Majority of Simpson Review panel sign 'alternate view' criticising recommendations

“The worst-case scenario is that Māori voices are relegated to discretionary advice only”

The Māori Health Authority proposed in the Simpson review is not empowered, has “little more than an advisory role” on equity issues, and carries a commissioning budget of less than $23 million, say dissenting panel members and advisory experts.

The three-page “alternate view”, included in the Health and Disability System Review, is signed by four of the six panel members and the entire Māori Expert Advisory Group. It resulted from the panel’s failure to form a consensus around the extent to which the authority should control the funding and commissioning of services for Māori. The dissent is located on page 173 of the final report, 150 pages after the section on Hauora Māori/Māori Health.

The three who did not sign the dissent were panel chair Heather Simpson and members New Zealand Transport Agency chair Sir Brian Roche and nursing lecturer, administrator and practitioner Margaret Southwick.

But all members are supporting the review recommendation to establish a Māori Health Authority “with direct accountability to the minister of health for all advice, monitoring and reporting with respect to Māori health”.

The official Simpson report recommended the incorporation of the principles contained within te Tiriti o Waitangi across the health system with appropriate legislative updates where necessary, as well as 50-50 Māori and Crown membership on the boards of the proposed Health NZ, DHBs, independent commissions and entities across the health and disability system.

Tikanga Māori would become the norm for service provision by those working with Māori whānau and communities, and guidelines would be required to ensure the tikanga of the appropriate iwi from each rohe is applied. All other health services would be required to engage with Māori in ways that endorse Māori cultural identities and values with much of this work to be led by the Māori Health Authority (MHA).

Funding for the new tier 1 category of health services, which includes general practice, would be weighted toward communities such as Māori, Pacific, higher deprivation and older populations, once accurate, centralised population data can be obtained. Until then, the review recommends those groups receive a 20 per cent weighting to create a more equitable distribution of funding.

It is also recommends that the MHA takes over three development funds, the Māori Provider Development Scheme, the National Māori Workforce Development Fund, and Te Ao Auahatanga Hauora Māori (the Māori Innovation Fund).

The combined spending of the three funds is almost $23 million. The health budget announced in this year’s Budget totalled $20.27 billion.

The alternate view says the review lacks ambition and is limited in scope, especially in not giving the MHA a “fully empowered commissioning role”. It says equity challenges “demand more than a clearer mandate for Māori policy development, more than the simple identification of strategy execution failures, and more than the identification of the systemic disadvantaging of Māori and kaupapa providers by contracting arrangements”.

The granting of a partnership role, says the dissent, reduces Māori input to “little more than an advisory role” with “a small and marginal budget”.

Their view is aligned with the findings of the Hauora Report (Wai 2575) and its interim finding calling for an investigation into a standalone Māori health funding authority, saying there is significant evidence that universal health systems have not benefited Māori.

One of the signatories to the alternative view is Peter Crampton, professor of public health in Kōhatu, the centre of Māori health at the University of Otago. He says its inclusion was the result of a “vigorous debate” that was important to win as it keeps the option of a fully funded, empowered, Māori commissioning authority on the policy agenda.

He supports those hoping the review had been braver in creating an innovative, world-leading authority within New Zealand’s “hairy beast” of a health system “in order to overcome the inhibitors and barriers we are so familiar with in the context of mainstream organisations. The barriers that drag the focus back to universalism and meeting the needs of the majority and not the minority.”

Chair of the Māori Expert Advisory Group Sharon Shea acknowledged the panel for including the dissenting view in the review and says they are pleased there are wins for Māori. “The fact there is an MHA, the importance of equity, the investment in the Māori workforce, and the inclusion of kaupapa Māori throughout the system, we’re really happy with that.”

She is also pleased the issue of how the MHA will be implemented remains open to debate: “The worst-case scenario is that Māori voices are relegated to discretionary advice only. That would not help anyone in terms of better outcomes for New Zealand.”

While she says the role of their advisory group has ended she is hopeful the review recommendations will “shift the dial” and inform mature discussions around equity issues. “We have to keep pushing the waka, otherwise we’re not going to fulfil the promise of te Tiriti…Māori cannot be marginalised or we will just revert back to the system we have been seeing.”

Ngā Mataapuna Oranga managing director and Wai 2575 claimant Janice Kuka thanked the advisory group for their efforts to bring the review into line with the ongoing te Tiriti settlement, even if the final result is “a mixed bag” that did not go as far as she would have liked. But like Ms Shea, she remains positive that the route to a properly resourced commissioning agency “with standing in its own right” remains open.

Via email, Helen Leahy, pouārahi of Te Pūtahitanga o Te Waipounamu, the Whānau Ora Commissioning Agency (South Island) says she celebrates and tautoko the alternate view featured in the review.

“An independent, empowered and empowering Māori health authority must have the teeth to implement the bold transformation required to improve health outcomes for Māori,” she says, adding that her agency will happily take its lead for their view: “We will use this report as a basis for discussing with whānau ora entities right across Te Waipounamu how we can plan for the success of an indigenous Māori commissioning framework. There is no time for deferring this argument again or waiting for consensus to emerge.”  

 Ms Leahy applauded the authors of the alternate view “for stepping up into the space which emerged from a lack of consensus on the funding power and commissioning mandate of the Māori health authority”.

 The alternate view was signed by panel members Shelley Campbell, Peter Crampton, Lloyd McCann, Win Bennett (majority Panel members) and the Māori Expert Advisory Group comprised of Sue Crengle, Terryann Clark, Dale Bramley, Takutai Moana Natasha Kemp, Linda Ngata and chair Sharon Shea.