‘Fails Māori’ Māori health advocates slam Pae Ora amendment bill
Whakaata Māori has reported on opposition from Te Tiratū Iwi Māori Partnership Board to changes proposed in the Pae Ora (Healthy Futures) Amendment Bill, which has now passed its second reading in Parliament but is not yet law.
Te Tiratū says the amendments would weaken the role of Iwi Māori Partnership Boards and sideline iwi authority within the health system. The boards were established under the Pae Ora (Healthy Futures) Act 2022 to ensure Māori communities have a formal role in health planning, priorities, and accountability.
Te Tiratū Co-Chair Tipa Mahuta said the proposed changes would dilute the influence of iwi in health decision-making and weaken the protections intended to give effect to Te Tiriti within the health system.
“This government talks about strengthening Māori voices, but these amendments sideline our authority. Iwi Māori Partnership Boards exist to ensure equity and accountability in health, not just to provide advice when convenient. We need genuine power, not paper pathways,” Mahuta said.
Mahuta said weakening Section 30 of the Act would reduce Māori decision-making and strip away important protections linked to Te Tiriti. She said evidence gathered through Te Tiratū’s work shows that iwi-led planning improves access, outcomes, and efficiency across health services.
“Our reports clearly show that iwi-led solutions improve access, outcomes, and efficiency across health services. From chronic disease management to cancer screening, the evidence demonstrates that local, Māori-led planning works. Yet the proposed reforms ignore this capability entirely.”
Pae Ora Bill weakens Māori voice, erodes accountability
MEDIA STATEMENT
FOR IMMEDIATE RELEASE
Wednesday 4 March 2026, 4:00 PM
2 minutes to Read
Te Tiratū Iwi Māori Partnership Board, representing over 121,000 Māori in the greater Waikato region, warns that the Pae Ora (Healthy Futures) Amendment Bill threatens to sideline Māori authority and strip Te Tiriti protections from New Zealand’s health system.
“This government talks about strengthening Māori voices, but these amendments sideline our authority. Iwi Māori Partnership Boards exist to ensure equity and accountability in health not just to provide advice when convenient. We need genuine power, not paper pathways,” said Te Tiratū Co-Chair Tipa Mahuta.
Drawing on the value of locality evidence from its Community Health Plan, Hauora Māori Priorities Summary, and Monitoring Reports on Te Whatu Ora, Te Tiratū believes weakening Section 30 of the Act reduces Māori decision-making, strip Te Tiriti protections, and deepen existing health inequities leading to poorer health outcomes for whānau.
“Our reports clearly show that iwi-led solutions improve access, outcomes, and efficiency across health services. From chronic disease management to cancer screening, the evidence demonstrates that local, Māori-led planning works. Yet the proposed reforms ignore this capability entirely.”
During last night’s debate, Te Pāti Māori MP Hana Maipi-Clark representing the Hauraki-Waikato Māori electorate warned that the Bill removes Māori influence and accountability from health governance.
“Iwi Māori Partnership Boards represent the community voice and Māori-led structures that ensure equity and accountability in our health system and this bill removes their influence.”
“Clause six removes the duty to maintain systems capable of understanding mātauranga Māori, kaupapa Māori services, and cultural safety and clause 33 strips equity and Te Tiriti expertise from public health advisory structures, including the Iwi Māori Partnership Boards. This is not tidying up legislation; it is dismantling accountability.”
Green MP Hūhana Lyndon added that IMPBs were originally designed to co-steer the system alongside Te Aka Whai Ora Māori Health Authority and Te Whatu Ora, but the amendments push them into the “back seat”:
While Labour argued “Why is the Government scared of local health services having to turn up to an iwi board and explain why they are not achieving outcomes for Māori? That is community accountability.”
Te Tiratū Iwi Māori Partnership Board point to the power of locally-led Māori responses during COVID-19 that were faster and more effective than centralised approaches.
“Our work shows the same principle applies across ongoing health inequities: whānau-led, evidence-driven governance delivers results,” Mahuta said.
Te Tiratū emphasises that Māori economic development depends on healthy, supported whānau. Empowered IMPBs drive workforce development, innovation, and local health infrastructure investment, aligning with Government economic goals.
“IMPBs play a critical role in ensuring Māori voices and mātauranga Māori shape health decision-making. Te Tiratū’s monitoring and priority reports provide actionable insights that improve outcomes and deliver stronger returns on taxpayer investment,” Mahuta said.
“The Crown’s duty to partner with iwi under Te Tiriti o Waitangi is non-negotiable. Reducing the role of the IMPBs risks repeating decades of systemic failure and wasted resources.”
Independent investment governance signals structural reset for Whānau Ora
There’s a significant governance shift underway in the Whānau Ora landscape and at the centre of it is Dr Mataroria Lyndon, one of our board members.
Recently he was appointed Chair of the Independent Investment Board for Rangitāmiro, one of four newly established Whānau Ora commissioning agencies.
It’s a role with real weight.
Rangitāmiro covers the country’s largest population base from the central North Island through Waikato and Tāmaki Makaurau to Te Tai Tokerau and holds approximately $67 million in commissioning funding within a national Whānau Ora allocation of around $180 million.
But this appointment is about more than numbers.
It represents a structural evolution of Whānau Ora. Strengthened independent investment oversight, clearer accountability mechanisms, and a sharper focus on measurable impact all while maintaining whānau voice at the centre of decision-making.
Independence, Investment and Evidence
One of the defining features of the new model is the establishment of independent Investment Boards for each commissioning agency.
Dr Lyndon spoke to The NBR recently and describes the mandate succinctly. It provides arms-length advice on commissioning priorities, guide needs analysis, and ensure funding is directed where it can achieve the greatest long-term impact.
The board itself brings expertise across Te ao Māori leadership, rural health, commercial investment, epidemiology and data science. It’s a deliberate mix designed to blend kaupapa Māori values with rigorous evidence frameworks.
“It’s a collective expertise,” he says. “That independence allows us to make strong, evidence-informed recommendations that centre whānau.”
How that balance is struck and how independence is maintained in a politically visible funding environment is a key theme explored in his korero with editor, Mike McRoberts.
Scaling the Frontline
One of the most visible shifts under Rangitamiro is the expansion of the Whānau Ora navigator workforce.
It has expanded its navigator workforce to 301 which is an increase of 120 alongside 51 providers operating across a geographically and socially diverse rohe.
That scale matters.
Dr Lyndon sees this as critical, “We’re putting more funding directly into frontline roles. Navigators are where Whānau Ora lives and breathes.”
Navigators are the frontline expression of Whānau Ora working directly with whānau, responding to crises such as recent extreme weather events in Te Tai Tokerau, and helping coordinate cross-sector services to avoid duplication and fragmentation.
But expansion raises important questions: sustainability, measurement of impact, and long-term investment certainty.
Dr Lyndon addresses each of these including how data, Whānau Voice and social return on investment metrics will be used to demonstrate effectiveness.
“We call it Whānau Ora 7.0 thinking intergenerationally. It’s about being good tūpuna ancestors. Not just outcomes for now, but pathways for the future.”
He says it is not only as a social policy platform but is an intergenerational investment model. Grounded in the long-standing outcomes framework first established under the leadership of the late Kahurangi Tariana Turia.
How it evolves and intersects with growing iwi economic capacity is elaborated on in more depth in the full interview.
The Political Question
With an election year underway, questions naturally arise about stability of funding and political appetite.
Dr Lyndon he has seen Whānau Ora supported across governments of different stripes. His focus, he says, is not on partisan cycles but on demonstrating impact convincingly enough to justify increased investment.
Exactly how that evidence case will be built and what success looks like under the new commissioning structure forms one of the most substantive parts of the conversation.
“We know there is hardship among our whānau right now. The question is what can we do with the pūtea and resources we have to support aspirations and outcomes?”
Why This Matters
Whānau Ora remains one of the most debated and scrutinised social investment models in New Zealand.
The shift to independent investment governance signals a maturing phase one that combines kaupapa Māori foundations with sharper accountability expectations.
For business, policy and governance audiences, the Rangitāmiro appointment is worth attention. It signals where Māori health and social investment strategy may be heading next.
To hear Dr Lyndon outline the vision, the risks, and the opportunities in his own words, listen to the full interview at NBR.
Whānau Ora's proof point
Dr Mataroria Lyndon, a board member of Te Tiratū Iwi Māori Partnership Board, has recently been appointed Chair of the Rangitāmiro Whānau Ora Commissioning Agency independent Investment Board, serving 2.3 million people across the upper North Island.
In an interview with Te Ao Māori Editor Mike McRoberts of The National Business Review, he shares his whakaaro on the kaupapa, the responsibility of stewardship, and the strategic mahi ahead to strengthen whānau wellbeing and long-term investment impact.
Explicit safeguards wanted for 12-month prescribing for Māori
For 12-month prescribing to be safe for Māori explicit safeguards are needed, Te Tiratū Iwi Māori Partnership Board says in a Position Statement authored by pharmacist Leanne Te Karu.
Ensuring barriers to access are recognised and removed is key, rather than reduced Māori engagement with their prescriber and medicines by way of a longer prescribing period.
The extended period will work well if it reduces routine GP visits for people with stable conditions, easing pressure on primary care services, but may not provide the same benefits to Māori Tiratū chief executive Brandi Hudson says.
Lighter paperwork, or better care?
A change to prescription time-frames isn’t a win for all whānau, writes Brandi Hudson.
I understand why some people welcomed the policy change extending the prescribing period to 12 months. It means fewer repeat appointments. Less admin. Less cost. More convenience.
But where I work, at Te Tiratū Iwi Māori Partnership Board, we’re deeply concerned.
Without strong equity and safety safeguards, this change risks widening Māori health inequities, increasing under-care, delaying diagnosis, and causing medication-related harm.
The policy itself sounds tidy. Prescribers can issue prescriptions for up to 12 months for some medicines, while dispensing at the pharmacy still occurs in maximum three-monthly periods. Controlled drugs are excluded. It’s framed as a way to reduce unnecessary appointments and ease pressure on the system.
The trouble is, medicines sit inside real lives. And for many whānau, those lives include multiple conditions, inconsistent access to care, and long gaps between clinical reviews.
It’s easy to imagine a “stable patient” who takes one medicine and has no complications as the basis for policy change. But many of our whānau are managing complex comorbidities, such as diabetes alongside asthma, cardiovascular disease alongside kidney issues, chronic pain alongside depression, and respiratory illness alongside poverty-related stress. Even the presence of two conditions can create risks, interactions, and side effects that need regular review.
For those whānau, prescribing is not just a matter of being told: “Here’s your tablets for the year.” The prescription is part of a care plan that should include monitoring, blood tests, screening, follow-up, and the chance to adjust treatment before harm occurs.
That’s why Te Tiratū supports reducing barriers, but we can’t support a change that reduces the number of touchpoints without putting in place safeguards to protect those who are already missing out.
Māori face significant barriers to accessing medicines. Despite higher rates of chronic conditions such as diabetes, cardiovascular disease and respiratory illness, Māori are overall less likely than non-Māori to access dispensed medicines. In some cases, prescriptions aren’t collected at all because cost, transport, and system barriers make it too difficult.
Extending the length of a prescription doesn’t automatically fix those issues. In some cases, it could even mask them. On paper, a person might look “covered” for 12 months. In reality, they might still be missing doses, skipping follow-ups, not getting blood tests done, or deteriorating quietly until they end up in hospital.
There’s another risk we need to talk about honestly, and that’s the assumption of “clinical stability”.
Who will get labelled stable enough for a 12-month prescription? And who won’t?
In a health system where bias can shape decision-making, sometimes unconsciously, our whānau may be less likely to receive careful follow-up, or more likely to be deemed “fine” without the monitoring that should come with long-term medicines.
Māori don’t experience ill-health in isolation. We live with higher rates of the country’s top five killers — cancer, diabetes, heart disease, stroke and respiratory illness — often all at once. These conditions don’t arrive one by one. They stack, interact, and compound over time.
Add to this the realities many whānau face, such as not always having enough kai, stable housing, or financial security. These are not side issues — they directly affect whether medicines are taken as prescribed, whether follow-up appointments are kept, and whether pain or deterioration is noticed early.
For many of our whānau, poor oral health and chronic foot problems are not minor inconveniences. They affect mobility, sleep, ability to work, and self-esteem. Pain becomes normal. Limited mobility becomes normal. Struggling through becomes normal.
And when complexity becomes normal in a health system under strain, it can quietly slip through the cracks.
Instead of prompting closer monitoring, long-term medicines and complex conditions can be treated as “baseline”. Symptoms are more likely to be interpreted as expected rather than concerning. Whānau may be assessed as “stable” or “fine” not because they’re well, but because their level of unwellness has been unconsciously normalised.
This is how bias can operate without intention. Not through overt neglect, but through lowered expectations of recovery, stability, and follow-up.
Equity in healthcare doesn’t mean treating everyone the same. It means recognising when people are carrying more medical, social, and economic burdens, and responding with more care, not less.
Dr Leanne Te Karu, our expert advisor, has warned that reducing prescribing touchpoints can reduce opportunities to detect deterioration, review side effects, adjust treatment, or optimise medicines. And while community pharmacists are essential, they can’t replace comprehensive clinical review and diagnostic reassessment.
That’s why the solution isn’t simply to provide longer prescriptions. The solution is to build stronger systems around them.
We need national guidance on who isn’t clinically-appropriate to receive a 12-month prescription, and we need equity-focused monitoring that shows what is happening for Māori, not just what is happening on average across the whole population.
We need transparent reporting of adverse events, hospitalisations, medication changes, and wastage. We need Māori-led evaluation of safety, trust, communication and cultural safety.
Most importantly, we need to stop treating medicines as isolated clinical decisions and start treating them as part of a Treaty-aligned system of care.
Te Tiriti obligations of partnership, equity and active protection aren’t optional extras. Partnership means Māori are involved in designing and governing the processes that provide access to medicines, not merely consulted after decisions are made.
Equity means Māori achieve the same access to subsidised medicines and support services as everyone else, with real-world barriers like transport and culturally appropriate information addressed directly. Active protection means outcomes for Māori are monitored, and the policy is adjusted quickly if harm is emerging.
There is a better way forward. Māori pharmacy experts like Dr Te Karu have long advocated for a Te Tiriti-aligned strategy, grounded in Pae Ora and mātauranga Māori, to bring all the right expertise into the room and design medicines pathways that reflect whānau realities, not just administrative convenience.
A 12-month prescription might reduce hassle. But it won’t keep you well if the system stops checking in.
If we want this change to succeed for whānau, we have to measure success by whether Māori are safer, healthier, and better supported — not whether the paperwork got lighter.
Brandi Hudson (Ngāti Maniapoto, Ngāti Rarua, Ngāti Pikiao) is the tumu whakarae (chief executive) of Te Tiratū Iwi Māori Partnership Board, providing strategic leadership across the Waikato rohe to strengthen Māori influence in health system design, planning and service delivery.
She has held senior roles across community, government and not-for-profit sectors, including inaugural CEO of the Independent Māori Statutory Board in Auckland.
Gaps remain in Māori health
The Waikato Local has covered Te Tiratū Iwi Māori Partnership Board’s warning about the 12-month prescription medicine policy change and its potentially adverse impact on whānau Māori as outlined in our Position Statement.
Prescriptions risk warning
The King Country News has covered Te Tiratū Iwi Māori Partnership Board’s warning about the 12-month prescription medicine policy change and its potentially adverse impact on whānau Māori as outlined in our Position Statement.
No safeguards for 12-Month prescriptions, Māori health leaders warn
Brandi Hudson, Te Tiratū Tumu Whakarae is warning the Government’s move to 12-month prescriptions could deepen under-care and widen health inequities for whānau Māori unless strong safeguards are built in from day one. Speaking with Waatea she says longer scripts may suit some, but without proper monitoring and follow-up they risk fewer check-ins, delayed diagnosis and worsening long-term conditions. The board is calling for mandatory review points, proactive follow-up systems, culturally safe pathways designed with Māori providers, and real-time data oversight given the policy took effect on 1 February 2026.
12-Month prescriptions risk widening Māori health inequities without safeguards
MEDIA STATEMENT
FOR IMMEDIATE RELEASE
Friday 30 January 2026, 4:00 PM
2 minutes to Read
Te Tiratū Iwi Māori Partnership Board is warning that the introduction of 12-month prescriptions from 1 February 2026 risks increasing under-care, delayed diagnosis, and medicine-related harm for Māori unless strong equity and safety safeguards are put in place.
While Te Tiratū supports efforts to reduce barriers for whānau, Te Tiratū Tumu Whakarae, Brandi Hudson says affordability and convenience alone do not guarantee safe or equitable access to medicines.
“From a Hauora Māori perspective, access to medicines is not a single transaction, it is a continuous pathway of care,” she said. “Any policy change must actively uphold Te Tiriti o Waitangi obligations of partnership, equity and active protection.”
“Partnership means Māori are involved in designing and governing medicines access pathways, not just consulted after decisions are made. Equity requires ensuring Māori have the same access to subsidised medications and support services as others, addressing barriers like transport or culturally appropriate information. Active protection involves monitoring outcomes for Māori and adjusting policy to prevent under-care or delayed treatment,” she said.
The legislative change will allow prescribers to issue prescriptions covering up to 12 months for some medicines, with dispensing continuing in maximum three-monthly periods. Controlled drugs are excluded.
Māori already face significant barriers to accessing medicines. Despite higher rates of chronic conditions such as diabetes, cardiovascular disease, and respiratory illness, Māori are overall less likely to access dispensed medicines than non-Māori.
In some cases, prescriptions are not collected at all due to cost, access, and system barriers. These inequities mean that extending prescription duration alone will not ensure medicines safely reach whānau who need them most.
Dr Leanne Te Karu, expert advisor to Te Tiratū and author of its Tauāki Tū Position Statement on this policy change, says it carries significant risk if implemented without explicit safeguards.
“Māori already experience lower rates of monitoring, fewer proactive clinical reviews, and later diagnosis of chronic and complex conditions,” she said.
“Reducing prescribing touchpoints risks further decreasing opportunities to detect deterioration, review side effects, adjust treatment, or optimise medicines.”
Dr Te Karu warns that assumptions about “clinical stability” may be unsafe in contexts where care is fragmented, monitoring is inconsistent, and social and economic pressures affect medicine use.
“Prescriber discretion and unconscious bias can shape who is deemed ‘stable’.”
“Longer prescription intervals may be framed as empowerment when they instead reflect system withdrawal or under-service. Community pharmacists play a vital role, but they cannot replace comprehensive clinical review and diagnostic reassessment.”
Te Tiratū is calling on the Crown to ensure the implementation of 12-month prescriptions strengthens rather than weakens safety and equity, including through:
• Mandatory, equity-focused monitoring, with prescribing rates disaggregated by ethnicity, rurality, deprivation, disability, and continuity of care
• Transparent reporting of adverse events, hospitalisations, medicine changes, and wastage
• Māori-led evaluation of safety, trust, communication, and cultural safety
• Clear national guidance on who is not clinically appropriate for 12-month prescriptions
• A Te Tiriti-aligned medicines optimisation strategy, grounded in Pae Ora and mātauranga Māori
“Extending prescription duration alone will not improve health outcomes for Māori,” says Brandi Hudson.
“For a small number of whānau, longer prescriptions may be appropriate but only within a broader, equity-led system of care. Without strong safeguards, this policy risks entrenching, rather than reducing, inequity.”
Policy changes to prescription medicines must not place Māori at higher risk of harm or delayed care.
How this change to prescription medicine impacts our whānau from Tainui waka rohe.