Frontline providers want the axing of the Māori Health Authority declared unlawful. Here, Ruth Brown considers the arguments.
Axing Te Aka Whai Ora was a clear case of racist ideology getting the better of good economic sense, says Te Whatu Ora’s former chair Rob Campbell.
“I’m not prone to
saying that lightly. I think there was an anti-Māori form of racism that blinded us to the benefits for all the community.”
He calls the “destruction” of the Māori health authority midway through last year one of the greatest crimes against health services ever committed in this country. And it’s a move that hurts not just Māori but Pākehā as well.
If the authority had been allowed to continue, Campbell says we would already be seeing the benefits in reduced wait times at ED and better access to GPs. “I’m very confident we would have seen the flourishing of kaupapa Māori health services,” he says. It would also have greatly relieved pressure on overflowing emergency departments.
“There’s no doubt in my mind that a significant part of our primary health sector crisis now is caused by the fact we didn’t stick with the delivery of Te Aka Whai Ora.
“And there’s no question that where kaupapa Māori services are available and accessible to people they do take pressure off the hospitals, because they’re delivering in the way people want to have their primary healthcare delivered.”
Campbell says it’s long been known that to improve the health of the Māori population you had to improve Māori-based health services. “So the fact that was cut off means we deliberately made a decision not to improve Māori health.
“It’s a pretty extraordinary thing to happen. I don’t know how to describe that other than it’s a crime.”
Rob Campbell: Demands on the primary health sector would have been eased by sticking with the delivery of Te Aka Whai Ora. Photo / Supplied
That’s why the man who was sacked from his Te Whatu Ora Health New Zealand chairmanship in February 2023 for comments about National Party policy gave evidence in support of a claim to the Waitangi Tribunal over the closure of Te Aka Whai Ora.
The claim, brought by Lady Tureiti Moxon of Hamilton Maori health provider Te Kōhao Health and Janice Kuka of Ngā Mataapuna Oranga primary healthcare organisation in western Bay of Plenty, was heard in May and upheld by the tribunal. Following that, the two claimants joined by Auckland’s Papakura Marae and Ngāti Hine Health Trust in Northland have gone to the High Court seeking a declaration that the axing of the authority breached Māori rights under the treaty and the Bill of Rights Act.
The court challenge has two grounds: lack of consultation and engagement with Māori before the closure, and the failure to have a replacement plan to address inequities in health. Four days of hearings were held in August with another day set down for earlier this month; a decision is expected early next year.
Moxon (Ngāti Kahungunu, Ngāti Pāhau-wera, Kāi Tahu) also included Te Aka Whai Ora’s disestablishment, along with the removal of targeted cancer-screening for Māori and the repeal of planned smokefree law changes, in her complaint to the United Nations Committee on Elimination of Racial Discrimination, heard last month in Geneva.
Chris Tooley (Ngāti Kahungunu), chief executive of health and social services provider Te Puna Ora o Mataatua, an eastern Bay of Plenty iwi group, was on Te Aka Whai Ora’s board during its two years.
The authority spent about $535 million in its first year and $565m in its second but how much of its budget made it to the frontlines is unclear. Tooley says the first year was spent building the organisation from the ground up, including putting in place statutory requirements under the Pae Ora (Healthy Futures) legislation such as a charter, operational plans and structures.
For Māori providers who were granted contracts, it was an entirely new experience. “The beauty of Te Aka Whai Ora was that we were trusted,” says Moxon. “[Now] we’ve gone back to not being trusted. And we’ve gone back to having to jump through lots of hoops for the contracts we do have.”
Te Aka Whai Ora put the emphasis on getting better outcomes, Moxon says: having all the staff in the world counts for nothing without results showing you’re making a difference in people’s lives.
Te Kōhao Health was making that difference under Te Aka Whai Ora, Moxon says, and it can prove it.
Te Kōhao Health chief executive Tureiti Moxon: “We’ve gone back to counting widgets.” Photo / Supplied
“But unfortunately, we’ve gone back to counting widgets.” In her evidence to the Waitangi Tribunal, she gave an example: “We had a woman come to us with untreated diabetes. She hadn’t been going to the GP because she couldn’t afford it and she didn’t trust the system. We got her insulin. We helped her access food. We supported her to get stable housing. That’s what made the difference. But none of that shows up in the data the crown is collecting – because it’s not a GP visit.”
Te Kōhao Health began in 1994 on Kirikiriroa Marae and has since expanded to a new site with a large, multidisciplinary facility that includes a pharmacy, general practice, rongoā health, audiology and specialist clinics for the likes of paediatrics, diabetes and urology.
Under Te Aka Whai Ora, contracts required a plan showing how providers would deliver services and measure results, says Moxon. Kahu Taurima, covering a baby’s first 2000 days from pregnancy, transformed maternity and early childhod support for whānau. Te Aka Whai Ora’s 2023-24 annual report shows it invested an extra $13 million in Māori services for kahu taurima. The difference here, says Moxon, was her staff could use their resources to wrap around care that included practical measures – such as helping mums who might be living in poverty buy the things the baby needed – and to engage whānau to support them. “You can measure how mum is feeling, You can measure whether or not babies had their vaccinations, whether or not babies got good kai, and whether they’ve got nappies.
“The long-term goal, of course, is that we don’t have our children being uplifted and moved away from their whānau by Oranga Tamariki. So the goal is to strengthen mum, strengthen this baby to give them the best start.”
Then there’s food. A Pākehā dietitian may have a very different world view to that of a non-Pākehā patient seeking advice on losing weight. Foods suggested may well be out of reach financially, or items the patient is not used to eating. Te Kōhao now has a kaimahi (staff member) who’s “realistic” about food suggestions, Moxon says. “And we’ve got whānau who have lost lots of weight supported by this amazing kaimahi of ours.”
Underlying Te Kōhao’s approach is the premise that patients who come to it will be supported to make their own decisions rather than having decisions made for them.
But since Te Aka Whai Ora was abolished, it has lost about 10 staff, as it struggles to compete for contracts with larger, better resourced groups such as GP organisations.
Chris Tooley: Collaboration is the key. Photo / Supplied
Transactional outcomes
What Moxon calls “widget counting”, Tooley terms “transactional outcomes” – such as the number of immunisations or patient consultations carried out.
“With Te Aka Whai Ora, we actually got the ability to look beyond transactional outcomes and look at the whole wellbeing of the household,” he says.
An example is that a nurse who goes in to dress a wound for a kaumātua is given the time and resources to notice there’s a child at home who should be in school, that the cupboards are bare, or there’s a hole in the roof that’s letting in rain.
Being able to refer on to other services gets whānau out of the health system, so they’re not so reliant on it, Tooley adds. But siloed thinking that addresses only short-term needs is historically how the health system works. “You might stop [patients] going to one department in hospital but you still end up with them going to all the other departments in hospital.”
Like Campbell, he believes not just Māori would be seeing results if Te Aka Whai Ora had been allowed to continue. “We would be seeing massive shifts in structural trends across the health system.”
At the heart of it was trust and building relationships with Māori communities. “Until you have that trust and relationships you’re always going to have people that are sitting in the hard-to-reach basket or they only come into ED when they’re crawling on their knees with a heart attack. They should have come in a lot earlier.”
But why should health services be picking up the tab for things like the hole in the roof or the child who doesn’t want to go to school? Tooley points out the 2022 legislation was named Pae Ora (healthy futures) not hauora (good heath). “Yes, the health system shouldn’t be responsible for repairing the hole in the roof, right? But our practitioners should be able to go into a home, be able to do a full assessment, be able to identify any issues, and then have the means to actually pull in partners that might be able to do that part of the plan.”
Health Minister Simeon Brown.
Learnings lost
The National-led government quickly acted on its promise to abolish Te Aka Whai Ora, saying there was too much bureaucracy and promising one system for all based on need rather than race.
Health Minister Simeon Brown declined to be interviewed for this story, saying it was inappropriate to comment as the matter was before the courts. He said by email, “The government is committed to ensuring all New Zealanders have access to timely, quality healthcare, including Māori.“
Campbell says the collaborative approach to healthcare fostered through Te Whatu Ora and Te Aka Whai Ora working together “was a very inspiring atmosphere. We were demonstrating the ways in which Māori and the Pākehā system could work together. It was quite different to any other corporate board meeting or government board meetings I’ve been in.
“We knew there was a lot to learn about how to deliver primary care from the way in which Māori were learning to develop and deliver primary care.”
He gives an example of an older Pākehā man who was a regular visitor to a kaupapa Māori health service. When Campbell asked him why, the man said, “Do you know of any other health service in New Zealand that gives you a cup of tea when you come in?” The man didn’t mind waiting a while for his appointment – he got a cup of tea; people were nice to him. They weren’t rushing him out after 10 minutes.
We actually got to look beyond transactional outcomes to the whole wellbeing of the household.
“It’s just a different way of delivering service to what you get at an ED or indeed at most corporate doctor services now. Some of the things are quite simple, they don’t have to be all that sophisticated to work.”
Tooley agrees collaboration across Te Whatu Ora was key, with members of its board and Te Aka Whai Ora on committees of both bodies. “One of the my best mates was [former National MP] Amy Adams.”
From the East Coast, where rural deprivation and inequity are prominent, he found common ground with Cantabrian Adams on rural health. Together they pushed for ruralness to be labelled an equity marker alongside deprivation, ethnicity and other factors, signalling extra investment was needed in this area.
Now, Tooley has his sights set on the High Court case and is hopeful the verdict will back the tribunal finding. But no one is expecting a return of Te Aka Whai Ora. “Yes, we want a Māori health authority and it needs its own legislation and statutory weighting. But do we want to pick up Te Aka Whai Ora and just turn the switch back on? No.”
Tooley says health providers, practitioners and communities need to be consulted on what would work.
For now, though, providers such as Te Kōhao Health are diversifying and turning to other sources of funding to make things happen. Te Kōhao has won funding from Trust Waikato, Waikato wellbeing charity the DV Bryant Trust and the Lottery Grants Board to push ahead with plans for a partnership with Pacific Radiology. It has been running CT, mammogram, ultrasound and X-ray services in a joint venture with Pacific Radiology for a year in a specially designed diagnostic centre.
And other Māori providers are forging on with programmes to help their people.
“You know, despite what is often being done to us, some good things are still happening,” says Moxon. “It’s a bit like those beautiful flowers that bloom in the desert. We’re kind of in a desert right now but still the beautiful flowers find their way to the top.”
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