Funding inequities, institutional racism and poor Māori health statistics are the focus of the opening week of the historic Waitangi Tribunal’s Health Services and Outcomes Inquiry.
Two claims by Māori primary health provider groups (Wai 1315 and Wai 2687) are the first to be heard with both claims arguing that the poor national Māori health statistics are evidence of the Crown’s failure to care for Māori health and wellbeing and of institutionalised racism in the health system. The Wai 1315 claimants also point to a 2007 Deloitte Report – prepared in response to their initial Waitangi claim – indicating Māori PHOs and providers were being collectively underfunded by $21.77 million a year and they say nothing has been done by the Crown in the decade since to remedy that underfunding.
The Wai 2575 Health Services and Outcomes Inquiry groups together the more than 200 individual and group claims seeking the Crown to address a wide range of health-related grievances that have been grouped into three stages. The first stage, primary health claims, are being heard in a series of hearings in October and November at Tūrangawaewae Marae, in December in Wellington and finally in March next year to hear closing submissions.
Lady Tureiti Moxon, Managing Director of Te Kōhao Health (one of the Wai 1315 claimants), said its claim was first filed back in 2005 in response to the Government’s primary health strategy. “What we saw then continues now – the system is not meeting the needs of Māori. The inequalities that exist between Māori health and the health of others is a national outcry for our people and our Nation,” said Moxon.
“Currently Māori live shorter lives by 7 years compared to others, Māori are twice as likely to face discrimination in health, Māori are less likely to be referred for diagnostic tests, Māori children are over two and a half times as likely to have unfilled prescriptions due to cost and Māori are more than twice as likely to die from preventable diseases.”
Simon Royal, chief executive of the National Hauora coalition and a spokesperson for the Wai 2687 claim said the ultimate solution lay in constitutional reform based on Te Tiriti o Waitangi but in the meantime legislative reform and public policy change was needed to ensure Māori health was adequately resourced “so we can see Māori thrive.”
The Ministry of Health on behalf of the Crown has responded to the claims by acknowledging “Māori continue to experience significantly worse health status at a population level than non-Māori”. It also acknowledges that while the existing primary health care framework was flexible to allow Māori to apply “their own solutions to improve Māori health” that “however funding streams and service contracts may restrict this”.
Redress of underfunding sought
Both claimant groups are seeking for the Tribunal to focus its recommendations on Māori having greater responsibility and control over hauora (health) services and funding for Māori along with financial redress for Māori and iwi primary health providers who have “tried in earnest to implement Hauora Māori within a system that disregards Māori systems of care”.
The claimants are arguing that primary health funding formulas have had detrimental impacts on Māori health and that negotiations initiated after the initial 2005 claim had not resolved the problems highlighted at the time.
“In all of the Ministry’s evidence it is clear that apart from the Deloitte work, which was ignored, the Ministry have never made any attempt to cost how much it costs to provide services to a very high needs population or to quantify the gap between the cost and the funding actually provided,” says Janice Kuka, chief executive officer of Wai 1315 claim provider Ngā Maatapuna Oranga, in her evidence statement to the Tribunal.
A funding summary tabled by the Ministry shows that DHB and Ministry funding to Māori health providers rose from $255.9m in 2011-12 to $270m in 2015-16 an increase of 5.6% over the four years while Vote Health in the same time period rose 9.6%. The Ministry statistics that its contribution to Māori health provider funding rose at slightly more than its own funding increase over the same time period but that average DHB funding to Māori providers (where roughly two-third of their Crown funding comes via) had increased only on average by 7.2% compared to the 11.7% increase that DHBs received. Also that individual DHBs funding to their local Māori providers ranged from increases of 43% to decreases of 12.8% over the four year period.
“I seek repayment to each of the Wai 1315 claimant organisations of the costs that we have had to cover ourselves over the past 17 years (since the Primary Health Strategy was implemented) because we have been underfunded,” says Moxon in her evidence submitted to the tribunal. “This would have an immediate impact on our ability to care for our patients.”
“It is time for the Crown to finally listen to us,” add Kuka in her statement.
“In response to a health system failing Māori, we created our own Māori PHOs and Providers to give better care to our people,” she says. “We cannot wait for the Crown to create solutions. This will be too slow and will likely only create more of the same and more suffering for our people.”
Witnesses presenting evidence before the Tribunal include Dr Katherine Gottlieb, an expert from a global delegation from Alaska that are indigenous pioneers in primary health care redesign, academics Professor John Broughton and Professor Peter Crampton alongside Māori health leaders former Cabinet Minister John Tamihere, Dr Peter Jansen, Simon Royal; and the original claimants from 2005 including Lady Tureiti Moxon and Janice Kuka.
The Wai 2575 Health Services and Outcomes Inquiry stage two claims will cover three main areas with the first being mental health (including suicide and self-harm, the second being Māori with disabilities, and the last encompassing issues around alcohol, tobacco, and substance abuse. That stage is expected to begin midway through next year. There is currently no start date for the stage three claims which will cover the remaining national significant issues and eligible historical issues.