Little AndrewPAE ORA (HEALTHY FUTURES) BILLSecond ReadingHon ANDREW LITTLE (Minister of Health): I present a legislative statement on the Pae Ora (Healthy Futures) Bill.ASSISTANT SPEAKER (Hon Jenny Salesa): That legislative statement is published under the authority of the House and can be found on the parliamentary website.Hon ANDREW LITTLE: I move That the Pae Ora (Healthy Futures) Bill be now read a second time. This bill was introduced on 20 October last year. It was returned to the Pae Ora Legislation Committee which was set up specifically to consider it. I want to thank the members of that committee for their work over the last six months. They considered 4665 submissions and they heard in person from nearly 200 individuals and organisations. Now that's both a testament to the public's deep interest in the state of our health system and an enormous credit to the committee for its hard work over that time. I want to particularly think its chair Dr Deborah Russell and deputy chair Tāmati Coffey for their incredible work in those roles.Submitters made some very important points and these are reflected in the changes that the committee has recommended. I want to thank the many people who shared their personal experiences and their trust by disclosing their personal stories when they presented to the committee and made their submissions. The committee also heard perspectives from across the health sector including workforce organisations non-Government organisations regulatory bodies and individuals who assist in the provision of health services. There is strong support for the need to change our health system. It is particularly welcome that so many of those who spoke to the committee supported the general approach taken in the bill and commented favourably on the creation of Health New Zealand the Māori Health Authority and the recognition of iwi-Māori partnership boards.As members will be aware not everyone is in favour of the proposed approach and I'd like to firstly address the concerns raised by many submitters and in media comment that the reforms are separatist and create a two-tier system. This is completely untrue. I absolutely and wholeheartedly agree that this should not be a two-tier health system. But sadly that is exactly what we have at the moment in practice and that is exactly why we are reforming it. People experience unjustifiable differences in access to services and health outcomes because of where they live their ethnicity or other circumstances. We need to create a system that at its core recognises and addresses that inequity so that not just some but all New Zealanders have the opportunity and support to live healthy and full lives.I've previously spoken about the reasons why we need to reform our health system not the least of which is that Māori die seven years earlier than Pākehā. And it's not just Māori that experience poor health outcomes that the system needs to address: Pacific people rural people and disabled people are just some of the New Zealanders for whom the health system needs to perform better. The system has failed too many people for too long and that needs to change now. If we don't begin to invest in the future of the health system we will never see change. That would mean tolerating more inequity more ill health and more premature deaths. We need to make change for reasons of equity—we've established that. We need to make change in order to properly fulfil our obligations under the Treaty of Waitangi. The essence of the Treaty is an agreement for Kāwanatanga—Government—which also respects the rangatiratanga—leadership by Māori of their people. We've started to see when we govern on the basis of acknowledging rangatiratanga such as when we handed responsibility to Māori to lead a COVID vaccination programme for their people last year then we can make a real difference. I reject utterly the argument by some that enabling Māori to lead their people on health in their own way and to express their rangatiratanga is biased or separatist or in conflict with principles of good governance.Clause 3 of the bill is clear that the purpose of it is to protect promote and improve the health of all New Zealanders. The health sector principles in clause 7 confirm the need for the system to be equitable which is in clause 7(1)(a) and to protect and promote people's health and wellbeing through a number of means clause 7(1)(e). The scheme of the bill makes it clear: Health New Zealand and the Māori Health Authority need to work closely together—and I can tell the House that during this establishment phase that is exactly what has been happening. The committee has recommended important changes that will strengthen the bill to help achieve the purpose of the reforms. I welcome these recommendations. They will ensure the bill succeeds in laying the foundations for a transformed health system to tackle inequities and improve health outcomes for all New Zealanders.I'd like to touch briefly on just some of the main areas that the committee spoke to. The bill makes the important step of formally recognising iwi-Māori partnership boards in the legislation. At introduction the bill didn't include functions or powers for the boards because we wanted to take time to engage with Māori about what they wanted in it. That engagement has happened and we now have functions and powers for iwi-Māori partnership boards in the bill. An updated process to recognise these boards is also recommended by the committee and ensures boards are representative of the whole Māori community in the area while leaving flexibility and discretion for Māori to adopt a tikanga-based approach to boards.Many submissions asked for a stronger accountability of the Māori Health Authority to Māori. I want to be very clear that the Māori Health Authority is accountable to the Minister of Health who is accountable to Parliament. This has always been the case in the bill and there's been no change in that position. However as a responsible Tiriti partner the Crown must recognise the disproportionately poor health outcomes that Māori face under the current system and work to make that right. The bill ensures Māori voices are at all levels of the system to address these longstanding unacceptable outcomes. One of those voices is the Hauora Māori Advisory Committee. The select committee has recommended it be appointed directly by Māori through iwi-Māori partnership boards and hauora Māori organisations. The Minister has to consult the committee when appointing members to the board of the Māori Health Authority and when exercising other ministerial powers. In making a decision the Minister would not need to necessarily agree with the committee's advice but would have to clearly state where it had not been followed. This strikes the right balance of accountability to Māori and to Parliament. It means an entity appointed by Māori for Māori is involved in key accountability functions leaving no doubt as to the Government's intention to give effect to Tiriti partnership at the highest level of the system.It will be no surprise to members that the committee also heard from users of health services and from the workforce about the need for culture change. We know workforce cultural development will be critical but these cannot be easily legislated for. What we can legislate for and as the bill requires is for workforce development to be included in the health strategies and the New Zealand health plan as well as the creation of a New Zealand health charter. One change that came out of the committee process is a technical one: the change to the ordering of precedence for the Government policy statement (GPS) on health. The change makes the Government policy statement appear secondary to the health strategies but the GPS is not secondary to the strategies; it is the basis on which the strategies should be developed. So I do not agree with this change and there will be a Supplementary Order Paper to change it back.The committee heard loud and clear that people want their voices to be heard in the system. Current planning commissioning and delivery of primary and community care is disjointed and does not routinely seek or respond to the voices of consumers. I've also heard comment that in the pursuit of centralisation these reforms take power away from voices at the local level. We currently have 20 separate systems operating in 20 different ways in a country of 5 million people. It doesn't work. Hearing the voices of New Zealanders is a key pillar of the single New Zealand health system one that is centrally coordinated but locally delivered with health services genuinely informed by the needs and the priorities of the people it is serving. The bill puts consumer voices at the heart of the new structure. There are active engagement requirements at all levels so services are designed for people's needs. I agree with the committee's recommendations to strengthen these engagement requirements. In particular I strongly support the inclusion of annual progress reporting for locality plans. These will complete the feedback loop to local communities on the priorities and outcomes agreed with them.Some submitters ask Why now?" and I say because every week of inaction means another week of tolerating inequity of tolerating Māori dying younger than Pākehā of disabled people being seven times more likely to report psychological distress of Pacific people dying six years younger of people in our rural communities continuing to miss out. This is the status quo and it is completely unacceptable. We are changing that. The transition is already well under way. Interim Health New Zealand and the interim Māori Health Authority are set up and are working together. They have chief executives key leaders in place and recruitment under way. They have confirmed the prototype sites. The first nine localities are building their organisational structures and are working closely on the interim New Zealand health plan that will set priorities for service improvements in the first two years. They are ready to go.Pae Ora for everyone in New Zealand means that our health system should be refocused to keeping everybody well for longer. We need a law to lay the foundation of our new health system a system for all 5 million New Zealanders with equity at its core. This bill does that and on that basis I commend this bill to the House.ASSISTANT SPEAKER (Hon Jenny Salesa): The question is that motion be agreed to."