island—let’s not get confused amongst the two—but someone, whether they are in that postcode or my postcode, shouldn’t be treated any differently. They should have equitable access to healthcare in Aotearoa New Zealand and this change is doing exactly that. These reforms will give the reform space the attention but also the resource that is expected and that is required as well.

When we reflect on the existing experience that—you know, people have certainly talked to me and I’m sure others in this House about the systemic failure. They talk about their experience. They talk about their inability to navigate the system. They talk about and share their experience in simply just wanting to give up because it’s not as easy as it should be. When we live in a society and we live amongst a community where people are making those sorts of decisions, then that is a sad indictment on the state of healthcare and health reform that’s required here in this country.

This will be a dedicated and a connected health service for all New Zealanders. But I acknowledge that this particular bill that’s before us at the moment has a particular focus on wanting to do something for our Māori, for our Pasifika, and for our disability communities as well. But that doesn’t mean that others will be left behind; far from it. Members in my community that talk to me about being able to access local services is a regular occasion. In actual fact, Palmerston North in terms of access to GPs to general practitioners, is amongst the worst in the country for my community. Now, these reforms in terms of the localised options in these locality plans that Dr Tracey McLellan touched on, will do something about that, and that’s just one part of this reform package.

The pleasing thing from my perspective is that this bill is based on a set of principles. As I made a contribution in the House last night around remuneration, I reflected on the fact that a good starting point is one where principles are front and centre. So when I look at what’s in clause 7 of the bill before us, the principles are outlined that “the health system should be equitable”, that it’s about an ability for Māori and other population groups to have access to services, to have equitable levels of service to achieve equitable health outcomes. I say to other members in this House, what is wrong with that? What is wrong with wanting to ensure that members in our community actually have access to services, that they actually receive equitable level of service, and that they have achieved equitable health outcomes? Absolutely nothing wrong with that. Those are the principles. Actually, there are more than that. There are a number of principles that are outlined in terms of decision-making opportunities, and it’s all contained in clause 7. I could go on.

In terms of my own local community, I think of the good folk at Te Tihi. I think of the people at Whakapai Hauora, the people at Te Waka Huia o Manawatū and the good work that they do and will continue to do with communities that otherwise could be seen as disadvantaged—communities that are large in terms of socio-economic deprivation. And I know that actually the work that they will continue to do will be better enhanced, will be better resourced, will allow for their communities of interest to be able to access good services because of the reforms that this particular bill and this particular Government have on the agenda. Because at the end of the day, it’s about removing barriers, right? It’s about ensuring that people can access what is a fundamental right, and that is access to public health here in New Zealand.

Colleagues have touched on the various reforms in the organs and, yes, there’s Health New Zealand, which has a long-term lens, working in partnership, as colleagues have said, with the Māori Health Authority, again with a longer-term lens focused on delivery of service, commissioning opportunities as well. But also, let’s not forget that the Ministry of Health has a revised dedicated focus in terms of policy development and policy advice, but also the Public Health Agency, which will be included within that ministry, as colleagues have touched on as well.

I have an education background, but when I started my first year in teaching actually was teaching senior health. And so I reflect on the contribution earlier this evening from Dr Kerekere, where she effectively referred back to, well, a few things, actually, but Te Whare Tapa Whā and the importance of all parts of our wellbeing and hauora in order for us to thrive and be contributing members of our community and our society. That’s what I want for members of my community. That’s what I want for the people that have put me here in this place. And that’s what this particular bill delivers: a dedicated connected health service for all New Zealanders, but at the same time, acknowledging that there are some in our community that are unable to access what is a primary right. It is a responsibility, I believe, of the State and therefore this Government to do something about it.

In conclusion, I just want to say that this reform, even though it’s 20 years in the making, is long overdue. It will make such a difference to my local community, my Pasifika community, my Māori community, and the wonderful people of the Manawatū. To see those individuals and Kiwis being able to avoid what are unavoidable inequities will be a huge, huge achievement and I look forward to seeing this bill progress through the select committee. I am sure that the select committee will hear from a number of members of the community and organisations and entities, and I hope that people do submit on it because, you know, the select committee will be open to that process. But as I say, this is a wonderful bill. It’s a great opportunity to do something to support what is a fundamental right of all people who call Aotearoa New Zealand their home.

Thank you, Madam Speaker. In rising to take this call this evening, it’s with measured trepidation, considerable measured contemplation, because that’s just drawing and reflecting over the last three decades of my life of service and reflecting on the life of service of those who’ve gone before and those who are still here. So I make acknowledgment, particularly, to our Māori health sector pioneers: Dame Tariana Turia, Meihana Durie, and of course Professor Whatarangi Winiata. They are kaumātua who before my time here, I’ve had the privilege of being alongside them in learning. And of interest, this is about relationships. I am moving to the bill, because the bill is specifically premised on the divide between Māori and non-Māori. And the recognition of the status of the Treaty of Waitangi, Te Tiriti o Waitangi. However, in that recognition, I’m mindful also that since 1840 there’s been an evolution of what the nature, the meaning, the relevance, and relationship that we as a nation of Aotearoa New Zealand, we as the peoples of Aotearoa New Zealand, have based fundamentally on that foundational document of our nation and our relationship as peoples.

I said I rise to take this call with measured trepidation, because I know that my people will judge me. But something also that I know is that my ancestors, my tūpuna, taught and passed on through the generations the importance of leadership, and with that the importance of values, and with that the importance of fearlessness in one’s advocacy and representation. And that is a tool passed to me that was shaped and honed in my learnings and in my application as a lawyer and as an advocate: one of fearlessness.

As is well-known, I am a member of the National Party and the National Party does not support this bill. I concur with that, and the reason I do is premised on my lifetime of experience, reality, and pragmatism. I am well aware over the decades, of the findings and the recommendations that have come from many in the way of legal jurisprudence and jurisdictions of the Waitangi Tribunal, but importantly the mātauranga and the whakaaro of my tūpuna and my ancestors. I draw on that also, importantly, because this bill is premised on a hope that this will address the disparity of health inequities in our nation for Māori. However, Māori are not the only peoples of this nation of Aotearoa.

My ancestry is as Māori. My ancestry is also as Pākehā. So I will just move back to the evolving nature and relationship of what the Treaty of Waitangi means. And I invite people in contemplation and further debate, and I invite respectful debate, irrespective of the differences that we may have in view and life experience—respectful debate, without scorn or without laughing or without diminishing. The Pae Ora (Healthy Futures) Bill is a 94-page document. Well-intentioned, aspirational as it is, it is about recalibrating and resetting the framework of the delivery of health services within Aotearoa New Zealand to address and provide better health equities. I’m not convinced that it does.

And I say that I’m not convinced because—this is going to undoubtedly be passed into law because the Opposition does not have the numbers—it will bear out in time to show that despite the good intentions, it is not going to deliver the way that we hope and we aspire for it to do. Why do I say this? Back in 1998, along with my whanaunga Dame Tariana and her now deceased husband George, we embarked on setting about establishing the first Māori health provider in Aotearoa New Zealand: Te Oranganui iwi health authority. And I go to that medical health service to this very day and my children have done since they were born as well—28 years it’s been in existence. What has evolved over time too is well known is that Dame Tariana was the champion for Whānau Ora—the coleader of the Māori Party with the National Party. And we put that into the fabric and the fibre of the health sector of Aotearoa New Zealand as it is today. Whānau Ora is about delivering to our people at flax roots, ground level. Despite all the good intentions, the Māori Health Authority is a recalibration and a reframing of a bureaucratic institution standing alongside another public health authority. I am not convinced that that is the way to go. I have screeds of notes here before me, but I am speaking as I know it, and I will refer to those notes at another time.

But I say, I’m not convinced that this bill is going to calibrate the way that we would desire and hope that it does in addressing those health inequities in our nation. I’m not convinced because we’ve seen, during this COVID time, that the Ministry of Health has put the handbrake on the funding to go to the very people we know who know our communities, who know best to be resourced to provide and deliver to our people in the communities. Now, if it’s thought that a Māori Health Authority, which is going to be a bureaucratic institution that is going to be filled with the elite—it is going to be filled with more bureaucrats and it is going to take the pūtea, the funding, the money that is desperately needed to be rerouted directly to our people who are of the most vulnerable and of the most need. We’ve seen that during these COVID times and we’ve seen and we’ve heard the Minister direct his ministry to say that money goes directly to our service providers, our Māori communities, and our vulnerable on the ground. And they will be the ones to deliver. So really, we have hope, I have hope, but I am a person who’s based on pragmatism and reality and lived life experience.

There are other components to this bill that are important. Essentially, it establishes three entities: a Health New Zealand entity, which is the new Crown agency; a Māori Health Authority, which I’ve spoken to; and a Public Health Agency, which means is, effectively, the current Ministry of Health. The key message that comes at this point in time is we are in a crisis as a nation with our health crisis, but also our crisis as a nation in terms of what is our identity. What is our identity? Are we going down a pathway where we separate out? And I know full well the relevance and the significance of the relationship and the status and the standing of mana whenua of this nation, but I also know full well the relevance and the significance of those whom we stand alongside, and should we be going down separate pathways.

There will be robust and respectful debate that I invite on this, but I will invite also members, before we come back to the second reading of this bill—distinguished Professor Dame Anne Salmond, in her article she talks about how we could be designing a new institutional order, which is a big picture of Aotearoa, rather than Māori verse non-Māori. Look at provoking ways of imagining those relations and relationships that we have with each other. There is an opportunity to rethink identity in terms of whakapapa that includes other living systems and lifeforms. Whanganui, Te Awa Tupua, we are evidence of that in terms of the legal personification of our living life source of our awa and our river. And Dame Anne Salmond also talks about bringing together ideas of whakapapa and complex systems in designing new institutional forms of order in Aotearoa as well as relationships between people. I do not support this bill.

Thank you, Madam Speaker. I am overjoyed to be able to stand here and wrap up what’s been an interesting afternoon of debate. We’ve heard a lot from that side of the House—the side of the House that is not going to be supporting this bill. That side of the House that doesn’t want to talk about Te Tiriti o Waitangi and the partnership obligations that we have—

💬 Harete Hipango: I just did.

TĀMATI COFFEY: —as a Government to be able to deliver—Yeah, one, one. I’ll give you that Harete, but you’re still opposing this and so for that reason I just need to acknowledge that actually everybody else on that side who has stood and spoken today has not acknowledged the partnership. Everybody is really keen to stand there and talk about Māori apparently taking over the system, talking about the inequity but not really talking about the nub of it, which is about partnership. This is about partnership.

Members over there, over on that side, challenged us and said “What’s going to change once this comes in?” I’ll tell you what’s going to change, Māori are going to have faith in our health system. I’ll say it again: what’s going to change? Māori are going to have faith in our health system. Because that very principle that this whole reform is based is the principle of partnership, but also the principle of rangatiratanga. Rangatiratanga that was signed up to in 1840, and for so long our Māori people have been waiting for that seat at the table. Not just as advisers, we don’t want to be advisers, we’re over being advisers, we want to see that the decision-making table—and I heard it before, Penny Simmonds stand up and talk about the tertiary sector. Hey, there’s work going on there. And, actually, we’re sitting there with Joseph Mooney—actually we’ve heard from the Ministry of Education and there’s some great work happening with Te Pūkenga. Why? Because the clause in their bill expects them to honour Te Tiriti. Honour Te Tiriti. This bill is going to revolutionise our health system, because what does it do? It encourages us, it actually mandates our health system to give effect to Te Tiriti. This all comes back to Te Tiriti, and for those people that don’t understand that, you really do need to have a lesson. And actually, those people that do not learn from history are doomed to repeat it.

So what I want to do is I just want to talk for a moment, if you will, about once upon a time when we reformed our health system, back in the 80s, the early 80s. There was scepticism back then about what exactly our health system was doing for Māori. I want to acknowledge the Hui Whakaoranga, which happened in 1984. In 1984, there was a hui that was called, Māori showed up from all around the country—I want to acknowledge my colleague Nanaia Mahuta, whose mum was there and actually gave a presentation at the Hui Whakaoranga. So did Puti O’Brien, she came together to talk about the changes that were happening in small Māori communities that they said to the Ministry of Health and the Department of Education at the time “You need to get on board and help us to solve these issues.” Many of the conclusions that they reached back in 1984, the things that they were asking for are still valid now. They’re still valid now because we don’t have that equity in our health system. That’s why we did the review, that’s what the review told us, it told us that Māori were underserved by our current health system, it told us that we need to get rid of our DHBs and that we needed to have Māori sitting there in a partnership role giving them the rangatiratanga that they want over the health system.

I want to talk about some of the conclusions that were actually reached in that particular hui, and it was, as I say, it was very similar to the things that we’re talking about now and the things that we’re seeking to change. One of the conclusions: they want Māori people to be able to define health for themselves—1934, rangatiratanga. They wanted Māori to be able to identify their own specific health concerns and devise solutions to meet those—1984. They wanted to see health as part of who we are, where we’ve come from, where we’ve gone. They wanted to be able to involve taha wairua into our health system to make sure, to understand, to have a bit of cross-cultural understanding that actually te ao wairua is huge for our Māori people. This is really big—I want to tell a story about my dad, who was born without any skin. For two years he sat in the hospital, nobody knew what went wrong, it was my great-grandmother that called from the East Coast and said to my grandmother, “You’ve burnt some photos. You’ve burnt some photos and there’s a spell on him and you need to go back and you need to do a karakia and you need to fix it.” My nan did that and my dad’s skin started to grow back. Taha wairua is huge. The knowledge and the mātauranga that Māori have been denied for so long in our health system, has come to the fore through this bill.

This bill is going to change things, and it will change things instantly for our Māori people. They will see themselves reflected in the governing institutions, they will see themselves reflected in the governance board of the Māori Health Authority. They will understand that the health system is actually underpinned by rangatiratanga—the thing that we signed up to in 1840. The thing that we were crying out for in 1984 when Dame Whina Cooper stood there and said, at the Hui Whakaoranga, “We want more action.” We want more people to understand that, actually, Māori have got a valuable consideration and a valuable contribution to make. Not as advisers, but actual decision makers in this whole health system.

The fact that I’m going to die seven years younger than every other non-Māori person in this place is an absolute injustice. And yes, we should all hang our heads in shame about that. But do we just hang our heads? Or do we actually do something about it? Well, I’ll tell you what we’re doing: this Government is committed to doing something about it. We are going to do something about it. We brought this bill to the House. This is actually—this is not light, this has had hundreds of years behind it.

I acknowledge the signing of the treaty. I acknowledge the people that turned up to the Hui Whakaoranga back in 1984. I acknowledge the contribution from my colleague Elizabeth Kerekere when she talked about back in the day; Dr Meihana Durie and his te whare tapa whā model, and his want to be able to get that acknowledged in mainstream health. I want to acknowledge Dr Rose Pere with her wheke model from the Lake Waikaremoana, far off into the distance. She wanted everybody to understand that mātauranga Māori shouldn’t be separate to our health system and that actually te ao wairua is everything. And that’s the reason that there is so much distrust from many of our Māori in our hard to reach communities, because they don’t trust the health system. And actually, if COVID has taught us anything—if COVID has taught us anything—it should be teaching us that actually we need to turn that around. We need to be able to encourage our Māori to have faith in the system. How are they going to have faith in the system? We need to revolutionise it, and that’s what we’re attempting to do here. It’s not a complete revolution. We’re not throwing everything out and starting again. No, we have to work with what we’ve got, but we can tweak the systems and we can underlie it with some principles.

I know that, actually, the future looks bright for our health system. We need to, at every opportunity, encourage Māori to be able to create their own solutions for themselves. That’s what we’ve always wanted: by Māori for Māori. But actually, you know what? An extension of that. As my good colleague Meka Whaitiri talks about, “By Māori, for everyone.” Actually, that’s pretty cool because actually some of those concepts, some of those principles are actually worth considering. But for so long, Māori haven’t been at that table, and this is about to change that.

I want to acknowledge all of those iwi-DHB partnerships all around the country that have tried to put together a strategic plan and work towards common goals. But at the end of the day, the DHBs, they’re not doing a great job. That’s nothing to do with the workers that are actually working day in and day out in our healthcare system. That’s not their fault, it’s the system. And that’s what we need to change here. And that’s what we’re looking to do. We’re changing the system and we’re inserting Māori into this conversation like they should have been in this conversation in 1840. They weren’t there then. We weren’t there then. We’re here now.

For that reason, this is a significant piece of legislation. It will pass, but we want to make it the best possible legislation that it can be. So this is a karanga out there to everybody that’s listening via radio, via television. This is a call to those people that have ever experienced inequity in our health system to come forward and to put your submissions in, because we need to hear your voices. For so long, your voices have been quiet. For so long, you’ve been sending in your complaint letters. For so long, nobody’s been acknowledging you or seeing you. Well, today we see you. We hear you. We acknowledge you and we want you to contribute into this process. I commend this bill to the House.

The question is that the Pae Ora (Healthy Futures) Bill be considered by the Pae Ora Legislation Committee.