Williams ArenaARENA WILLIAMS (Labour—Manurewa): Madam Speaker tēnā koe. I also want to join with my colleagues around the House in acknowledging our colleague Efeso Collins and to mihi to him and his whānau today.This bill is incredibly disappointing and the speeches we have heard this afternoon have reflected that—both on this side of the House with a very moving contribution by my colleague the Hon Willow-Jean Prime in her reo rangatira to share her personal reflections about the impact that repealing this will have on her communities and her family and also on the contribution of Cushla Tangaere-Manuel when she spoke about the impact of the long history of health inequality for Māori in New Zealand on her mother and the way that inequitable access to not only advice but medicines impacted not only her health but the health and wellbeing of her entire family.That has been met with incredibly disappointing speeches on the other side from practitioners some of whom were previously practitioners in general practice and supposedly experts in health who know that the status quo never worked for Māori and appreciate the deep inequities which have delivered health outcomes for Māori that would not be fixed by going back to that system. More Māori die from avoidable deaths than non-Māori. Māori die seven years earlier than any other group. Māori are twice as likely to die of a cardiovascular or heart disease. These are things which returning to the status quo will not improve and the Pae Ora healthy futures reform allowed a once-in-a-generation opportunity to address those things. Instead of building on those reforms instead of continuing the work that was happening not only at the community level but within families themselves which Cushla Tangaere-Manuel and Willow-Jean Prime have spoken about we are walking back to a system which is more centralised which leaves iwi Māori out of the system where we had worked so hard to bring them into it. It leaves out the voices of those people who have systematically been left out for generations but who for the first time had a seat at the table—and not only those iwi-Māori partnership boards but in the Hauora Māori Advisory Committee and in the Māori Health Authority itself. This is a huge regression for Māori and it represents a huge lost opportunity for a new generation of New Zealanders.Now we know that the old system underperformed. It underperformed for a number of practical reasons and I'll get on to those but I would point out that speakers on this side of the House have already underscored the fact that the Minister knows that appreciates the underperformance in the system but that this is part of a wider political narrative. And we keep hearing it from the other side when they stand up and say We have an electoral mandate to do this." The electoral mandate is there because it was won in a furore of his wrong-headed idea that Māori were getting special rights and special treatment and in fact that debate was whipped up by members on the other side of this House. That electoral mandate was won not from Māori who suffer the worst and most inequitable health outcomes in our entire country; it was won by people who were afraid of the kind of narrative that politicians on that side were feeding them.Labour had the courage to stand up and say there are practical fixes we can do for this that will make the health outcomes for Māori more equitable. There are practical ways that district health boards (DHBs) haven't been able to deliver on their promises and so a nationalised health system that has a mandate to get in there roll up its sleeves and deal with Māori health outcomes will actually be able to do that. But it did take courage. It did take telling the story and for the most part I think New Zealanders appreciated that there was a longstanding inequity here that the system could not solve if there wasn't substantive change.I think it's really disappointing now that we are standing in this House and not only are we repealing the Māori Health Authority but there are also a number of changes in this bill which I will be asking the Minister questions about in the committee stage which take away the voice of iwi of Māori and of appointed experts in Māori health within the system and replace them with people who are appointed directly by the Minister and who can be dismissed by the Minister at any time. This is not localisation in any way. This is taking away the power of iwi and local entities to work with Māori communities and it is essentially a power grab for the Minister to take all of those devolved powers back into the central ministry. This is bureaucracy for Māori health outcomes. This is not only returning to the old system that did not work for Māori; it's bureaucratising the system that was actually successful for Māori that generated a number of successful initiatives like the iwi-led MMR vaccines drive which was so effective and we want to see more of. There is no consistency around the way that we localise these things in the way that works.I said I'd talk about the practical implications of these changes. One of the good examples of this was the Counties Manukau DHB. That DHB which dealt with the health concerns of South Aucklanders and provided health services for South Auckland for many many years carried a burden of diabetes and heart disease unlike any other DHB in the country. The number of cases of diabetes and particularly type 2 diabetes that were presenting in the public health system in that DHB was unlike any other DHB. What that meant was that other services had to be provided at a lower level so that the DHB could continue to provide for those services. Dealing with that locally if you lived within Counties Manukau meant that at the DHB you might have say a longer waiting-list for a certain procedure or say you might be eligible for a certain service at 65 where in Auckland Central you would be eligible for that service at 60. The reason for that disparity was because it had a high prevalence of Māori in the area and the needs of Māori were so great that this locality was dealing with a deeply underserved population for many many reasons which have been made clear in this House. And so that localised system simply didn't work for the entire population because there was this deep need for Māori health services.So when the Pae Ora reforms proposed to solve that problem it wasn't just that localities would be done away with; it was that these problems that had been besetting DHBs like Counties Manukau would actually be dealt with head-on: that things that the Māori population needed to enjoy longer and healthier lives would be done in an equitable way not only in Counties Manukau but all over the country; that these systems that had been dealt by that DHB to create efficiencies in the system would be shared with everyone. That is a good thing. It is not a woke kind of reform because we believe in it or because the Treaty obligations require the Crown to; it is simply something practical which meant that everyone in the population could get a better health service.There's also a practical example around historic underfunding of hospitals and communities with large Māori populations. Essentially for the same kind of logic that these towns and areas and localities with high Māori populations have always had high health needs they haven't been able to develop the infrastructure in the same way as other communities that do not have those high-needs populations. So because of this historic underfunding the way that the capital programme works and the way that the Crown invested in its hospitals meant that hospitals were successively underfunded more and more over time. And so the Pae Ora reforms actually again dealt with that problem by disestablishing the DHBs and it meant that underfunded populations would not continue to lose out on the kind of infrastructure they need in the health system. Those are two practical examples of how the Pae Ora reforms addressed that. It's really sad to see that now we won't have a Māori Health Authority that is charged with continuing on those important gains which we all want to see in our health system for the benefit of everyone not just Māori within the health system.A quick observation before we get to the committee stage on the consistency with the Government's Treaty of Waitangi obligations. I want to speak here about the departmental disclosure statement which found that there was not necessarily any obligations that were being breached when in fact Crown Law's own advice in its memo to the Waitangi Tribunal dated 31 January found that "The Crown confirms that procedurally no formal consultation was planned or occurred by the Crown before Cabinet confirmed the decision to disestablish Te Aka Whai Ora. On a conventional assessment of impact and importance the Crown deciding to make this decision without consultation can be expected to result in a finding by the Tribunal that Treaty principles have been breached and that prejudice has resulted."It's important for the House to fully appreciate that the Crown's own advice is that the introduction of this bill would on the face of it constitute a breach of the principles of the Treaty of Waitangi."