Equity in Commissioning

Equity in Commissioning

Te Pae Tata (Interim NZ Health Plan) lays out 6 strategic objectives.

1. Place whānau at the heart of the system to improve equity and outcomes

2. Embed Te Tiriti o Waitangi across the health sector

3. Develop an inclusive health workforce

4. Keep people well in their communities

5. Develop greater use of digital services to provide more care in homes and communities

6. Establish Te Whatu Ora and Te Aka Whai Ora to support a financially sustainable system

In circumstances of commissioning where there is no Māori alternative available (ie ambulance services) there should be explicit workforce diversity targets set into contracts. This way providers of health services who are not directly overseen by the crown are held accountable to Whakamaua: Māori Health Action Plan 2020-2025, Te Pae Tata Interim New Zealand Health Plan, Te Tiriti and ensure a health care system that achieves equity.

Without contractual accountability and key diversity targets, our health workforce will not change with the required impetus to achieve equity. Equity does not happen by accident and the past 150 years within Aotearoa have demonstrated this - it is achieved by design. Within the Paramedic Workforce – Māori and Pasifika are underrepresented at all levels (particularly leadership and senior clinical roles). Women are well represented within the total workforce – however they are underrepresented in senior clinical and leadership roles.

I reference the current  Emergency Ambulance Contract from the Te Whatu Ora website.

Section 8: Maori Health and Cultural Requirements

8.1 EAPs (emergency ambulance providers) will provide services in a culturally appropriate way and will comply with relevant cultural requirements as prescribed by the Ministry and ACC from time to time.

This is the sum total Te Ao Māori expectations in the contract for commissioning services. No mention is made of the workforce composition. This should not be an acceptable approach to commissioning critical services for our country. I am aware it has been addressed recently, however - a ubiquitous approach that is the same across all services commissioned by the crown. 

All contracts should have explicit levels set for diversity within a workforce, (ie 17.5% Māori across an organisation), funding provided and pathways developed in collaboration with Māori, Providers and the Profession to achieve a diverse and inclusive workforce.

Without setting specific targets for those who are contracting services, there will be no impetus for change in the sector. There will be no focused increase in the Māori or Pasifika workforce and no promotion of wāhine within these organisations. Despite suggestive wording in previous iterations of contracts, we still see that women are underrepresented in senior clinical and management roles within Paramedicine (as an example) and Māori / Pasifika workforce numbers do not reflect the level within the community. 

This is seen across health, there must be set targets and allocated funding to support this workforce growth. And organisations being funded by the crown should be accountable against these targets as a KPI for their ongoing renewal of contracts and funding.