On Wednesday, Health Minister Andrew Little will announce a massive health system shake-up, including the long-awaited Māori Health Authority.
The details have been kept under wraps, but Newshub Nation has obtained confidential advice to the Health Minister on how it should look.
First, Andrew Little has to decide whether it will be a Crown entity or an independent authority with commissioning powers.
The Māori Party says Little's choice is obvious: if it's not independent, it will fail.
"Yes, yes it'll definitely fail. And it'll be just a rehash of other attempts to be able to address generations of inequities," says co-leader Debbie Ngarewa-Packer.
"They need to be able to recognise the disparities it truly has to address. To do that, independence is critical."
Māori health advocate Lance Norman says there's currently no accountability.
"You have to work in partnership, that's a Treaty principle. But there's so much evidence the Crown has not done a good job for Māori for 170 years," he says.
Associate Health Minister Peeni Henare acknowledges the inequities in the health system are plain to see.
"We know we need to do something major to turn the dial on Māori health outcomes," Henare told Newshub Nation.
On average, Māori die seven years younger than non-Māori, and are more likely to die of heart disease, strokes, and cancer.
'We've relied on some pretty average historical policy and then followed through with some pretty average models of care and that's why we've got substandard results in the health space for Māori," says Norman.
Henare is optimistic things can change.
"They'll get an independent Maori Health Authority that they've been asking for, we've been quite clear on that. The challenge is as we get into the details about what does that look like and what they're able to do," he says.
The Cabinet paper recommends the setting up of Iwi-Māori Partnership Boards to deliver healthcare on a grassroots level. District Health Boards currently have Māori advisory boards, but they're free to ignore their advice. Iwi-Māori Partnership Boards would have more power.
"It makes it more of a Treaty partnership base, with the Crown through DHBs, if they're still around, and iwi working collaboratively together," explains Norman.
It says the Authority should have full commissioning powers to direct money where it's needed, similar to Whānau Ora.
"The Whānau Ora model is a massive success model. And it's a massive success model because it's been given that independence," says Ngarewa-Packer.
The briefing also says the Authority will need "substantial" funding.
Norman says the budget needs to be $5 billion - a quarter of the total health spend - because Maori make up 25 percent of the health system, despite only making up 16 percent of the population.
"Some people are saying 'oh we shouldn't be funding Māori, we should be funding based on need.' Well Māori are the need," he says.
Last year's Health and Disability Review chaired by Heather Simpson recommended the Māori Health Authority be created, but with a budget of just $23 million, and no powers to commission health services.
Simpson's recommendation was contrary to the majority of the review panel.
"I find it ironic a report on racism, or unconscious bias, vetoes the bulk of the logic," says Norman.
National's health spokesperson Dr Shane Reti doesn't support an independent entity.
"We can do that in other ways. We could do that in a required legislative Māori strategic plan for every DHB," he says.
Māori are calling on the Government to be bold.
"Nobody wants to go backwards and see us be more unwell and marginalised as tangata whenua," says Ngarewa-Packer.
"I'm really hoping the Government uses this opportunity to make a big, bold decision and be a legacy government on health policy, which could impact on other policy down the line," says Norman.
Whether or not Little accepts the briefing's recommendations we'll find out on Wednesday.
The future of Māori health across generations now in his hands.
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