Maori Health Provider Hui

As we flew over today, over the silhouette of Ka Tiritiri o te Moana - the Southern Alps - I was really overwhelmed by the majesty of the mountain range; their spiritual presence that calls you to them.

On Friday I was at a hui nestled under the watch of maunga Ruapehu at Te Maungarongo Marae,  and on Sunday it was the lure of Taranaki that I responded to, so it is probably not surprising that I am feeling the majesty of our mountains; and that  have been on my mind.

There is something so grounding about their massive presence in our landscape; connecting us through eternity to our origins.   Certainly back home, in our tribal pepeha we are forever linked, as we are to our rivers, our seashores, our lakes, the land; the features of our natural world.  Indeed, those of us of Whanganui descent firmly believe we are born out of the House of Toka, out of Ruapehu.

Today we are concentrating on the other vital part of our identity, he tangata, he tangata, he tangata.

But there is another aspect of the mountains which intrigues me and that is the stories of Maori courage which have been passed down from early journeys across the land.  Their life example provides us with the inspiration for the journey we must still travel, to secure a stronger future for our mokopuna.

This hui today, is another stage in that journey.

I want to thank you all for taking the first step in choosing to be here today, to being prepared to consider new ways of looking at the business of health.  You too, as our ancestors did, are prepared to enter new territory in the interests of the next generations.

The reason for this hui is clear - change is in the wind and we need to be prepared for that change.  We need to be well informed and to position ourselves to take advantage of any opportunities which will improve the status of whanau health.

We all know the dire state of health currently experienced by Maori -the impact and incidence of chronic illness and disease; stroke; various types of cancer; diabetes; kidney disease and respiratory conditions. 

Initiatives to improve workforce recruitment, retention and professional development are crucial.  And yet we are facing chronic shortages in many professional fields including nurses, doctors, midwives, psychologists, physiotherapists and other allied health professionals.

The constantly increasing pressures on Vote Health are but one reason why this hui has been called. 

We are challenged by the implementation of Better, Sooner and More Convenient to know that we must take a broader view at what investment each health dollar actually makes, in the long term health and wellbeing of the people.

But I want to state from the outset, that this is not about cutting services or reducing budgets for the sake of savings on the balance sheet. 

I was concerned, in fact, to learn not long ago of potential cuts being made to the Special Populations Funding that is managed by the Canterbury DHB.   From the reactions I received it appeared that Maori, Pasifika, new migrants and youth services were all feeling threatened that their community health workers might well be placed at risk by budgetary changes.

And I do not expect that any Maori health providers or any of those of other providers that I have spoken about - should be facing changes in primary health provision which are not also being universally applied across all services and all populations.

But I do expect that all of us should welcome the opportunity to look anew at our health services, and to critically assess the way in which our current services are meeting our changing needs, the pressure of demands, the expectations that we have of quality primary health care.

The question that we must continue to ask, is -  are we truly putting the people at the centre of health care?

The process we are going through extends past a focus on services and providers, to focus on whanau; to focus on outcomes.

And I want to share some concerns that have troubled me.

For some of our families, it is not uncommon for up to a dozen providers walking up their path, each one of them seeking to address an activity which is specified as a milestone in their contracts with the funder. 

So providers are funded to be lead maternity carers; to address the damp and the mould of the house; to introduce a behaviour regime for the truant; to establish employment incentives to get off the dole.  Often services are over-lapping and fragmented; or locked into the perpetual unpredictability of a pilot.

This is not just an issue affecting New Zealand in isolation.  Now, More than Ever, the World Health Organisation report in 2008, warned us that increasingly health systems are focusing on single issues, with parties competing for scarce resources, drifting from one short term priority to another, without a clear sense of direction.

So it is timely to be looking at the way we manage health, to see if we can improve our response capacity and anticipate new challenges, while building on the significant gains already made by Maori health providers over the last two decades.

However, no matter how impressive the progress has been made in understanding how to achieve Maori health gain; the sector can not be insulated against other influences occurring outside of health.

We only have to look at the last two months in which Christchurch has experienced the horror of violence impacting on the lives of families and neighbourhoods to realise the scale of the challenge facing us.

And so I say again, how proud I am that right across the country, Maori health providers are leading the charge in taking up the challenge to develop new models of primary health care.

I am really pleased that two examples of health innovation are to be shared today by the national Maori Primary Health Organisation Coalition and Waipareira Trust - both providing us with examples to think about our capacity and capability for large scale change.

And I have greatly appreciated the support of the Ministry of Health in supporting me in wanting to take this programme on the road.

After some of the hui, iwi have approached me, and taken up the call to exercise rangatiratanga within their rohe.  In fact in Auckland I think it would be fair to say that Tainui took the hui over!  And in a way that's how it should be - it should be the people telling

They have expressed to me their desire to be the first port of call for any initiatives which may impact not just on their capacity to care for their own; but also on their responsibility to manaaki all who live within their tribal boundaries.

They are enthusiastic about the opportunities for iwi leadership to help shape the pathway forward.  And I don't think any of us should be nervous about that.

The biggest test for us all, will be in our ability to share resources; to think cooperatively and collaboratively, in the best interests of our families.

And so I return to our tupuna, travelling across mountains and over land to carve out the best future for their uri.

We must be determined that whatever approach we take up, whanau must be at the very centre.  I want to see an integrated approach to whanau wellbeing which may well involve collaborative relationships between other agencies of the state as well as with other community groups.  It will take a major mindshift within the community as well as across Government agencies.

I want to see a focus on restoring the whanau to wellness - not services modelled on crisis intervention, only intervening at the occasion of greatest stress.

We know that prevention is as equally important as cure, and that health promotion, counselling, screening, access to treatment and people centred services are critical to improving health right across the board. 

But what is it that makes us well and keeps us well?

Wellness may well incorporate an absence of disease or illness, but it is also be about the intergenerational transmission of knowledge, of culture, of kaupapa tuku iho.

Whanau ora will be seen when whanau take collective responsibility for their family, and for determining their own destiny. 

It will be evident when whanau are comfortable in their own skin, confident in their identity, speaking their own mita, valuing their own cultural practices such as rongoa.

Whanau ora will be demonstrated when our people have sufficient resources; sufficient access to resources - and good quality information to make decisions.

It is about respecting the very essence of our whanau - their vision; their roles and responsibilities; their histories; and their future.

And so today is an excellent opportunity to hold that ideal in front of us. 

Our role - as providers; as agencies, as Government -  is to assist whanau to be more in control of their own lives - empowering them with the information so that they can take care of themselves and their own.

It will be hard work - but it has to be the way forward.

We must consider how best to support a culturally competent workforce; and to create a responsive, accessible and effective health system whilst all the time working to develop an environment which places trust in our whanau to do the best for themselves.

It is about building the trust - we expect Government agencies to trust providers.  And in turn, it is really important that providers trust whanau to determine their best way forward.  We must believe in their potential, focusing more on their potential rather than what is wrong.

I thank you all for being willing to consider how you will be involved in this journey forwards.   If we walk the walk together, and that includes walking alongside the whanau we can make a huge difference, rather than always focusing on the individual and their problem.

Tena tatou katoa.