Rapid review of Putting Patients First

It is hard to keep up with all the Tiriti o Waitangi breaches occurring within the health sector at this time. This co-authored paper for the New Zealand Medical Journal is a Rapid Tiriti Review of the health workforce strategy Putting Patients First: Modernising health workforce regulation. Spoiler alert it is poorly aligned with Te Tiriti o Waitangi responsibilities.

Putting Patients First was drafted in a political climate that is hostile to Te Tiriti and actively dismantling Māori health gains and undermining tino rangatiratanga (self-determination) by reframing equity as "needs not race". This framing mischaracterises equality as sameness and ignores the institutional racism that underpins health disparities. A Rapid Tiriti Review of the proposal reveals that it failed to align with the preamble or articles of Te Tiriti o Waitangi, offering no equity analysis and disregarding entrenched inequities. The document remained silent on the Crown's duty to protect hauora as a taonga, which risked embedding monocultural practices and further marginalising kaupapa Māori health models like rongoā (traditional Māori healing).

In terms of engagement, the PPF proposals failed to acknowledge the vital Tiriti relationship between hapū (tribal nations) and the Crown, breaching the intention of good faith and mutual benefit. By limiting submissions to the Ministry of Health’s website, the Crown prevents the essential kanohi ki te kanohi (face to face) and rangatira ki te rangatira (leader to leader) engagement necessary for genuine partnership. Furthermore, there is no clear account of Māori involvement in decision-making, and feedback from Māori professional associations remains invisible. This exclusion suggests a retreat from measurable commitments to Māori health equity and hinders the ability to hold institutions accountable for institutional racism and monocultural practice.

The proposal also falsely positions cultural safety as competing with clinical competence by asking biased questions about whether regulators should focus on one or the other. In reality, quality holistic healthcare requires practitioners to be both clinically and culturally safe, as a clinician who breaches tikanga (cultural protocols) or acts with racism contributes directly to poorer health outcomes. To address these failings, it is recommended that all health regulatory boards have at least 50% Māori membership and that standard Te Tiriti, cultural safety, and antiracism competencies be mandated across all regulated professions. Without these commitments, health workforce regulation will continue to perpetuate inequities rather than remedy them.

Check out  the full paper: https://nzmj.org.nz/journal/vol-139-no-1634/equity-regulation-and-te-tiriti-o-waitangi-a-rapid-review-of-putting-patients-first

Came, H, Aspin, C, Barnes, A, Baker, M. (2026) Equity regulation and Te Tiriti o Waitangi: A Rapid Tiriti Review of Putting Patients First in New Zealand Medical Journal. 139(1634). Pp1-7.