This report has much to commend it. The move to a national services procurement programme with a population health focus will do much to reduce fragmentation of services, and fewer DHBs with no appointed governers is likely to increase efficiency.
But it has two problems – the first being that the chronic inequity of health outcomes for Māori and Pacific peoples is primarily a function of intergenerational poverty and the institutional racism that infects large organisations. Although poverty is acknowledged in the Report it is not robustly engaged with as a pathway to health. Institutional racism, on the other hand, does get a number of mentions in the Report but unfortunately, it seems mostly devolved to the responsibility of the Māori Health Authority.
The Māori Health Authority is the other problem. Sequestered off by itself, without significant commissioning capability and buried as a necessarily compliant Departmental Agency in the Ministry of Health, is not a promising place to be. And why on earth is this the case when a majority of the HDSR Panel and the whole of the Māori Advisory group argued for a position that empowered the MHA to be effective?
The Alternative View argues for a Te Mātāwai or Whānau Ora Commissioning-like model.
Possibly, a Tiriti- based dual-CEO model Health New Zealand with a broad equity-based Terms of Reference and six Māori board members out of the eight would have a much better chance of producing equitable outcomes for Māori, Pacific, disabled and other decile 9/10 peoples.
Professor David Tipene-Leach
Te Ohu Rata o Aotearoa (Te ORA)
Māori Medical Practitioners Association