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The Waitangi Tribunal has found the Government had no clear alternative plan for Māori health when it scrapped Te Aka Whai Ora - the Māori Health Authority.
The second part of the Hautupua: Te Aka Whai Ora (Māori Health Authority) Priority Report was released on Friday, and examined the Crown’s process for developing plans to address Māori health in place of a Māori health authority.
The Tribunal found the Crown:
- failed to adequately inform Māori about its alternative plans
- failed to recognise and respect tino rangatiratanga
- failed to consult with Māori and be sufficiently informed about key elements of its plans
- failed in its duty of active protection and Māori’s right to self-determine what is best for Māori health
- failed to properly engage with Māori about the Hauora Māori Strategy and Pae Ora Amendment Act.
It found these breaches had caused, and would continue to cause, short and long-term prejudice to Māori and repeated its previous finding that the Crown had shown “reckless disregard for the Crown-Māori relationship”.
They recommend that a stand-alone Māori health authority be revisited.
‘Significant lag’ after Te Aka Whai Ora disestablished
Te Aka Whai Ora was scrapped as part of the Government’s 100-day programme. The Pae Ora (Disestablishment of the Māori Health Authority) Amendment Bill was introduced under urgency in February 2024.
Then-Health Minister Dr Shane Reti said at the time the Government wanted to pursue “a different dream” for Māori health, with greater decision-making and care delivered closer to home and hapū.
However, the Tribunal said the Crown did not have a clear alternative plan in place when that happened.
It said the Crown’s failure to develop one resulted in a “significant lag” between the disestablishment of Te Aka Whai Ora and an alternative.
“For nearly 18 months the Crown repeatedly informed claimants, the Tribunal, and the public of its intention to develop alternative plans in lieu of Te Aka Whai Ora, but these intentions did not materialise and were not reflected in Crown action,” the Tribunal said.
It found the delay was inconsistent with the principles of kāwanatanga and good government.
“The Crown failed during this period to take any meaningful action towards Māori health equity or to provide an alternative plan to Te Aka Whai Ora,” it said.
The Tribunal found that inaction breached the principles of equity, active protection and options.
‘No meaningful consultation’
The Tribunal said there was no meaningful consultation with Māori over key elements of what the Crown eventually described as its alternative plan.
“We see no evidence of meaningful engagement or consultation between the Crown and its Tiriti / Treaty partner,” the Tribunal said.
It said the Crown’s approach had “in many ways” deteriorated since the first stage of the inquiry.
The Tribunal found iwi-Māori partnership boards were approached after decisions had already been made. It described this as “more of a box-ticking exercise than any form of meaningful engagement with Māori”.
It said the purpose of consultation was for the Crown to fully understand the impact of proposed legislation, policies and actions on Māori rights and interests.
“The Crown has failed to do that in this instance,” it said.
The Tribunal found the Crown failed to adequately inform Māori about its alternative plans, saying it had told them the plans were forthcoming before later confirming the plans were already in place.
It found this breached the principle of good government.
The Tribunal said the Crown failed to properly engage with Māori about two key elements of the alternative plan: the Hauora Māori Strategy and changes to the Pae Ora Amendment Act.
‘Double standard’ over health system reviews
The Tribunal also criticised the Crown for what it described as a “double standard” in how it reviewed changes to the health system.
It found Te Aka Whai Ora was reviewed just 10 months after its establishment, while the Government said other system-wide changes in the health sector would need to operate for longer than a year before being reviewed.
“The Crown failed in its duty to follow its own laws, rules, and standards,” the Tribunal said.
“This signals a double standard and is a breach of the Tiriti / Treaty principle of good government.”
It said a regulatory impact statement for changes to the health system only partially met quality assurance requirements because of limited consultation. The Tribunal said this was despite its previous recommendation that the Crown should undertake proper regulatory impact analysis for matters affecting Māori health.
What was the Government’s alternative plan?
The Crown initially told the Tribunal an alternative plan was being developed.
Over the course of the inquiry, it pointed to a range of health system settings and changes, including the roles of iwi-Māori partnership boards, the Hauora Māori Advisory Committee, the Ministry of Health and Health New Zealand.
It also identified the Government Policy Statement on Health, the New Zealand Health Plan and the Hauora Māori Strategy as key elements.
The Tribunal assessed these existing health system settings as the Crown’s alternative plan. But it questioned whether those arrangements met the Crown’s obligations as a Treaty partner.
Tribunal concerned about shift away from Māori-specific health policy
The Tribunal highlighted a Cabinet circular issued in September 2024 directing agencies to focus on “needs”, rather than ethnicity.
It said the shift in language and policy approach was also reflected in health targets which focused on the total population rather than Māori-specific outcomes.
The Tribunal said evidence presented during the inquiry showed that the effects of this shift were “far from minimal”.
It said a focus on the mainstream population ignored the particular health characteristics and needs of Māori. A shift away from Māori-specific approaches was a clear signal that “te Tiriti is not central in relation to policy development, service design or delivery,” the report said.
Tribunal recommends revisiting standalone authority
The Tribunal recommended that the Crown:
- commits to revisiting the option of a stand-alone Māori health authority
- consults extensively with Māori and make informed decisions on matters concerning Māori health
- bases all decision-making concerning Māori health, particularly measures addressing longstanding Māori inequities, on robust evidence and scientific knowledge.
RNZ has requested responses from Health Minister Simeon Brown and Mental Health Minister Matt Doocey.
The former chief medical officer for the Māori Health Authority said the Government did not act in good faith when scrapping the entity.
‘Real shame’
Dr Rawiri Jansen was a key witness for the Waitangi Tribunal report into the Crown’s alternative plans for Māori health. He told Midday Report it was a “real shame” the Government acted in that way.
“They said they were going to have a plan, they didn’t do any work on a plan. They said they had a plan, they did not have a plan... Never seen anything like it.”
Jansen said before one health system would work for all, inequities needed to be removed.
“Fix all of that historic grievance and you can imagine having one system, but in the absence of fixing it that’s not an approach which we can rely on, and we don’t believe that they are honest and truthful in asserting it.”
Nā Layla Bailey-McDowell nō RNZ.
