Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill

I move, That the Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill be now read a second time.

Thank you, Mr Speaker. We have laid out a plan for Māori health in the context of an overarching strategy with priorities that include decentralisation, the importance of health workforce, and targets. We have heard how Māori health providers often service non-Māori, sometimes even more than they service Māori. I recognise and venerate this and, in fact, have already moved from just those nice words to putting it into action with the announcement in December of a $50 million immunisation programme that utilises the special actions that Māori health providers can provide, and what mainstream cannot, or will not; their ability to reach into remote and vulnerable communities as part of the expertise that they have.

In that announcement, which at $50 million was not inconsequential, we funded Māori health providers to deliver to a universal audience. We backed them. These are tangible actions, not just words. Yes, I did say transition would be in my kind hands, in reply to a previous speech. What I would suggest is ask the staff: is there any time in this process when there has not been respect and consideration?

In my first reading, I asked Māori Health Authority staff to join me—hardly demeaning but more encouraging and collaborative and hopeful. I have enjoyed engaging with Māori health providers and leaders as I’ve sought to find a way forward for what might deliver better health outcomes, including meeting with Iwi-Māori Partnership Board chairs and a Zoom meeting on or around 6 December, as I recall, and others who have contributed wisdom to the position we find ourselves in today.

To conclude, briefly, I’ve described the changes that this bill brings about: (1) Māori Health Authority staff to repatriate to Health New Zealand and the Māori Health Authority; (2) uplifting of the Hauora Māori Advisory Committee; (3) uplifting of iwi-Māori partnership boards; (4) reconsideration of localities. The plan is clear and we believe this plan will deliver better health outcomes. Kia ora mai tātou.

The question is that the motion be agreed to.

Thank you, Mr Speaker. We said, on this side of the House, that we will continue to interrogate the words in this bill and we will oppose this bill all the way through the stages of the House. Now, I want to touch on a number of those clauses within this bill that we will be looking towards interrogating as we come to the committee of the whole House. I also want to state here it plays into what’s already been made clear—well, actually, it’s quite unclear from this Government—and I want to draw the House’s attention to clause 6 in the bill.

The reason I want to do that is what we’ve heard from the ACT Party in this House is a Treaty principles bill, and that they want to have this discussion and then we hear from the Prime Minister that they won’t be supporting that bill beyond a particular stage of the bill. But what we read in this particular bill that we are debating here this evening is subterfuge. We are reading in here that this Government is already tinkering with Te Tiriti o Waitangi and its principles, and it’s laid out clearly in clause 6.

This is a Government where the Prime Minister stands up in Waitangi and in front of everyone in this country and says to everybody, “No, no, we won’t be supporting the Treaty principles bill; we are here to work with Māori and we will continue to support Te Tiriti o Waitangi.” Clause 6 of this particular bill that we are debating here tonight is clear subterfuge and straight-out play by this particular Government to make sure that they can continue to tinker with Te Tiriti o Waitangi.

When we were in power, we made it clear that Te Tiriti o Waitangi must continue to lead the Māori health aspiration. It’s riddled all the way through the whakamaua, which the Minister has already referred to this evening. It’s already in the GPS—the Government policy statement—and we wanted to make sure that it was throughout the entire system. What we are seeing from this bill and this Government is a clear play to change Te Tiriti o Waitangi without even going to the community to talk about it; without even allowing whānau right up and down the country to have their say on this particular bill.

Andy Foster: What are you talking about?

Hon PEENI HENARE: Now, the members on that side of the House say we are talking about it right now. No, they’re not; they’re only taking one-minute calls. I encourage them to get up, let’s debate these clauses in detail, Mr Foster—in detail—and make sure that we can have that robust conversation. I can tell that side of the House that all of us on this side of the House have spoken to the communities who these changes impact the most: Māori communities—Māori communities—even Pasifika communities. A known fact amongst our people: for those aged under 25, just over 50 percent of those people who are Māori are also Pacific. It impacts our communities right up and down this country, and this side of the House knows the sentiments and the feelings and, indeed, the wisdom towards this bill far better than the other side of the House.

We heard it already, that “We received the mandate in the last election.” Well—

Debbie Ngarewa-Packer: Not from Māori.

Hon PEENI HENARE: —not from Māori, they didn’t; not from Pacific, they didn’t. That’s clear as day to each and every one of us on this side of the House. That side of the House might choose to sit in ignorance and choose to sit there with blinkers on to the actual needs of Māori. I want to reiterate that point.

The Prime Minister has stood up publicly in this House, saying he will vote down a Treaty principles bill. Yet right here is a clear example of this Government tinkering and changing Te Tiriti o Waitangi to suit their aggressive Māori policy agenda.

Dana Kirkpatrick: We’re not changing Te Tiriti. How is it changing Te Tiriti?

Hon PEENI HENARE: Read clause 6—read clause 6. I encourage those members to get up and speak to it and explain why they are going to be changing this.

This lends itself further to the need for the Waitangi Tribunal to be able to prosecute this case and indeed offer recommendations for the consideration of any policy and anything to do with Māori health moving forward. It’s clear from this Government that they choose not to listen to those experts. Some people think that the Waitangi Tribunal is simply there to make recommendations and even—I’ve heard calls from the other side of the House that they are biased. I can speak to much of the work of the Waitangi Tribunal and say this: not only are their recommendations well considered, they also act as a body to store knowledge, to store information, and to store statistics relevant to the points that we are making here today with this bill and the cases in front of the tribunal.

What we’re not seeing from this Government is a commitment to looking towards those recommendations of the tribunal, yet we heard just now from the Minister that he has met with whānau and iwi right across the country. Well, I put to the House that that actually hasn’t been the case; that when we established Te Aka Whai Ora—very soon we’ll be rolling out the list of all the people we met with from Māori health providers, communities, experts, not just Māori health experts but health experts from right across the world, in fact—who all called for Te Aka Whai Ora to be built. Yet when we look towards the diary programme of the Minister and even his colleagues with respect to this matter, we can’t find the kinds of connection that they claim to be making here in the House.

We’re going to go further into the bill as we look towards some of the words that are changed and have been changed or will be proposed to be changed. We were quite clear when we established Te Aka Whai Ora that it had to be a “must”; that it had to be driven to make sure that they deliver for the people that they serve. What we’ve read in this particular bill are some changes to “may”. Now, for most people, that might not sound like much, but “must” and “may”—there are huge differences there.

The Minister, in his speech for the second reading, also spoke about the iwi-Māori partnership boards and supporting decentralisation. In this repeal bill, what it’s proposing is that the iwi-Māori partnership boards can only be constructed or approved by the Director-General of Health. Under the current bill as it stands right now before this repeal, actually there was a process there to go through Te Aka Whai Ora—the Māori Health Authority—to continue to consult and to make sure that in order for it to be recognised, it had to go through that process.

What this bill is proposing to do is cut out the voice of Māori and the recognition of themselves to be able to say, “I am an iwi and I want to be an Iwi-Māori Partnership Board to continue to serve my people.”—and this is the right process to be able to do that. What this bill does, however, is actually just say, “No, no, we’re going to put it in the hands of only the Director-General of Health.” Now, while I respect the Director-General of Health—the current one and indeed the one that we worked with in order to establish Te Aka Whai Ora, Sir Ashley Bloomfield, who was hugely supportive of the work that we did for the health reform and of course for Te Aka Whai Ora—what we’re seeing here is a continual silencing of the Māori voice as we look towards things like the Iwi-Māori Partnership Board that the Minister and that side of the House pretend to commit themselves to and pretend to support. It’s just not true, and it’s playing out not only in their words, because it’s contradictory to what’s being proposed here in the bill. We will also go on to interrogate the Minister, in his speech, talking about the simple repatriation of Māori staff or staff into the health system again—or into Health New Zealand or Te Manatū Hauora.

What the Minister just described there is the status quo. It’s simply the status quo. It’s going exactly back to where it was. What happened when it was like that? The health statistics for Māori continued to be poor. The outcomes for Māori continue to be poor. The Minister in the House here has just told everyone it will go back to the status quo. I can tell the Minister who claims to have met with the whānau to say that he will care for them and look after them, I can say that actually many of them left the status quo because it wasn’t working. They were going to something new and to try something new that will continue to provide for the aspirations of Māori health.

Now, sadly, from the other side of the House, all we’ve heard is the status quo. The status quo on steroids can only tell me one thing: that it’s going to go backwards even faster—the status quo on steroids tells me it is going to go backwards even faster.

The other side of the House talk about targets. We will continue to hold this Government to account. The Minister himself spoke about a $50 million fund to lift the rates of immunisation across the country. When I asked him about that matter not a couple of weeks ago, he spoke about a data system. That’s all he spoke about, a data system. He didn’t tell us how and how much we are going to lift the immunisation rates of our tamariki—in the House, on record, when asked about it, he talked about funding a data system. Tell me how that lifts, in a practical way, the immunisation rates of Māori. We continue to oppose this bill and we will continue to interrogate clause by clause.

Tēnā koe, Mr Speaker. I’d like to take the opportunity as an uri of Te Tai Tokerau to invite the Minister of Health and his colleagues to stand on Mōkau Marae in Whangaruru and address the people of Ngāti Wai, to come to Ōtīria Marae in Moerewa and address the people of Ngāti Hine and talk to us about this reform—talk to us around why Te Aka Whai Ora isn’t good for our people. As we mobilised hundreds of people to attend locality meetings, hundreds came to Moerewa to talk about their local health priorities; whether it’s Matawaia, Waikare, te Rāwhiti, vanloads of whānau arrived to talk about their health goals and aspirations, because that’s what localities provided. It’s an opportunity for our local voice, whānau, hapū, marae, community, local government, and the sector to come together and about what is best for their communities.

Let’s be clear that successive Governments have breached Te Tiriti obligations through the generations by failing to protect the health and wellbeing of te Iwi Māori. In 2019, the Waitangi Tribunal report for Wai 2575 confirmed the view and states that our primary healthcare legislation and policy breaches Te Tiriti and fails to care for Māori health and wellbeing. The system has failed to look after Māori, and we know this because Māori die at twice the rate of non-Māori from cardiovascular disease. Māori tamariki have a mortality rate of 1.5 times more than non-Māori children. Māori are more likely to be diagnosed and die from cancer. Nau mai ki Te Tai Tokerau.

[Welcome to Northland.]

Māori die, on average, seven years earlier than non-Māori in this country.

The Waitangi Tribunal report into hauora found that the legislative framework of the New Zealand primary healthcare system should recognise and provide for the Treaty of Waitangi and its principles. The report recommended the following principles for primary healthcare: te tino rangatiratanga, the guarantee of tino rangatiratanga, which provides for Māori self-determination and mana motuhake in the design and delivery and monitoring of the health and disability services; equity, the principle of equity, which requires the Crown to commit to achieving equitable health outcomes for Māori; active protection, the principle of active protection which requires the Crown to act to the fullest extent practical to achieve equitable health outcomes for Māori; options—I’m big on options; I love a bit of options. And there’s a principle of options from the Waitangi Tribunal which requires the Crown to provide for and properly resource Māori health and disability services.

But, furthermore, the Crown is obliged to ensure that health and disability services are provided in a culturally appropriate way that recognises and supports the expression of hauora Māori models of care, aka mātauranga. Partnership: the principle of partnership, which requires the Crown and Māori to work in partnership in governance, design, delivery, and monitoring of health and disability services. Māori must be the co-designers with the Crown in the delivery of primary health systems for Māori. That’s what Te Aka Whai Ora was doing; it was designing the health system alongside Te Whatu Ora as partners.

Now, let’s look at Te Aka Whai Ora. They were there to ensure that the planning and delivery of services responded to the aspirations of whānau, hapū, iwi, and Māori in general. They were there to design and deliver and arrange for services that were in accordance with the Act, Te Pae Ora, our pathway, our road map, and to achieve the best practical outcomes for whānau, hapū, and iwi in general. And then to promote Māori health and prevent and reduce and delay the onset of ill health for Māori, including collaborative approaches with other agencies, organisations, individuals to address the determinants of Māori health. I hark back to localities. Bringing local government into the conversation. Hauora is everyone. We’re all in this together—localities provided for that.

So I question: where is the good faith of this Government in working with us as te Iwi Māori to address the well-documented evidence of Māori health inequalities? Now, in the urgent hearing, which is before the Waitangi Tribunal, the Crown opening submissions shared on 23 February 2024: “For completeness, the Crown does not intend to raise the issue of whether engagement with Māori carried out by the current Minister of Health while in Opposition met a standard of consultation required under Te Tiriti and its principles. Accordingly, it does not intend to adduce evidence from the Ministry of Health.” So I guess the question is: did the Minister engage with te Iwi Māori while on the campaign trail in 2023 on the proposed scrapping of Te Aka Whai Ora? Because we’ve heard it’s been promoted for quite some time. Did he engage with te Iwi Māori on his proposal? Now, as the Minister of Health, did he carry out any engagement with te Iwi Māori on the proposal since becoming the Minister, and, if he has, who’s it been with and when was it and what response has he received?

It’s been reported that Te Aka Whai Ora will lift and shift into Te Whatu Ora; so indicating that somehow it’s just simply pick up the team—nearly 300 kaimahi—and put them into the mothership of Te Whatu Ora. Now, I have to query the transition plan for our Te Aka Whai Ora team, because you’re moving an ao Māori perspective into the mainstream ecosystem of Te Whatu Ora, and they may not have the capacity and competency to understand the Ao Māori world view that our team has. I question what work within Te Whatu Ora has been undertaken to uphold Te Tiriti o Waitangi and address the recommendations of the Waitangi Tribunal report 2575.

In Te Whatu Ora Health Status Report 2023, Te Whatu Ora will meet the requirements and expectations of the Pae Ora Act by enabling Māori to exercise authority over health, in accordance with Māori philosophies, values, and practices. Can the Minister confirm how Te Whatu Ora is going to enable Māori to exercise our authority over Māori health in accordance with our Māori philosophies and values and practices? He pātai miriona tāra tērā.

[That’s a million-dollar question.]

I ask this because it’s a fundamental question as to how this Government believes it knows best in terms of how to deliver health services for Māori. Te Whatu Ora is required to have capacity and capability to understand kaupapa Māori services, cultural safety, and responsiveness of services. Now, I query the board of Te Whatu Ora. There are currently two Māori members of Te Whatu Ora. And with the ending of Te Aka Whai Ora, the chair comes off that board, meaning that there’s only one Māori board member. So with only one Māori board member, does the Minister believe that the governance of Te Whatu Ora have enough Māori capacity and capability? What is the plan to increase the clear capacity and capability gaps on the board of Te Whatu Ora?

Now, if we look at the scrapping of Te Aka Whai Ora and shushing out community voice and te Iwi Māori voice, I reflect back on the submissions received on the Pae Ora legislation from November 2021 to August 2023—some 4,685 submissions. It’s an amazing thing to see the voice of our community come through the process. Now, we’re sitting in urgency, we’ve blocked out community voice, our people have no say on what’s happening right now. The creation of the 15 iwi-Māori partnership boards is a step in the right direction, and we know this—providing perspectives for whānau, hapū, and iwi in the design and delivery of healthcare. Now, that’s the mechanism for mana whenua to have a say. E te Minita, I ask and seek that we power up the iwi-Māori partnership boards, that we enable commissioning of services. Let’s go—let’s go.

But I do worry about the Hauora Māori Advisory Committee, because, in the new legislation, it’s not clear what their purpose is. Are they just an advisory board for the Minister of Health on hauora Māori as requested? How are the members to be appointed to this committee? Do iwi-Māori partnership boards have a role in nominating and appointments, or is it just purely a ministerial appointment process? The Hauora Māori Advisory Committee is a strong group. They’re health leaders. They’re professionals. Surely they could input and support the whole system: Te Whatu Ora, Ministry of Health, and the wider health ecosystem. Can we not power them up also?

I wish to note my observations around the Director-General of Health, because it appears that powers have been delegated back to that role in the new legislation to confirm iwi-Māori partnership boards. That’s interesting because, in my mind, surely the iwi-Māori partnership boards should be approved—

The member’s time has expired.

Thank you, Madam Speaker. There have been many societies in history who have seen their citizens based on something as flat as race, and often they regret it as they lose sight of the beauty of each individual. Whether the other side wants to hear it or not, this Government isn’t creating division; it is trying to restore trust in the society which the last Government trashed. There will continue to be support for Māori, by Māori health providers. This is about removing duplicate, expensive bureaucracy, whether in Wellington or Auckland.

For the benefit of Peeni Henare, I invite that member to finish his sentence on why he doesn’t have faith in the director-general. Iwi-Māori partnerships will continue to work with Health New Zealand to develop priorities to improve hauora Māori. Staff and structures will move to the Ministry of Health and Health New Zealand, and ACT supports this bill. Thank you very much.

Thank you, Madam Speaker. I rise on the second reading of the Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill. I’d just like to begin my contribution by noting the passion in this House today. That is because we all care very deeply about the health of New Zealanders, whether it’s our family, whether it’s people in our community, it is people right across the country. That’s why the contributions today are so passionate—so acknowledging our passion and also, too, acknowledging that there is a different way of getting to the same health outcomes. We all want to see increased health gain for all New Zealanders, and it is on that that New Zealand First stands by the health Minister, the Hon Dr Shane Reti, alongside our coalition Government, to be committed to improving Māori health outcomes.

We’re doing this in a different way: as the Minister noted, decentralisation is a key way we’re focusing on this; absolute health targets where we ensure that the outcomes will be positive not just for Māori but Pasifika and all other communities as well, and also addressing the huge workforce pressures right across the health system. It is our public health system that will deliver for Māori, it will deliver for Pasifika, and it will deliver for our vulnerable communities. But we must ensure that our public health system ensures that they are powered up in the right way.

We believe that Te Aka Whai Ora—and if we go back to the report that was written, the high-level assessment of Te Aka Whai Ora, the progress against Cabinet expectations, just a small note here: overall there had been insufficient internal capacity and capability to deliver. That’s the problem: it was not delivering health gain for Māori.

I just want to point to the Hon Peeni Henare’s comments relating to perhaps pretending to commit to the iwi-Māori partnership boards. Well, if I could draw his attention to Part 1, replacement section 15, inserted by clause 11, “Health New Zealand must support and engage with iwi-Māori partnership boards”. Under the previous legislation, the iwi-Māori partnership boards were nothing more than a token gesture. They didn’t have any commissioning powers to deliver health services for Māori. So, this way, under this Government, under this Minister, we will ensure that the health services will go down to the flax-roots. I commend this bill to the House.

I stand to speak to this bill, the reo—oh no, that was the other week. Beneficiaries—no, that was last week. Smoke-free—yet to come. The meth—sorry; this bill that is to do with the dissolution of our Māori Health Authority. I guess my point is that with 16 pieces of legislation coming through urgency, it’s really hard to keep track of which one you’re actually doing, because in an 18-month run—in an 18-month run; let’s not forget and lose sight of this—the Government keeps carrying on as if it has evidence. This is the fastest ever dissolution we’ve ever seen of anything in our lives. We’ve barely had our feet hit the ground, and, actually, we’re insulted by watching politicians stand up and speak for one to two minutes about kaupapa that are dear; not passionate. They’re about life and death for our communities.

Eighty-three percent of Māori didn’t vote for this Government, which is why there is such a comfort in what is being rolled out. So what we have here, in this whole whakaaro, we’ve had to not only endure listening to politicians that haven’t got the time to put any effort into this whakaaro but we also have to hear ourselves called “Marri” the whole time through this. I’ve got to tell you, there’s nothing more aggravating than actually not having ourselves respected, not only for who we are but how we feel about what is before us. You have allowed limited avenues for our people to be able to stand up and give their—

ASSISTANT SPEAKER (Maureen Pugh): I assure you, I have not.

DEBBIE NGAREWA-PACKER: —well, the Government—to be able to give our people the right to stand up, and I guess what we want to do is also remind ourselves. So while Māori were out there, defending this nation and looking after everyone, we had a leader of this Government who was out making sure that he shared the Māori vaccination code.

We are being deliberately corralled into a pocket of desperation and destitution, and I want to remind and reflect on the words of Sir Mason Durie, who is a Māori health expert—unlike anyone else that is in this House at the moment. Sir Mason Durie shared that the Māori Health Authority—Te Aka Whai Ora—was an “important step for Māori with implications far beyond the healthcare sector”.

This is an expert with 40 years of experience, with not a political bone in his body, who is really only worried about the wellbeing of our people. Instead, here, what we’ve got is an era of Government that won’t be transformational because it is seriously comfortable in an old system, using dollars as justification for change. Pumping chests, patting yourselves on the back, because you’ve given dollars—given millions of dollars—to something that actually is business as usual. That is what the Government’s job is to do: it’s to get the money out to the communities that need it the most.

So let’s reflect on this. So, in 1982, we had 55 doctors—55 Māori doctors. Now, we have 55 Māori doctors graduating a year, and, I guess, the hope that I have as I speak to our people is that if we were to put all our Māori health workers and authorities together, we would have a powerful vehicle for change. It is not going to come from this Government.

Iwi-Māori partnerships: now, they were put in, and I was always really critical of the fact that they had to have twice as many hui with half as much resourcing. What we want to ask and want to see from this Government—which we haven’t seen—is what was the Māori commission’s outcomes for a blueprint for Aka Whai Ora? How is it being upheld? How are they going to ensure that things are going to transfer back to Te Whatu Ora? What is your alternative model? What are you and how are you resourcing? How are the locality plans working, given that you have no data to say how they’re performing, no outcomes, and we haven’t seen any data outcomes since the DHBs were wound up?

So what my point is is that you cannot guarantee that we will not have more health inequities for Māori as we see this flip-flopping from a Government that wants to distance itself from the 100 days from the Government before it, and it really is worrying when we hear kupu about the commissioning agency and the approach, because Te Pāti Māori knows full well what’s required to get that up and running. Have you got the fortitude, the resourcing, and the commitment to let your non-Māori voters—again, remembering that 83 percent of Māori didn’t support this Government, I doubt very much that you have.

But I will take real caution and remind our people that we are, amongst ourselves, able to take on a Government that supposes that it knows more about us without us. This is not the first time we’ve had to contend with this type of approach to our wellbeing. I urge that we all work together, stand strong, and stand united as we continue to take this Government on with its anti-Māori agenda. Kia ora rā.

To be frank, our heart is still aching for the loss of our brother Efeso, and it’s hard to speak to this bill to do with Māori health—many of the issues that are faced by Māori are also faced by Pasifika. We have a sense that his big heart gave out at age 49, and that is a, sadly, too common fact amongst our Māori and Pasifika people in this country.

So, fresh in this loss that we experience as a party and as a House and as a nation, it is galling that in two days’ time, on the day that we will bury Efeso Collins, there is a Waitangi Tribunal being heard on this very question, and that this House and this Government is not willing to wait a mere two days. It is yet another insult upon insult upon injury upon injury to our Treaty partners, tangata whenua Māori.

Māori are twice the rate of non-Māori in terms of cardiovascular disease—twice the rate. The 2009 report and the Wai 2572 Health Services Outcomes Kaupapa Inquiry revealed that our primary healthcare legislation and policy breaches Te Tiriti and fails to care for Māori health and wellbeing. So we take action to correct that failure. We take action with Te Aka Whai Ora. The Waitangi Tribunal, in the hauora report, found that the legislative framework of the New Zealand primary healthcare system should recognise and provide for the Treaty of Waitangi and its principles. That is self-determination for Māori.

“People with greater experience of negative health outcomes than most want more power in their decision making.” That’s from Taimi Allan and the Mental Health and Wellbeing Commission board. Tino rangatiratanga, which provides for Māori self-determination and mana motuhake in the design, delivery, and monitoring of health and disability services—that is what was put in place by Te Aka Whai Ora. Two years—and only one year really functionally operational. To give you some context, Madam Speaker, colonisation is bad for your health.

A Pākehā fellow showed up 254 years ago, an English fellow by the name of Joseph Banks. In 1770, he observed that, among Māori, he saw many very healthy old men, and, in general, the whole of them—forgive the term—are “as vigorous a race as can be imagined … indeed these people are blessed with [sound health] in a very high degree … I do not remember a single instance of a person distempered in any degree that came under my inspection.”—“Among them I have seen very [many] healthy old men … in general the whole of them are as vigorous a race as can be imagined.”—254 years ago. What is the state of Māori health now?

What is the state of Māori health now? Māori die at twice the rate of non-Māori from cardiovascular disease. Māori tamariki have a mortality rate 1½ times the rate of non-Māori children. Māori are more likely to be diagnosed and die from cancer, and, as many people have said, die on average seven years earlier than non-Māori. This specious and gross double-speak which suggests that putting special focus on those in need of that focus is somehow a race-based privilege, is revolting—it is revolting double-speak. This is an effort to address the injustice and the harm caused by, frankly, 253 years of another health system. And one year of letting Māori take care of their own health—you’re going to kill it. One year. Not you, Madam Speaker; this Government. It is appalling, it is shameful, it is a breach of Te Tiriti o Waitangi, and it is anti-Māori, frankly—as this Government expresses it wants to be.

Thank you, Madam Speaker. Look, we understand that the health system is under significant challenge. The reality is, under the last six years, the health outcomes for New Zealanders have gone backwards. New Zealanders haven’t been able to get the care they need. Our wait-lists and times have soared. I have constituents telling me that it’s been so difficult to get meetings with specialists and with surgical staff. Immunisation rates have plunged, and this Government is committed to lifting the health outcomes for New Zealanders. And as part of doing that, we will disestablish the Māori Health Authority and merge the functions of the Māori Health Authority and transfer the rolls into the public health system. We believe, through doing that, that we will have the expertise there that we need to deliver improved health outcomes for all New Zealanders—Māori and non-Māori alike. We support this bill.

Kia ora, Madam Speaker. Tuatahi he tika ki te mihi ki tō tātou rangatira, a Efeso. Nō reira e te rangatira, e kore mātou e wareware i tō kaha ki te kōkiri i ngā kaupapa i ngā wā katoa. Nō reira e te rangatira, moe mai, moe mai, moe mai rā.

[Firstly, it is appropriate to acknowledge our noble friend Efeso. So, noble leader, we will never forget your strength in progressing initiatives at all times. And so, noble leader, rest in peace.]

I sympathise—empathise—with are our friends in the Greens. I was listening to Steve Abel there, and I think we’re all still a bit stunned with the death of Efeso. He was very close to a number of us, and if things had gone right, he would have been with the Labour Party, but he ended up with the Greens, and I spoke at the tangi yesterday for our team, and it was lovely to give the whānau some aroha and some support. It’s such a loss, and I’m thinking of him at this time, because this is a kaupapa he supported 100 percent—100 percent. He was that type of person; a great advocate for people right across the spectrum—not just Greenies or Labour people; Pākehā, Māori, working-class people. But he was absolutely aware of how important this sort of kaupapa was, particularly within the system.

I look across at Dr Reti over there, who is someone who we have some respect for, because we’re aware of his mahi in the North, as his whanaunga over here are also, and I’m stunned by what’s happened here. I’m stunned because a man like Dr Shane Reti should respect—and I know he has said a number of times he respects the work of a lot of our professionals, but when you have people of the ilk—I was going through Dr Rawiri Jansen’s submission to the tribunal. These are people who have given their lives to our people not just in the medical side; they advocate actively for the political rights of our people. I was looking at Dr Rawiri Jansen’s submission to the tribunal, and it’s so clear, and you heard the Hon Peeni Henare talking about the Treaty. I was looking at one of the paragraphs that Rawiri was talking about, and he summarises it well. He says, in short, “The Te Tiriti - based approach, where engagement is not an afterthought and partnership decision-making is in evidence, which elevate and reflect the voice of Māori, will be lost. The Crown’s proposal to proceed without having made any effort to develop an alternative or to engage with Māori to develop an alternative is a clear breach of Te Tiriti o Waitangi.” That is from Dr Rawiri Jansen. We know him well. We appointed him to a number of boards, and he gives his heart and soul to this kaupapa. I ask Dr Reti to consider that.

Also, I heard the co-leader of the Māori Party Debbie Ngarewa-Packer talking about Mason Durie. You’re talking about one of the most brilliant minds of the last generation, without a doubt. And he’s not political, despite who his son-in-law is.

Hon Member: He is; I just said he wasn’t. He really is, but, you know.

Hon WILLIE JACKSON: Oh, he is political, but he’s not a person who misuses that political standing at all.

Shanan Halbert: He tells it straight.

Hon WILLIE JACKSON: He tells it straight. He’s a good man—a good man—brilliant, brilliant, brilliant, brilliant. And there’s a solidity and stability about him, and he’s given great direction to many of us—to many of us. I know when Peeni Henare was the Minister, he sought his counsel. These are not radical extremist Māoris, like Debbie—oh, no, I won’t go down that track. Ha, ha! But this is the thing: this argument has been turned into some sort of race debate. That’s the sad thing here. We hear some of these idiots from the ACT Party, you know, who run these lines of “separatism” and “apartheid” and “it’s all your fault, you Māoris in the Māori caucus and you Greenies and you Māori Party.” That’s got nothing to do with it. These are pragmatic people who are leaders in our society, like Dr Mason Durie, Dr Rawiri Jansen, Dr Papaarangi Reid. And this is mana wahine absolute—absolute. Papaarangi challenges everyone; not just the National Party. She’ll challenge Māori males; she’ll challenge the Labour Party. And I say to this doctor over here, you are ignoring exceptional people who know about this kaupapa much more than the people you have consulted, who seem to only be his mates in the National Party, the rednecks in the—I shouldn’t go that far—the right-wingers in the ACT Party, and the lost lot of New Zealand First. These are the people that Dr Reti has consulted. They wouldn’t have a clue. I’ve got to ask—

Hon Member: Sit down.

Hon WILLIE JACKSON: —I’ve got to ask—no, you sit down and you stay down, because you’ve got no right to speak on this kaupapa. We are being patronised by idiots, you know. Who are the experts that these people are talking about? I’ve just named three. What about Dr Anthony Jordan? He’s another brilliant and exceptional young man.

Shanan Halbert: Yep, he’s a lucky man, too.

Hon WILLIE JACKSON: I don’t know if he’s a lucky man. I don’t know about that, Shan. But he’s an exceptional young doctor who worked with us in the roll-out in the vaccination process. What about Dr Lily Fraser at Turuki Health? Dr Lily, who’s also one real gun amongst the doctors. We really love her work, particularly in South Auckland in Māngere. She works at Turuki Health, an organisation that was set up by my uncle Syd Jackson and by my first cousin Ramari Jackson. That’s been part and parcel of our South Auckland community for the last 30 or 35 years. I ask Dr Reti: who are your people who you have consulted with? Give me two, three, one Māori professional who supports this. Does he really believe in this? Because our people have waited decades for this. Tureiti Moxon, my dear friend Tureiti Moxon, who is the chairman—the chairperson, I should say—of our National Urban Māori Authority—a bit of a thorn in our side sometimes.

Hon Peeni Henare: Good lady.

Hon WILLIE JACKSON: A good lady. A bit of a thorn in our side sometimes, my dear friend Tureiti Moxon, who actually took my position as the chair of the National Urban Māori Authority. But she has constantly—constantly—talked about how Māori needed an opportunity within the system. So these are just some of the experts that I was rolling out. I was going to also talk about Lance O’Sullivan, who’s another expert—

Shanan Halbert: He wanted to be a National Party MP.

Hon WILLIE JACKSON: That was the problem with Lance, but he’s still a good man. They’re all saying the same thing, but who are the experts that the other side can quote? That’s my challenge. And when we get into the question time, I want to hear—apart from Winston Peters and Jenny Marcroft and Shane Jones, who did Dr Reti talk to? Name some professionals. It’s like David Seymour—who the heck is he consulting with his Treaty principles bill? Oh, that’s right: Elizabeth Rata. Oh my goodness! Such an expert on Māori race relations! There’s an arrogance that has come from this Government that really upsets us, because our experts have said, “We want this set up within the system.” And so I’m proud that our party was able to set this up, led by my friend and brother over here Peeni Henare, who set this up within the mainstream system. We never dreamt that we could have a Māori Health Authority within the system. We’ve done that. We’re proud of it. Our people love it. The other side want to destroy it. We’re looking forward to going through question time and finding out who the experts were that they spoke to. Kia ora, Madam Speaker.

I rise to speak on the Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill, for the second reading. This Government is committed to finding more effective ways to work with all communities for better outcomes and to deliver solutions, as well as finding savings through disestablishment which may actually go to better health outcomes. You can build whatever structures you like, but till you focus on outcomes, you’re going to have increasing health inequities, and patients will suffer. Merging the functions of the Māori Health Authority and transferring its roles in the public health system means health systems keep its experts and expertise it needs to improve the outcomes for all New Zealanders, including Māori. So, therefore, I recommend this bill to the House.

Tēnā koe. Tuatahi māku he tautoko i ngā mihi a Hōnore Jackson i tēnei rā ki te whānau o Efeso, otirā ki a koutou hoki, tana pāti e noho tonu ana i raro i te kapua pōuri.

He mihi hoki ki tōku ake whānau e noho ana i raro i te kapua pōuri, arā ngā whānau Horran, ngā whānau Reedy. Kei te tangi te ngākau ki a koutou.

Heoi anō ki ngā mahi huhua o te wā, haere, haere atu rā koutou.

Huri noa ki a tātou o tēnei Whare, tihei mauri ora. Tihei mauri ora.

[Thank you. Firstly for me is support for the acknowledgments of the Hon Willie Jackson today to the whānau of Efeso, indeed to you also, his party that remain under the cloud of sadness.

An acknowledgment to my own family also that sit under the cloud of sadness—i.e., the Horran families, the Reedy families. My heart cries for you.

However, the many recently departed, go forth, rest in peace.

And to us all around this House, the breath of life.]

Tihei mauri ora—behold, the breath of life. That is what Te Aka Whai Ora represented to us—an opportunity that we may, ourselves, breathe the breath of life into our people, Aotearoa whānui, utilising our traditional knowledge and our modern expertise in the area of medicine as well. That hope is being dashed today as we stand here to disestablish Te Aka Whai Ora.

I’m reminded of an experience I had about 20 years ago while studying. A century on from the Tohunga Suppression Act, it came up in our studies. A woman a bit more senior than myself, and a dear friend, said to me, “Now I know what’s wrong with me.” I said, “What do you mean?” She’s someone we would characterise as a kaimahi rongoā, or, indeed, a tohunga. But for many years, because she was deprived of our traditional models and the knowledge of our tikanga and our practices, she thought something was wrong with her. She had nobody to teach her. It impacted her mental health. She turned to alcohol and drugs, and finally she knew why. So I think this serves as a precautionary tale to us. All these years later, we take that risk again.

I had every intention of coming into this calm and speaking about some of my family experiences, but I can’t help but sit here and feel insulted—insulted by that side of the House, who are telling us that they understand what’s best for us, they want what’s best for us. Excellent; let us tell you what that is and help us put that into action.

I’m furthermore insulted, such is the arrogance that when the Hon Willow-Jean Prime was making her case for hauora Māori—the wellbeing of Māori, in our language—barely half of that side put in their earpieces to hear what she was saying.

Heoi anō, I want to acknowledge the presence today of some kaimahi hauora Māori in our area. Tēnā koutou. Nau mai, haere mai. I want to acknowledge the amazing mahi you do, not only for whānau Māori; I know for a fact that the services these people represent cater to all people in their region—Māori mai, Pākehā mai, Pasifika mai, ahakoa nō hea [including Māori, Pākehā, Pasifika, wherever they are from]. No matter who they are or where they are from, these services help them and their whānau, utilising the unique and impactful kaupapa Māori practices that we have. Tēnā koutou. Be assured that I and this party will continue to advocate for you to be able to do the unique mahi you do for the benefit of all New Zealanders.

Heoi anō, another reason this Te Aka Whai Ora is so important to me is as a daughter who wonders what would have been had my mother’s belief in rongoā Māori been honoured. She was told, “One or the other.” There was no balance sought. You know what? We wanted her to be able to treat her body as tapu, but when she declined surgery, she was told, “You’ll be back in a box.”, and treated inadequately because she believed in rongoā Māori. I’m pleased to report my mother did live for another 10 years, but we can only wonder what would have been if her beliefs were honoured and she was provided mainstream care to go alongside that.

Heoi anō, just this afternoon, the Prime Minister said—and I quote—“We believe in better outcomes for Māori.” Sadly, it appears that’s only if Māori behave in the capacity of committee members and advisories, not as authorities on a subject that is literally us. So I’m sad to say that this bill represents the dashing of hope, because it was something that was Māori-inspired, Māori-led, and all-inclusive. Tēnā rawa atu koe, e te Māngai.

I rise in support of the Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill. It is my great pleasure to do so, because one of the reasons that I came to this House was because of my incredible anger at the destruction of our wonderful health system, wrought upon us by the previous Labour Government.

The Māori Health Authority seemed like such a great idea and I held out such hope, as did so many of my health colleagues but, unfortunately, the causes of Māori health poor outcomes have got nothing to do with the health system; it’s to do with colonisation, it’s to do with the impacts of poor, it’s all about the fact that economic decisions and social policy have more impact than anything to do with the health system. So trying to restore and improve health outcomes for Māori through health policy is going to be useless.

I remember my friend Dr Marcia Walker, who is the granddaughter of Ranginui Walker—she was on the committee with me for the council of general practitioners—

Shanan Halbert: What would she say to what you’re doing today?

Dr VANESSA WEENINK: —she said that she hoped that the board would stand up and say—

Shanan Halbert: How shameful that you would use her name.

Dr VANESSA WEENINK: —“All of this money should be used to—

ASSISTANT SPEAKER (Maureen Pugh): Mr Halbert, please don’t bring the Speaker into this.

Dr VANESSA WEENINK: —house Māori, and we will actually put the money towards things that will make a difference to Māori health, and the Māori Health Authority will do nothing at all.” The thing that we hoped for that would make a difference was the iwi-Māori partnership boards; however, the previous Government actually watered down the recommendations for that and they were going to be completely toothless—

Hon Dr Ayesha Verrall: Is that why you’re taking away their voice?

Dr VANESSA WEENINK: —and now we’re keeping the iwi-Māori partnership boards and actually making them effective. You’ve talked about primary health care—

ASSISTANT SPEAKER (Maureen Pugh): Please don’t bring the Speaker into the debate.

Dr VANESSA WEENINK: I beg your pardon. She knows nothing much about primary healthcare. I really hoped that primary healthcare was going to be improved but, unfortunately, the previous Government used their mandate on primary healthcare to upset the entire system in a time of a pandemic, and destroyed the morale of our absolutely blasted workforce and did this.

So this is one thing that we can do to try and restore some form of health outcome improvement, and I commend this bill to the House.

Madam Speaker, tēnā koe. I also want to join with my colleagues around the House in acknowledging our colleague Efeso Collins and to mihi to him and his whānau today.

This bill is incredibly disappointing, and the speeches we have heard this afternoon have reflected that—both on this side of the House, with a very moving contribution by my colleague the Hon Willow-Jean Prime in her reo rangatira to share her personal reflections about the impact that repealing this will have on her communities and her family, and also on the contribution of Cushla Tangaere-Manuel when she spoke about the impact of the long history of health inequality for Māori in New Zealand on her mother and the way that inequitable access to not only advice but medicines impacted not only her health but the health and wellbeing of her entire family.

That has been met with incredibly disappointing speeches on the other side from practitioners, some of whom were previously practitioners in general practice and supposedly experts in health, who know that the status quo never worked for Māori and appreciate the deep inequities which have delivered health outcomes for Māori that would not be fixed by going back to that system. More Māori die from avoidable deaths than non-Māori. Māori die seven years earlier than any other group. Māori are twice as likely to die of a cardiovascular or heart disease. These are things which returning to the status quo will not improve, and the Pae Ora healthy futures reform allowed a once-in-a-generation opportunity to address those things.

Instead of building on those reforms, instead of continuing the work that was happening not only at the community level but within families themselves, which Cushla Tangaere-Manuel and Willow-Jean Prime have spoken about, we are walking back to a system which is more centralised, which leaves iwi Māori out of the system where we had worked so hard to bring them into it. It leaves out the voices of those people who have systematically been left out for generations but who for the first time had a seat at the table—and not only those iwi-Māori partnership boards but in the Hauora Māori Advisory Committee and in the Māori Health Authority itself. This is a huge regression for Māori, and it represents a huge lost opportunity for a new generation of New Zealanders.

Now, we know that the old system underperformed. It underperformed for a number of practical reasons, and I’ll get on to those, but I would point out that speakers on this side of the House have already underscored the fact that the Minister knows that, appreciates the underperformance in the system, but that this is part of a wider political narrative. And we keep hearing it from the other side when they stand up and say, “We have an electoral mandate to do this.” The electoral mandate is there because it was won in a furore of his wrong-headed idea that Māori were getting special rights and special treatment, and, in fact, that debate was whipped up by members on the other side of this House. That electoral mandate was won not from Māori, who suffer the worst and most inequitable health outcomes in our entire country; it was won by people who were afraid of the kind of narrative that politicians on that side were feeding them.

Labour had the courage to stand up and say there are practical fixes we can do for this that will make the health outcomes for Māori more equitable. There are practical ways that district health boards (DHBs) haven’t been able to deliver on their promises, and so a nationalised health system that has a mandate to get in there, roll up its sleeves, and deal with Māori health outcomes will actually be able to do that. But it did take courage. It did take telling the story, and, for the most part, I think New Zealanders appreciated that there was a longstanding inequity here that the system could not solve if there wasn’t substantive change.

I think it’s really disappointing now that we are standing in this House and not only are we repealing the Māori Health Authority but there are also a number of changes in this bill, which I will be asking the Minister questions about in the committee stage, which take away the voice of iwi, of Māori, and of appointed experts in Māori health within the system and replace them with people who are appointed directly by the Minister and who can be dismissed by the Minister at any time. This is not localisation in any way. This is taking away the power of iwi and local entities to work with Māori communities, and it is, essentially, a power grab for the Minister to take all of those devolved powers back into the central ministry. This is bureaucracy for Māori health outcomes. This is not only returning to the old system that did not work for Māori; it’s bureaucratising the system that was actually successful for Māori, that generated a number of successful initiatives like the iwi-led MMR vaccines drive, which was so effective and we want to see more of. There is no consistency around the way that we localise these things in the way that works.

I said I’d talk about the practical implications of these changes. One of the good examples of this was the Counties Manukau DHB. That DHB, which dealt with the health concerns of South Aucklanders and provided health services for South Auckland for many, many years, carried a burden of diabetes and heart disease unlike any other DHB in the country. The number of cases of diabetes, and particularly type 2 diabetes, that were presenting in the public health system in that DHB was unlike any other DHB. What that meant was that other services had to be provided at a lower level so that the DHB could continue to provide for those services. Dealing with that locally, if you lived within Counties Manukau, meant that at the DHB you might have, say, a longer waiting-list for a certain procedure or, say, you might be eligible for a certain service at 65, where, in Auckland Central, you would be eligible for that service at 60. The reason for that disparity was because it had a high prevalence of Māori in the area, and the needs of Māori were so great that this locality was dealing with a deeply underserved population for many, many reasons which have been made clear in this House. And so that localised system simply didn’t work for the entire population, because there was this deep need for Māori health services.

So when the Pae Ora reforms proposed to solve that problem, it wasn’t just that localities would be done away with; it was that these problems that had been besetting DHBs like Counties Manukau would actually be dealt with head-on: that things that the Māori population needed to enjoy longer and healthier lives would be done in an equitable way, not only in Counties Manukau but all over the country; that these systems that had been dealt by that DHB to create efficiencies in the system would be shared with everyone. That is a good thing. It is not a woke kind of reform because we believe in it or because the Treaty obligations require the Crown to; it is simply something practical which meant that everyone in the population could get a better health service.

There’s also a practical example around historic underfunding of hospitals and communities with large Māori populations. Essentially, for the same kind of logic that these towns and areas and localities with high Māori populations have always had high health needs, they haven’t been able to develop the infrastructure in the same way as other communities that do not have those high-needs populations. So, because of this historic underfunding, the way that the capital programme works and the way that the Crown invested in its hospitals, meant that hospitals were successively underfunded more and more over time. And so the Pae Ora reforms actually, again, dealt with that problem by disestablishing the DHBs, and it meant that underfunded populations would not continue to lose out on the kind of infrastructure they need in the health system.

Those are two practical examples of how the Pae Ora reforms addressed that. It’s really sad to see that now we won’t have a Māori Health Authority that is charged with continuing on those important gains which we all want to see in our health system for the benefit of everyone, not just Māori within the health system.

A quick observation, before we get to the committee stage, on the consistency with the Government’s Treaty of Waitangi obligations. I want to speak here about the departmental disclosure statement which found that there was not necessarily any obligations that were being breached, when, in fact, Crown Law’s own advice, in its memo to the Waitangi Tribunal dated 31 January, found that “The Crown confirms that, procedurally, no formal consultation was planned or occurred by the Crown before Cabinet confirmed the decision to disestablish Te Aka Whai Ora. On a conventional assessment of impact and importance, the Crown deciding to make this decision without consultation can be expected to result in a finding by the Tribunal that Treaty principles have been breached and that prejudice has resulted.”

It’s important for the House to fully appreciate that the Crown’s own advice is that the introduction of this bill would, on the face of it, constitute a breach of the principles of the Treaty of Waitangi.

There’s no denying that, really, we could improve Māori health outcomes in New Zealand, and this Government is working hard on it. I heard the Opposition side of the House mention inequity, a failed health system, racism, discrimination, etc., but I haven’t heard any members from the opposite side mention the word “self-responsibility”. As a diabetes and cardio specialist, I can tell you that with self-responsibility and discipline, some of the health issues we’re facing in New Zealand can be prevented. This Government will continue to work together with our Māori community to deliver a solution. But creating an unequal system based on specific race is not a solution to our health system. People in New Zealand want a health system based on needs, not race. This bill is about equity, not inequity. Therefore, I commend this bill to the House.

This bill is set down for committee stage immediately.

In Committee

Part 1 Amendments to Parts 1 to 3