When Nursing standards put Treaty politics ahead of patient care – Deborah Chambers

Some Māori want that. It matters to them. There is also a narrower argument that is not ridiculous on its face: if a Māori patient is more likely to stay in the system when staff know a little of the history and do not humiliate them, teach that. Courtesy, language, family, the ordinary things. What the Council has done is different. It has made a political compact the spine of a scientific licence.

Cultural safety was invented here. In the late 1980s Irihapeti Ramsden and Māori nurses argued that patients, not the profession, decide whether care feels safe. Two other countries took up the idea: Australia and Canada. They tell staff not to humiliate Indigenous patients, and to know enough not to be clumsy. They do not make an 1840 treaty the overarching frame of every nurse’s legal scope, whether the patient is Māori, a Chinese immigrant or a Colombian one.

Forty-three per cent of Aucklanders were born overseas. Ask them, in that moment, whether an 1840 Treaty has anything to do with their broken arm and most would say no. Most New Zealand-born patients would say the same.

Sandra McDonald, a Māori nursing educator on Te Toki, the Council’s Māori committee, told Kai Tiaki (the nurses’ union journal) that cultural safety relates to clinical outcomes. “If someone leaves the hospital and doesn’t have that understanding … their health outcome can be astronomically different.”

That leap is not science. When you are sick, you want the arm set, and the pain dealt with.

The diversion has a cost. Years and public money have gone into frameworks, guidance, advisory groups and consultations. That effort does not set a bone. It does not shrink the waiting list. It does not explain why Māori die earlier. Time spent teaching a worldview is time not spent on beds, nurses, and the unfashionable things that do move the numbers.

Doctors were marched down the same path. Earlier this year, the Medical Council released two draft statements: one on cultural competence and cultural safety, and one on hauora Māori. The consultation paper said Māori have “additional Indigenous rights to good health, self-determination and equity”. The drafts told doctors that settler traditions still privilege people who fit the old norms. They were to acknowledge their own power, privilege and biases, and use their “professional influence” to help “dismantle unfair systems and power imbalances”.

That is a political programme issued as if it were clinical competence. In June the council refused to lock the drafts in as binding standards. It parked them to feed later rules. The 2019 statement still stands.

Health Minister Simeon Brown said the Medical Council had become “increasingly distracted by politics instead of focusing on its core responsibilities of improving patient outcomes and ensuring New Zealanders can get the care they need, when they need it”.

“Kiwis expect the Medical Council to be focused on strengthening the medical workforce, not on an ideological agenda.” He wanted doctors focused on treating patients based on their needs. He declined to reappoint the chair and deputy and has also replaced most of the Nursing Council board.

None of this was required by the plain words of the law. The Health Practitioners Competence Assurance Act exists to protect the public by keeping practitioners competent. The 2003 Act already included cultural competence. In 2019, the Ardern government added that it must include “effective and respectful interaction with Māori”. That is a reasonable sentence. It does not mention the Treaty. It does not say a nurse’s legal scope is a Treaty framework. It does not tell a doctor to dismantle systems. Labour wrote the statutory hook. The Minister appoints the members of both councils. Labour put on people who would treat that hook as a worldview. This Government has been removing them. The regulators built a theology on the clause.

The people who write these standards would not call the project “woke”. They call it a Treaty obligation: a treaty which does not mention medical care. The word does not matter much. What they have built has the same shape as the identity politics of the last decade: you are your group; power is the subject; common care is not enough. The philosopher Susan Neiman, herself a socialist, argues in Left Is Not Woke that the old left was meant to be universal, not tribal: duties to people who are not “your” group. Labour could say the extra storeys go beyond the 2019 sentence. It has not. Last week it proposed a new council to run the school curriculum – another body that, if the last decade is a guide, will be staffed from the same pool.

Māori health gaps are real, and they are a tragedy. Poverty, crowded housing and distance from a hospital sit in the picture. So do smoking, obesity and alcohol. So do late presentation and poorer engagement with services. Pretending the gaps are mainly a failure of Pākehā bedside manner is the story we have been asked not to test. There is no warrant for making every nurse a student of a 19th-century document, or every doctor an activist against “settler” medicine.

Who failed? Institutions, and a profession that let a small political language colonise a scientific one without standing up and saying so. The bottom failure is common sense, and the nerve to say ordinary things out loud. Compassion pointed at the wrong target becomes a purity test. Purity tests become rules. Rules become the practising certificate. Conformity did the rest.

The argument should have happened before cultural safety was allowed to leave science and be set up as a test of belonging. My friend Heeni encapsulated the point perfectly: they overcooked the pancake.

This column is dedicated to my first husband, Dr Charles Hollings – a hospital doctor known for his kindness and for his belief that the scientific method is still the best tool we have for making life better, for every culture on the planet.

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