The Māori Health Authority was disestablished just 18 months after it was launched. Gabrielle Baker reflects on what could have been.
Yesterday afternoon I watched Parliament TV as the bill disestablishing Te Aka Whai Ora (the Māori Health Authority) was passed, rapidly, under urgency. The whole thing took less than 24 hours.
Te Aka Whai Ora was the result of decades of dreaming about (and hard work labouring over) how the health system in Aotearoa could be configured to better serve Māori and give expression to Te Tiriti o Waitangi. The exact shape and functions of Te Aka Whai Ora were never exactly what was advocated for in forums like the Waitangi Tribunal (when it was raised by claimants in the primary health care claims in 2018), as the dream was always something truly independent, away from government control. But it was a step forward.
Yet, after only a little more than 18 months as a real-life entity, Te Aka Whai Ora has reached the end of its road. Staff will be transferred to Te Whatu Ora / Health New Zealand (the organisation that replaced DHBs 18-ish months ago), and Te Aka Whai Ora won’t exist after June 30, 2024.
All three political parties in the coalition government stated their intentions to get rid of Te Aka Whai Ora during their election campaigns (and before). So, it was not a surprise that this common ground was part of the coalition agreements, nor that introducing legislation to disestablish Te Aka Whai Ora was on the new government’s 100-day plan (meaning that legislation would have to be introduced by March 8, 2024).
The fact that it lacked the element of surprise didn’t make it any less objectionable to the Māori individuals and groups who had been advocating for greater prominence for Māori health. Within days of the 100-day plan being announced, the first claim was filed with the Waitangi Tribunal (by Lady Tureiti Moxon and Janice Kuka, who were two of the six named claimants in the primary health care claims to the Tribunal), saying that closing Te Aka Whai Ora was a breach of the principles of the Treaty (which is what the Waitangi Tribunal is set up to consider).
The claimants sought urgency, making a case that looking into the disestablishment of Te Aka Whai Ora should take priority over the Tribunal’s other business and should be heard as soon as possible.
The Tribunal acted quickly on the request, and by January 19 this year had agreed that there were grounds for urgency. There were two components to this Tribunal decision:
- There was no consultation with Māori on disestablishing Te Aka Whai Ora (electioneering not being appropriate consultation), raising questions about whether the principles of Te Tiriti o Waitangi had been complied with, and;
- The Crown wouldn’t say what would be replacing Te Aka Whai Ora, and so there were concerns that Māori would be “irreversibly prejudiced” by the change.
Throughout January and February there have been several exchanges between the Tribunal, claimants, and the Crown, but the upshot was that a hearing was set out for February 29 and March 1 so that the Tribunal would be able to report on its inquiry before the 100-day plan deadline. This was pretty extraordinary, truncating a whole inquiry process into a few days, but reflected the level of Māori interest in the issue. It was also a signal that the Tribunal wanted to be as helpful as possible to the government by giving it a report that could strengthen the legislation.
As evidence was being submitted to the Tribunal and claimants were preparing their opening submissions to the Tribunal, the Crown threw a spanner in the works on the evening of February 22, when it announced (to paraphrase), “actually, the government could introduce the legislation at any point before 8 March, it could even do it next Tuesday”.
And, just like that, they did.
Parliament went into urgency on Tuesday afternoon, the Pae Ora (Disestablishment of Māori Health Authority) Amendment Bill introduced by minister of health Shane Reti, and then taken through all stages of the parliamentary process. At which time, the Tribunal lost the ability to look into the legislation, so the Tribunal cancelled its urgent hearing.
While the loss of Te Aka Whai Ora is a step away from valuing Māori and prioritising Māori health aspirations, the fact it was always on the cards means that its disestablishment is not the only story here.
One of the real impacts of today’s legislation is that it looks like the parliamentary process was used to prevent a Tribunal inquiry. As was stated many times by opposition MPs during the various stages of the bill’s debate in parliament, the government could have waited until next week to introduce the legislation. Or it could have said earlier that it was introducing legislation before March 8 (and at least cut short the intensive work to prepare evidence and legal cases). Neither happened. The Tribunal jurisdiction kicks in again once the Bill comes into force (June 30, 2024), but by then the opportunity to improve the bill has – obviously – gone.
The decision to disestablish Te Aka Whai Ora was always a political one. There were loose arguments presented during the parliamentary debate about how the agency wasn’t seeing results (after 18months – an impossible standard that no government agency would ever reach, frankly), how it was overly Wellington-centric (not one that stands up to much scrutiny since it is also Auckland-based), and how Māori health needed to be “matrixed” in to be the responsibility of the wider health system (as if somehow it wasn’t already). However, within the health system there has been a great deal of support for Te Aka Whai Ora, and good will from those hoping it could achieve the lofty aims it carried with it from Māori.
Reti said in his media statement on the legislation that “the narrow focus on disestablishment doesn’t mean an end to our focus on Māori health for those who need it…[w]e are committed to finding more efficient ways to work together to deliver those solutions, as well as savings which can go back into better health outcomes.” The challenge now is making good on this and translating the commitment to better health outcomes for all, into doing things that work for Māori, are Māori-led and -driven, and ideally create efficiencies (avoiding duplication, that kind of thing). Sort of like a Māori health authority…
