Little Andrew; Dean JacquiPAE ORA (HEALTHY FUTURES) BILLFirst ReadingHon ANDREW LITTLE (Minister of Health): I present a legislative statement on the Pae Ora (Healthy Futures) Bill.SPEAKER: That legislative statement is published under the authority of the House and can be found on the Parliament website.Hon ANDREW LITTLE: I move That the Pae Ora (Healthy Futures) Bill be now read a first time. I nominate the Pae Ora Legislation Committee to consider the bill.Today is a pretty momentous day for this House as it commences its work in a pretty fundamental reform of our health system. I found the last debate instructive really about the understanding about not so much the health system but the health outcomes in our country. The reality is that there is an extraordinary disparity of health outcome in this country depending not only on who you are—and if you are Māori you are much more likely to have worse health outcomes than pretty much anybody else in the population—but also about where you live. Where you live will also determine what access you get to many forms of healthcare and therefore what happens to you.The system we have at the moment which is the DHB system conceived roughly 20 years ago was an attempt to make sure that we have a health system that was as responsive as it could be to local needs but completely funded by the Government of the day. It is a system that has done OK actually in some respects and it has allowed hospitals to develop what they perceive as their needs for their community.But actually over time a problem has emerged: differences between DHBs difference in performances and also it is a system that has simply been incapable of keeping up with developments in technology. So we are now able through good data and digital systems to provide a lot of coordination a lot of analysis and a lot of understanding about what is happening in different parts of the country and indeed across the population as a whole. But when you disaggregate decision making for a system for 5 million people into 20 different organisations then we shouldn't be surprised that disparities emerge and differences emerge and differentiation emerges and then people suffer the problem of access to different health services and therefore different health outcomes depending on where you are in the country. So in many respects the way we live what we do and technology—all those things—have conspired to make the current system obsolete. It is no criticism of anybody in our current system that those circumstances have emerged but that is what it is.So it was important that we took the opportunity to reflect on that and we did that with the Health and Disability System Review which was chaired by Heather Simpson and they reported. We've also had the benefit of the Waitangi Tribunal and the claim by Māori who took their claim to the tribunal and what is known as the Wai 2575 claim and we've had the benefit of the interim report of the Waitangi Tribunal reflecting on the health system and the extent to which it has served or not served the interests of Māori and the extent most importantly to which it has been consistent with the Crown's obligations under Te Tiriti o Waitangi.What was very interesting in the members who spoke opposite—with the exception of Elizabeth Kerekere—was the singular failure of any of those members who spoke to refer to the Treaty of Waitangi. The Crown has obligations under the Treaty of Waitangi and they are very clear. This was part of the examination of the Waitangi Tribunal. It said very clearly that it is a system that has simply failed Māori in that the most kind of standout measure that you can see is life expectancy. On average Māori men can expect to live seven years shorter than anybody else in the population. That tells you that there is something seriously wrong. The health system has not kept up with the needs of Māori but actually we know it hasn't kept up with the needs of much of the rest of the population either but in other respects.If ever there was any evidence about the problems and the challenges we have with the current health system you've only got to look at the current COVID pandemic and actually the roll-out of the vaccination campaign to vaccinate as many as possible of the population. Why is it that for Māori there has been such a lag in the uptake of the vaccine? It is because of a whole bunch of factors that we know have always been there but they have been exposed for all to see. We've had kaupapa Māori health services pressed into action finally now getting the traction that the rest of the system couldn't get because we said—and with the leadership of my colleague the Hon Peeni Henare with whom I have worked very closely on these reforms and on this bill. Finally when Peeni Henare worked with those Māori health leaders it actually started to get traction and it demonstrated something very important to us: that actually Māori health leaders know what is needed to make the gains and to make the difference.So this legislation does some very important things. It takes the 20 DHBs that we have at the moment and puts them into one organisation. It has the benefits of coordination across the system as a whole; not 20 different decision makers in different parts of the country but one decision maker that can plan across the system as whole and that takes into account the fact that there is increased mobility of the population. Where you go to get your health treatment should not be significantly different depending on where you are in the country. This reform and this bill will allow us to do that with the establishment of Health New Zealand.We will also establish the Māori Health Authority not because as some members have argued—and I get the culture wars that members like the Hon Simon Bridges want us to buy into and David Seymour. They want these culture wars and they'll try some division and what have you. The Māori Health Authority does not set up a separate system; it is an independent statutory body that works hand in glove with Health New Zealand to make sure that their advocacy—that is to say the Māori Health Authority's advocacy but also commissioning powers—makes sure that the needs of Māori are met in a way that they simply have not been for many many years and that we are seeing demonstrated time and again just in the last 20 months. That is why that is important.The bill also gives statutory recognition to the iwi-Māori partnership boards which have been around and have worked to varying degrees of efficacy in the time they've been around. They will be powered up through the leadership of the Māori Health Authority to make sure that that local iwi-Māori voice is heard so that when the commissioning decisions are made jointly between the Māori Health Authority and Health New Zealand that we have commissioned primary community care services that are relevant to the local population.The bill provides for and requires Health New Zealand and the Māori Health Authority to support the locality planning process. I know that many people have held on to the DHB boards and the elected boards and those boards to have been providing the ability to get local input to get great decisions made but actually the evidence tells us the opposite. It hasn't worked. We are not getting local voices making meaningful differences in local communities. Now through the locality planning process we would draw together the health providers in an area the community representatives and we can actually start to get health plans in locality areas that are relevant to those communities. That is what the bill will do.So this bill is a very important reform and evolution of our health system. And then it will ensure greater accountability and transparency through things like the Government policy statement on health the New Zealand Health Strategy the New Zealand Health Charter that will govern the values of the workforce and the institutions in our health system. There will be some transparency. We will have a national public health agency; a discreet body within the ministry that will provide the nationwide leadership in public health that the ministry has through its director of public health but actually a discreet agency providing that because the other thing that the pandemic has shown is that we need nationwide and consistent coordination and a powering up of our public and population health approach to our health system.I am confident that the changes that will be brought about because of this legislation will make a significant difference through the structure under which we make health decisions resource allocation decisions and policy decisions. It will help not only the hospital system and health policy but it will give greater emphasis and support to our primary and community care sector as well which is so vital. If we are really going to change health outcomes if we are really going to improve access for all New Zealanders and improve health outcomes actually we have to really beef up our primary community healthcare sector. This bill will allow us to do that through the establishment of Health New Zealand through the stewardship and leadership of the Māori Health Authority and the commissioning decisions that they have got to do through those bodies. I commend this bill to the House.ASSISTANT SPEAKER (Hon Jacqui Dean): The question is that the motion be agreed to.