Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill

Members, the House is in committee on the Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill. We come now to Part 1. Part 1 is the debate on clauses 4 to 37, “Amendments to Parts 1 to 3” of the principal Act. The question is that Part 1 stand part.

Thank you, Madam Chair. Thank you for the opportunity to open with a contribution, of course, analysing Part 1. I mentioned in the first reading and in the second reading that we will be going through clause by clause to make sure that we can interrogate properly the Government’s intentions and actions as set out in this particular bill, and we will challenge them as we will continue to oppose this. But those views have been well articulated across the House and it brings me to my first question—and I mentioned it in my first and second reading speeches—which relates directly to clause 6. It says here that clause 6 amends section 6, which describes how the Act provides for “the Crown’s intention to give effect to the principles of te Tiriti o Waitangi (the Treaty of Waitangi),” to reflect changes made by the legislation.

Well, the first question I have for the Minister is that in considering this particular clause, one can’t help but question as we look across all of the clauses in Part 1 what this one sets out in clause 6—how it’s trying to divorce itself from the rhetoric throughout the entire bill. For example, one of the principles here is, of course, the principle of partnership, yet we see later on, in clause 19, that section 35 is being amended, and with respect to the preparation of the Government Policy Statement (GPS), it removes a Māori voice. In fact, if you look across at section 35, “Preparation of the GPS”, it silences the Māori voice there.

My question to the Minister in the first instance is: does he see clause 6 sitting separately or intertwined throughout all the clauses we’ll be debating in Part 1? That’s the first question.

The second question is that as we look across the principles of Te Tiriti o Waitangi, the principles of partnership and acting in good faith don’t seem to be apparent as we look towards the changes that this bill is making. I’ve already highlighted clause 19 and the section 35 amendment. We can also go on to give another example here of clause 15, where section 30 is amended, and it goes down to the bottom there, to clause 15(5), which is: “Repeal section 30(1)(g).”, and that’s about iwi Māori getting to have a say on appointments.

Now, when we think of the principles of the Treaty of Waitangi, it’s quite clear to me that (1) their voice isn’t being heard, so therefore one can argue here that that partnership isn’t being met there; and (2) it’s once again a clear breach of good faith as Māori are expected to only serve part of their consultation and part of their duty within this particular legislation and across the entire Pae Ora legislation, and yet are being silenced in other areas that are key to the successful execution of the Pae Ora legislation itself. So, just to reiterate, the first one is around whether or not the Minister sees that clause 6 stands alone or whether or not he sees it intertwined throughout the entire bill, and I’ve already given the examples of where those changes, I believe, are in contradiction to the principles of the Treaty of Waitangi—and I’ll state them again: clause 19, “Section 35 amended (Preparation of GPS)”. I wonder if the Minister can then explain to the committee and answer this question: then, where in the GPS is the Māori voice heard?

For some of the newer members across the committee, they might not understand how the structure of good health policy in health legislation works. The GPS is one of those important documents that continues to drive the policy of health in this country, yet what we’re seeing here is a complete breach of clause 6, which says about the principles of the Treaty of Waitangi—and here, once again, is another example of how this particular bill continues to silence the Māori voice on such important matters and important documents that will continue to drive health policy in this country.

I now turn to another part which continues to do this—contradict the principles of Te Tiriti o Waitangi. When I look at new section 15 in clause 11, where it says here that “Health New Zealand must support and engage with iwi-Māori partnership boards” and then it goes down to say “Health New Zealand must—(a) take reasonable steps to support iwi-Māori partnership boards”, one of those reasonable steps, one would expect, is actually consultation up front. What this sets out to do is give somewhat of a back-door exit, if you will, to give the Government a bit of a clause to escape out the back door when we look towards whether or not the engagement by Health New Zealand with Māori is appropriate and is timely. I’d like the Minister, if he can, with respect to that particular clause—if he can explain to us in his mind and, indeed, the mind of the Government what do “reasonable steps” look like to support iwi-Māori partnership boards to achieve their purpose in section 29.

It does go on further to say that part of that is by including “administrative, analytical, or financial support where needed;”. It would be remiss of me not to indicate to the committee at this point in time that the iwi-Māori partnership boards in their establishment—some are ahead of others, some are far better equipped, some have better infrastructure to be able to look towards having a proper, functioning iwi-Māori partnership board within their region, and I can describe one of those. It’s where a number of us in the House come from, in Te Tai Tokerau. Te Kahu o Taonui already has pretty good infrastructure across the Māori health provider network and it has already proven really great outcomes during COVID-19, which I elaborated on through the first and second readings of the bill. That is why I want to make sure that if the Minister can answer this question, he understands where those iwi-Māori partnership boards are with respect to their ability to provide their function, because what he’s proposing here is to include by providing “administrative, analytical, or financial support where needed;”. Well, I’ve already indicated some are ahead and some aren’t quite as far ahead as others. So is the Minister committing, then, to making sure he can support its administrative function and its analytical function, and so on, as it says in new section 15?

The other one is: sufficient and timely information. The other side of the House—and this is the question I put to the Minister—were rather dismissive of the COVID-19 pandemic that hit the world, and one of the key arguments for the case of Te Aka Whai Ora was made by Mr John Tamihere in the timely release of analytical data in order to serve our communities. That community was the Māori community. In fact, he took that case all the way to the High Court. In new section 15, I’m asking the Minister: what then does “sufficient and timely information” look like? Is it the kind of data that will allow iwi-Māori partnership boards and Māori health providers and iwi to make decisions in order to serve those communities in a timely fashion and in a very targeted fashion?

We heard the Minister talk about how it’s important to target, set targets, and home in on where the need is. Well, it’s clear to us—and all of the data that’s presented by health professionals—that the need sits with Māori. So, to reiterate, for that particular question: what does “sufficient and timely information” look like? What does it look like? Is it structured in a way that allows Māori to have input on what it is that they’re looking for in order to get the outcome that the Government might look towards, or is it simply another case of paternalistic central bureaucracy telling iwi what to do?

In the last minute and a half of this particular contribution, I want to come back and circle back to clause 6. Clause 6, in reference to the principles of Te Tiriti o Waitangi: in order for that particular clause to work, we made it clear, as the Government of the time, to make sure that all of the steps throughout the entire pae ora legislation would continue to reference back to the principles and allow it to be successful. I want to remind the Minister that as we scroll through the proposed changes in his bill here, we can’t help but see the stripping away of a Māori voice, of a Māori presence, and of the ability for Māori to contribute meaningfully, not only to the outcome but to the planning, to the discussions, and to everything that it takes in order to get a successful outcome.

Just finally from me, you will hear from the members on this side of the Chamber, those with significant community experience and with significant health experience, a continual prosecution of the clauses within this particular bill proposed by the Minister in order to get some clear definition. It’s important that we get that clear definition for our Māori communities, who have been silenced on the progress of this bill. Madam Chair, thank you very much.

Tēnā koe, Madam Chair. Thank you for the opportunity to make a contribution in this committee stage. I have a number of questions for the Minister of Health about the way that the function of the iwi-Māori partnership boards and the Hauora Māori Advisory Committee will work without the assistance of the Māori Health Authority. My specific questions are also to do with a number of amendments which I have tabled which are seeking to clarify the role of those bodies, given that the Māori Health Authority will not be playing the role that it was set up to perform for the benefit of Māori health outcomes and for the stewardship of those outcomes within the system.

My first question to the Minister is this: given that the iwi-Māori partnership boards, under the Minister’s proposals, will not be able to appoint people to the Hauora Māori Advisory Committee, I’m interested in how the Minister sees the iwi-Māori partnership boards having conversations within the health system at a top level about the priorities within their locality.

This relates to my second question, which is that iwi-Māori partnership boards, under the Minister’s proposal, would no longer have an ability to feed into the development of those locality plans. That is being expressly written out of the legislation, but it was something which was a subject of the select committee’s inquiry into the bill, in the Pae Ora Legislation Committee, which was set up as a special committee, about how iwi-Māori partnership boards and how iwi themselves would need to feed into that locality planning, and it would be a really good way of localising the planning that needed to happen in the health system, given that we would now have a broadly nationalised system. So that question to the Minister is about how iwi-Māori partnership boards can continue to have that local focus and feed into what needs to be a deeply localised planning model at that level.

My third question to the Minister is about who he intends to appoint to the Hauora Māori Advisory Committee, because under the Minister’s new proposals, he would be the only appointer of eight new members of that committee. Just for the benefit of the committee, that committee would not have been something which was appointed only by the Minister before. This, in fact, represents a major centralisation of power here. It represents Ministers taking on a role that was previously devolved to representatives of local communities, who worked hand in glove with organisations like their local councils, their local providers, and their local people on the ground actually seeing and distributing these health services. So the question to the Minister is: is it his intention to appoint people who will fulfil that role of local leadership, local stewardship, from iwi Māori groups, and if he could give the committee an indication of the eight people whom he intends to appoint—because their appointments are due on 30 June—that would assist the committee greatly in understanding how that local voice will be preserved.

It would also be very useful for the Minister to clarify for the committee what criteria he’s using to make those appointments, what advice he has taken to make those appointments, and the considerations that he has taken into account to achieve a balanced representation when he is considering those appointments. There are a number of factors that any Minister will go through in considering what sort of advisory group he or she will be appointing, and so it is really beneficial for the committee to understand that, because those are not outlined in the primary legislation. Unlike many of the ministerial appointments where there is a clear guidance for the type of skills, there is none of that because it is not an established process, and it is not outlined in the primary legislation. So we need to appreciate that before we can go forward on that.

My next question to the Minister is: will the Hauora Māori Advisory Committee have a secretariat? Under the new proposals by the Minister, this group would fulfil a role which is unlike its current role, and so it’s important that that is a group that is resourced to be able to make the kinds of recommendations which this set of proposals to repeal the bill would require of it—so whether there is a secretariat, what kind of resourcing will be available to it, whether it will have its own staff, whether it will be set up to succeed, or whether it will be set up to fail. That is the question I’m asking here, because currently it is not doing the kind of job that is envisioned by these reforms, and so it’s really important for the committee to appreciate whether there is a protection for it to continue to do that work.

The next question I have for the Minister is: will it be able to proactively advise the Minister, because as it is worded in the current reforms, it is for the Minister to establish it, but then there is no requirement on the Minister to consult it on any matters. This is different from what existed in the legislation before, where the Minister was required to engage with certain bodies within the health system on outcomes for Māori. Essentially, this was about creating ownership—rangatiratanga—over outcomes for Māori, by Māori. It was about establishing leadership within the health system of experts who were appointed by people who supported them and saw them as leaders within the system to make proactive points to the Minister. Those powers have been taken away, so we need an assurance from the Minister that he will allow this board to proactively advise him on his decisions and decisions being made in the health system which will have an impact on Māori health and Māori health outcomes. They are things like resourcing decisions, things like legislative decisions—which my colleague Cushla Tangaere-Manuel talked about—that, historically, have been made without Māori involvement and should be, going forward, because I have no doubt that everyone in this House believes, to some degree, in people being involved in the decisions which affect them.

My next question to the Minister is specifically about the locality plans. If iwi-Māori partnership boards—as is proposed in these reforms—do not have the ability to contribute to locality plans, how will locality plans represent the interests of Māori within them? How will the entities that are tasked with providing the Ministry of Health with a locality plan be sure that they have taken population concerns for everyone into account, knowing that there is this particular equity concern for Māori, and how will those locality plans be responsive to the needs of Māori and to addressing the Māori health outcomes going forward?

The final question that I have for the Minister is this. Under the new model, there is no legislative backstop for the Hauora Māori Advisory Committee to be able to give proactive advice that the Minister doesn’t like. There is no legislative backstop for that group of people to say something publicly that is challenging for the status quo. That was a large part of the strength of the pae ora reforms: it was to create a way for Māori health to be prioritised systematically to enable continuous improvement in the way that we address inequity for Māori. So my question to the Minister, finally, is: what happens if they say something he doesn’t like? How will we ensure that all advice, not just good advice, is what makes it to the Minister when he is the sole appointer and has the sole power to dictate their resourcing and their ability to provide that advice going forward, because it’s in everyone’s interest, not only Māori, to have a health system that works for everyone and to make sure that resources are spent in the most efficient way that’s actually going to work for people.

So those are my questions about the way that this works, and I will, if I may, come back to the amendments, which I think would more effectively achieve some of the changes to the way that Māori participate in the system, in coming speeches. I have 40 amendments in my name, Madam Chair; I would love to have 40 calls in this debate.

Thank you, Madam Chair, and I thank the members for their discourse. To come first to the member who has raised questions around clause 6, clause 6 is a descriptive clause that reflects the changes to Health New Zealand functions to ensure that some of the Māori Health Authority functions can transfer over to Health New Zealand and the Māori Health Authority.

With regards to the broader question around obligations that are contained in clause 6, I’d say several things, particularly where the member was asking really good questions around the Māori voice. Several things: first of all, the legislation clearly uplifts the voice of the Hauora Māori Advisory Committee (HMAC), so a very clear Māori voice there. Secondly, health service monitoring and decision making by iwi-Māori partnership boards (IMPBs) is mana motuhake almost by definition. Thirdly, delivery of services close to the home and hapū is consistent with obligations we have to all New Zealanders.

The member also asked about the IMPB capacity, and he’s absolutely right. IMPBs are at different levels of capacity, and we’ve looked at what that will entail to bring them up to a level where they are able to analyse, to collate, to take in local information, to do local analysis of it, to then institute local actions as to how to change it, and then pass it up further for aggregation at regional and other levels, where we can get a wider view across the whole sector. So those are some of the expectations, and with those expectations will need to come support to power that up.

The member over here had some very good questions about the Hauora Māori Advisory Committee appointments. I’d just point out that the process that the legislation talks to is the process now and has been for the past two years. There’s nothing different to it; I’m just not instituting what was going to be taken into account in July later this year. Those appointments—yes, they’re ministerial appointments, like, as I say, it’s been for the past two years, but of course I will seek advice and consultation from out in the sector and, of course, from IMPBs, as but one group whose voice I need to take into account. So their voice is not lost; it’s just not formalised in the legislation as it was going to be as at July 2024.

You’ve asked a question around an invitation for HMAC to proactively offer advice: yes, please. To offer advice that I need or offer advice that I may not want to hear is the privilege and the purpose of HMAC—to be in that position, to be trusted advisers to the Minister and to us so that we can do a better job. So, yes, to answer that question, I do envisage the Hauora Māori Advisory Committee to proactively offer advice.

There were several questions around localities. I’ve already indicated in the legislation that through Schedule 1, I think it is, locality plans will be paused and localities will be paused while I reconsider their position going forward. I think that answers a number of questions around localities, the relationship with iwi-Māori partnership boards—they are paused in this legislation.

Thank you, Madam Chair. This may be the last call before the dinner break, and I just want to say that in the Minister’s answers, he was very light in addressing the questions and, in fact, didn’t answer a lot of the points that had been raised by my colleagues.

I just want to speak, at this point, to clause 6, which is all about the amendments to Te Tiriti o Waitangi and the principles. In the stroke of a pen and their proposed amendments, what they are actually doing—what they are, effectively, doing—is removing all of the things that had been put into the legislation. This is what clause 6 says: “In order to provide for the Crown’s intention to give effect to the principles of te Tiriti o Waitangi …, this Act”—will do all of those things listed.

Now, what the Minister is proposing to do is to repeal paragraphs (b), (e), (h), (i), and (j), and replace all of those things with new section 6(c). His answer to how to give effect to the principles of Te Tiriti o Waitangi—the entirety of it—is that it will require “the Minister to establish a permanent committee, the Hauora Māori Advisory Committee, to advise the Minister;”—that’s it.

So in order to give effect to the principles of Te Tiriti o Waitangi as they relate to pae ora, what was outlined in that section of the Act was the establishment of Te Aka Whai Ora, all of its roles, and all of its functions, and, in the stroke of a pen, the Minister is proposing to repeal paragraphs (b), (e), (h), (i), and (j), and replace them with new section 6(c).

Now, there are unanswered questions asking for detail about that particular Māori advisory committee. I think that the Minister needs to answer those ones, because if all of the Government’s obligations and commitment to Te Tiriti o Waitangi is contained in the new section 6(c), then I have some serious concerns.

In the departmental disclosure report, there is a section there that says the “Consistency of the government’s Treaty of Waitangi obligations”. The Government has done an analysis on “the Treaty implications of disestablishing the Māori Health Authority.” and, in their own opinion, “considers it will continue to meet its Treaty obligations.” by simply just having a Hauora Māori Advisory Committee, Minister—appointed by yourself. You can choose whether you take their advice or not. What about all the other roles that Te Aka Whai Ora had in the delivery of pae ora? All of the mechanisms, the ones that you are taking away—for example, in paragraph (e), it will require “the Hauora Māori Strategy to be jointly prepared by the Māori Health Authority and the Ministry;”. That’s gone. Just gone straight out of the Act, so no Māori health strategy.

Then we’ve got paragraph (h). Paragraph (h) “requires Health New Zealand and the Māori Health Authority to engage with Māori partnership boards;”. Nope, gone—don’t need that. In terms of paragraph (i), it “requires Health New Zealand and the Māori Health Authority to jointly develop and implement a New Zealand Health Plan and to work together in the performance of specified functions of Health New Zealand;”—gone. Paragraph (j): “includes, as criteria for appointment to the board of the Māori Health Authority, that the board collectively has knowledge of, and experience and expertise in relation to, te Tiriti o Waitangi …, tikanga Māori, mātauranga Māori,”—which, I point out, you also want to take reference to “mātauranga Māori” out”—kaupapa Māori services, and cultural safety and responsiveness of services;”. Repeal that—repeal all of those things.

Hon Paul Goldsmith: Yes, we’re repealing the bill.

Hon WILLOW-JEAN PRIME: Yeah, that’s right. So how can the Minister say that this Hauora Māori Advisory Committee, appointed now by him with no consultation or input from Māori and none of the processes that we followed in the first place—Tā Mason Durie and others, iwi who had a role in participating in this and appointing these people who have the support, the mana, the mandate, the tautoko from te ao Māori. Nope, you’re going to appoint them, and it’s going to be their job to uphold your obligations of Te Tiriti o Waitangi principles in pae ora. So please explain how your Hauora Māori Advisory Committee is going to achieve all of those things.

CHAIRPERSON (Maureen Pugh): The member’s time has expired. Members, the House is adjourned for the dinner break and will resume at 7.30.

Sitting suspended from 5.58 p.m. to 7.30 p.m.

Members, the House is in committee on the Pae Ora (Disestablishment of the Māori Health Authority) Amendment Bill. Before we adjourned for the dinner break, we were on Part 1, and this is the debate on clause 4 to 37, amendments to Part 1 to 3 of the principal Act.

Thank you, Madam Chair, and thank you for the opportunity to contribute further in this very important debate as we go through clause by clause. There were a number of questions that were posed to the Minister before the dinner break which, in the opinion of members on this side of the Chamber, were a light touch in the answer from the Minister. So we’ll look forward to interrogating these clauses further to allow the Minister more time to be able to come up with something far more comprehensive in his response to a number of the questions that members on this side of the Chamber had.

So I wish to start my contribution after the dinner break by talking directly to clause 8, which seeks to amend section 12. The original purpose of that particular section was about making sure that when you’ve got a Māori health authority board, what it did was it guaranteed a place for a member from that board on to Health New Zealand, and that was really important. That was about making sure the voice of Māori was heard at the top echelon of health leadership in this country. You’ll see in the clause there that it’s looking to repeal that section. I’m wanting some assurances here from the Minister about whether he is looking to have Māori representation on Health New Zealand, and how does he look towards appointing that?

We’ve already heard and canvassed a number of matters with respect to the HMAC—or the Hauora Māori Advisory Committee. This one, though, is specifically speaking to Health New Zealand, and there are a large number of Māori health professionals who are more than capable to be able to sit on both the HMAC—which has already been touched upon—but also Health New Zealand. What this particular clause does, though, is repeal the ability to have a Māori representative on there. Now, I understand that the Minister and the Government have already made it clear that they are going to disestablish the Māori Health Authority—I get that—and we will prosecute that as we continue in the committee of the whole House. But with respect to Health New Zealand, the important part was to ensure that there was a Māori voice there.

I spoke briefly before the dinner break about the structure of the way health policy is made in this country. There are a number of terms in here which might seem new to some of the new members in the House, but they are important for us to make sure that the voice of Māori is heard across the entire scope of health planning, and that’s the Government policy statement, the health charter, the New Zealand health plan. What we are afraid of in repealing section 12(4) is that this Government will continue to minimise the voice of Māori.

We’ve heard from members right across the committee about how important equitable health outcomes are and that resources and the commitment of energy and resource will go to where those health priorities are. It’s clear that the data and everything suggests they are all in the Māori community, so then how do we ensure that there is a Māori voice at the top of the tree? Of course there’s the Minister there, and I acknowledge him and his expertise, but with Health New Zealand—and that’s what I wanted to ask the Minister: how can he ensure there’s a Māori voice on the Health New Zealand board? Is he intending to make sure that there is a Māori voice and Māori representation on the board? How will he plan on doing that if he’s going to be repealing the ability for the Māori Health Authority board to have somebody on the Health New Zealand board?

It was well served since its creation by Tipa Mahuta. But also, we were really proud of a number of the others who were on the Health New Zealand board who were part-Māori, and I wonder if the Minister can explain how we will continue to have that Māori voice at the top of the tree.

The next question I have is with respect to clause 13, where it’s going to insert new section 16A with respect to engaging with and reporting to Māori. It says here, in new section 16A(b), “report back to Māori from time to time on how engagement under this section has informed the performance of its functions.” If the Minister can be clear with us on what “from time to time” actually means; is it what we’re hearing from members on the other side of the Chamber that it’s only every three years because “We’ve got a mandate.”—because that’s what we’re hearing from that side—or is this suggesting that there are going to be far more periodical opportunities for Māori to be able to engage with the reporting back? I ask those questions of the Minister, if he will indulge us.

Thank you very much, Madam Chair. This is my first opportunity to speak in the debate on this piece of legislation, and I want to pick up where my colleague the Hon Peeni Henare has left off, around the way in which the various parts of what will now be the way in which the health system interacts with Māori take shape.

In doing so, I have to—because it’s my first opportunity to speak on the bill—indicate that philosophically, I find this bill repugnant. I do that because what this bill does is shift us from a place where a by Māori, for Māori focus at central government level is guaranteed to take that away and rely now on a series of patchwork, band-aid - type approaches which say from this Government to Māori, “We know best how this will work.” That’s not actually the philosophy of Te Aka Whai Ora, which was that Māori know best what works and that the Government would facilitate and encourage that. I just have to put on the record that that’s why I am so strongly opposed to this legislation.

But what the Government is now proposing in replacement for that is what I want to now ask some questions of the Minister of Health about. That is, essentially what starts in the amendment to section 6 in clause 6 in Part 1, and the first question I have for the Minister relates to the establishment of the Hauora Māori Advisory Committee and their concept of this being a committee to advise the Minister. I want to understand from the Minister how he thinks that advice will be generated to him, because one of the concerns we have on this side of the House is that almost universally, we’re hearing from iwi and hapū around the country that they supported Te Aka Whai Ora because of that very by Māori, for Māori approach that I mentioned before. So my first question to the Minister is: what is the nature of the advice that he expects to get from this committee, and how will that advice be informed by iwi and hapū around Aotearoa?

On this point, I want to note my colleague Arena Williams’ proposed amendment to section 6(2), which is to insert, after the words “to advise the Minister”, the words “including alerting the Minister proactively to any matters that impact on the health and wellbeing of Māori”. Now, what we’re trying to do on this side of the House is to actually improve what we consider to be by a huge distance a second-, third- or fourth-best approach that the Government is taking but also actually try to give some shape to this, because otherwise I think we’re establishing an advisory committee that will have little teeth and be without, really, the kinds of connections that we would expect within te ao Māori to actually be able to give that advice to the Minister.

The reason I connect this to what my colleague has just been speaking about is that when you look at what the Government is doing in Part 1, you’ve got the committee that’s going to be advising the Minister, and then you’ve got the board of Health New Zealand—so, you know, this is the structure of our system. We’ve got the Minister, we’ve got Health New Zealand, and we will come—and this will probably be in a future call, when we come to talk about the iwi-Māori partnership boards, who represent another layer of the structure.

I know the Minister is a fan of the whiteboard in his office, and it wouldn’t be a bad idea if we could just drag the whiteboard down here and put it up behind him so that we could actually follow the logic here, because I have real concerns about how the voice of iwi and hapū will be heard in the structures that the Minister is now proposing. So he has this advisory committee, and, as I say, I’d like to hear from him around exactly how that advice will be generated, how it will work, and what he would consider about giving some more specificity, as Arena Williams has proposed in her amendment. But then we have to get into what Health New Zealand is going to do, because now a huge amount of work has been placed on Health New Zealand, and, as Mr Henare has just said, how are we going to see Māori representation there? We were well served when we had Te Aka Whai Ora working closely with Health New Zealand—Te Whatu Ora. Now, I don’t know, when I look at clause 8 of this bill, “Section 12 amended”, whether the board of Health New Zealand will genuinely be able to play its role in there.

Madam Chair, we’ll see whether you’ll give me another call, and I’ll move on to the next of my questions—Madam Chair?

CHAIRPERSON (Barbara Kuriger): The Hon Grant Robertson.

Hon GRANT ROBERTSON: Thank you, Madam Chair—it was good timing. I won’t take the whole of this call, because this is the third of my questions.

If we then go down to new section 15 in clause 11, which is Health New Zealand providing information to iwi-Māori partnership boards, I’m really concerned by that phrasing, because that is not the relationship that iwi-Māori partnership boards were meant to have. Their relationship is both within their communities and it was a very direct relationship with Te Aka Whai Ora. Now, we’ve got this very weak clause.

Let’s think about some of the words that have been used in it: “support and engage”, “take reasonable steps”—who’s deciding what “reasonable steps” are, Minister? Can you tell us what a reasonable step is? Is it a reasonable step if that iwi-Māori partnership board turns around and says to Health New Zealand, “This isn’t working.”—and guess what! That’s what they’re going to say, because that’s been the case for decades, and the whole reason that we created Te Aka Whai Ora was so that there was a more direct line.

So, again, I say that we’ve got the Minister and his advisory committee, we’ve got Health New Zealand, and we’ve got the iwi-Māori partnership boards. At every level, I would say to the Minister he is weakening those relationships. So I’d ask him to tell us what it means to take reasonable steps to support those, and whether or not the engagement “with iwi-Māori partnership boards when determining priorities for kaupapa Māori investment”, which is the new section 15(b) in here—does that mean that those iwi-Māori partnership boards will have some control and some say, or is this just window dressing, because I have to be honest with the Minister that that’s what it looks like.

So, for me, there are three sets of questions in there. The first is around where that Māori health advisory committee will get its advice from and how it will advise the Minister, then picking up Mr Henare’s question about the Health New Zealand board and how that will have proper representation for Māori, and how iwi-Māori partnership boards will actually be able to fulfil the role that they’re given in the Act when I think what we see here is a significant weakening of the language. I’d like the Minister’s response on all three of those matters.

We live in unprecedented times in Aotearoa New Zealand tonight. Why do I say that it’s unprecedented? Because this Government has deliberately introduced this legislation, knowing full well that it would restrict the jurisdiction of the Waitangi Tribunal to hear the urgent claims into the disestablishment of Te Aka Whai Ora this Thursday and Friday. At no other time have we seen this.

I would like to ask the Minister, what advice did he receive? Knowing that the date was set for the urgent hearings, what advice did he receive from his officials on the urgent hearing and the impact that introducing this legislation today would have on the jurisdiction of the Waitangi Tribunal? We were advised at 6 o’clock tonight from the Waitangi Tribunal that its jurisdiction to hold the urgent inquiry on Thursday and Friday, as scheduled, is now vacated. So the question to the Minister is: what information and advice did he receive, knowing this was no surprises? We knew that urgency was happening. Our people, te Iwi Māori, need to know how did he make his decision to introduce the legislation tonight.

Further, we’re wanting to examine the capacity and capability of Te Aka Whai Ora to understand kaupapa Māori services, cultural safety, and responsiveness of services to improve Māori health outcomes. It’s a kupu tāpiri—it’s a little bit along the lines of what Peeni Henare has said—but I do want to share and I do raise the concerns that I did raise earlier in my previous speech that having two Māori voices on the current Te Aka Whai Ora board is only a few out of the seven. Then, with the disestablishment of Te Aka Whai Ora, our whaea Tipa Mahuta will lose that position, and we are left with one.

Therefore, some of the tasks of Te Whatu Ora require that there needs to be engagement with te Iwi Māori and there needs to be capacity to work with our iwi-Māori partnership board, and so there’s two levels of engagement that I’m asking for the Minister to provide a response on. Does he believe that the Te Whatu Ora board in its current capacity has the ability to engage both with iwi-Māori partnership boards and te Iwi Māori whānui, and what are his plans to fill those gaps? Is he going to expand the board table? Will he recruit more talent, knowing that we have talent across the Māori health sector—as we’ve heard from previous speakers—that could come on board to help power up this new, mainstream waka of ours that will be the rongoā for te Iwi Māori health issues?

In closing, I want to share Kahurangi Tureiti Moxon’s feedback on breakfast TV this morning, where she said that the existence of the Māori Health Authority gave us some semblance of control and that we could do what was right for us, but, instead, here we are, being plonked back in a system where we started, and right back into a system that doesn’t really work for Māori. She added that she doesn’t believe that it will work for te Iwi Māori.

So that’s the challenge for our Minister and for the Government: how will this model—or, actually, we don’t have the plan; all we know is kāore kāore. What is the plan, and can you give us assurance that we will see the plan as te Iwi Māori and have the ability to help input into what is the new waka hauora for us? Kia ora.

Thank you, Madam Chair, and I thank the members for their questions. I’d like to start with a set of questions from a member before the dinner break, raising the question that, as far as could be seen, the only focus around the amendments to section 6 in clause 6 was with the Hauora Māori Advisory Committee (HMAC). This isn’t correct. I’ve already identified in previous replies three functions that demonstrate obligations under section 6: (1) HMAC will be one representation of the Māori voice; (2) health service monitoring and decision making by iwi-Māori partnership boards (IMPBs)—

Hon Willow-Jean Prime: Sorry, what was that?

Hon Dr SHANE RETI: —and (3) delivery of services as close to the home and the hapū as possible.

CHAIRPERSON (Barbara Kuriger): Excuse me, we’ve just got a question. Could you just—

Hon Willow-Jean Prime: Sorry, could you just repeat that? I didn’t hear your “one”.

Hon Dr SHANE RETI: Oh, yeah—sure.

CHAIRPERSON (Barbara Kuriger): Thank you.

Hon Dr SHANE RETI: I have already identified in previous responses three ways that obligations under section 6 will be met: (1) HMAC will be one representation of the Māori voice; (2) health service monitoring and decision making by IMPBs; and (3) the intent of delivering services as close to the home and the hapū as possible. So to suggest that the response to section 6 is just HMAC is clearly flawed.

If the member is also worried—and it’s come up in questions from two previous speakers also—around the proposed appointment process to HMAC, again, that has been the appointment process, and it is the appointment process today. It has been for the last two years. It was created by this Government, and there’s nothing different to that. It was due to change on 1 July 2024, but it is the current process, so I don’t think that really stands up.

A member more recently raised the question under clause 8 about the Māori Health Authority and appointments—and, indeed, the last member did also—to Health New Zealand. Several things here: first of all, I believe this is an “and and” between skills-based and representation. I would point you to one of the Māori members on the Health New Zealand board already: Dr Curtis Walker, who clearly is skills-based and brings representation. So it is my intention to have that as an “and and” on the Health New Zealand board.

On new section 16A in clause 13, the question was raised as to when is reporting back “from time to time” and what does that mean. At the present time, metrics are currently reported quarterly, and this is a feature of the ability of Health Quality and Safety Commission and others to provide robust data. So I would anticipate at this point that quarterly reporting will continue, and we’ll say more about that when we bring our targets forward.

The Hon Grant Robertson also raised the amendments to section 6, and was the third member to review the material we’ve already discussed. The only extra point I would add in—and it’s not “extra” because I mentioned it before the break anyway—is that, yes, I do envisage the Hauora Māori Advisory Committee to be proactive, as I mentioned in a previous call.

I’ve already discussed Health New Zealand’s Māori representation. New section 15 in clause 11, Health New Zealand providing information to iwi-Māori partnership boards—again, before the break, it was raised. Well, there’s a different capacity for iwi-Māori partnership boards—and that’s absolutely correct—and until we can power them all up, there will be some who need corporate services. Well, clearly, there’s going to need to be information passed back to IMPBs, and that would seem to be self-evident. Furthermore, when they are powered up to be able to do more analysis and reporting, for them to be able to see where they sit in the context of a national measure is likely to be really helpful. So, again, Health New Zealand will be passing information back to the IMPBs.

Kia ora, Madam Chair. Thank you for that. Look, I don’t usually speak on health bills, but there are aspects of this bill which I would really appreciate it if the Minister could elucidate. There are, essentially, only two aspects to my question. It strikes me that pae ora—the original objective—was really to give some self-determination around health delivery for Māori consistent with Treaty obligations, and, in particular, the idea or the concept of rangatiratanga in respect of health delivery. We’ve been talking, and I’ve heard my colleagues talk about representation and voice and consultation. I guess my question is this: if the Minister agrees that Te Tiriti is a partnership where we should be giving as much self-determination to Māori as is possible, then what is the rationale for the retreat from that here?

We give self-determination in the delivery of Government services in many areas, and kaupapa Māori schools are a really good example of that, where they are designed in a te ao Māori way and delivered in a te ao Māori way. They have fantastic outcomes—we know that. Why is that in this critical area of health delivery, we are retreating from the delivery of health services to Māori in a way which Māori have self-determination over how that is delivered?

If the answer is “We’re not retreating from that.”, how is it that we are respecting the right of self-determination—of rangatiratanga—in this domain when all of the amendments that I’m reading talk about seats on boards, seats around the table, and not a table of their of their own? Given that this is a massive retreat from self-determination of delivery of health services, and that you’re saying to Māori that “No, I don’t trust you to deliver”—effectively—“health services. I think this is a bloated bureaucracy.” and that having by Māori, for Māori in health is nothing more than having a bloated bureaucracy, what have you done to talk to Māori about that retreat? Whom amongst iwi and hapū have you spoken to? What is the view of Māori of your decision?

If the answer to that is “That’s the election.”, then I would put to you that that’s not satisfactory and that we must engage with Māori whenever we change the law in a way which directly affects Māori. There can be no more substantial change than taking the autonomous delivery of health services away from Māori. So I’d appreciate it, Minister, if you could answer those two questions.

Tēnā koe e te Pīka, otirā tēnā rā tātou e te Whare. E tū ana ahau hei waha i ngā kōrero mō Te Pāti Māori mō tēnei pire o Te Aka Whai Ora.

[Thank you, Mr Speaker; indeed greetings to all of us of this House. I stand to give voice to the statements of Te Pāti Māori for this bill on Te Aka Whai Ora.]

I’m going to be talking on “(a), (b), (c), (d), A, E, I, O, U, (1), (2), (3), (4), (5)”, because, basically, this whole bill, in itself, knowing that we are taking a Māori Health Authority amendment bill rushing through urgency, is a complete breach of Te Tiriti o Waitangi in its full context, and even looking at this bill, with only a couple of hours to look at it, I see that “mātauranga Māori” has been axed and replaced with “cultural safety”. Now, that is a huge concern, knowing that this coalition Government has no rules or regulations or complete conscious awareness of what cultural safety actually is, with their 100-day coalition plan. Knowing that they are going to replace mātauranga Māori—well, what is the plan? What is the strategy? What does that mean, by taking out mātauranga Māori—is that the “Tohunga Suppression Act 2.0”?

Also, bringing in Peeni Henare’s amendment to new section 15 in clause 11, of a targeted approach—now, why I’m looking at that is because Māori have a completely different way in the way that we engage, we interact, and we service our health and our different perspective on life in a te ao Māori context world view, and that’s even looking at bringing up Wai 262 and the way that we bring in Māori data sovereignty. So that is a huge concern in this amendment bill.

I want to ask the Minister of Health what are the different strategies that he is proposing to deliver on Māori health outcomes, knowing that us, in Waikato—we have been proposing strategies for decades. Even if we look at Princess Te Puia Hērangi in 1930, which is when she wanted the aspiration and goals to establish a Maōri hospital at Māhinerangi in Tūrangawaewae House. We are now in 2024, and we—her mokopuna—are still fighting for those exact aspirations and dreams.

Te Aka Whai Ora was a step to that realisation, and I’m also standing here. I could not not stand up, purely because I am a mokopuna of the original claimants in the Maōri health claim, Wai 2575, and also Wai 3307. Actually, the Wai 3307 claim was tabled in 2005, when I was only two years old, and, actually, my grandparents were the ones who tabled this health claim. I want to ask the Minister why has he not had consultation with these original claimants like Tureiti Moxon, Taitimu Maipi, and the many different mātanga and experts in this field, knowing that they’ve given decades upon decades of work to the establishment of a Māori Health Authority but also, as a larger context, looking at the mahi and blood, sweat, and tears that they have done in terms of the Wai health claims, bringing that forward to a Waitangi Tribunal.

Also, knowing that we do have the strategies, it’s ironic that members across keep shouting that Māori need to retain their self-responsibility. Well, that’s exactly what we want to do. That is actually tino rangatiratanga. It is self-responsibility. We want to have self-responsibility over our health, over our data sovereignty, and over our outcomes, but we can’t because the Crown is in charge of that.

Yeah, I’m looking at the time—oh, e āhei ana au—

CHAIRPERSON (Barbara Kuriger): Yeah, keep going—keep going.

HANA-RAWHITI MAIPI-CLARKE: OK, thank you—cool. Also, looking at the way that we want to have self-responsibility over our tino rangatiratanga for our health and outcome deliverables—for example, my grandmother, actually, and Ramari and also other rūruhi within our community such as manu Tutata Matatahi, who were the first ever Māori community health workers on their own marae. We have the strategies in place. Those were our grandparents, and now we can’t come to a third generation, where we are—Madam Chair, can I take this second call?

CHAIRPERSON (Barbara Kuriger): Hana-Rawhiti Maipi-Clarke, you may.

HANA-RAWHITI MAIPI-CLARKE: Cool—ngā mihi nui ki a koe. Also, if we look at the mahi that whaea Tipa Mahuta has done and if we look at the, I guess, layer of colonisation that has affected us specifically in Waikato-Tainui with the Raupatu settlement claim, I quote from Sir Governor Grey. In 1863, he actually said that Māori—he had never seen such healthy kids anywhere else in the world other than in Waikato, and such fertile land. In 1863, Sir Governor Grey said that.

Our job as Kīngitanga, our job as an iwi, our job as a post-settlement iwi, our job as Wai claimants, and our job as third-generation mokopuna is to make that we peel back those layers of decolonisation. So I want to ask the Minister what he is going to do to make sure that we are shredding those layers, because us, as Māori, looking at in a Māori context, world-lens view, we don’t just look at the physical outcome of health but—like what Tā Mason Durie has done in his amazing mahi—we are actually looking at a Whare Tapa Whā, a complete holistic awareness of a Whare Tapa Whā approach.

So, yep, that’s what I have to say, and if this Government keeps saying we’re woke, they must be asleep. E oho ana tātou, e moe ana koutou.

[We are awake, you are asleep.]

Ngā mihi ki a koutou.

Thank you, Madam Chair, and I thank the Minister for his brief answers that didn’t give any detail to the questions that I asked. I’m going to ask some few questions, for fear of repetition or him saying that he’s already answered these things.

I spoke to the amendments to section 6, in clause 6, which are the key amendments to disestablishing Te Aka Whai Ora. I spoke to how section 6 actually outlines how the Crown will meet its obligations under the principles of Te Tiriti o Waitangi by establishing Te Aka Whai Ora and its roles and functions, and I asked the Minister if now the—what are you calling it? HMAC, the Hauora Māori Advisory Committee—that’s what I couldn’t understand from your answer. HMAC is now going to be the answer to the way in which the Crown is going to fulfil its obligations to meet the principles of Te Tiriti o Waitangi.

What I wanted to ask the Minister, though, is: when you look at the current legislation, there are words in there that are very strong directives and obligations on the Government and on the various organisations and agencies in here. They use words like “require”: “requires the Minister to have regard to any advice of the Māori Health Authority when determining a … strategy; … requires the Hauora Māori Strategy to be jointly prepared … provides for iwi-Māori partnership boards to enable Māori to have a meaningful role in the planning and design of local services; and … requires the Government Policy Statement to contain priorities for hauora Māori; and … requires Health New Zealand and the Māori Health Authority to engage with iwi-Māori partnership boards; … requires Health New Zealand and the Māori Health Authority to jointly develop and implement a … Health Plan and to work together in the performance of specified functions”, and so on.

That is very strong language legislated for, and a “require” is that you must do it; not that you can choose to do it. We’ve had decisions like the King Salmon case, for example. When legislation has words like that in it, the Government is required to follow that. What the Minister is proposing is new section 15, for example, which will require the health authority to—what? To “take reasonable steps to support iwi-Māori partnership boards to achieve their purpose” and “engage with iwi-Māori partnership boards when determining priorities for kaupapa Māori investment.”

Māori need certainty. They went from having mana-enhancing provisions—a partnership approach to their healthcare, to their strategy, to the priorities, and to what’s going in the Government policy statement—to now having in the legislation words like the Minister will take “reasonable steps”. What are “reasonable steps”? Can you define it? Can you tell us and can you tell those that are listening tonight—

CHAIRPERSON (Barbara Kuriger): “Can ‘the Minister’ define”, please.

Hon WILLOW-JEAN PRIME: Can the Minister please tell those in the committee and those that are listening tonight what they can expect in terms of “reasonable steps to support iwi-Māori partnership boards to achieve their purpose”? Can you please tell us what “engage with iwi-Māori partnership boards when determining priorities for kaupapa Māori investment.” actually looks like? Where are the details on how this is going to be given effect to?

You said, Minister—sorry, Madam Speaker. The Minister said that having iwi-Māori partnership boards is mana motuhake. Can you please define “mana motuhake” for me, and how your board, set up under a piece of Crown legislation, is actually mana motuhake? Please give me the tikanga definition of “mana motuhake” and how your iwi-Māori partnership boards are going to be giving mana motuhake to our hapū and our iwi.

I also have questions around the functions of the iwi-Māori partnership boards and the amendments proposed to remove the functions of agreeing to locality plans, and nominating members to the Hauora Māori Advisory Committee. Now, the Minister has stood up in the committee tonight and said that the process is exactly the same for the appointment of HMAC. No, it’s not. It’s very clear, when you read your tabled amendments, that the Minister is actually changing that process and that there was a role for the iwi-Māori partnership boards in that and there was a role from—and it flows on, so into the Hauora Māori Advisory Committee and into Te Aka Whai Ora. So the Minister is not correct when he is saying that the process has not changed at all and that it’s the same that was in there before.

My question to the Minister is: what weight will he give those priorities that are developed through clause 15, because what is the point of engaging with Māori—you know, you’re saying you’re going to do it through the iwi-Māori partnership boards and you’re saying you’re going to do it through Hauora Māori Advisory Committee. But what weight are you actually going to give to those priorities, because what I would argue is that what was in the legislation that you are changing and disestablishing were far more requirements to work in partnership to develop the health strategies, the plans, the objectives, the Government policy statement, and so on. So I want to know what weight the Minister will give to the priorities that come out of this process, or will it just be a box-ticking exercise and lip service?

Also, there’s no dispute resolution process in here. But I do want to take the opportunity to turn to clauses 23, 25, 29, and 30, because what concerns me is that these are the consequential amendments. So, for example, clause 23 amends section 50, which relates to the development of a New Zealand Health Plan, and what it says is: “The effect of the amendment is that the plan will be developed solely by Health New Zealand.”—right. Clause 25 amends section 52, which relates to the preparation of the annual performance report: “The effect of the amendment is that Health New Zealand will be solely responsible for preparing the annual performance report.” Clause 29 amends section 57, which relates to the making of the New Zealand Health Charter: “The effect of the amendment is that Health New Zealand will be solely responsible for facilitating the making of the charter.” Clause 30 amends section 58 by removing the reference to the Māori Health Authority: “The effect of the amendment is that Health New Zealand will be solely responsible for reporting on the charter.”

How can Māori have confidence when such significant changes are being made to the way in which our health system is going to operate that their voice is going to be reduced to a Hauora Māori Advisory Committee whom, it says here, the Minister can request information from. It doesn’t even embed their functions. It doesn’t give it any level of priority in his decision making. What confidence can Māori have?

In these changes that the Minister is making, he hasn’t given any real detail on them. He has not defined “reasonable steps”, he has not defined what “actual engagement” looks like, and he has not defined what the systems for engaging are going to be. He has not defined the functions of the iwi-Māori partnership boards. He’s pushed out for five years the localities planning, which is kind of an important part of how you’re going to have a bottom-up approach to the delivery of health services and how our communities are able, through that process, to identify what their needs and aspirations are—which you say you want to deliver on, but, actually, you have no mechanisms to do that.

So those are my questions to the Minister. Can he please provide us with some detailed answers, because everybody is desperately wanting to hear how he’s going to deliver on his vision with his proposed changes here.

Thank you, Madam Chair. I’ll respond to some of the questions. From the member over here regarding timing, this has been well flagged through our 100-day commitments. I’d also comment that the tribunal—once the legislation has been enabled—is still able to critique it, and that is the understanding that I have had, and we wanted to provide some surety to the staff at the Māori Health Authority so that they knew what the plan was. So we did want to move with some degree of timeliness.

It was also commented—and I’ve already mentioned it before—about the skills base and representation to the Health New Zealand board. The member that was over here raised the question of whether there was actually a reduction in autonomy; I don’t think that’s the case, because what we’ve said is that Māori will be involved in monitoring, delivery, and decision making at local levels. So I don’t accept there will be any reduction in autonomy, and he also asked about whom discussions had been had with. I’d already said that we’d met on or around 6 December with iwi-Māori partnership board chairs, but if they want to have further discussions, start with Tuwharetoa, and ask how the consultation has been with them.

The member down over here asked the questions about Māori health outcomes and how are we actually going to do that. Several things: first of all, health workforce are going to be pre-eminent. It’s really a common pathway to challenges we have in the health system at the moment. So health workforce will be important, targets will be important, and we have to give people the tools to do the jobs, so that talks to infrastructure. So those are three key ways that we are going to improve Māori health outcomes.

We’ve had discussions with New Zealanders over many years—in fact, since the Māori Health Authority was first described. I recall, that afternoon, going into public domain, and there have been many, many discussions over what now must be about three years. There is nothing new here tonight about the discussions. The Māori frameworks of health—yep, the Te Whare Tapa Whā o Te Wheke, which I think Rose constructed. What I would say here is that we totally believe and I believe in cultural competency and the Māori health frameworks that support that. Thank you.

Thank you, Madam Chair. I have a question, first of all, to clarify, following on from my colleague. I wasn’t clear with the Minister of Health’s answer regarding the Waitangi Tribunal and the timing. Is it accidental that this is being rammed through in urgency two days before, or is it deliberate? That’s my first question.

Secondly, given the coalition Government’s support for localism, at least in theory, the Minister seems to have such severe doubts about localism in this area that it’s going to take five years to introduce localities. So how will that provide services—I think I quote—“as close as possible to Māori hapū”?

Moving on to a comment, I’d like to know whether the Minister agrees with a member of his own caucus that seemed to direct the health deficit for Māori to their own fault. If that’s not victim blaming, I’m not sure what is. Does the Minister think that it’s Māori’s fault that they languish as a result of socio-economic deficit, that they tend to live far away from the centres of walkable cities and towns, that their socio-economic status means that they are not able to buy healthier food and that milk remains a lot more expensive than fizzy rubbish, despite the wonderful farmers that provide us with it?

Then, finally, how much worse is Māori health going to get over those five years—and I think it might be unlikely that he will still be the Minister of Health in 2029. How much worse is the health deficit going to get? Thank you.

Thank you very much, Madam Chair. I’m very pleased to have an opportunity—my first chance, actually—to be able to contribute to this committee of the whole House stage.

I’ve taken close attention to the debate. I was watching before the dinner break and have been here since the start of the dinner break. And, since it is my first opportunity to contribute, I think it’s pretty important that it is noted in the Hansard how disgraceful I think this bill is. It’s very clear, I think, to anybody that looks at the stats for Māori across Aotearoa that the health system as it’s stood has not delivered—that, with health stats and life expectancy, it hasn’t worked, for whatever reason. But there was a very clear message that the country got during COVID that a delivery model that was delivered by Māori and designed by Māori was effective. So, in establishing the Māori Health Authority, there was actually something in place to deliver the things that the Minister has promised the committee are his priorities here tonight.

Now, there’s one thing that sticks in my mind—before I get to my question—and it’s that, as many members who have been here a while know, our rural communities are particularly important to me, and therefore so too is the equitable access to health. I, alongside some of my colleagues, played a pivotal role in ensuring that the requirement for a rural health strategy was included in the legislation that set up the reformed health system, and I’m incredibly proud of that, because we recognise that those that live in isolated and remote areas simply do not have the same level of access to health. The same rationale applies here, and I cannot help but think that if this were an Act that had established a rural health authority, would this Government be repealing it? You’ve gone pretty quiet now, Joseph Mooney. The fact is they wouldn’t, because rural people vote for this Government, and Māori people don’t, and the National Party is like a river: it takes the path of least resistance. When it comes to talking about any issue that requires or that establishes something that focuses solely on Māori, instead of taking leadership they took the easiest path, and that is reflected in this repeal bill.

The question that I have is specific to clause 35. It is looking at replacing section 89 with three parts outlining the Hauora Māori Advisory Committee. It says here in new section 89(2) that “The committee comprises 8 members appointed by the Minister after consulting the Minister for Māori Development.” At what point does this outline that the people who are going to be on this committee are going to be able to deliver the same level of expertise and insight that the Māori Health Authority did? If the Minister truly believes—as he has outlined on a couple of occasions; not all occasions, but on a couple of occasions in his contribution during this stage—that he feels that what he is outlining is going to deliver better, what protections are in this clause? What protections in clause 35 of this bill would stop a future Government imposing eight members that know nothing about Māori? They might not even be Māori. There are no protections in this.

Now, the Minister may say that the selection criteria is exactly the same as it has been. When you’re talking about a Māori Health Authority that clearly outlines the requirements and the expertise that is required for the people that are involved in the decisions and the advice that are provided, it’s pretty clear cut. We’re not now. This Government is getting rid of this. We have a committee to advise the Minister when he requests it. Now, the Minister may be offended by this suggestion that he wouldn’t select people, but what’s protecting future Ministers? What is protecting a future political party, campaigning on the basis of identifying that there is some unease in the community about this idea that there’s something specific to Māori. In the future, it is entirely possible that a political party might find that it is in their interests to campaign against something that focuses just on Māori—even though deep down they may or may not know that it is the right thing to do—and get elected on that basis. What is to protect a future Minister from stacking this committee—to try and demonstrate a Māori-specific focus to health, which I assume is the intent of this committee—with people that will undermine it because they don’t have the expertise that’s required to deliver the purpose of this, and then stand up and say, “See, it doesn’t work.”?

Now, I repeat, I’m not suggesting at all that this Minister—who I believe is a man of integrity; I fundamentally oppose what he is doing here. But what is to stop a future Minister doing that? Three simple sentences here; they just simply talk about the number and a very brief requirement that they consult another Minister, but there’s no protection. I think the committee deserves to know an answer to that.

Just before I call the Hon Peeni Henare, I just want to say that we are still getting some new questions about some new clauses and we are under urgency, and as long as I keep hearing new clause numbers and questions that are new questions, we can allow a little bit more time for this debate.

Thank you very much, Madam Chair. Members on the other side of the Chamber seem a little glum this late in the evening, so I’m going to start my question by quoting that well-known Māori fellow by the name of Billy T James. What he says is, “When you put Kiwis in the room, you put two of them in the corner and they’re bound to make a separate committee.”

Now, why do I say that? That’s because one of the parts in clause 17, which looks to repeal subpart 5 of Part 2, which is dispute resolution—now, that’s really important, because we’re not always going to agree, and I accept that the Government has already made their intentions clear with respect to the Māori Health Authority. But where, throughout this entire system, is there an opportunity to resolve issues where we do not agree? That’s just a fact of politics; that’s a fact of life. In that particular part that’s being repealed, there are separate provisions there that instruct the Minister of Health to also consult with the Minister for Māori Development. I’m looking for reassurances from this Minister: is that still his intention, to include the Minister for Māori Development in the decision making and the process around dispute resolution?

The part that’s being repealed here also recommends that the Minister of Health also discuss these matters with the Minister for Te Arawhiti. That’s really important, because what we’ve found, and certainly in our time as Government—and this Government’s finding out at the moment—is that dispute resolution is really important, especially when we’re talking about large bodies who have opportunities to be able to influence, in this case, health policy, who do not agree. The question is quite clear to the Minister, who’s looking to just simply scrap any dispute resolution process here: what is the Minister going to do when there is clearly a dispute—one between, let’s say, the Hauora Māori Advisory Committee and Health New Zealand; let’s say an iwi-Māori partnership board and Health New Zealand; let’s say an iwi-Māori partnership board and its locality leadership? There are questions here; there are matters here that not everybody’s going to agree on. So we’re looking for assurances from the Minister that dispute resolution mechanisms will continue to remain there.

I’ve already mentioned the Minister for Māori Development and the Minister for Te Arawhiti. They play important roles in making sure that the Minister himself gets the support he needs to make sure that, as we work through a dispute resolution process, all voices are being heard fairly, the arbitration process is going to be heard fairly, or is the Minister suggesting to everybody, with this particular bill, that he’s going to play God on the matter, that it’s entirely up to him on how the dispute is resolved, or his decision is the final say, and he’ll play judge, jury, and executioner? I think that’s completely dangerous and against the democracy that our countrymen, our fellow Kiwis, expect from this particular institution. That’s really important.

So, if the Minister of Health is, as I’ve mentioned, going to be the final decision-maker on any dispute resolution process, how then do Māori actually find their voice in that particular process? Is it through the tribunal? Well, we’ve heard that that’s not going to be the case. Is it that they make an appointment with the Minister directly? Well, what we’ve seen is the Minister’s willingness to speak to more and more people and to engage with far more Māori about matters relating to health in general and Māori health in particular. So do they need to make an appointment? Are they able to discuss these matters directly with the Minister, or is it simply waiting for the opportunity for the Minister and the Government to front up to the iwi chairs, where the iwi-Māori partnership boards, for example, are able to prosecute their particular dispute with whatever body the Minister has in charge of Health New Zealand? These are important fundamental questions.

As I said, as Kiwis we won’t always agree, but it is important that there are strong mechanisms. Given that the Minister’s repealing this, we want to seek a surety from the Minister that there will be mechanisms to resolve these disputes, that he will continue to seek the support and counsel of his colleagues, namely the Minister for Māori Development and, of course, the Minister for Te Arawhiti, and, indeed, even further colleagues across his Cabinet. That’s going to be really important, and I look forward to hearing the Minister on those questions.

Thank you, Madam Chair, for taking further questions related to the removal of Māori voice from the health system in this bill. My colleagues have already made a number of points about the ways in which that is occurring, but I have two that I believe have not been canvassed. So we’ve already heard about the loss of iwi-Māori partnership board (IMPB) ability to approve locality plans. We’ve seen them lose the ability to appoint to the Hauora Māori Advisory Committee—lose control over who is representing them in the system. That now goes to the Minister. We have been told that it is not the fact that that is the case in the current legislation; that was a transitional provision. We’ve also seen that the role for Te Aka Whai Ora in drafting the Government Policy Statement is gone, and the right for Te Aka Whai Ora to directly advise the Minister is also gone.

I want to ask two particular questions. The first relates to clause 6(3), which is the advice on the New Zealand Health Plan. Can the Minister clarify if the IMPBs will be involved in giving advice on the New Zealand Health Plan, because otherwise there is no input from the local level into what is a key instrument in the health system. In fact, I often say that the main feature of the health reforms was to enable long-term planning for the health system, and that New Zealand Health Plan is an incredibly important document for shaping the future of the health system.

The second thing I want to ask relates to clause 15, which is the requirement for Health New Zealand to support and engage with iwi-Māori partnership boards. Given that his words dictate what must occur in practice, I’d like the Minister to define what he means by “support and engage”. To me, “support” sounds a little bit paternalistic, and I’m particularly interested in understanding how “support and engage” fulfils the Government’s requirement to work with iwi in partnership under Te Tiriti.

Thank you very much, Madam Chair. I want to add to the list of questions on a section that I don’t believe has had any substantive debate and, in particular, an amendment in the name of my colleague Arena Williams, which I know has not had any debate at this time. That is clause 18 of the bill, which covers section 33 of the original Act. Now, for the most part, what Part 1 of this bill does is simply remove references to the Māori Health Authority.

CHAIRPERSON (Barbara Kuriger): It’s 15.

Hon GRANT ROBERTSON: Yeah, 15—18, section 18. Clause 18, in fact, if we’re being specific. Clause 18, which is amending section 33 of the original Act. For the most part, we’ve got a bill that removes references to the Māori Health Authority or the Health Authority. What clause 18—and, in particular, clause 18(2)—does, however, is replace section 33(1)(d) of the Act, the Pae Ora Act, which currently says, “Health New Zealand, the Māori Health Authority, and relevant iwi-Māori partnership boards to agree to locality plans for localities:”. But unlike most of the other clauses, this one ditches the iwi-Māori partnership boards from their role in approving the locality plans.

My question for the Minister is: how is he going to ensure that the voice of hapū and iwi at the local level is protected in the creation of locality plans? Because that is the very point of their existence. So I get it; the Government is disestablishing the Māori Health Authority, and they want to take all the references to the Māori Health Authority out of the original Act. I disagree with that strongly. But, now, we’re altering the role of iwi-Māori partnership boards here. This is going much further—and illogically much further—because the iwi-Māori partnership boards were to be that very linkage at the local level when the locality plans are being developed.

So my colleague Arena Williams has proposed changes here, in particular in clause 18(2): after the word “locality”, insert the phrase “based on the advice of the relevant iwi-Māori partnership boards.” So the Minister might like to tell us if it was a mistake. It is possible it was a mistake, but I don’t think it was. I think it was an intentional move, and I think the Minister should explain to the committee why, in the cause of ridding references to the Māori Health Authority, we are now ridding reference to the iwi-Māori partnership boards in the development of these locality plans. And by way of explanation—and I know there’s a lot of buzzwords in health that are being used in the Chamber tonight—those locality plans were, and are indeed, absolutely critical to the overall health reform process, in order to make sure that, in creating Health New Zealand, creating a Māori Health Authority, we give respect to the fact that local communities know the health needs of their communities.

Now, that was what lay behind the district health board model; it didn’t work. So we’ve come up with a different model that says “locality plans”. This clause excludes the group of people who were designed to make sure that we had iwi and hapū voice in the development of the locality plans. I find it extraordinary that a party and a Government who would tell us that they don’t like centralisation and that they want to see things done at a local level would remove the very Māori voice that has been created. The Minister, in a couple of his contributions, has said he wants the iwi-Māori partnership boards to keep doing their jobs, albeit neutered through the bill that’s in front of us tonight. So that is my question for the Minister.

Firstly, is this an intentional thing to take iwi-Māori partnership boards out of locality planning, which seems completely illogical to me? And, secondly, would he consider Arena Williams’ amendment, which would at least mean that those plans would be based on the advice of relevant iwi-Māori partnership boards?

Thank you, Madam Chair. Again, taking into context that 83 percent of Māori did not support this coalition, I therefore have some real concerns on assumptions that are made—again, through clauses 11 to 15—from a different perspective. Quoting the Minister earlier and his view on the Māori-iwi partnerships and the need to power them up, in clauses 11 to 15, if that is indeed the Minister’s view, the question we have is: how long does the Minister believe it will take to power up the iwi partnership boards? How will they be resourced? What sense or lens will the Minister have over the inequities for Māori as this transitioning is happening, particularly remembering our mana hauā, our tangata whenua in rural areas, our tangata Pasifika?

There’s a lot of emphasis on iwi-Māori partnerships. Indeed, we heard one iwi tonight that has supposedly endorsed this approach—kei te pai if that’s the case. But there is a lot of emphasis on iwi-Māori partnerships who have had one-on-one meetings with the Minister who are likely expecting some direct funding and hoping that this model will provide a better resource model than what currently exists. However, if the power-up capacity that the Minister himself referred to is not there, how long will it take the Minister—and, again, what we’re not hearing is what the gap filler is. What strategy is going to be applied during this transition—assuming that the Minister believes this will happen in a linear, coherent way? Knowing Māori and iwi as well as I do, each will have—and should have—their own authenticity and, indeed, their own right to self-determine the path through that. It’s not clear. If the Minister would, please, share how they intend to monitor this progress, if indeed they are? At the moment, it’s really difficult to find data on the iwi-Māori partnerships and indeed the locality plans and indeed the successful prototypes.

What is the expected outcome? How will the Minister ensure that we will have sight, as communities affected, of those particular outcomes—so, when he sees that a particular partnership hasn’t worked, that there isn’t the resourcing around that? Let’s just take some of the regions that I come from, where there hasn’t been a successful model in the district health board model. They hadn’t gotten up to speed and certainly haven’t had the support and the capacity to get to a “powered-up model”—again, I use the Minister’s words, not my words.

It’s really unclear how we can, as communities most affected, be assured that this would be monitored. It’s really unclear for the rest in Aotearoa, who are taxpayers, who indeed are looking at this being a better model; a better return on investment; a better social return on investment. How is the Minister going to track the success model, given that some of the capacity that’s been committed to this particular model in Te Aka Whai Ora lose their mahi, lose their connection to the very communities that they’ve been building—I guess rapport?

Also, what’s really not obvious in this, if we were to go to clause 28—I mean, just bear with me. It says, in clause 28, “Section 55 amended”, which relates to the development of locality plans by Health New Zealand. The amendments remove the requirement for Health New Zealand—I won’t go through the whole thing—to engage and removes the requirement for the relevant iwi-Māori partnership board to agree to the annual report assessing progress against outcomes in the plan.

So it is really, really important that we are not being sold something that has been set up to fail, but, most importantly, that our communities are going to get less of a service, less of a focus on our health inequities. That is our primary objective: that we get clarity from the Minister that there is a guarantee that our people are going to come out with less inequities and a better outcome from this health model.

Thank you, Madam Chair. I’ll reply further to some questions that have arisen, particularly around localities and their relationship with iwi-Māori partnership boards (IMPBs)—several members have raised that. What the legislation does is it pauses Schedule 1, I believe, for the localities planned to be formed. That is because we’re still considering the role and the place, as I said in my first reading, of localities. So that’s quite clear.

Second, there were some questions over there around protections, around the composition of the Hauora Māori Advisory Committee going forward. Look, no one can predict that far into the future what future Governments will do. But I have flagged in my readings, and flagged with our intent, that I absolutely support cultural competence and believe it to be important, and that I’ll seek advice from IMPBs around appointments, and that I also believe that there can be skills-based and representation with the Health New Zealand board. So, as much as we have some view of what’s in front of us here now, I’m offering that support.

Dispute resolution has also been raised. And, yes, it is my intention to continue to have engagement with the Minister for Māori Development and the Minister for Māori Crown Relations: Te Arawhiti, the Hon Tama Potaka, in dispute processes.

The member who’s just completed, Debbie Ngarewa-Packer, was talking to something we’ve already touched on: IMPB capacity building. I agree they will need resourcing. They have already been moderately resourced. I absolutely understand that they will need further resourcing, depending where they are on the capacity and competence sort of metrics, if you like—and to help them achieve the functions that they need, I will commit to that.

Thank you, Madam Chair. This is my first call, and I wouldn’t normally be here to speak on health issues. I’m a white boy from the deep South.

Hon Grant Robertson: Nothing wrong with that.

SCOTT WILLIS: Ha! Indeed, yeah. But I’m here to speak for many of those who’ve been denied a voice because of this outrage of urgency to force through a destructive agenda to continue to break rather than make. We really are taking another great leap backwards after so much mahi to create something that will be meaningful. I can speak for tangata Tiriti who care about health for all, who care about addressing the inequities in health.

I’d like to hear the Minister of Health clarify New Zealand’s reasonable consultation process that it will use before introducing any employment policy that is reasonably likely to have material impact on that employee. How can it be reasonable when this is done under urgency? I remember I heard a member opposite earlier talk about her pleasure in condemning Te Aka Whai Ora to the scrap heap, and I’m shocked. I’m shocked by the victim blaming I’ve heard from that side of the Chamber, and I want to know what the impact on those employees will be, those employees who will be materially impacted by these changes, done under urgency with no engagement.

CHAIRPERSON (Barbara Kuriger): Can I just mention to the member that discussions about employment are in the next part of the bill, so if you’ve got something that pertains to Part 1, then we’d like to hear it. Thank you.

SCOTT WILLIS: Yes, thank you, Madam Chair. I am concerned that this blitzkrieg of repeals—the disestablishment of Te Aka Whai Ora—is an abuse of urgency that denies voice to those most affected. I want to understand why the Minister is so afraid of the Waitangi Tribunal, and why is the Minister so afraid of the select committee process that would allow people to engage correctly? If there was any good in this, I think the Minister should be willing to allow scrutiny and examination of the proposal.

Mr Chair, to the Chair—that switcheroo happened quite quickly; didn’t notice that—I’ve worked for a kaupapa Māori organisation and I’ve seen the benefit of this holistic approach to health led by Māori, for Māori. I’ve worked with Māori and whānau in energy hardship, and what’s clear is that we need that comprehensive approach by Māori, for Māori. The one-size-fits-all, with some participation that may be willed by the Minister, is something that is just insulting to what has been created so far. It’s not going to lead to hauora Māori. It’s more than physical wellbeing; it’s mental and emotional wellbeing, social wellbeing, and spiritual wellbeing. I saw the value as a white boy from the deep South. I saw the value of a kaupapa Māori approach to health, wrapping support around those other interventions to ensure wellbeing. The ability to join the dots came from a tino rangatiratanga model of delivery, and the beauty of it was that it was Māori and tangata Tiriti, or non-Māori, all benefiting from a richer way of doing things, because innovation can become mainstream unless we reject it, unless we take a great leap backwards.

I would like to understand from the Minister why we can’t have a good debate, why we can’t allow the Waitangi Tribunal to open this up, why we can’t allow a select committee to open this up.

I won’t use this to take up any more time in the debate, but I will just note that my question asked prior to the Minister’s last call, to define “engagement and support”, as in clause 15, has not been answered

Thank you, Mr Chair—thank you. I appreciate the opportunity to take a call. I do want to note at the start of my call that some of the questions I’m going to ask are quite specific about the legislation, and the reason I’m going to get quite specific about the legislation is that we don’t have the select committee process, and normally these are the types of questions that would actually be asked of officials.

I just want to put on record my concern that I’m not sure if we’re going to be able to get into that level of detail, just because I’ve been listening to some of the Minister’s answers and I’m concerned that we’re not really getting into the detail of the bill. I have got some very specific questions, and they relate back to some of the speeches I’ve observed from Government members earlier today in the debate, and how I have witnessed the Māori Health Authority operate in my electorate. The specific question I have is: how is that going to change and be continued? And I have some really specific questions about some of the wording in the bill that I really would like some answers on because I’m hearing concerns from my electorate and I have some concerns.

So just to give some context, in some of the Government speeches earlier today, including speeches from the Minister, I heard comments that people felt the Māori Health Authority was a centralised process. I want to give an example from within my own electorate that will just set up and give the context for the questions I’m to ask, because I think that context is really needed. So we have a Māori health provider across Te Tau Ihu—top of the South Island. It operates across Tasman, Nelson, and Marlborough, and it’s called Te Piki Oranga. They are an excellent, established Māori health provider, and I’ve taken a number of my colleagues there. I want to mihi to Anne Hobby and her workers there for the mahi that they do in the community.

Now, what Anne and her team have told me is that prior to the establishment of the Māori Health Authority, they used to receive funding that went from the DHB, through to the primary health organisation (PHO), and then through to them. There was a ticket clipping along the way, and so, essentially, the money comes through the appropriation from health, then to the DHB, then to the PHO, then to Te Piki Oranga to provide Māori health services. What they have told me—and it’s not clear in the bill how this is going to continue, which is my question that I’m going to get to shortly with the Minister—is that with the establishment of the Māori Health Authority, they have received funding directly from the centre to their agency. It has not gone through that ticket-clipping exercise, which, having heard members opposite talk about bureaucracy, I just find it quite ironic because we’ve actually stripped away that bureaucracy and got more money to the agency and we’ve got it there faster. So I’m going to get into the questions I have around the bill and how the Minister is going to explain through this legislation how that’s going to continue.

So I understand that clause 15 of the bill amends section 30 to reflect the transfer of certain functions from the Māori Health Authority to Health New Zealand. So, when I read through that section of the bill—and this is my question to the Minister—in clause 15, where it says section 30 is amended, it talks about in clause 14(4) “In section 30(1)(f), replace “the activities of the Māori Health Authority” with “the hauora Māori activities of Health New Zealand.” So my specific question is: what are the hauora Māori activities of Health New Zealand? How do they relate to the funding mechanism from the Māori Health Authority directly to providers like Te Piki Oranga? What is the operational expectation that the Minister has of how that will function in practice?

These are really relevant questions, and I again make the point that we don’t have a select committee process. If I was sitting in a select committee process, I’d be able to sit here and bounce back and forth, question back and forth, with officials. I cannot do that, and it’s actually really frustrating, because we have a significant agency that receives funding. I am not clear from this legislation and from leading this part of the legislation—and I don’t even know if this is the correct part of the legislation to read, because we don’t actually have anywhere near enough detail that we would ordinarily be provided at a select committee to be able to even know, “Am I asking about the right section of the Act?”

So I do expect more than a surface answer from the Minister about, “Oh, well, we’ll engage with this, that, and the other.” I actually want a specific answer. How will funding to Māori health providers continue under the legislation that they are putting through urgency tonight? And I am going to come back to it if this question is not answered, because it’s really, really important for my community to know how they are going to continue getting that funding without the ticket-clipping, bureaucratic exercise that we had until the introduction of the Māori Health Authority. Thank you, Mr Chair.

I move, That debate on this question now close.

Thank you, Mr Chair. He aha te mea nui o te ao? He tangata, he tangata, he tangata.

[What is the most important thing in this world? It is the people, it is the people, it is the people.]

I just wanted to just open this evening with this whakataukī because this is the first time I’ve spoken in the Chamber since the death of our colleague Fa’anānā Efeso Collins, and I wanted to open with that to acknowledge him but also to highlight it in the committee tonight in the context of this bill, because we know that the health of our people should be at the heart of the work of Government. Sadly, tonight, with the proposed passing of this bill, we’re neglecting the fact that what’s good for Māori is good for all of us here in Aotearoa, and we’ve lost sight of it with this bill.

I wanted to pick up specifically on clause 13 in this first part that we’re looking at. I want to do this because, despite living in a country where we’re known for our advanced healthcare system, relative to the rest of the world, it’s been well traversed earlier in the evening and in the earlier readings just how pervasive and dire the health inequities faced by Māori are. And it’s literally a matter of life and death. What makes it worse, though, is that these disparities are not only unjust but they’re also preventable.

So, in the admirable aim of any Government—and like this Government purports to be doing—who genuinely seeks to address these disparities, one powerful tool emerges, and that is independent monitoring. I really want to hear from the Minister how clause 13 actually relates to that. Now, the reason why I want to home in on the independent monitoring is it offers a pathway to actually address the disparities that we have, and it was something that Te Aka Whai Ora was tasked with in providing independent monitoring of Te Whatu Ora. It made so much sense, and it was the right thing to do in stepping toward a system that upheld Te Tiriti and stepping towards what tino rangatiratanga could actually look like for Māori in the health system here in Aotearoa. I’m sure that the Minister, with his background, will be well aware of how critical this independent monitoring role is.

Now, with this Government seeking to abolish Te Aka Whai Ora, I’d really appreciate hearing from the Minister who or what body or what system will now be put in place to take up the role of that independent monitoring, just because it’s so invaluable. We know that we need this, ideally impartial, oversight of healthcare services. We know independent monitoring ensures accountability, it helps identify areas of improvement, and it also has the ability to safeguard against discrimination within the healthcare system, which Māori, we know, are faced with every day. Now, particularly with clause 13, which inserts new section 16A “Engaging with and reporting to Māori”, it says Health New Zealand must “(b) report back to Māori from time to time”. Now, this doesn’t, to me, sound like a robust monitoring and evaluation system, so I’d really like to hear the Minister’s comments on that.

In his response, I’d love to hear the appreciation and understanding that this independent monitoring role needs to be continued, and that it needs to be Māori monitoring and evaluating their own health outcomes for their people and not that it’s going to be absorbed into Te Whatu Ora where it will be a broken, discriminatory system monitoring itself. I really want to hear that acknowledgment and commitment to the essential importance of independent monitoring, and committing to supporting and amplifying the needs and voices of Māori as part of a healthcare system that truly serves the needs of all. Thank you.

Thank you, Mr Chair. I’ll speak in reverse order to the member who’s just returned to her seat, Lan Pham, raising the question of monitoring. The Hauora Māori Advisory Committee (HMAC) will be a significant independent monitoring body, as will the Ministry of Health, who has the responsibility to actually monitor the whole health system. And, of course, Health New Zealand will have monitoring roles as well, but the independence will be with HMAC.

The question around clause 15, on section 30(1)(f), “replace ‘the activities of the Māori Health Authority’ with ‘the hauora Māori activities of Health New Zealand’.” That’s simply because the Māori Health Authority will no longer exist. Those functions needed to transfer, and they’ll transfer to the operational arm of the system, which is Health New Zealand. Clause 15—what do I envisage by “support and engagement”? Well, support would include cultural, professional, and financial support. Engagement is the collaborative communication and sharing of information. Thank you.

I move, That debate on this question now close.

I will indicate to members that I have been watching this debate closely and we are close. It’s a while since we have had any new material, and we’ve done this. However, I will take Camilla Belich.

Thank you, Mr Chair. It’s my first opportunity to take a call in this debate, and I’m pleased to be able to do so and, as you’ve requested, cover some points which I don’t think have been traversed fully in Part 1, which is the substantive part of this amendment bill.

The area that I really wanted to cover is, first of all, just to make a comment that, fundamentally, the case for the Māori Health Authority is met through an evidence base. There are very few groups in society where you can say that there is a higher mortality rate, a higher infant mortality rate, higher rates of smoking, higher rates of diabetes, and higher rates of the less effectiveness of some medications. I was particularly struck when visiting the University of Auckland and actually hearing that some of the medications that are developed are less effective on some populations than on others because they’re not tested on those populations, and that does apply to Māori and Pasifika people. The actual medicine that we’re developing is not as effective. So there is so much for the Māori Health Authority to do and so much less clarity on the role of this body that the Minister seeks to establish.

In Part 1, which we are now on, one of the most important and substantive sections which I don’t think has been looked at as much as it could have been is the amendment to section 6 in clause 6, which looks at the repeal of part of Te Tiriti o Waitangi—the Treaty of Waitangi—provisions of the Act. My colleague Arena Williams, as she said in her contribution in this committee stage, has raised 40 amendments to Part 1, and the substantive number of those amendments relate to clause 6, which goes through—and in her particular amendment, she has deleted particular clauses in the amendment bill which we’re looking at, which then relate to the primary piece of legislation, the Pae Ora (Healthy Futures) Act. I hope the Minister has a copy of that Act, because that is really the substance of my colleague Arena Williams’ amendments to it.

So, if you look at her amendments, essentially, what she is suggesting to the Minister—and my question to the Minister is: does he agree that there is some value in including these clauses in the legislation as it moves forward in relation to the new committee that he’s setting up and the new regime that he’s setting up to look at Māori health? The main things that Ms Williams wants to include in this section, which I agree with, are a whole lot of Māori strategy, jointly prepared by the Māori Health Authority and the ministry—so retaining that particular functionality in those two groups. It’s also looking at retaining section 6(h) of the Pae Ora legislation, which requires Health New Zealand and the Māori Health Authority to engage with iwi-Māori partnership boards. It’s requiring Health New Zealand and the Māori Health Authority to jointly develop and implement a New Zealand health plan and to work together in the performance of specified functions of Health New Zealand, and, most importantly, a really fundamentally important part of the Pae Ora (Healthy Futures) Act, which established the Māori Health Authority, is section 6(j), which looks at the particular experience of the people who are making these decisions for Māori.

If we look comparatively at the new piece of legislation that the Minister is introducing, it does focus in the main on ministerial appointments and those who are perhaps favoured by the Government of the day. Conversely, the piece of legislation which the Minister is seeking to repeal through the passage of this legislation looks at the knowledge and experience and expertise that the people on the Māori Health Authority would have on Te Tiriti o Waitangi, tikanga Māori, mātauranga Māori, kaupapa Māori services, cultural safety, and responsiveness of services. So that clause is being deleted, repealed by the section that we’re looking at in clause 6.

So my question to the Minister is this. I think, and I hope, that we can all agree that that particular range of expertise is very important. So how is that going to be reflected in the new body which is to be established? I also note that this primary piece of legislation, the Pae Ora piece of legislation, implements the principles of Te Tiriti o Waitangi. It was passed democratically by this House, where everyone had a say on who was implementing the laws, and that is why it is a part of our law, which I think is an important point to remember.

Thank you, Mr Chair. I thank the member for those questions. At 19.41, Grant Robertson was the third speaker on clause 6. This is now the fourth, and I’ve already indicated how we would meet our obligations under clause 6, so I don’t have anything further to say on that at this point.

I move, That debate on this question now close.

Arena Williams’ tabled amendments to clause 6(1) and deleting clause 27(3) are ruled out of order as being outside the principles and objects of the bill.

Arena Williams’ tabled amendment to clause 19(2) is ruled out of order as not being in the correct form of legislation.

The question is that Arena Williams’ remaining tabled amendments to Part 1 be agreed to.

Amendments not agreed to.

The question is that the Hon Willow-Jean Prime’s tabled amendment to clause 10 be agreed to.

The question is that the Hon Willow-Jean Prime’s tabled amendment to clause 15 be agreed to.