Māori health providers fight for autonomy in face of ACC barriers to care

Wednesday, 16 March 2022

New analysis shows ACC is biased against women, Māori and Pasifika. Women are less likely to make claims, more likely to be declined when they do, and receive far less compensation than men.

It’s laughable that one of the strongest Māori health providers was given a 5.2/10 rating for “cultural responsiveness”, but it’s indicative of the systemic failings of ACC’s home support.

That’s what Lady Tureiti Moxon (Ngāti Pāhauwera, Ngāti Kahungungu ki te Wairoa, Kai Tahu) put to the Waitangi Tribunal on the third day of the Health Service and Outcomes Kaupapa Inquiry.

Moxon, director of Waikato’s Te Kōhao Health and interim board member of the almost established Māori health authority, said it was a shame she had to come before the tribunal again to discuss the institutional and systemic racism Māori health providers faced when trying to look after Māori in their rohe, but the barriers weren’t going away.

Te Kōhao Health supports more than 8000 people across Waikato. Approximately 85 per cent have high needs.

Lady Tureiti Moxon says the Crown is putting barriers in the way of Māori seeking help from Māori health providers.

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Moxon said that from 2003 to 2012 the provider had been supporting whānau who sought home support through ACC for injuries but, through a series of management decisions, Te Kōhao Health – like other smaller organisations – had been ignored, only to be subcontracted when larger organisations needed assistance.

The flow-on effect of this treatment largely meant that Māori were being cared for by Pākehā-centric organisations that don’t have the cultural foundations to serve Māori needs the way health providers like Moxon’s could.

She used the example of Geneva Health Care in 2018.

Geneva put forward two proposals to ACC to be contracted for referrals.

One focused on general population, the other was a combined proposal with multiple Māori health providers encouraging Māori patients to be referred to health providers such as Te Kōhao Health.

Of the 11 patients Te Kōhao Health care for under ACC’s home care support system, just three are Māori.

The first proposal succeeded, the combined proposal didn’t and was ranked 14th out of 15.

“It didn’t matter what we did, it would never be enough to get us across the line, despite numerous reports concerning inequities between Māori and Pākehā care,” Moxon said.

“The mere fact the only Māori rōpu [group] to put in a tender scored 5.2 out of 10 for cultural responsiveness is totally astounding.

“People think because they speak a little reo that they become the specialist, the expert but, in actual fact, you've got to be able to see things from a Māori viewpoint, and if you can’t then it makes it difficult for you to understand the nuances of our people.”

Te Kōhao Health is a subcontractor under Geneva, taking on patients who need in home support care, but the referrals it gets are miniscule, Moxon said.

“Right now there are only three Māori people in our region that come from the whole of Waikato that have filtered through the limited supplier model to receive home care from a Māori provider.

“As the tribunal are aware, the breach of Te Tiriti o Waitangi in relation to ACC in the home and home care support services are the same.

“These are systemic everywhere – societal and structural racism, institutional systemic racism, interpersonal and personally mediated racism and internalised racism – nothing seems to change.”

Moxon called for an overhaul of the ACC system that included pulling all Māori home care support services typically controlled by ACC to be transferred to the Māori health authority in July once the organisation had officially been launched.

“There is no recognition of Te Tiriti by ACC … the concept of mana motuhake [autonomy] by Māori for Māori with Māori.

“No matter how you dress it up, it will still be a master-servant relationship, which is far from what it ought to be.”

The red pools depict the limited opportunities Māori health providers get to assist Māori. The blue streams are Pākehā-centric health providers supporting Māori.

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Moxon’s barrister Roimata Smail said the Crown accepted Māori health providers were the “gold standard of care” following the urgent inquiry into the Government’s handling of the Covid-19 vaccination and protection programme, but the acknowledgement of the value of by-Māori for-Māori care appeared to have ended there.

“By-Māori for-Māori care is a tiny feature of the health system. In stage one [of the hearings, the Crown] said that it is a matter of Māori choice. The Crown suggested Māori choose non-Māori providers.

“If a Māori person needs home support, you would expect them to quickly and seamlessly be referred to a Māori provider in their community.

“This claim demonstrates that this is not a matter of choice at all, and how the Crown has created barriers is complex.”

Smail shared a diagram depicting a flowing river, representing Māori seeking home care assistance through ACC, and the structural barriers it must pass through before a few drops land in the waiting buckets of Māori health providers.

“If Māori need home support and are in the pool shown at the top of the page, they are siloed by the Crown.

“We do not know how many Māori need home support, or how many Māori are in the top of the pool.

“While this claim is about home support, we think it shows how the Crown creates structures and barriers between Māori and appropriate care, and we believe that this claim likely illustrates the same health issues across the whole health system.”

The hearing continues.