Frontline providers want the axing of the M\u0101ori Health Authority declared unlawful. Here, Ruth Brown considers the arguments. <\/p>\n
Axing Te Aka Whai Ora was a clear case of racist ideology getting the better of good economic sense, says Te Whatu Ora\u2019s former chair Rob Campbell.<\/p>\n
\n \u201cI\u2019m not prone to
\n saying that lightly. I think there was an anti-M\u0101ori form of racism that blinded us to the benefits for all the community.\u201d\n <\/p>\n
He calls the \u201cdestruction\u201d of the M\u0101ori health authority midway through last year one of the greatest crimes against health services ever committed in this country. And it\u2019s a move that hurts not just M\u0101ori but P\u0101keh\u0101 as well.<\/p>\n
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. \u201cI\u2019m very confident we would have seen the flourishing of kaupapa M\u0101ori health services,\u201d he says. It would also have greatly relieved pressure on overflowing emergency departments.<\/p>\n
\u201cThere\u2019s no doubt in my mind that a significant part of our primary health sector crisis now is caused by the fact we didn\u2019t stick with the delivery of Te Aka Whai Ora.<\/p>\n
\u201cAnd there\u2019s no question that where kaupapa M\u0101ori services are available and accessible to people they do take pressure off the hospitals, because they\u2019re delivering in the way people want to have their primary healthcare delivered.\u201d<\/p>\n
Campbell says it\u2019s long been known that to improve the health of the M\u0101ori population you had to improve M\u0101ori-based health services. \u201cSo the fact that was cut off means we deliberately made a decision not to improve M\u0101ori health.<\/p>\n
\u201cIt\u2019s a pretty extraordinary thing to happen. I don\u2019t know how to describe that other than it\u2019s a crime.\u201d<\/p>\n
Rob Campbell: Demands on the primary health sector would have been eased by sticking with the delivery of Te Aka Whai Ora. Photo \/ Supplied<\/p>\n
That\u2019s 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.<\/p>\n
The claim, brought by Lady Tureiti Moxon of Hamilton Maori health provider Te K\u014dhao Health and Janice Kuka of Ng\u0101 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\u2019s Papakura Marae and Ng\u0101ti Hine Health Trust in Northland have gone to the High Court seeking a declaration that the axing of the authority breached M\u0101ori rights under the treaty and the Bill of Rights Act.<\/p>\n
The court challenge has two grounds: lack of consultation and engagement with M\u0101ori 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. <\/p>\n
Moxon (Ng\u0101ti Kahungunu, Ng\u0101ti P\u0101hau-wera, K\u0101i Tahu) also included Te Aka Whai Ora\u2019s disestablishment, along with the removal of targeted cancer-screening for M\u0101ori 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.<\/p>\n
Chris Tooley (Ng\u0101ti 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\u2019s board during its two years. <\/p>\n
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. <\/p>\n
For M\u0101ori providers who were granted contracts, it was an entirely new experience. \u201cThe beauty of Te Aka Whai Ora was that we were trusted,\u201d says Moxon. \u201c[Now] we\u2019ve gone back to not being trusted. And we\u2019ve gone back to having to jump through lots of hoops for the contracts we do have.\u201d<\/p>\n
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\u2019re making a difference in people\u2019s lives.<\/p>\n
Te K\u014dhao Health was making that difference under Te Aka Whai Ora, Moxon says, and it can prove it. <\/p>\n
Te K\u014dhao Health chief executive Tureiti Moxon: \u201cWe\u2019ve gone back to counting widgets.\u201d Photo \/ Supplied<\/p>\n
\u201cBut unfortunately, we\u2019ve gone back to counting widgets.\u201d In her evidence to the Waitangi Tribunal, she gave an example: \u201cWe had a woman come to us with untreated diabetes. She hadn\u2019t been going to the GP because she couldn\u2019t afford it and she didn\u2019t trust the system. We got her insulin. We helped her access food. We supported her to get stable housing. That\u2019s what made the difference. But none of that shows up in the data the crown is collecting \u2013 because it\u2019s not a GP visit.\u201d<\/p>\n
Te K\u014dhao 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, rongo\u0101 health, audiology and specialist clinics for the likes of paediatrics, diabetes and urology.<\/p>\n
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\u2019s first 2000 days from pregnancy, transformed maternity and early childhod support for wh\u0101nau. Te Aka Whai Ora\u2019s 2023-24 annual report shows it invested an extra $13 million in M\u0101ori services for kahu taurima. The difference here, says Moxon, was her staff could use their resources to wrap around care that included practical measures \u2013 such as helping mums who might be living in poverty buy the things the baby needed \u2013 and to engage wh\u0101nau to support them. \u201cYou 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\u2019ve got nappies.<\/p>\n
\u201cThe long-term goal, of course, is that we don\u2019t have our children being uplifted and moved away from their wh\u0101nau by Oranga Tamariki. So the goal is to strengthen mum, strengthen this baby to give them the best start.\u201d<\/p>\n
Then there\u2019s food. A P\u0101keh\u0101 dietitian may have a very different world view to that of a non-P\u0101keh\u0101 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 K\u014dhao now has a kaimahi (staff member) who\u2019s \u201crealistic\u201d about food suggestions, Moxon says. \u201cAnd we\u2019ve got wh\u0101nau who have lost lots of weight supported by this amazing kaimahi of ours.\u201d<\/p>\n
Underlying Te K\u014dhao\u2019s 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.<\/p>\n
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.<\/p>\n
Chris Tooley: Collaboration is the key. Photo \/ Supplied<\/p>\n
Transactional outcomes<\/p>\n
What Moxon calls \u201cwidget counting\u201d, Tooley terms \u201ctransactional outcomes\u201d \u2013 such as the number of immunisations or patient consultations carried out. <\/p>\n
\u201cWith Te Aka Whai Ora, we actually got the ability to look beyond transactional outcomes and look at the whole wellbeing of the household,\u201d he says. <\/p>\n
An example is that a nurse who goes in to dress a wound for a kaum\u0101tua is given the time and resources to notice there\u2019s a child at home who should be in school, that the cupboards are bare, or there\u2019s a hole in the roof that\u2019s letting in rain. <\/p>\n
Being able to refer on to other services gets wh\u0101nau out of the health system, so they\u2019re not so reliant on it, Tooley adds. But siloed thinking that addresses only short-term needs is historically how the health system works. \u201cYou might stop [patients] going to one department in hospital but you still end up with them going to all the other departments in hospital.\u201d<\/p>\n
Like Campbell, he believes not just M\u0101ori would be seeing results if Te Aka Whai Ora had been allowed to continue. \u201cWe would be seeing massive shifts in structural trends across the health system.\u201d<\/p>\n
At the heart of it was trust and building relationships with M\u0101ori communities. \u201cUntil you have that trust and relationships you\u2019re always going to have people that are sitting in the hard-to-reach basket or they only come into ED when they\u2019re crawling on their knees with a heart attack. They should have come in a lot earlier.\u201d<\/p>\n
But why should health services be picking up the tab for things like the hole in the roof or the child who doesn\u2019t want to go to school? Tooley points out the 2022 legislation was named Pae Ora (healthy futures) not hauora (good heath). \u201cYes, the health system shouldn\u2019t 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.\u201d<\/p>\n
Health Minister Simeon Brown.<\/p>\n
Learnings lost<\/p>\n
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.<\/p>\n
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, \u201cThe government is committed to ensuring all New Zealanders have access to timely, quality healthcare, including M\u0101ori.\u201c<\/p>\n
Campbell says the collaborative approach to healthcare fostered through Te Whatu Ora and Te Aka Whai Ora working together \u201cwas a very inspiring atmosphere. We were demonstrating the ways in which M\u0101ori and the P\u0101keh\u0101 system could work together. It was quite different to any other corporate board meeting or government board meetings I\u2019ve been in.<\/p>\n
\u201cWe knew there was a lot to learn about how to deliver primary care from the way in which M\u0101ori were learning to develop and deliver primary care.\u201d<\/p>\n
He gives an example of an older P\u0101keh\u0101 man who was a regular visitor to a kaupapa M\u0101ori health service. When Campbell asked him why, the man said, \u201cDo you know of any other health service in New Zealand that gives you a cup of tea when you come in?\u201d The man didn\u2019t mind waiting a while for his appointment \u2013 he got a cup of tea; people were nice to him. They weren\u2019t rushing him out after 10 minutes.<\/p>\n
We actually got to look beyond transactional outcomes to the whole wellbeing of the household.<\/p>\n
\u201cIt\u2019s 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\u2019t have to be all that sophisticated to work.\u201d<\/p>\n
Tooley agrees collaboration across Te Whatu Ora was key, with members of its board and Te Aka Whai Ora on committees of both bodies. \u201cOne of the my best mates was [former National MP] Amy Adams.\u201d <\/p>\n
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.<\/p>\n
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. \u201cYes, we want a M\u0101ori 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.\u201d <\/p>\n
Tooley says health providers, practitioners and communities need to be consulted on what would work.<\/p>\n
For now, though, providers such as Te K\u014dhao Health are diversifying and turning to other sources of funding to make things happen. Te K\u014dhao 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.<\/p>\n
And other M\u0101ori providers are forging on with programmes to help their people.<\/p>\n
\u201cYou know, despite what is often being done to us, some good things are still happening,\u201d says Moxon. \u201cIt\u2019s a bit like those beautiful flowers that bloom in the desert. We\u2019re kind of in a desert right now but still the beautiful flowers find their way to the top.\u201d <\/p>\n