Why Oppose the Healthy Futures (Pae Ora) Amendment Bill
This is not about “timely, effective care” — it’s a governance rewire. The bill removes core health principles and the Health Charter, dilutes Te Tiriti implementation, centralises ministerial control, and hard-wires private providers into planning — all while weakening independent oversight.
Here’s what the bill really does, why it’s dangerous, and how it shifts our health system from equity and partnership to target-chasing and political direction.
What This Bill Really Does
- Repeals sector guardrails: Removes the health sector principles and the New Zealand Health Charter — fewer statutory duties for equity, transparency, and accountability.
- Dilutes Te Tiriti mechanisms: Narrows iwi-Māori partnership boards to “engagement” roles feeding advice via HMAC, creating a double filter before decisions.
- Centralises control at the top: Minister approves and can condition Health NZ’s delegations policy; appoints all members of a permanent Infrastructure Committee; Director-General may attend board and executive meetings and access all papers.
- Embeds private provision: Objectives/functions explicitly include “(including, to avoid doubt, private healthcare providers)” — normalising outsourcing.
- Removes independent review: The New Zealand Health Plan no longer requires Auditor-General scrutiny.
- Mandates target lists: GPS must include specific operational targets (ED times, electives, immunisation, etc.), pushing services to “teach to the test”.
Why This Threatens Public Health
- Equity takes a back seat: Without principles and a Charter, there’s less legal weight behind fair access and transparent decision-making.
- Partnership weakened: Māori influence is pushed further from the point of decision, undermining genuine co-design and kaupapa Māori investment.
- Politics over practice: Ministerial sign-off on delegations and committee appointments risks political priorities overriding clinical need.
- Targets distort care: Services may chase metrics at the expense of prevention, mental health, rural access, and complex chronic needs.
- Public money, private gain: Normalising private providers can fragment care and siphon resources from rebuilding public capacity.
- Less sunlight: Removing Auditor-General review reduces independent scrutiny of strategy, funding, and performance.
The Bigger Pattern
Change the labels, shift the power. Rebrand rights and partnership as “efficiency”. Move decisions upward to Ministers and central agencies. Replace independent oversight with internal controls. Embed private actors as “partners”. Then measure success by targets, not by equity or community voice.
This is a structural pivot — from a health system guided by principles and partnership to one driven by political direction and contracting.
If You Care About a Fair Health System
This bill is not a patient-first upgrade — it’s a control shift. It risks turning public health into a spreadsheet exercise while sidelining communities and Māori partnership.
If you believe public health must be anchored in equity, transparency, and genuine partnership…
If you believe independent oversight is a safeguard, not a burden…
If you believe rebuilding public capacity matters more than outsourcing…
Then now is the time to oppose this bill.
“Public health must be guided by equity, transparency, and genuine partnership — not centralised control and target-chasing.” — Ukes Baha