Pae Ora Healthy Futures is not just a name. It sets the foundation for envisioning a new health system as shared by Tā Mason Durie—healthy people (Mauri Ora), healthy whānau (Whānau Ora) and healthy environments (Wai Ora). Pae Ora embodied the principle that health is a taonga that binds us to our whakapapa, our whenua, and our mokopuna. It recognised that Māori must not only be participants in health policy but leaders in shaping systems that sustain wellbeing for generations. This is the essence of mana motuhake and mana mokopuna, the responsibility to ensure that decisions made today uphold the dignity, potential, and wellbeing of future generations.

The gifting of Māori names to the health system such as Pae Ora, Te Whatu Ora and Te Aka Whai Ora recognises the holistic world view of Te Iwi Māori and the opportunity Pae Ora provided for working together through the Te Tiriti o Waitangi relationship for a transformative approach to promote equity and healthy futures for all New Zealanders.

The Pae Ora Healthy Future Amendment legislation ignores this vision, the whakapapa of the legislation, and turns its back fundamentally on Te Tiriti o Waitangi.

The modified Treaty of Waitangi clause in the bill is widely criticised, including in submissions from Te Kāhui Hauora o Ngāti Whātua, Te Whare Tohu Rata o Aotearoa (the Royal College of GPs) and Treaty specialists. The language shifts from explicit partnership and active protection principles, as required by case law, to “give effect to the principles of Te Tiriti o Waitangi” and from active protection principles, toward minimal recognition: “consider Māori interests”, undermining earlier commitments to equity and partnership. This linguistic downgrade represents a profound constitutional and moral regression. It replaces the active obligations of partnership, protection, and participation with passive recognition. Legal scholars, including Professor Claire Charters, have warned that this ‘weakening’ departs from best practice and risks breaching Crown obligations.

The bill also directly contradicts the Waitangi Tribunal’s WAI 2575 Health Services and Outcomes Inquiry, which affirmed that Māori health inequities are the result of persistent Crown breaches of Te Tiriti, and that the path to equity requires Māori-led authority and decision-making. By dismantling Māori governance mechanisms, the Crown undermines mana motuhake and breaches the constitutional balance between kāwanatanga and tino rangatiratanga.

From a mana motuhake perspective, this failure is intergenerational. To weaken Treaty commitments now is to deny protection of our mokopuna, perpetuating systems that have already failed Māori for generations.

The bill proposes the loss of substantive functions for Iwi Māori Partnership Boards (IMPBs), removing direct lines of accountability and diminishing their influence on local health priorities.

Previously, IMPBs acted as tangible vehicles for iwi and Māori to shape services in their communities and report on outcomes relevant to local needs. The removal of IMPB functions including localities, alongside weakened reporting requirements nor clarity on monitoring functions, abandons what submitters such as the Federation of Māori Authorities and Te Rōpū Whakahaere Hauora Māori described as “meaningful partnership”. Instead, the bill substitutes a distant, national Māori advisory committee—one stripped of statutory independence and with unclear lines of accountability, erasing the principle that iwi must hold health entities answerable at the locality level.

One of the clearest signals of disregard is the decision to subordinate the Māori name of the bill (“Pae Ora”) beneath its English title. Extensive submissions framed this as a symbolic but revealing slight—petty and undermining, suggesting Māori concepts remain secondary within a health system purporting to advance equity and partnership. Labour, the Greens, and Te Pāti Māori consider this decision disrespectful and regressive.

At its heart, this bill fails mana mokopuna, our sacred duty to protect and uplift the generations who follow. Health is a taonga, guaranteed under Te Tiriti o Waitangi. To honour it is to design systems that safeguard their right to live well, in balance, dignity, and connection with their whakapapa, whenua, and wairua. The dismantling of Māori-led structures does not only weaken governance but recentralises control that breaches that taonga. When mana motuhake is eroded, the cycle of inequity and harm deepens across generations.

Our vision of Pae Ora was one of enduring justice, where Māori authority, cultural integrity, and community voice secure wellbeing for our mokopuna.

Previously, Te Whatu Ora Health New Zealand had a statutory requirement to collaborate with IMPBs, guaranteeing regular engagement between the central health system and Māori structures in every region. Localities were a key feature of Pae Ora Healthy Futures to resource and empower local community voice, inter-sectoral collaboration, and planning across community and rohe-wide.

The bill’s removal of this obligation—highlighted as unacceptable by Te Arawhiti and multiple Hauora Māori groups—will create “multiple points of detachment,” reducing accountability and weakening the system’s responsiveness to local voices.

Where there was once local monitoring and direct reporting, now the bill prescribes advisory input at the national level only, distant from communities and diluted by bureaucratic process.

The bill includes new statutory health targets, a move heavily criticised by public health scholars and submitters. Many submitters argued that legislating specific health targets could incentivise gaming of statistics and narrow efforts to only areas measured, undermining holistic care. They warned this short-term focus might neglect equity and prevention, diverting attention from underlying determinants of health.

Concerns also included reduced flexibility for responding to local needs and a lack of consultation on what targets best serve communities. Submissions noted that replacing equity-focused outcome goals with generic targets risks perpetuating existing disparities, particularly for Māori. Overall, critics said the approach fails to address core system challenges and may worsen inequities. Professor Tim Tenbensel argued that targets attempt to bind future governments to outdated priorities, risking rigidity and undermining democratic adaptation of policy as needs change. Others warn that targets can distort service delivery, encourage gaming of statistics, and fail to reflect real health system complexity.

Of significant concern, the bill weakens Health New Zealand’s mandate to act on social and environmental determinants of health, undermining the cross-sector approach central to the original Pae Ora reforms. This effectively reduces commitment to equity, and prevention.

Another key concern is the repeal of “Te Mauri o Rongo”, the New Zealand Health Charter. The charter sets out core values, principles, and expected behaviours for everyone working in the health sector, aiming to foster safe, supportive workplaces and strong collaboration. Te Mauri o Rongo represents the diverse voices of the workforce and health sector developed together maintaining ongoing commitment to Te Tiriti o Waitangi.

Its purpose is to guide how health workers relate to each other, care for their communities, and continuously improve health outcomes: a statutory concept enshrined in the original Pae Ora Act to embody mana and well-being as guiding principles.

Submissions from Māori health leaders and Treaty experts argued that its removal strips the legislation of spiritual and cultural substance, narrowing the framework back to a technocratic model and breaking from commitments to Māori worldviews.

Reducing the suite of seven statutory health strategies to two (a New Zealand Health Strategy and a Hauora Māori Strategy) can have the effect of de-prioritising equity for marginalised groups that have fought hard to have their unique challenges recognised. Reducing the number of statutory strategies could also limit long-term visibility of outcomes and remove specific statutory obligations for equity and inclusion.

We note that officials’ own advice on the bill points to a loss of accountability, and risk of being seen to deprioritise explicit focus on determinants of health, going against the intent of previous reforms and pre-emptively removing localities. The bill also risks fragmenting the legislative framework and undermining the coherence of the 2027 statutory review. The changes are ad hoc and potentially destabilising for the sector.

The resultant narrower Health Plans under the bill could limit system-wide coordination, evidence-based planning, and collaboration with other agencies. These risk reducing the plan to an operational tool rather than a strategic population health document.

Misalignment between the six-year Government Policy Statement cycle and the three-year Health Plan cycle could create inconsistencies in planning and resourcing. The longer cycle also reduces opportunities for public and parliamentary scrutiny.

The longer cycles relating to the alcohol levy could reduce flexibility to respond to alcohol harm evidence and trends.

The bill introduces references to “public service principles of political neutrality”, a change that was poorly defined in committee and ambiguous in scope. Submissions argued this could have a chilling effect, deterring health entities and even contractors from strongly advocating for Māori needs, health equity, or critiquing government performance. Furthermore, uncertainty remains over whether this principle applies to external providers, risking confusion and constrained voice in health policy.

By transferring collective bargaining authority for the entire health sector to the Public Service Commission, the bill substantially undermines the autonomy of Te Whatu Ora Health New Zealand and the agency model. With wages accounting for approximately 70 percent of Te Whatu Ora’s operating costs, this means the Te Whatu Ora HNZ Board loses control over the single largest cost driver, and accountability is diffused to another layer of government administration.

Submissions from the New Zealand Nurses Organisation and the Association of Salaried Medical Specialists described this as undercutting the principle of devolved governance and weakening health system performance.

Despite Te Pāti Māori’s attempt to propose a series of amendments to restore equity, uphold Te Tiriti, and protect Māori health during the select committee process with support from Labour and the Green Party, all of the amendments were voted against by Government members. These included:

• Clause 4—Title of Principal Act Amendment: Rename to “Pae Ora (Healthy Futures) Amendment Bill”. Rationale: Restore the mana of te reo Māori and the original intent of the Act.

• Clause 5—Purpose of the Act Amendment: Add equity and Te Tiriti as core purposes. Rationale: Ensure these are not optional considerations.

• Clause 8—Te Tiriti o Waitangi Amendment: Insert “the articles and principles of Te Tiriti o Waitangi”. Rationale: Strengthen accountability and Treaty obligations.

• Clause 9—Health sector principles Amendment: Retain section 7. Rationale: Preserve equity, cultural safety, and responsiveness to Māori.

• Equity principles after section 13 Amendment: Add duty to achieve equity, especially for Māori. Rationale: Restore fairness and balance.

• Clause 14—Consultation with Māori advisory boards Amendment: Require consultation with Hauora Māori Advisory Committee and Iwi Māori Partnership Boards (IMPBs). Rationale: Ensure Māori input in planning and delivery.

• Clause 15—Kaupapa Māori investment engagement Amendment: Safeguard engagement with IMPBs. Rationale: Support Māori-led service design.

• Clause 16—Systems for Te Tiriti understanding Amendment: Retain requirement to understand Te Tiriti and mātauranga Māori. Rationale: Prevent institutional ignorance.

• Clause 17—Engagement with Māori Amendment: Retain Section 16A. Rationale: Maintain accountability to Māori communities.

• Clause 19—Iwi Māori Partnership Boards Amendment: Restore powers to evaluate, commission, and monitor hauora Māori. Rationale: Reinstate mana motuhake.

• Clause 26—Reporting on equity Amendment: Require annual reporting on Māori health equity, audited by the Auditor-General. Rationale: Embed accountability.

• New Section 52A—Workforce and cultural safety Amendment: Require ministerial reporting on workforce wellbeing and cultural safety. Rationale: Maintain oversight if Charter is removed.

• Clauses 26–27—Audit requirements Amendment: Retain audit requirements for NZ Health Plan and performance reports. Rationale: Ensure transparency.

• Clause 28—New Zealand Health Charter Amendment: Retain sections 56–58. Rationale: Uphold values of equity, Te Tiriti, and cultural safety.

• Clause 31—Hauora Māori Advisory Committee Amendment: Make advice binding and require annual reporting to Parliament. Rationale: Elevate influence and accountability.

• Clause 32—Te Tiriti expertise Amendment: Retain original appointment criteria. Rationale: Ensure expertise in Te Tiriti, equity, and population health.

Every amendment was grounded in kaupapa Māori, Treaty justice, and practical equity. Their rejection confirms that this bill is not about partnership, it is about control.

Our mokopuna will inherit the consequences of this bill. Without Māori leadership, culturally grounded care will be sidelined. Without statutory equity duties, disparities will persist. Without accountability, the Crown will continue to fail Māori.

Māori deserve better. Our mokopuna deserve better. We deserve a health system that puts Te Tiriti front and centre, listens to Māori voices, and targets to close the gap in health inequities. We deserve to lead our own solutions, to exercise mana motuhake, and to act as kaitiaki for our own people.

This is about our babies and future mokopuna. Health is a taonga and to protect it is our collective duty under Te Tiriti o Waitangi and our whakapapa.

In summary, Labour, Greens, and Te Pāti Māori object that the Healthy Futures (Pae Ora) Amendment Bill undermines the voice of Māori in the system, weakens Treaty principles, and distances decision-making from communities. It erodes partnership in favour of advisory bureaucracy, binds future governments with inflexible targets, strips the bill of Māori identity and substantive wellbeing principles, and reduces health system autonomy in workforce matters—all despite the clear evidence presented by submitters that these changes will exacerbate inequity and undermine trust in the reforms.

The Healthy Futures (Pae Ora) Amendment Bill was referred to this committee on 22 July 2025. The House instructed us to report on the bill no later than 24 November 2025. We invited the Minister of Health, Hon Simeon Brown, to provide oral evidence on the bill. The Minister declined the invitation.

We called for submissions on the bill with a closing date of 18 August 2025. We received and considered submissions from 1,787 interested groups and individuals. We heard oral evidence from 97 submitters. We wish to acknowledge the contributions of all submitters and thank them for their engagement.

Advice on the bill was provided by the Ministry of Health. The Office of the Clerk provided advice on the bill’s legislative quality. The Parliamentary Counsel Office assisted with legal drafting.

Sam Uffindell (Chairperson)

Dr Hamish Campbell

Dr Carlos Cheung

Ingrid Leary

Cameron Luxton

Hūhana Lyndon

Jenny Marcroft

Debbie Ngarewa-Packer

Hon Dr Ayesha Verrall

The documents we received as advice and evidence are available on the Parliament website.