The following is an email sent from our board chair Louise Wall to the minister Simeon Brown regarding Proposed Amendments to the Pae Ora (Healthy Futures) Act and the Role of Iwi Māori Partnership Boards.
28 June 2025
Hon. Simeon Brown
Minister of Health
By email: S.Brown@ministers.govt.nz
Tēnā koe Minister Brown,
RE: Proposed Amendments to the Pae Ora (Healthy Futures) Act and the Role of Iwi Māori Partnership Boards
On behalf of the Tūwharetoa Iwi Māori Partnership Board (TIMPB), I write to express our concerns regarding the Government’s proposed amendments to the Pae Ora (Healthy Futures) Act 2022 — amendments which would significantly reduce the role of Iwi Māori Partnership Boards (IMPBs) within the health system and risk undermining important gains in Māori health outcomes.
Evidence of Current Investment and Inequities
Recent data provided by Health New Zealand shows total health expenditure within our rohe for 2023/24 was approximately $63 million. Of this, 75% ($47.4 million) was spent on aged care, pharmacy, and GP services, while only 2% was invested in maternal, child and youth health, and mental health. This distribution is concerning given the growing pressures in these younger populations as they age.
Moreover, the per capita Hauora Māori investment varies widely across the country, from $1,352 in some districts to only $341 per capita in the Tūwharetoa rohe. These inequities are largely inherited from former DHB funding patterns and translate directly into uneven health outcomes. Our ability to work collaboratively and locally with Health New Zealand to target investments where they will have the greatest impact on health equity is critical.
Clinical Leadership in Local Innovation and Improvement
TIMPB’s statutory role has enabled us to lead clinically focused initiatives that align strongly with Government priorities:
Immunisations: We support your Government’s goal to improve childhood immunisation rates. At a practice level, we have engaged with the National Public Health Service regional offices and Pinnacle PHO to provide targeted communications, training, and mentoring for reaching underserved whānau. We have also established an award recognising practices that achieve 95% immunisation coverage.
Screening and Preventive Care: We are working directly with NPHS, Pinnacle PHO, and primary care practices to improve performance in cardiovascular risk assessments and cancer screening, with the goal of reducing preventable illnesses.
Alignment of Priorities: TIMPB collaborates closely with Te Whatu Ora Lakes District business units—including Hospital Services, NPHS, and Hauora Māori Services—to align priorities and embed tangible Māori health outcomes in the 2025/26 operational plans.
The Nurse Practitioner-Led Primary Care Model: A Proven Approach
Recognising the unsustainability of the GP-led primary care model in rural areas like Taupō, TIMPB is investing in a Nurse Practitioner (NP)-led service delivery model, consistent with international best practice.
The Canadian province of British Columbia (BC) provides a compelling example. In 2010, facing a GP shortage, BC invested heavily in the “NP4BC” programme, significantly expanding the NP workforce. This programme successfully alleviated pressure on GPs, enabling them to focus on complex patients while NPs managed routine and preventative care. Importantly, this model improved access to care for Indigenous and vulnerable urban communities and increased overall job satisfaction for GPs.
We encourage the Government to study the impact of the NP4BC programme and consider its applicability here. Currently, patients in Taupō face GP wait times of 4-6 weeks; expanding NP-led primary care could greatly improve timely access and outcomes.
The Importance of Maintaining IMPBs’ Statutory Role
While we support the establishment of the Hauora Māori Advisory Committee (HMAC) as a national advisor, the proposed amendments that remove IMPBs from local health design and decision-making would weaken the system’s responsiveness to Māori needs. Relegating IMPBs to a secondary advisory role risks losing local clinical innovation and the gains achieved through direct collaboration with Health New Zealand.
The Waitangi Tribunal’s Wai 2575 findings emphasise the necessity of equal and effective Māori participation in health governance through co-design and accountability mechanisms to address inequities. The current IMPB framework directly enables these outcomes.
Our Recommendations
We respectfully urge the Government to:
1. Retain the statutory authority and co-governance role of Iwi Māori Partnership Boards in local health system design and decision-making;
2. Maintain direct engagement pathways between IMPBs, Health New Zealand, and the Minister of Health;
3. Prioritise equitable investment focused on maternal, child, youth, and mental health services within Māori communities;
4. Support innovative service models such as NP-led primary care to improve access and quality, especially in rural and underserved areas.
We welcome the opportunity to meet with you to discuss these points further and to present the positive outcomes already delivered under the current Pae Ora framework. TIMPB remains committed to advancing Māori health equity through practical, clinically-driven action grounded in partnership and responsiveness to whānau needs.
Ngā manaakitanga,
Louisa Wall
Chair
Tūwharetoa Iwi Māori Partnership Board (TIMPB)
Email: louisawall72@gmail.com
Phone: +64 21 227 5043