Maori Health Authority – Do we need it?
Maori Health Authority – Do we need it?
A Maori Health Authority is to be set up as one of the
recommendations of the Simpson review – full title: Health and Disability System Review – Final Report. The review
could not really agree on whether a Maori Health Authority should hold full
commissioning powers and has “kicked for touch” so to speak. Andrew Little
going in the opposite direction seems to have agreed to the idea, possibly to
please the Maori political masters. He has told us nothing of how a Maori
Health Authority might operate; except to say it could have a commissioning role
rather than an advisory role, plus it could hold some form of veto rights – but
veto rights over what? He provided a typically “woolly” sort of answer.
I am not sure if we should be so worried about the concept
of veto rights which could well die a natural death. But here are a few
thoughts on the issue. No one knows whether veto rights could be traded on and
off in the back rooms somewhere? If veto rights were to be seen as bargaining chips
the health system could be “gambled” away very quickly to a state of
dysfunction.
My hope is that better minds will prevail and that veto
rights will be dismissed completely and with it the entire concept of a Maori
Health Authority. We do not need it.
This post argues against the idea of Maori Health Authority.
Quoting the Simpson
review:
The New Zealand system is too
small to duplicate expertise and effort unnecessarily, and when significant
investments are needed, it is important they are made in the right places at
the right time so that health outcomes and equity are improved for all New
Zealanders.
The review is no doubt referring there to duplication of
particular assets, personnel and services in different parts of New Zealand. But,
is the review arguing against some of its own recommendations? Note the words
“too small to duplicate expertise” and “equity” and “all New Zealanders”. No
racialism in those words. If the system is too small how can it logically
sustain dual authorities, services and management systems which a Maori Health
Authority would demand?
We need to continue with an all-inclusive health service, as
the existing service is by the way. Certainly it is fragmented but not to the
point of collapse. The existing service requires a degree of streamlining but the
imposition of two authorities, two providers, is not streamlining. Sorry to say
it but we would be heading toward something monolithic, or attaching more
carriages to the gravy-train.
If the current argument is that Maori do not have access to
or are not participating in existing services then what is the underlying
problem? I cannot believe that great numbers of Maori are unaware of how the
health system in general works. Point: What is the number of Maori who are
truly at risk? A very small number I would guess. Another point: The greater
number of Maori are in fact urbanised and have been assimilated into the wider
culture. Access for urban Maori cannot
form any part of the problem.
Put aside for another day arguments for and against a definition
of true Maori ancestry. How, where, and to what degree is true qualifying
ancestry traced? Think in terms of eventual elitism and established privilege.
Would we really need another huge layer of services to
cover, again, a very small number? In terms of resources a dual big-bang system
would begin from a base which is already hugely handicapped through lack of
specialties, lack of funding, low staff numbers and morale. The recent pay
freeze will not have helped in any of those areas.
Over years how many special Maori health projects have come
and gone or are currently up and running? Is it a matter of educating some
Maori to the point where they have a much improved understanding of the health system?
All of the various demographics – age, race, special needs etc. - will require dedicated
programmes from time to time. With good management tools those can be readily
accommodated in any all-inclusive system.
If it is a lack of trust in the system then what is the
basic cause of any mistrust? Mistrust may well have been propagandised to and programmed
into the thinking of some Maori people. In other words mistrust is a hearts and
minds issue to be overcome without the need for a Maori Health Authority.
My feeling is that the clash of languages down the
generations has played a major part in mistrust. Maori educators and leadership
please note – work in and with an all-inclusive system. Do we need to teach remedial
English language to many of our Maori people, rather than teach Maori language
to English language speakers?
We often hear that “things are not being done in a
culturally safe manner” or that there is always a “cultural way” to do this or
that. “Cultural safety” is a mantra applied to any number of situations to
demand that many social and/or health transactions should be performed in a
near ritualistic manner which suits the so-called and mythical needs of a racial
group.
Cultural competence and safety needs to be a core
requirement of the entire workforce. All staff must develop cultural safety and
competence to work effectively with Māori, Pacific peoples and others. Embedding
cultural safety is one approach to eliminate institutional racism in the
system.
The review uses the term “cultural safety” on 16 occasions
and the term “culturally safe” on 22 occasions. The term “racism” or
“institutional racism” is used on 19 occasions, though no evidence in the way
of case studies of institutional racism is offered. And some of us thought that
cultural safety etc. had been taught from the 1980s onward. 40 years approximately. What went wrong?
Cultural safety if it requires defining, or redefining, is
simply the basic everyday respect we show to each other in any societal setting
– a natural occurrence. Otherwise the term cultural safety is mostly redundant.
My reading of the review is that there is an exaggerated demand to have
cultural safety directed more toward Maori than to any other group.
Is there any special cultural way to propel a wheelchair up
or down a hospital corridor? If there is please instruct your local hospital administrators.
I have provided the human motive power to a wheelchair a few times where
cultural considerations were never thought of. Soon enough hundreds of thousands
to millions of us will receive Covid vaccinations. There is one way only for a
vaccine injection to be administered and it has nothing to do with culture.
What is my overall view of the Simpson review? I have given the
big thumbs down to a Maori Health Authority. I feel the review has placed
excessive emphasis on Maori issues, culture and language. With regard to
language there is a distracting overuse of Maori language terms – many untranslated.
Certainly there is a swathe of recommendations which if taken up fully will
benefit all New Zealanders, Maori included.
Comments