EXECUTIVE SUMMARY

2. The model gives practical effect to the Government's commitment to the principles of the Treaty of Waitangi. It proposes that relationships be built at each level of the health system - from the Minister to service delivery - and that these relationships focus on ways to accelerate improvement in Maori health and development. It proposes that existing relationships are continued and consolidated and that new relationships be established where they do not already exist.

3. At the Ministerial level a new relationship is proposed. A National Maori Forum convened at least once a year will provide Maori representatives and the Minister with an opportunity to discuss existing and future Maori health policy direction.

4. At the District Health Board governance level, Treaty relationships that currently exist with the HFA will be transferred to DHB Boards. Where no present relationship exists, DHB Boards will be obliged to establish them as soon as is practicable with mana whenua¹ of the region. (DHBs will be assisted in this process). The partners will work together to set goals and agree on strategies to meet the health needs of their communities.

5. At the District Health Board operational level, relationships that currently exist with Maori Development Organisations (MDOs) and Maori Co-Purchasing Organisations (MAPOs) will be transferred from the HFA to DHBs. Through delegated management, contracting, and monitoring of health services, these relationships will reduce transaction costs for both Maori providers and Boards. Where relationships do not currently exist they will be encouraged, where practicable.

6. At the health and disability service provider level, incentives for collaborative partnerships between mainstream providers and Maori providers will be provided by the funding agreements and the pressure upon DHBs to deliver effective Maori health services. Continuing to build and develop the confidence and the capacity of the emerging Maori health and disability service sector will be important. The Maori Provider Development Scheme will continue to play a key role in this process.

BACKGROUND

7. Maori participation has been increasing at all levels of the health sector in recent years. Maori organisations have established governance and operational level relationships with successive health funding agencies; the number of Maori health service providers has grown to more than 240; and participation by Maori in the health workforce is steadily increasing.

8. The Government indicated in January that it wished to build on this development, through a strengthened partnership between the Crown and Maori, based on the principles of the Treaty of Waitangi² [CAB (00) M 2/4 refers]. To give affirmation to this commitment the Government has also:
   1. sought advice on the inclusion of a Treaty clause in the New Zealand Public Health and Disability Act (see accompanying paper on the Treaty of Waitangi in Health Legislation)
   2. agreed there will be equitable representation of Maori on DHB Boards (also discussed in an accompanying paper)
   3. included the Treaty of Waitangi and Maori health development goals and objectives in the draft New Zealand Health Strategy.

9. The model described below elaborates on a generic model described in an earlier paper [Sector Design: Maori Issues - CAB (00) M 11/1A(4) refers] and is designed to give practical effect to the Government's commitment to the principles of the Treaty. It proposes that relationships be built at each level of the health system - from the Minister to service delivery - and that these relationships focus on ways to accelerate Maori health development. It proposes that existing relationships are continued and consolidated, and that new relationships be established where they do not already exist.

10. The expected outcomes from productive partnerships will range from a better understanding of each party's perspective to a demonstrable growth in Maori participation in the health sector and a measurable improvement in Maori health.

THE PARTNERSHIP MODEL

The Basis of Partnership

11. The partnership of Crown and iwi, which is implicit in the Treaty of Waitangi, is the foundation of each of the relationships that form part of this model.

The Purpose and Benefits of Partnership

12. The purpose of the partnership is to work together, Crown and Maori, for the benefit of Maori health, whanau, iwi, hapü and Maori development, and, in turn, the development of the nation as a whole.

13. Partnership implies a commitment to work together for the mutual benefit of both parties. In its judgement on the Waipareira case, the Waitangi Tribunal suggested that the partnership between the Crown and Maori might more productively be regarded as a marriage rather than a business contract:

    "The Treaty is more like a marriage contract, in which broad and general vows express the desire and the intention of the parties to live together in mutual love and respect. The success of a marriage depends not on the ability of the parties to formulate or interpret vows advantageously to themselves, nor on their ability to enforce them in the case of a dispute. Rather, it depends on their commitment to work through problems in a spirit of goodwill, trust, and generosity, actively seeking creative solutions, and taking opportunities to bolster each other."³

14. The benefits that flow from a good relationship will range from a better understanding of each party's perspective, to a demonstrable growth in Maori participation in the health sector, better collaboration between sectors in relation to the wider determinants of health, and a measurable improvement in Maori health. Effective partnerships will lead to:
    1. more effective services for Maori (provided by both Maori and mainstream)
    2. greater participation by Maori in the health workforce
    3. better access for Maori to health services
    4. reductions in avoidable illness
    5. a greater level of Maori consumer satisfaction
    6. an overall improvement in Maori health statistics
    7. faster progress towards the goal of parity between Maori and non-Maori health status

The Guiding Principles of the Model

15. Maximising Maori involvement at all levels of the health system is the key to the success of this partnership model. A Maori voice in the key policy making forums; Maori participation at all levels of the health workforce; Maori service providers involved in the widest range of service delivery;- these will be both a measure of, and a prerequisite for, a successful partnership.

16. Building forward is equally important. Maori participation has been increasing at all levels of the health sector in recent years. Maintaining that momentum, ensuring continuity, and building on the progress that has been made so far are important for retaining Maori confidence through the process of structural change.

17. Maintaining flexibility is the other principle that drives this model. Fostering the development of effective and enduring partnerships requires avoiding the temptation to prescribe too closely the shape that partnership relationships might take. At most of the levels of the model, therefore, the existence of the relationship is explicit; but the nature of it lies in the hands of the participants.

A PARTNERSHIP MODEL

18. Fig 1 below illustrates how Maori will be involved at each level of the health sector . A description of the relationships follows.

Fig 1: Model of Maori Partnership and Participation at all levels of the health sector

Footnote(s):

1

The term 'mana whenua' refers to Mäori who have iwi links to the region. (The term 'tangata whenua' is also used in this context.) The distinction is drawn between mana whenua and 'taura here' or 'manuhiri' (Mäori in the region whose iwi links are elsewhere).

2

According to the Privy Council [1994] the "principles" are the underlying mutual obligations and responsibilities which the Treaty places on the parties. They reflect the Treaty as a whole and include, but are not confined to, the express terms of the Treaty. Three basic principles have been identified: First, that the Crown acts reasonably and in good faith to its Treaty partner; second, that the Crown makes informed decisions; and third that the Crown avoids impediments to providing redress. The latter can be, and often is, phrased in terms of the duty of active protection. [from Crown Law advice to the Ministry of Justice, 1996]

3

Te Whänau o Waipareira Report; Waitangi Tribunal (1998) p. 222