Katene Rahui: New Zealand Public Health and Disability Amendment Bill — Second Reading 
Katene Rahui: New Zealand Public Health and Disability Amendment Bill — Second Reading 
[Volume:667;Page:14369] 
RAHUI KATENE (Maori Party—Te Tai Tonga) 
: 
 The New Zealand Public Health and Disability Amendment Bill amends the New Zealand Public Health and Disability Act 2000 to face the challenge of providing high-quality health care and disability support services that are affordable. The goal of the legislation is therefore pretty straightforward. The bill amends the Act. It encourages or forces district health boards to work together with the ambition of creating and achieving cost efficiencies. It allows the Minister of Health to step in and sort out conflicts between district health boards to enable those powers to have wider application particularly where there are disputes between district health boards about how national regional and local requirements are best provided for. 
In the aftermath of other recent legislation suggesting that there be extraordinary and exceptional powers for Ministers such as the case of the Canterbury Earthquake Response and Recovery Act or the Rugby World Cup 2011 (Empowering) Bill I have to say that we looked into these new amendments to the New Zealand Public Health and Disability Act very deeply. We welcome the move from the Health Committee to clarify the directive powers of the Minister and to amend the respective sections to clarify that the Minister has the same directive power that he or she has under the Crown Entities Act 2004 which is essentially that the Minister cannot become involved in operational matters. 
But there is another section of the bill that we want to give particular priority to and that is the district health board public consultation requirements. The select committee’s view was that the bill would likely weaken the consultation element of the Act being amended. Presently the Act requires the same standard of consultation as in section 83 of the Local Government Act 2002. The bill will require consultation but the standard of consultation is not defined. That weakness as the committee reported it worried us and it worried Women’s Health Action. Women’s Health Action told the select committee that it held “serious concerns about the fate of public consultation in the proposed changes to the Principal Act outlined in [this] Bill … Women’s Health Action strongly recommends that consideration be given to strengthening consultation requirements in the Bill.” The New Zealand Council of Trade Unions also shared those concerns. In its submission it noted: “The CTU recommends that the consultation requirements on DHB annual plans are retained and that there are provisions in the Bill to ensure that the Ministerial power of direction is used sparingly.” 
The bill as originally drafted determined that “The Minister may give a direction to all DHBs to comply with stated requirements for the purpose of supporting government policy on improving the effectiveness and efficiency of the health and disability system.” Before giving any direction the Minister must consult all district health boards and any persons who may represent the interests of people likely to be substantially affected but only if the Minister considers it necessary in the circumstances. So we come to the crunch issue that the bill could if the Minister so desired be implemented in such a way that serves to undermine a district health board’s consultation with its community. There is no specific clause to require district health boards or the Health Quality and Safety Commission to consult with mana whenua. 
Another aspect of that issue relates to consultation with disabled people and their families. The submission from IHC provided a very strong statement about the relationship between the models proposed in the bill and the model that might work for disabled people. It stated: “IHC is concerned that the proposals for change contained within the Bill infer that the same approach will benefit both the health and disability sectors on an equal basis. IHC cautions against this approach. Given the social model of disability and the aspirations for disabled people to live an ‘ordinary life’ we believe that the medical context and models proposed within the Bill may not be appropriate for disabled people.” 
The Maori Party supports the proper recognition of disabled people and their families in the context of whanau ora. We believe that disabled people have the right to participate in decision making to be protected by law and to have control of their lives. The IHC’s submission is a reflection of the disability sector’s view that if the model does not fit this bill may not benefit the sector as much as it could. We note that although some select committee members have concerns about the whole aspect of consultation they were satisfied that new section 92(1)(g) inserted by clause 16(1) would impose sufficient procedural requirements for consultation. I have to say that we will be watching this issue very closely. 
A key development in this bill that we are very interested in is the establishment of the Health Quality and Safety Commission. We support the intention of the select committee to elevate the status of this commission by including specific information in the bill that itemises key functions. These key functions include providing advice to the Minister on health epidemiology quality assurance mortality how to improve quality and safety determining quality and safety indicators providing public reports on quality and safety promoting and supporting better quality and safety and disseminating information about quality and safety. 
We note the strong support from both the Council of Trade Unions and the Medical Association for this commission and it is an area that we in the Maori Party also support. We have canvassed strongly on this issue in our policy manifesto  
He Aha Te Mea Nui? He Tangata He Tangata He Tangata 
. We have promoted the policy line that the community must receive accurate information about the performance of hospitals public health organisations and district health boards including having adverse events reported publicly within 3 months. 
I remember a  
Lancet 
 article a few years ago in 2006 of a study of a sample of 6579 patients who had been admitted to 13 hospitals in New Zealand. That study concluded that Maori patients had a higher risk of preventable adverse events in hospital than patients of non-Maori non-Pacific origin. In fact the study concluded that Maori were more likely to receive suboptimal care. They received poor-quality practice that harmed patients. That could and should have been prevented. Our biggest concern with this report was the impact that such information has on Maori confidence in the public health system. On that basis we argued that adequate information about health status must be a priority that the health system should attend to. 
We will be supporting this bill but I alert the Minister to what will be a key focus for us—how this bill affects the appointment of Maori representation in regionalisation. Our policy is that we support the separation of the funder and provider roles of the district health boards. We also entered into Government with the position that we sought to review the duplication of corporate and administrative functions between hospitals public health organisations and district health boards and to see whether any savings were available if duplications were removed. Efficiency effectiveness quality and accountability all matter to Maori and to the Maori Party. But most of all I return to our key policy mantra: he aha te mea nui o te ao? He tangata he tangata he tangata. Our longstanding concern will remain with the people. 
Debate interrupted.