EXTRACTS FROM A PAPER WRITTEN BY THE CHAIR OF THE AUCKLAND AREA HEALTH BOARD ABOUT A BOARD INITIATIVE
THE INSPIRATION OF WAI 2575
For more than twenty years, the report on WAI 2575 concluded in its finding late last year: “(the) Crown has breached the Treaty of Waitangi by failing 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 (autonomy, self-determination, sovereignty, self government)." This finding was supported by the Crown who "acknowledged the situation has not substantially improved since 2000: Māori continue to experience the worst health outcomes of any population group in New Zealand”
EQUITY FOR MAORI IN HEALTH SERVICES
In late 2018 and early 2019 there were a series of discussions with the five DHBs from the Waikato north, encouraged by the Minister. The aim was to seek to establish common purpose around the recognition of Te Tiriti in the health sector and the improvement of access to services for Maori. Those conversations culminated in the formation of our Northern Iwi/DHB Partnership Board, approved with Ministerial sign-off on 5 March 2020 (attached below).
If we are to improve equity, "address persistent Maori health inequities" and meet our Te Tiriti responsibilities it follows we must change practice. But which practices do we change, and how do we do this and what happens to those who might stand to miss out from such a change?
DELEGATION OF FUNCTIONS TO THE NORTHERN IWI/DHB PARTNERSHIP BOARD
One set of practices that we have already changed with the Minister’s approval is the delegation of functions to the Partnership Board. They are to:
· Determine Maori health outcomes and Maori health equity priority areas for the three Northern DHB areas
· Provide Maori health leadership, advice and guidance across all DHB funded and provided services, activities and workforce to meet their Treaty of Waitangi and statutory obligation to Maori
· Oversee resource allocation and investments made by the three DHBs for the purpose of achieving Maori health outcomes and advancing Maori wellbeing
· Engage experts and advisors to carry out work and complete specific tasks on behalf of the Partnership Board
This approval allows each DHB to delegate functions, duties or powers to this Iwi/DHB Board. The impact of this delegation has been most usefully experienced during the pandemic where the Northern Iwi/DHB Partnership Board meeting with the Regional IMT has approved funding to Maori providers to address local community requirements for safety in the pandemic across the region.
THE IMPACT OF THIS PARTNERSHIP ON THE COVID RESPONSE
This joint decision making has been both timely and effective. Pandemics have historically been very devastating for Maori https://thespinoff.co.nz/atea/18-03-2020/why-equity-for-maori-must-beprioritised-during-the-covid-19-response/. Not this time, so far.
What we have noted in the Northern region is that positive action, taken by DHBs to work directly with Maori communities has worked where they have the decision rights as to the intervention appropriate to their needs. The effect has been to reduce the risk of infection for Maori to levels at or below the levels achieved for all other communities and to have some of the highest testing rates. This has never previously occurred. Maori leadership in provision of care has reached deep into their communities and has become the most reliable conduit of information on their population health during this virus. DHBs have never before had this level of support on the ground and data about the Maori populations. The net outcome has been a significant public health safety net supported by Maori interests to protect their people. The Northern Iwi/DHB Partnership Board has been the conduit for resourcing this safety net alongside the local Maori community investment which has been extensive, profound and insightful. Right here, we have found a new way of working. This is the enlargement of equity in action.
A CHANGE IN PRACTICE
Such success has raised the expectation that if a change of practice in a pandemic can generate such positive health equity outcomes for both communities what should we change to make improvements in a non-pandemic setting? Could we get substantially improved results if we relied more on community engagement to direct more of the services available? How might these changes increase equity and provide a fairer health delivery system for all users? Within six weeks we have discovered in real time and under extreme pressure the power of a regional, delegated Iwi/DHB decision making model.
All this innovation and learning now points us to the next Everest for equity. WAI 2575 is clear that “Māori continue to experience the worst health outcomes of any population group in New Zealand.” None of us believe this is right or fair. Doing nothing won’t work as the Tribunal makes clear on the lack of progress over the last 20 years.
So we must act to change practice. We are explicitly taking on this challenge by testing as to whether we have the right approach to the waiting list for surgery. We want to see Maori health improve and thus timely and appropriate access to surgical intervention is a data point in this journey. This is inherently challenging. If we advantage one person or group we are disadvantaging others. Even the language of trying to do the right thing can get us into strife.
Let us therefore seek clarity. We want our clinical assessment process to be intrinsically evidence based and fair to our population within the resources available. But it hasn’t been and we can’t avoid that. The evidence is in from the Tribunal and the Government agrees. There are multiple reasons for this and they have been extensively argued and published. I propose that we don't spend our energy there as the studies emphasise the dilemma without the practical solution. Rather why don’t we reframe this differently?
THE NEXT STEPS
The test for ourselves might be described thus. The Government has committed to a goal of higher levels of equity in the health services particularly in relation to meeting its Treaty obligations and more generally to the Pasifika and low-income populations. We accept this challenge and will test different approaches to addressing this goal using an evidence based framework that explicitly recognises clinical prioritisation and the cultural knowledge and support that brings the service innovation required to provide enhanced outcomes for these populations being served.
EDITED AND REPRODUCED WITH THE PERMISSION OF PAT SNEDDEN