Tariana Turia

Thank you Murdoch (Pahi) for opening our hui, and thank you to you all, for coming along. You are the most important people to be here today.

The other night, following the first of these hui at Taupo, my office staff told me of the remarkable view they had enjoyed miles above the clouds as their tiny plane winged back to Wellington.

On the west wing, the moon shimmered in full glow; while on the east the firey rays of the sun blazed out in absolute radiance.

It was as clear a tohu as any, that our future is assured.

For too long we have been putting up with services which are overlapping; duplicating activities for the purpose of the contract; the actual needs of whanau have been fragmented and uncoordinated.

And we have struggled to deliver health services to our whanau while realising that a new roof; support with transport, or some interventions to help a young one stay at school might actually be the more pressing problem that's required.

We have had to put up and shut up; while all the time knowing that there were things we could do, to make the difference.

Today is our chance to say, we can have it all; we can have the rising moon and the setting sun at the same time; and we call this whanau ora. Because it is a right that has been handed down to us by our tupuna.

The purpose of today, is for us to consider how we can make the movement required, to achieve primary healthcare which is not only "better, sooner, and more convenient" but healthcare which fully meets the needs of our whanau.

At the first of these hui in Taupo, I have to say that there appeared to be a fine tightrope between excited optimism and terrified anxiety.

I think such a spectrum of responses is pretty much inevitable when we think about the change process.

And the change is dramatic - John Tamihere in fact referred to it as a 'seismic revolution'.

But the revolution is of ourselves.

Remember the advice of Confucius : 'they must often change, who would be constant in happiness or wisdom'.

And the reality is, the situation is less than perfect in terms of the outcomes our whanau are currently experiencing in healthcare.

Earlier this week I launched the Stroke Awareness Week which in that one area alone gave every reason for looking at the healthcare experiences our people are currently experiencing.

And we have to ask why - when there has been an overall decline in the disease amongst New Zealanders, Maori stroke rates have increased by 30 percent.

Why, when Maori may have the same level of disability dependence and handicap at discharge as non-Maori, that a year later they are much worse off?

Why it is that Maori stroke survivors feel they aren't being offered effective education, occupational or physiotherapy support to aid their recovery; or feel as if they are receiving positive expectations set for them, to plan out their recovery?

And I have to wonder, what has happened to the values, the principles and the approaches that have driven primary health care over the last few decades.

There are other things that trouble me. The World Health Report, 'Primary Health Care - Now More than Ever' reported that, and I quote,

"Rather than improving their response capacity and anticipating new challenges, health systems seem to be drifting from one short-term priority to another, increasingly fragmented and without a clear sense of direction".

And if that isn't enough of a challenge we also know, that many of the causes of ill-health and disease live well outside the boundaries of the health sector, and have to be confronted by a wider cross-sectoral approach.

These are just a few of the challenges that have led to the intention to "develop a more personalised primary health care system".

You will have heard today of the fast-track being driven, to do exactly what the World Health Organisation is urging us to do - to anticipate new challenges, to introduce new models of care, to up the game, and to improve the delivery of healthcare services.

The challenge that we must take up now, is how to ensure we are part of the fast-track; how will we guarantee that the new health care service model will be one that is appropriate, accessible and effective for tangata whenua.

I am really interested to see what providers throughout Wellington, the Wairarapa, central North Island and top of the South, are thinking in response to the presentations that you will hear.

I can not estimate enough the importance of primary health care as providing us with some direction on how to organise the full range of care that is needed.

I know that you are all believers in the view that prevention is as equally important as cure, and that health promotion, counselling, screening, access to treatment and people centred services are critical to improving health right across the board.

But I want us to be brave in looking at the inefficiencies, the inequalities and the injustices as we map our way forward.

And I want us also, to be clear about the destination in which we are heading.

In my mind the road map to wellbeing is not one in which I can count off multiple activities and events undertaken in the name of health, with reckless disregard for the outcomes that are being achieved.

And by outcomes, I am not just talking about diagnostic tests; appointments for minor surgery; access to treatment even though all these things are important.

I am thinking about our moemoea; our aspirations for whanau to be strong, secure, safe, healthy and happy.

I am thinking about our whanau having healthy respectful relationships; about valuing and respecting all who belong to them - tamariki, kuia, kaumatua, matua.

In this whanau, we will have knowledge of our whakapapa and our history; we will be comfortable in who we are and where we have come from; we will express collective responsibility for the wellbeing of all.

We will value our own cultural practices such as rongoa; we will speak our languages; we will reclaim our tikanga and kaupapa as foundations for change.

And I want to be very clear, that in the process of looking anew at our health system we must uphold whanau ora as the ultimate goal.

Sometimes we get nervous when we think that we are missing out, or that business as usual becomes vulnerable to the tides of change.

This is about the wellbeing of the whanau and that's where we have to focus all our thinking.

And it is huge, it is with us now, the pathway forward is a rapid one.

We must be ready to go.

You will be aware that the Minister has called for Expressions of Interest for developing a primary health care service model.

In the fine print of the forms, keen eyes might also see that final funding and contracting agreements may involve an examination of all the available revenue throughout the rohe.

So what's that saying to us?

This is not about competition. This is about whanau; it is about collaborating, cooperating and working together.

This is about us coming together in the best interests of the families we are serving.

We also don't want to be in the position of rushing for crumbs when all the croissants have been taken.

I met with a large iwi the other day who told me, that nothing will happen in their rohe without going past them, And in many ways I could see that there would be huge tension because of all the other providers on the ground.

But it was an iwi expressing their rangatiratanga and they want to work constructively with those people. They want to be able to look after their own and others living in their rohe. And yet, I could sense a huge nervousness about other providers in that rohe as they feel they will be losing something.

And I think that's sad because in reality, we should be able to maintain the rights of iwi to demonstrate leadership rather then feeling we are going to lose something by iwi asserting themselves. We wouldn't be in this position, competing against each other, if we had maintained iwi leadership in the first place.

And so, there is a very keen interest from iwi leadership about how all this progresses forward.

That is what we must do now in taking advantage of the opportunity ahead of us. It may mean new approaches - an emphasis on cooperation rather than competition; a focus on working together while still maintaining our distinctive edge.

We must have the attitude - to embrace the sun and the moon -and to know that whanau ora is worth every investment that we make.

I want to thank the Ministry of Health, the national Maori PHO Coalition, I'm very sorry that Te Whanau o Waipareira are not here to share their vision for the way forward. But I thank the others for their contribution to this hui today, and I look forward to hearing your responses throughout the day about what you think is important for your services.