Submission on The Healthy Futures (Pae Ora) Amendment Bill

August 13, 2025
|In Uncategorized
|By Sen Thong
SUBMISSION 
To:  Health Select Committee 
From:  Te Pae Oranga o Ruahine o Tararua IMPB 
Date:  13 August 2025 
Subject:  Submission on The Healthy Futures (Pae Ora) Amendment Bill
  1. PURPOSE 

1.1 Te Pae Oranga o Ruahine o Tararua is an iwi, mātāwaka and mana whaikaha mandated Charitable Trust representing the seven mana whenua, mātāwaka and mana whaikaha across the MidCentral region. We hold the statutory IMPB function under the Pae Ora (Healthy Futures) Act 2022 and represent the hauora interests of approximately 44,000 Māori across five takiwā. 

1.2 We vehemently oppose the Healthy Futures (Pae Ora) Amendment Bill in its current form. The Bill continues a pattern of legislative erosion against Māori that began with the disestablishment of Te Aka Whai Ora, and severely undermines te Tiriti o Waitangi commitments, equity, and iwi authority as te Tiriti partners. It unilaterally removes critical statutory functions of IMPBs dismantles and destroys proven local commissioning models essential to achieving hauora Māori outcomes. 

  1. KEY CONCERNS

2.1 Dishonouring of Te Tiriti o Waitangi 

2.1.1 The Healthy Futures (Pae Ora) Amendment Bill continues an unacceptable and despicable legislative trajectory that began with the Pae Ora (Disestablishment of Māori Health Authority) Amendment Act 2024, which repealed Te Aka Whai Ora. The Hautupua Waitangi Tribunal Report found that this repeal breached multiple principles of Te Tiriti o Waitangi including: 

  • Tino rangatiratanga: The Crown unilaterally removed the primary mechanism through which Māori could exercise authority over hauora Māori, without consultation or consent.  
  • Partnership: The Crown failed to consult or engage with Māori as Tiriti partners in the decision-making process. 
  • Active protection: The Crown did not safeguard Māori interests despite clear evidence of persistent health inequities. 
  • Good government: The Crown bypassed its own policy development standards, including the requirement for a regulatory impact statement, and acted on political ideology rather than evidence​. 
  • Redress: Te Aka Whai Ora was a negotiated form of redress for historical failures in Māori health policy. Its removal, without a replacement, constitutes a breach of the principle of redress.  

2.1.2 Te Aka Whai Ora was described by the Tribunal as the ‘linchpin’ for hauora Māori, that was structurally embedded in the Pae Ora Act to uphold tino rangatiratanga, and the primary mechanism for implementing tino rangatiratanga in the health system. Its removal, and the absence of a Tiriti-compliant alternative, was found to be prejudicial to Māori, undermined the Act’s integrity, and left Māori without a Tiriti-compliant mechanism for health leadership.  

2.1.3 The Healthy Futures (Pae Ora) Amendment Bill continues this unacceptable and despicable erosion by repealing and seeking unilaterally to weaken several provisions that previously gave effect to te Tiriti o Waitangi that iwi, hapū and whānau had negotiated with the Crown as te Tiriti partner. These include: 

  • Repeal of Section 6(b): Removing the requirement for the Minister and health entities to be guided by the health sector principles that uphold equity, Māori leadership and culturally responsive services. Its removal eliminates the statutory obligation to uphold equity and Māori leadership in health. 
  • Repeal of Section 7 (Health Sector Principles): These principles previously mandated equity, cultural safety, Māori decision-making authority, and responsiveness to Māori needs. Their repeal removes the legislative foundation for equitable service delivery. 
  • Repeal of Section 15(b): Eliminating Health NZ’s obligation to engage with IMPBs when setting kaupapa Māori investment priorities. 
  • Replacement of IMPBs with HMAC: Severing direct engagement between Health NZ and IMPBs as guaranteed under te Tiriti, replacing it with indirect reporting to HMAC which is a creature of the Crown and does not have the support of iwi, hapū and whānau. 
  • Unilaterally redefining IMPBs: IMPBs are now defined as entities that ‘represent local perspectives and report to HMAC, rather than being strategic partners in system design and investment. This is an absolute breach of te Tiriti and the right of iwi, hapū and whānau to exercise their mana motuhake 

2.1.4 These changes unilaterally dismantle the Tiriti-based architecture of the Pae Ora Act developed in partnership with iwi, hapū and whānau and once again unilaterally reduce iwi, hapū and whānau to passive stakeholders rather than our rightful and guaranteed Tiriti o Waitangi partners. 

2.1.5 The Healthy Futures (Pae Ora) Amendment Bill not only purposely and unilaterally fails to restore what was lost with the repeal of Te Aka Whai Ora, but it abhorrently deepens the breach by removing additional protections and statutory functions that were designed to uphold and give effect to te Tiriti.  

2.2 Repeal of Health Sector Principles 

2.2.1 The repeal of the health sector principles in the Healthy Futures (Pae Ora) Amendment Bill is an unsurprising significant regression and about face of the Crown’s commitment to Te Tiriti o Waitangi and to equitable health outcomes for Māori. These principles served as an intentional statutory safeguard to ensure that health services were not only accessible and equitable, but also culturally safe, less racist, responsive, and reflective of Māori decision-making authority and participation to improve health outcomes for Māori and thus the nation. If we improve outcomes across the nation and world for minorities then we lift our nation and the world. 

2.2.2 Under the Pae Ora (Healthy Futures) Act 2022, the health sector is required to: 

  • Ensure Māori have access to services proportionate to their health needs. 
  • Deliver services that are culturally safe and responsive.  
  • Provide Māori with decision-making authority on matters of importance to them.  
  • Resource kaupapa Māori and whanau-led services. 
  • Maintain a health workforce representative of the communities it serves.  

2.2.3 The removal of these principles unilaterally strips away the rightful legislative mechanisms that held the system realistically accountable for addressing persistent inequities and racism in the system. It also undermines the capacity of iwi-Māori Partnership Boards to rightfully influence and thus contribute to service design and delivery in a way that reflects local Māori aspirations and needs the core of which comes through the voice of whānau.  

2.2.4 This is completely unacceptable given the findings of our IMPBs recent Hauora Insights Report (July 2025) which inter alia highlights: 

  • Māori enrolments remain below population share benchmarks. 
  • Māori GP consultations are consistently lower than expected. 
  • Māori IPMHA encounters have doubled since 2021, yet access remains inequitable. 

2.2.5 Removing the Health Sector Principles will further entrench these inequities and reduce the system’s responsiveness to Māori needs thus resulting in poorer health outcomes for Māori which will cost the Crown more in the long run and thus the taxpayer.  

2.2.6 The Crowns unilaterally decision to place sole reliance on the Hauora Māori Advisory Committee as the primary conduit for Māori engagement is repugnant and insults iwi, hapū and whānau across the nation. The Hauora Māori Advisory Committee consists of ministerial appointees and does not represent iwi, hapū and whānau, who are the Crowns Tiriti partners. This is racism at its best. This centralisation of a ‘Crown grown’ Māori voice not only breaches Tiriti obligations but it silences the diverse and locally grounded perspectives that Iwi-Māori Partnership Boards were designed to uphold a duty they hold in the highest esteem and see as core to their functions  

2.2.7 The recently published Integrating Māori Worldviews with Health Economic Evaluation report (July 2025), commissioned by the Ministry of Health highlights the fact that removing the health sector principles also undermines the economic case for culturally aligned commissioning. The report demonstrated that health interventions grounded in Māori values yields both health and economic benefits such as improved outcomes, reduces hospitalisations, and strengthens community resilience. It further highlights the importance of local commissioning to support these economic benefits. Removing the principles that enable such commissioning presents a missed opportunity for system-wide improvement and savings for the Crown in the long-term.  

2.3 Repeal of section 30 Functions of Iwi-Māori Partnership Boards 

2.3.1 Te Pae Oranga o Ruahine o Tararua vehemently opposes the repeal of the functions of Iwi-Māori Partnership Boards and expect them to remain as is. This includes s30(1)(e) to engage with Health New Zealand and support its stewardship of hauora Māori and its priorities for kaupapa Māori investment and innovation.  

2.3.2 The Integrating Māori Worldviews with Health Economic Evaluation report (July 2025) shows that: 

  • Māori health models such as Te Whare Tapa Whā and Economy of Mana emphasises holistic wellbeing. These models do not just apply to Māori, they are used across the system successfully for everyone. 
  • Conventional health economics undervalues Māori-led interventions. 
  • Local commissioning aligned with Māori values yields both health and economic benefits and thus cost savings for the Crown in the long term. 

2.3.3 Removing iwi-led commissioning completely and unjustifiably ignores this evidence and will result in funding decisions that are misaligned with Māori definitions of success. It also severely undermines Indigenous data sovereignty and relational accountability, which are essential for sustainable hauora Māori outcomes. Local commissioning that is grounded in Māori values and led by Māori communities enables the design and delivery of health services that are culturally resonant, build trust, and strengthen whānau and community cohesion. Such commissioning will result in savings for the Crown overtime as the longer Māori stay well the less cost there is on the system. The changes proposed will contribute to the ongoing colonial oppression of Māori through a reduced life expectancy. The commissioning approach not only improves health outcomes by ensuring services are responsive to local needs and aspirations, but also generates economic benefits, such as reduced downstream healthcare costs, increased social capital, and enhanced provider sustainability by leveraging community strengths and fostering long-term system resilience.  

2.4 Dilution of IMPB Functions and Iwi Authority 

2.4.1 The Healthy Futures (Pae Ora) Amendment Bill unilaterally and severely undermines the IMPB role as Tiriti partners and unacceptably diminishes their authority in hauora Māori governance. Instead of engaging directly with Health New Zealand, IMPBs are now relegated to a narrow role of whānau voice and reporting to the Hauora Māori Advisory Committee, a ministerial appointed body. We wish to make it clear our IMPB will not have its powers usurped and reduced to this we shall continue to carry out our existing function as they were guaranteed to us under the te Tiriti not Crown legislation. Furthermore, as IMPBs reflect directly the voice of whānau it follows we will continue to have such functions and roles. This structural change centralises decision-making and severs the direct iwi-Crown relationship that was foundational to the Pae Ora (Healthy Futures) Act 2022. We shall thus maintain that relationship directly with the Crown and shall not be hailed to be subservient and report to the Crowns HMAC Committee. 

2.4.2 The repeal of Section 15(b), which required Health New Zealand to engage directly with IMPBs on kaupapa Māori investment, and the reassignment of engagement obligations under Section 14(3) to the Hauora Māori Advisory Committee, removes iwi from the decision-making table. We do not accept this and will continue to sit at the table. 

2.4.3 The redefinition of IMPBs under Section 29 as entities that ‘represent local perspectives’ strips them of their strategic commissioning and monitoring roles. This shift undermines tino rangatiratanga, and disregards the findings of the Hautupua Waitangi Tribunal Report, which emphasised the importance of direct iwi-Crown relationships in health governance. Our IMPB will continue this role as guaranteed under te Tiriti and we are more resolute in our duty to do so. 

2.4.4 The Healthy Futures (Pae Ora) Amendment Bill ultimately erodes the structural mechanisms that uphold Māori authority in health and risks perpetuating the very inequities the Pae Ora (Healthy Futures) 2022 Act sought to address. Our IMPB does not accept this and will continue to advocate and ensure there are mechanisms that uphold our authority and address inequities. 

2.5 Complete Disregard and Lack of Consultation with Iwi, Hapū and Whānau as Tiriti Partners 

2.5.1 The Hautupua Waitangi Tribunal Report found that the Crown breached Tiriti obligations with respect to the disestablishment of Te Aka Whai Ora. The Crown: 

  • Did not engage with Māori before deciding to disestablish Te Aka Whai Ora. 
  • Ignored advice from officials and Treasury to conduct a regulatory impact statement. 
  • Proceeded with urgency, bypassing the Waitangi Tribunal’s scheduled hearing. 

2.5.2 This exclusion breached the principle of partnership and undermined the Crown–Māori relationship. The Tribunal described the Crown’s actions as showing “reckless disregard” for its Tiriti obligations. 

2.5.3 Despite the findings of the Hautupua Waitangi Tribunal Report, the Crown continues to disregard its Tiriti obligations with respect to the Healthy Futures (Pae Ora) Amendment Bill. The Health Delivery Plan: Update on Policy and Legislative Changes Cabinet Paper refers to the Regulatory Impact Statement for the amendments to the Pae Ora (Healthy Futures) Act 2022. The panel considered that the Impact Statement only partially meets the quality assurance criteria. It noted that limited consultation has been undertaken and engagement with Māori representatives has been limited to the Hauora Māori Advisory Committee. This is unacceptable and our IMPB shall continue to hold the Crown accountable in health as guaranteed under te Tiriti. 

2.5.4 Engagement limited to the Hauora Māori Advisory Committee does not meet the Crown’s Tiriti o Waitangi obligations and certainly note our IMPBs functions and roles. The Hauora Māori Advisory Committee is composed of ministerial appointees and does not represent the independent voices or tino rangatiratanga of iwi, hapū and whānau which sits with our IMPB and will not be usurped or watered down as we i, are the Crown’s Tiriti partners not HMAC. Relying on the Hauora Māori Advisory Committee alone excludes iwi from direct participation in shaping legislative reforms that affect Māori health outcomes, undermining and completely ignoring the principle of partnership and abhorrently breaching the Crown’s duty to engage meaningfully with Māori guaranteed under Te Tiriti o Waitangi. It also completely contradicts the Crown’s own regulatory standards, which require inclusive engagement with affected communities. 

  1. CONCLUSION

3.1 Te Pae Oranga o Ruahine o Tararua demands the Government scrap the Healthy Futures (Pae Ora) Amendment Bill. The proposed changes undermine te Tiriti commitments, equity, and iwi, hapū and whānau authority.  

3.2 For our IMPB it will be business as usual, and the proposed removal will have no effect on the way we operate under Te Tiriti o Waitangi as advocated by our tupuna over a century ago. 

3.3 We seek to present this submission in person and provide further evidence of the impact these changes will have not just on Māori but on our wider communities who also access and thus support our service delivery models. 

 

Appendix 1: Te Pae Oranga o Ruahine of Tararua Geographic Coverage