Formal Opposition to
Healthy Futures (Pae Ora) Amendment Bill
(Government Bill 179–1)
From: Ukes Baha | 14 August 2025
Submitted in response to the call for public submissions on the Healthy Futures (Pae Ora) Amendment Bill
Summary of Position
I oppose the Healthy Futures (Pae Ora) Amendment Bill in its current form.
While framed as improving timeliness and effectiveness of services, the bill removes core health sector principles and the New Zealand Health Charter, weakens Te Tiriti o Waitangi implementation, and centralises control with the Minister and senior officials. It narrows Māori partnership mechanisms, opens the door to greater private sector involvement, and reduces independent oversight of health planning and delivery.
Rather than strengthening health services, the bill risks politicising governance, undermining community voice, and prioritising infrastructure and performance targets over equitable, needs-based care.
1. Removal of Health Principles and Charter
Reference: Repeal of health sector principles and New Zealand Health Charter.
Problem:
- Removes high-level statutory commitments to equity, transparency, quality, and public accountability.
- Weakens the legal framework that guides decision-making, leaving Health NZ with fewer obligations to uphold patient rights and the public interest.
2. Weakening of Te Tiriti o Waitangi Implementation
Reference: Amendments to s.6, change of IMPB role, new HMAC structure.
Problem:
- Downgrades iwi-Māori partnership boards (IMPBs) from direct engagement with Health NZ on kaupapa Māori investment priorities to a secondary advisory role to the Hauora Māori Advisory Committee (HMAC).
- Removes several Treaty principles from s.6, reducing statutory force.
- Creates a “double filter” for Māori input, weakening direct influence on funding and service priorities.
3. Centralisation of Ministerial and Executive Control
Reference: Ministerial approval of delegations policy; appointment powers for the Infrastructure Committee; Director-General meeting attendance rights.
Problem:
- Minister can approve and condition Health NZ’s delegations policy and appoint all members of the Infrastructure Committee.
- Director-General granted unrestricted attendance and document access at board and executive meetings, with a direct advisory role to the Minister.
- Politicises governance, blurs operational independence, and increases scope for political priorities to override community or clinical needs.
4. Infrastructure Overreach
Reference: Creation of permanent Infrastructure Committee with delegated powers.
Problem:
- Overemphasis on “cost-effective” and “financially sustainable” infrastructure risks prioritising capital projects and cost-cutting over patient care.
- Infrastructure Committee’s delegated powers concentrate decision-making in a small, Minister-appointed group.
5. Opening Door to Private Sector Expansion
Reference: Addition of “including, to avoid doubt, private healthcare providers” to objectives and functions.
Problem:
- Legally entrenches private providers as a core part of service delivery planning.
- Risks shifting resources and focus away from strengthening the public health system, especially if private options are framed as faster or cheaper.
6. Reduced Independent Oversight
Reference: Removal of Auditor-General review of the New Zealand Health Plan.
Problem:
- Weakens independent scrutiny of health system strategy and spending.
- Replaces this with Ministerial and internal oversight, reducing transparency and public confidence.
7. KPI-Driven Targets With Political Risk
Reference: New mandatory targets in the Government Policy Statement.
Problem:
- Politically set targets may distort priorities, with services chasing metrics at the expense of unmeasured but essential areas such as mental health, prevention, and rural access.
- Risks short-term political gains over long-term health equity.
8. Shrinking Public and Local Voice
Reference: Narrowed IMPB functions; reduced direct engagement with Health NZ.
Problem:
- Reduces meaningful input from Māori and local communities in decision-making.
- Risks centralised, target-driven planning that overlooks local needs and disparities.
Conclusion and Recommendations
The bill centralises control, weakens Treaty-based partnership, and reduces independent oversight, while embedding private sector access to public health funding. These changes threaten transparency, equity, and local responsiveness in health service planning and delivery.
I recommend the Committee:
- Retain the health sector principles and the New Zealand Health Charter as statutory obligations.
- Maintain direct engagement between Health NZ and IMPBs on kaupapa Māori investment priorities.
- Limit Ministerial control over operational committees and the delegations policy; ensure governance independence.
- Remove statutory reference to private healthcare providers from objectives and functions.
- Retain Auditor-General review of the New Zealand Health Plan to ensure independent oversight.
- Design performance targets in consultation with health professionals and communities, with safeguards against metric distortion.
- Strengthen, rather than dilute, mechanisms for community and Māori voice in health decision-making.
Public health must be guided by equity, transparency, and genuine partnership — not centralised control and target-chasing.
Respectfully submitted,
Ukes Baha
Public Health Advocate | Counsellor | Policy Analyst
ukesbaha.com