The Waitangi Tribunal's report Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry finds that the Crown has breached the Treaty of Waitangi by ailing to design and administer the current primary health care system to actively address persistent Māori health inequities and by failing to give effect to the Treaty’s guarantee of tino rangatiratanga.

The stage one report addresses two claims concerning the ways the primary health care system in New Zealand has been legislated, administered, funded and held to account by the Crown since the passing of the New Zealand Public Health and Disability Act 2000. The Act laid out a new structure for the health care system centred on the creation of district health boards to deliver health care to distinct populations.

While there was initially optimism about the new system, the Tribunal says all parties in the inquiry - including the Crown - acknowledged the situation has not substantially improved since 2000: Māori continue to experience the worst health outcomes of any population group in New Zealand. The Tribunal found that the reforms ushered in by the Act in 2000 failed to consistently state a commitment to achieving equity of health outcomes for Māori.

The Tribunal says it has found serious Treaty breaches concerning the way the Crown holds the primary health care sector to account and reports on its performance, finding that there were few mechanisms in place to ensure accountability and that those mechanisms that did exist were rarely used in relation to Māori health.

It has further found that the Crown fails to ensure that Māori have adequate decision-making authority and influence when it comes to the design and delivery of primary health care services. It found that the Act’s provision for Māori representatives on district health boards does not fully reflect the principle of partnership, and that no other Treaty-consistent partnership arrangements exist at the district health board level.

Further, the Tribunal says the Crown fails to properly resource and support Māori-controlled PHOs and health providers to deliver quality health care to Māori communities, in breach of the Treaty principles.

Inquiry background

The Health Services and Outcomes Kaupapa Inquiry began on 30 November 2016 when the Tribunal's chairperson prioritised an inquiry into nationally significant health issues.

There are numerous health-related claims before the Tribunal. It decided to take a phased and thematic approach to the inquiry, hearing claims in three stages.

The first stage, and the subject of the report, inquired into two claims brought by the Māori Primary health Organisations and Providers claimants and the National Hauora Coalition claimants. The Tribunal says it decided to hear from them because they raised urgent and current issues of a significantly discrete nature in relation to Māori health, they raised concerns that exemplify system issues, and they were brought by claimants who were ready to proceed.

The stage one claimants alleged that the primary health care framework has failed to achieve Māori health equity and is not sufficiently fit for that objective in its current state. The claimants raised concerns about the role of, and resourcing for, Māori primary health organisations and health providers. They broadly argued that Māori were not able to exercise tino rangatiratanga in the design and delivery of the primary health care system.

Recommendations

Based on its deliberations in this report, the Tribunal has recommended that the Act and its associated policies and strategies be amended to: give effect to the Treaty principles and ensure that those principles are part of what guides the primary health care sector; and include an objective for the health sector to achieve equitable health outcomes for Māori.

The Tribunal has made an interim recommendation that the Crown and the stage one claimants work together to further assess the extent of the problems in primary health care, and co-design a set of solutions.

Both claimant groups broadly suggested creating a national, Māori-controlled agency, organisation, or collective, which would have substantial oversight and control of Māori health-related spending and policy. The Tribunal has suggested that these proposals be the starting point for the conversations between the Crown and the parties.

The Tribunal has directed that the Crown and the claimants inform the Tribunal of the progress of these discussions by 20 January 2020. The Tribunal has reserved the right to issue further recommendations in response to the responses from parties.