Katene Rahui: New Zealand Public Health and Disability Amendment Bill — Third Reading 
Katene Rahui: New Zealand Public Health and Disability Amendment Bill — Third Reading 
[Volume:667;Page:14572] 
RAHUI KATENE (Maori Party—Te Tai Tonga) 
: 
 At the second reading of the New Zealand Public Health and Disability Amendment Bill I raised the issue of district health board public consultation requirements. The House will recall that the Health Committee’s view was that the bill would likely weaken the consultation element of the Act that is being amended. In essence the core objection the Maori Party had to the bill was directly related to the Treaty clause in the New Zealand Public Health and Disability Act which we see to be of crucial importance. A Treaty clause is also included in Crown funding agreements with district health boards. Although there is a standardised Treaty clause some differ depending on the agreement with the provider. The general thrust of the Treaty clause is the statement: “The DHB has a responsibility to assist the Crown in fulfilling its obligations under the Treaty of Waitangi and are guided in that responsibility by the NZPHD Act and other policy directions from the Crown. The Act requires DHBs to take active steps to reduce health disparities by improving health outcomes for Maori.” 
For all those prone to anxiety about how symbolic intent translates into implementation let me assure the House that the strength of the principal Act is that it provides specific and pragmatic assurances about how these obligations can be fulfilled. For example Crown funding agreements with district health boards state: “DHBs must establish and maintain DHB processes to enable Maori to participate in and contribute towards strategies for Maori health improvement. This recognises and respects the principles of the Treaty of Waitangi. References to the Treaty of Waitangi and the principles of partnership participation and protection in DHB accountability documents and agreements between the Minister and the Crown derive from and should therefore be understood in this context.” 
I want to be really clear about just how important this Treaty framework is and for all providers to understand how to enact the founding document of our nation. A Treaty clause is used in Ministry of Health contracts with providers primarily to fulfil and comply with section 4 of the New Zealand Public Health and Disability Act 2000. The Act recognises the importance of the Treaty relationship in facilitating Maori involvement in Maori health provisions and outcomes. For the record I remind us all of the wording of section 4 of that Act which has become a benchmark for the way in which we can truly respect and adhere to the aspirations that all our ancestors had when they signed up in 1840: “In order to recognise and respect the principles of the Treaty of Waitangi and with a view to improving health outcomes for Maori Part 3 provides for mechanisms to enable Maori to contribute to decision-making on and to participate in the delivery of health and disability services.” This is a vital reference point for the bill as an entirety and specifically in relation to the concerns I have raised in the House previously in relation to consultation. 
I pay credit to my colleague the Hon Tariana Turia for the leadership she demonstrated back in 2002 with the introduction of  
He Korowai Oranga: Maori Health Strategy 
. That strategy says outright that the Government is committed to fulfilling the special relationship between iwi and the Crown under the Treaty of Waitangi. It goes further outlining how the principles of partnership participation and protection derived from the Royal Commission on Social Policy will continue to underpin that relationship. They are threaded throughout  
He Korowai Oranga.  
Partnership will be demonstrated in working together with iwi hapu whanau and Maori communities to develop strategies for Maori health gain and appropriate health and disability services. Participation will be illustrated in involving Maori at all levels of the sector in the decision making planning development and delivery of health and disability services. Protection will be evident as a priority when the sector collaborates and cooperates to ensure that Maori have at least the same level of health as non-Maori and that Maori cultural concepts values and practices are safeguarded. 
The foundation that I have laid out today is critical to understanding why we have raised concerns about the vital need to enhance and articulate the detail in consultation. An overarching aim of the health and disability sector is the improvement of health outcomes and the reduction of health inequalities for Maori. How else are we to do this other than with the active involvement of whanau hapu and iwi? We in the Maori Party want to see the active involvement of manu whenua to facilitate Maori access to services the provision of appropriate pathways of care which might include but are not limited to matters such as referrals and discharge planning and ensuring that services are culturally competent and are provided to meet the health needs of Maori. It is expected that there will be Maori participation in the decision making about and the delivery of the service. 
When I spoke to this bill at the second reading I raised my concerns from the select committee’s view that the bill would likely weaken the consultation element of the Act. Presently the Act requires the same standard of consultation as section 83 of the Local Government Act 2002. The bill requires consultation but the standard of consultation is not defined. When I spoke I said that that worried us and it continues to worry us. The local body elections held over a week ago have provided even further reason why we need to be vigilant about the issues of representation and participation of Maori in the health sector. Around the country we saw that Maori were unfairly inequitably and disproportionately under-represented on elected councils including district health boards. 
Section 29(4) of the Public Health and Disability Act 2000 requires the Minister of Health to ensure that Maori membership of the board is proportional to the number of Maori in the district health board’s resident population and that there are at least two members on the board. Despite the legislative measures in place all our experience and anecdotal evidence tells us that there are still far too many district health boards that fail to meet even those most minimum requirements. We want to be absolutely sure that we have every base covered and that we maintain a determined resolve to ensure that Maori membership of the district health boards is both proportional to its Maori population and a minimum of two members. We will be insisting that robust and comprehensive consultation processes are in place to enable Maori to contribute to decision making on and to participate in the delivery of health and disability services. 
Finally I do not want to leave the impression that it is district health boards only where Maori representation is an issue. I refer the House to the report to the Minister of Local Government on the review of the Local Government Act 2002 and the Local Electoral Act 2001 special topic paper on representation February 2008. They reveal that in Wellington and Dunedin only 1 percent of the members on local councils are Maori; in Blenheim there are none. Clearly there is a much bigger picture surrounding Maori participation and representation. It is an issue that we want to fully canvass in the upcoming constitutional review. 
We will support this bill at its third and final reading but we will be looking to the Minister to provide us with more confidence on the capacities of district health boards to consult and fully involve mana whenua.