There has been what appears to be an attempt to bury what is potentially an explosive backdown by the Government with thr release of a report late on Thursday, hours before the Easter shutdown.
The Pae Ora Committee’s report and draft bill to legislate the health reforms legislation makes no reference to what had been called a Maori Health Authority veto over New Zealand Health Authority decisions.
The original proposal was included in a Cabinet Paper and in a Regulatory Impact Statement by the Department of Prime Minister (DPMC) on the Bill that was considered by the Select Committee.
The DPMC, in the statement said the Maori Health Authority would jointly develop national and regional service plans with Health New Zealand and would need to co-sign or approve those plans or strategies before they came into effect.
Health Minister Andrew Little conceded in Parliament last year that the Maori Health Authority and Health New Zealand — the proposed new national health body — would be able to veto each other.
But in changes made by the Select Committee the two bodies will not interact with each over the health plans and any final decisions will be made by the Minister of Health. There have been other changes which add up to an erosion of the powers of the Maori Health Authority.
National’s health spokesperson, Dr Shane Reti, told POLITIK last night that the Bill had been watred down by the Select Committee of which he was a member.
Reti opposes the concept of a separate Maori Health Authority and argues that the main drivers of Maori health are income, employment, education and housing.
He is also National’s spokesperson on Maori-Crown relations and said despite his views on a Maori Health Authority he believed the Government had thrown Maori under the bus over the Authority.
“The polls and popular opinion became too hot for Labour to stand by the virtue signaling and so they’ve cast it out,” he said.
Reti said there was other evidence in the Bill as reported by the Select Committee of it being watered down.
“If you look at the bill before it went to the select committee and after it’s come out, the first part of the bill. The purpose of the bill before it went into select committee said the purpose of the bill was to reduce health disparities,” he said.
“After it’s come out of select committee the purpose isnow to strive to eliminate health disparities.
“You draw your conclusions about reduced ambition right there, right at the very beginning of the bill.”
In a Cabinet paper from last April, Health Minister Andrew Little, said he expected the Maori Health Authority to exercise a “co-leadership” role within the health system.
“My expectation is that the Māori Health Authority should have a co-lead role in relation to national planning and in designing the key operating mechanisms that the system will use,” the paper said.
““This would require the Māori Health Authority to jointly agree national plans and operational frameworks (e.g. the commissioning framework), with clear approval rights including an ability to exercise a veto in sign-off.
“Having such an approval mandate would ensure the Māori Health Authority is engaged early and constructively, and that critical operations are aligned with a clear hauora Māori vision, embed Māori priorities and mātauranga Māori systems, and enable mechanisms that give life to local Māori leadership in the health system.”
National’s then-leader Judioth Collins questioned the Prime Minister, Jacinda Ardern, about the veto on May 4, last year.
Collins: “So when national and regional plans have to first be approved by the Māori Health Authority, how is that not a power of veto over all of the Government health policy and implementation?”
Ardern: “Because that is the difference between partnership and consultation—you have to have that equal say—and this isn’t something we should be afraid of. We have tried the process of having a consultation style of approach. It hasn’t worked.”
But instead, the Bill as reported back now requires the Minister of Health to prepare a National Health Strategy” and the Ministry of Health and the Māori Health Authority must jointly prepare the Hauora Māori Strategy.
That will then be submitted to the Minister for his approval.
There is thus no legislative right for the Maori Health Authority to have any say in the National Health Strategy.
Reti was also critical of another change made by the Select Committee.
“In the Bill before it went to the Select Committee, the Maori Health Authority had quote has all the powers necessary to perform its functions unquote,” he said.
“The Select Committee has completely deleted that.
“Maori I’ve spoken were just aghast.
“This has been watered down.”
There are other subtle changes which will diminish the powers and scope of the Maori Health Authority.
A section of the Bill which originally said “The Māori Health Authority must) have systems in place for the purpose of engaging with Māori in relation to their aspirations and needs for the health system” has seen the “health system” replaced with simply “hauora Māori.”
In other words, whereas it was originally proposed that the Maori Health Authority would be able to inter-act with the whole system it will now be restricted only to those elements of the system that deal with Maori health.
A Select Committee’s decisions are theoretically independent of the Government but it is an open secret around Parliament that Ministers can use all sorts of influence to get the outcome they want from a Committee.
Equally, Government MPs, who hold a majority on any Select Committee, are unlikely to agree to radical changes to legislation such as the Pae Ora Committee has agreed to, without assuring themselves that the Government would be comfortable with those changes.
This points to the Government getting spooked by the growing debate over Maori co-governance.
Another test is likely shortly when Maori Development Minister, Willie Jackson, reports to Cabinet ion his consultations with Maori over the UN Declaration of the Rights of Indigenous Peoples.
That will include references to “He Puapua”, the report on Maori sovereignty, which Collins last year alleged was behind the veto in the Pae Ora legislation.