New authority in place in under a year, but Māori services put best foot forward now

The Māori Health Authority will be “lights on and up and running” on 1 July 2022, says associate health minister Peeni Henare, but there is much mahi to be done before that happens.

The new entity was one of the most anticipated features of the health reforms.

It has emerged as the Crown and claimants work through the Waitangi Tribunal’s first report on the Wai 2575 Health Services and Outcomes Kaupapa Inquiry.

The consultation process that will establish the structure and official name for the authority will not be known until after funding is announced in the Budget on 20 May.

The entity will be able to commission and fund health ser­vices, particularly those following a kaupapa Māori model. It will also have a co-commissioning role with Health New Zea­land for other services whose users include Māori people, and hold a veto power over plans and strategies.

These powers run counter to the minority, and ultimately final, recommendations of the Health and Disability System Review, which saw the authority as having a limited advisory role and control of two small development and innovation funds. A majority of review panel members and the entire Māori expert advisory group had their alternate view included in the final report, and they favoured commissioning.

The Cabinet paper submitted by health minister Andrew Little prior to announcing the reforms, highlights a greater role for the 20 iwi partnership boards now working with DHBs.

As self-governing bodies designed for and by iwi, Mr Little says they are not Crown agencies and could provide leadership and decision-making, in areas such as priorities and service design, to the authority on behalf of local communities.

Mr Little says this is necessary as the authority will be un­able to represent the voice of all Māori at all levels and “should not assume it speaks on behalf of iwi”.

The minister also suggests existing Māori health providers may be called upon to coordinate locality networks.

If most are waiting to see what the Budget brings this month, that does not mean nothing is happening.

Mr Henare has confirmed the long-rumoured involve­ment of Sir Mason Durie in the development of the authority, and is looking for candidates to serve as interim chief executive and board members until next July. These announcements are expected to roll out over the next few months.

Work has also begun on the legislation that will underpin the authority.

Māori health providers have expressed excitement, saying the reforms open up new op­portunities to expand kaupapa Māori services.

One of these is Mahi a Atua, a model of care developed by consultant psychiatrist Diana Kopua, using traditional narra­tives and creation stories to connect with Māori.

This programme is being used by Waikato and Hauraki providers to train health im­provement practitioners.

Turuki Healthcare chief exec­utive Te Puea Winiata is dusting off ideas that have struggled for traction (and funding) within the present system.

These projects will ride on the back of their south Auck­land, marae-based, COVID-19 vaccination programme.

“I am so excited by this,” Ms Winiata says. “[Marae] have the community engagement, and we bring the clinical support, and we hope this is the first step in developing a suite of health and wellbeing services that would fit well with the lo­cality model.

“I think we have already jumped ahead in how we pro­vide access to whānau for those services, and we are ramping up our work in the digital space as well. It is all about opening up new doorways for whānau to [get] the help they need.”

Ms Winiata hopes to confirm an 18-month trial of a mobile primary care service, with Counties Manukau DHB and the Ministry of Health. Vans would take a nurse, social work­er and support worker on home visits to hard-to-reach whānau, boosting the profile of health­care in communities.

Turuki is also looking to fit out con­tainers as mini-clinics, to be placed in shopping mall car parks so late-night care and welfare support can be provid­ed to the homeless and rangatahi.

Such community-driven initiatives would be helped by people like Harry Burkhardt, chair of the Ngāti Kuri Trust Board and Northland DHB, and member of the iwi partnership board working with the northern DHBs.

Mr Burkhardt says the proposed repurposing of the boards will enable the provision of whānau and hapū health through a Te Tiriti o Waitangi lens. He says it allows whānau to make decisions around their health journey: “At the moment, there are gaps in that conversation and the reach of healthcare.

“I know there are those who would characterise the health reforms as cen­tralisation; in my view, that is not the intent of it, and the iwi partnership boards are the answer to the conun­drum of how you operate nationally but allow communities to do what they need to do and support them in doing that.”

The fact the Māori Health Authority is attracting “passionate” political re­sistance shows the plan is at least halfway there.

“If there was no resistance, then it would probably be dead in the water,” he says.