Te Tiriti o Waitangi Policy Statement

Introduction

  1. This Te Tiriti o Waitangi Policy Statement is a formal expression that provides high level direction for how we will work to honour our obligations as a Tiriti partner when undertaking our statutory functions and responsibilities as Te Kaunihera Tapuhi o Aotearoa/Nursing Council (Nursing Council) of New Zealand.
  2. The statement is accompanied by a companion document Te Tiriti o Waitangi Framework to support staff to interpret and implement the Te Tiriti in their everyday work.

Our commitment to Te Tiriti o Waitangi

  1. The Nursing Council recognises its role and responsibilities to meet its obligations under Te Tiriti o Waitangi. This statement confirms our commitment and provides high level direction for how we will deliver on our obligations under Te Tiriti o Waitangi.

Our expression of Te Tiriti o Waitangi

  1. The following expresses a set of goals that the Nursing Council will strive towards as a Te Tiriti o Waitangi partner in relation to our statutory functions as a regulatory authority within the nursing profession. The goals are expressed through the Māori concept of “mana” and align with the Ministry of Health’s Tiriti goals for Māori:
    • Mana Māori – enabling Māori customary rituals framed in te Ao Maori, encapsulated within mātauranga Māori and enacted through tikanga Māori
    • Mana tangata – achieving equity in health and disability outcomes for Māori across the life course and contributing to Māori wellness.
    • Mana motuhake – enabling the right for Māori to be Māori and to exercise self-determination over their lives and to live on Māori terms according to Māori philosophies, values and practices including tikanga Māori

Our approach to achieving these goals

  1. These goals can be achieved through our expectations of a profession that values, reflects and understands the communities it serves, is culturally safe and able to meet the standards for the nursing profession.
  2. The principles of Te Tiriti o Waitangi (set out below) and as articulated by the Courts and the Waitangi Tribunal defines the approach for how we will meet our obligations as a Tiriti partner in our every-day work in a modern world:
  1. Meeting our obligations as a responsible Tiriti partner is a must if we are to realise the overall aim of achieving equity of health outcomes for Māori.
  1. We know that no one organisation can achieve these goals on their own. While remaining independent, we will look to collaborate as well as align across systems and settings (as appropriate) to ensure we honour our commitments, responsibilities and obligations under Te Tiriti o Waitangi as a Tiriti partner with responsibility for performing our statutory functions.

Te Tiriti o Waitangi Context

Introduction

  1. This Te Tiriti o Waitangi framework provides guidance to our organisation about our responsibilities as a Te Tiriti o Waitangi partner. The framework is intended to influence and enable how we work as an organisation to fulfil our commitment, responsibilities and obligations to Te Tiriti o Waitangi.
  2. This context is accompanied by a companion document – Te Tiriti o Waitangi Policy Statement which is a formal expression that provides high level direction for how we will work.
  3. This context is intended to provide the important frame to better understand the background in which we operate. It can be used as a practical resource that links and aligns to a range of other key strategies, documents and machinery of government settings to enable consistency, accountability and transparency in terms of our commitment, responsibilities and obligations to Te Tiriti o Waitangi.[1]
  4. The framework (along with Te Tiriti o Waitangi Policy Statement) should be read as “living documents” enabling review and realignment over time. The framework applies to Te Kaunihera Tapuhi o Aotearoa / the Nursing Council (the Council) governance members, staff and contractors.

Background

  1. Governed by the Health Practitioners Competence Assurance Act 2003, the Council is the nursing profession’s regulatory body responsible for ensuring that nurses are competent and fit to practice in Aotearoa New Zealand.
  2. To achieve this the Council has responsibility for:
    • setting the standards for the nursing profession
    • publishing a code of conduct for the nursing profession.
  1. These two functions enable the Council to protect patients from unsafe nursing practice.  Through its regulatory authority, it has the responsibility to address cultural safety and conduct issues.
  2. The Council also plays an important role in approving and accrediting over forty nursing education programmes across Aotearoa New Zealand. These programmes are spread across 27 tertiary providers including universities, polytechnics, wānanga and private training organisations.  Three of these nursing education programmes are Māori specific programmes.
[1] The Nursing Council acknowledges the Māori text of te Tiriti o Waitangi.

Te Tiriti o Waitangi and the Nursing Council

  1. Te Tiriti o Waitangi is regarded as one of New Zealand’s founding documents of government in Aotearoa New Zealand. “Te Tiriti forms the foundation for government on the basis of protections and acknowledgement of Māori rights and interests within the context of a shared citizenry” (Cabinet Office, 2019).
  2. The Council acknowledges Te Tiriti o Waitangi (including the preamble and the three articles, the Ritenga Māori Declaration) as the major sources of Aotearoa New Zealand’s constitutional settings.
  3. As a regulatory authority, independent from the Crown, we have a responsibility to work with iwi and Māori to give effect to and realise the promise of Te Tiriti o Waitangi.  Achieving this will require time, flexibility and the ability to self-reflect, at both Governing Board level and internally as an organisation.  With a specific focus on the nursing profession, our success as a Council will be shaped by our ability and capacity to form a range of relationships with iwi and Māori as well as key government agencies, Māori health providers, associations and other communities of interest.

Te Tiriti o Waitangi Articles

  1. The following sets out the articles of Te Tiriti o Waitangi that guide our organisation to demonstrate our obligations under Te Tiriti as we fulfil our statutory role and functions.
  2. The Council acknowledge the Māori text of Te Tiriti o Waitangi as a gesture that recognises ngā iwi Māori and the history that brought two peoples together.
  3. As articulated by the courts and the Waitangi Tribunal, the Council has a responsibility to:
  • under Article 1: enable Maori to exercise authority over their own health and wellbeing.
  • under Article 2: contribute to equitable health outcomes for Māori.
  • under Article 3: exercise its responsibilities in ways that enable Māori to live, thrive and flourish as Māori.
  1. Meeting our obligations under Te Tiriti will make a small but significant contribution to improving the health outcomes of Māori.

Te Tiriti o Waitangi Principles

  1. Through convention, the Articles of Te Tiriti o Waitangi have been interpreted and expressed through a set of principles. The principles have evolved over time and provide direction for how we are obliged to consider these directions and reflect on the implications for our work as an organisation.
  2. The recent Waitangi Tribunal Claim Wai 2575 – the Health Services and Outcomes Inquiry released initial findings in July 2019.  While this is one health claim of many, the basis for the Wai 2575 claim is primarily focused on the Māori population having (on average) the poorest health status of any ethnic group in Aotearoa New Zealand. The Tribunal also received uncontested statistical evidence demonstrating that, despite reform and readjustments, Māori health inequities have persisted in the nearly two decades since the New Zealand Public Health and Disability Act 2000 was introduced.  All parties to stage one of this inquiry, including the Crown, consider the poor state of Māori health outcomes unacceptable (Hauora, Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry).
  3. The Council notes and agrees that the three historic and commonly used principles (partnership, participation and protection) used for interpreting the articles of Te Tiriti (and which stem from the Royal Commission on Social Policy 1988) provide an important backdrop; However, over time and given the shift of Te Tiriti jurisprudence over the past 30 years, we need to ensure we are not out of step from modern Te Tiriti o Waitangi study, knowledge, decisions and science of law.
  4. The principles that we consider relevant to our work (above) are premised on the most recent Waitangi Tribunal Claim – Wai 2575: the Health Services and Outcomes Inquiry. We consider that this enhanced set of principles provide deeper clarity and guidance about the actions we must demonstrate to realise our commitment, responsibilities and obligations to Te Tiriti o Waitangi.

Self-Determination / Tino Rangatiratanga: The principle of self-determination – this provides for Māori self-determination and mana motuhake. This requires the Nursing Council to work with partners in the design, delivery and monitoring of our relevant statutory work.

Partnership/Pātuitanga: The principle of partnership – requires the Nursing Council and iwi/Māori to work with each other in a strong and enduring relationship.

Equity/Mana Taurite: The principle of equity – this requires the Nursing Council to commit to achieving equitable health outcomes for Māori through the functions that it is responsible for.

Active Protection/Whakamarumarutia: The principle of active protection – this requires the Council to be well informed on the extent, and nature, of both Māori health outcomes and efforts to achieve Māori health equity through culturally safe nursing standards and the practice of cultural safety.

Options/Kōwhiringa: The principle of options – this requires the Nursing Council to ensure that all of its services are provided in a culturally appropriate way that recognises and supports the expression of te ao Māori models of care and nursing.

Connections and Alignments

Kawa Whakaruruhau & Cultural Safety

  1. Firstly, the Council wish to acknowledge the mana and the wehi of ngā wāhine Māori who lead, persisted and worked tirelessly in the development of Kawa Whakaruruhau.
  2. While Te Tiriti o Waitangi underpins the primary political, social and economic relationship of this country, Kawa Whakaruruhau is regarded as one of the most significant pieces of research produced and published on the impact of western (or colonial) centred nursing practices that have dominated the health sector since colonisation in Aotearoa New Zealand.  Published in 1990, Kawa Whakaruruhau provided an intense and justified critique of the Florence Nightingale model of nursing education as well as practice in Aotearoa New Zealand.  Many Māori continue to draw links between persistent poor health outcomes of Māori, lack of equity in the distribution of resources (particularly since 2000), ongoing institutional racism and a health system that is woefully “unsafe” when it comes to Māori.
  3. While Kawa Whakaruruhau is primarily focused on the importance of cultural safety, at its heart is Māori patients their whanau, hapū and iwi.  At its best, Kawa Whakaruruhau provides for a holistic model of Māori health care that moves beyond an individual patient’s treatment and acknowledges the interaction between physical, mental, spiritual and whanau wellbeing.  It reinforces that Māori concepts and epistemologies of health care matter and have a place in today’s health system.
  4. Kawa Whakaruruhau reflects on other determinants of health from across other sectors and systems including education, poverty and employment.  This strengthens the notion that Kawa Whakaruruhau is wide reaching and is a Tiriti response and frame of analysis that takes a whole-of- system lens as a way of addressing equity issues across the health system.
  5. Today, Kawa Whakaruruhau continues to be a highly regarded taonga that has been gifted to the nursing profession to ensure that the profession learns from the past.  The Council, recognises the importance of Kawa Whakaruruhau and consider it to be a crucial pillar (pou) that continues to demand change and transformation of how we deliver health services (and in particular nursing services) to Māori.
  6. However, there is much to be achieved.  Over the past 30 years (since publication in 1990), Kawa Whakaruruhau has been reinterpreted, misinterpreted and reconstructed to suit a range of environments – to varying degrees of success.
  7. Given the Council’s past role in the commissioning of the original report, it is important that the Council lift its efforts and work alongside Tiriti partners in terms of how we implement Kawa Whakaruruhau at an operational level in a way that is shared and has influence across the health system.
  8. Increasingly, the concept of cultural safety is gaining momentum and has begun to reach more broadly across a number of health organisations and regulatory authorities.  The Council can provide leadership in this space when working with other regulatory authorities as we journey with others to implement and embed it across the profession.

He Korowai Oranga–New Zealand’s Māori Health Strategy & Action Plan

  1. Developed by the Ministry of Health, He Korowai Oranga sets the overarching framework that guides the Government and the health and disability sector to achieve the best health outcomes for Māori. The Ministry is responsible for the machinery of government settings and we play an important role in providing information and intelligence back to the Ministry as we carry out our duties as a regulator.[1]
  2. The following diagram sets out the Māori Health Strategy.


  1. The newly developed Māori Health Action Plan compliments He Korowai Oranga and identifies priorities, some of which are related to our function.  These include:
a) Maori Crown partnerships
b) Māori leadership
c) Māori health and disability workforce
d) Maori health sector development
e) Working across sectors
f) Quality and safety
g) Insights and evidence

h) Performance and accountability.   [1] The Ministry of Health are the system leaders for the health sector and have legislative and policy responsibilities for those settings.  The Ministry also has responsibility for advising the Minister for Health about membership (including Māori, iwi) of the Nursing Council’s Governance Board.
  1. Those highlighted (above) are the key priorities where we can make a contribution as we work collectively towards improving equity of health outcomes for Māori.
  2. There are a number of other determinants from across a range of sectors that support better health outcomes for Māori. The Council is mindful of the work being undertaken by a range of government and non-government agencies such as Whānau Ora (Te Puni Kokiri), Family Violence (Ministry of Social Development), Kainga Whenua (Kainga Ora), boosting achievement of Māori in tertiary education (TEC) and the work of the Child Poverty Action Group (to name but a few). While this work is beyond our remit as a regulatory authority, we recognise the shared interests of the collective and the collaborative efforts required to make a difference. The Council are always willing to participate and contribute our learning and knowledge gained from our work where relevant.

Maori Crown Relations - Te Arawhiti

  1. This is a new Government portfolio that has been established to demonstrate that true and practical relationships and/or partnerships are possible, beyond settlement negotiations.
  2. Te Arawhiti provide strategic leadership, advice and guidance to organisations to ensure engagement with iwi and Māori is meaningful. This guidance will prove to be useful to our work as we strive to meet our Tiriti commitments, responsibilities and obligations.
  3. While we remain independent from the Crown, the guidance from Te Arawhiti will support us as we build our organisations capability to engage meaningfully with iwi and Māori as a Tiriti partner.
  4. Our relationships with iwi and Māori who share an interest in our work (as a regulatory body) does matter because it enables us to better carry out our duties and responsibilities as a member of the health system. 

Our Organisational Values

  1. We need to ensure alignment between Te Tiriti and our core values as an organisation. Organisation values are important because they contribute to a workplace culture, behaviours and beliefs intended to reflect how we want to work and the experience we want our Māori Crown partner and stakeholders to receive and measure us by.
  2. The refreshed organisation values (outlined in the box below) support our Te Tiriti o Waitangi position and support our determination to achieve our goals as well as create a workplace culture that we and others can measure ourselves by.

We honour our bi-cultural partnership - Whakahoatanga tikanga rua
We work collaboratively and with integrity - Mahi ngātahi ā mana
We are accountable, effective and efficient - Whai haepapa, whai tika
We lead, learn and improve - Arataki, ako, whakapai ake
We set standards, codes of practice and expectations that contribute to improved health equity for Māori - Wairua tōkeke hauora

  1. Connecting and aligning our Te Tiriti framework with other key settings is important to us because of the shared interests that many organisations have across the health system.  The following outlines three key elements of the public sector system that support our context and work. These are:
  • Public Service Legislation– that (amongst other expectations) identifies a set of expectations for Māori Crown relationships
  • He Korowai Oranga: the Māori Health Strategy and associated Māori Health Action Plan
  • Crown Māori Relationships – Te Arawhiti, the new Crown agency responsible for guiding organisations as they develop or enhance their relationships with iwi and Māori.

Public Service Legislation Bill

  1. Given our status as an autonomous and independent regulatory authority, we still need to be mindful of activities occurring across the State Sector. The proposed amendments to the New Zealand State Sector Act provide some useful direction for the Nursing Council and will guide the Council as we carry out our duties and responsibilities. 
  2. A particular focus in the State Sector Act is the importance of the relationship between the Crown system and iwi and Māori. This is an area of emphasis that overtime will benefit how we work and who we work with as we co-design and co-construct our advice to the Board, the sector and Ministers.
  3. 42    The new expectations have been interpreted to fit the role and functions of the Nursing Council. Members of the profession and the public can expect the Council to carry out its role and functions in-line with the guidance provided by the new Public Service legislation. The areas for critical action are outlined here and include:
  • Engagement, Participation and Partnership with Māori – this means the Nursing Council has to be proactively informed and collaborative where there are mutual benefits and that strengthen our relationship with iwi and Māori
  • Delivering Services and Results – our regulatory, accreditation, monitoring, conduct and competency functions need to be well informed decisions and our interventions need to improve health equity for Māori
  • Profession Composition and Capability – ensuring that our nursing profession values, reflects and understands the communities it services, is valued for its cultural competence and empowers Māori to succeed as Māori in the nursing profession
  • Leadership and Culture – collective accountability for a culturally competent service that delivers with and for Māori and is committed to support Māori leadership and decision-making roles.

Conclusion

  1. Our work as a regulatory authority makes a small but significant contribution to an important part of the health system and the nursing profession. We need and want our nursing profession to be culturally safe in their practice while at the same time we want to support the growth of more Māori into the nursing profession. 
  2. Our focus on quality and safety can be achieved though the setting of codes of conduct, standards and processes for addressing competency and conduct issues in a way that reflect our obligations to Te Tiriti o Waitangi. This includes the accreditation and monitoring of nursing education programmes that reflect our commitment, responsibilities and obligations as a Tiriti partner.
  3. We have much work to do and advancing our Māori Crown partnerships through building authentic relationships partners, stakeholders and communities of interest will be key. This is an area that we will continue to build our organisation’s capacity and capability to achieve.
  4. We acknowledge and recognise the journey we are on to improve our responsive to Māori and Te Tiriti o Waitangi.

References

Te Tiriti o Waitangi/Treaty of Waitangi Guidance, 22 October 2019, Cabinet Office circular (CO (19) 5

Guidelines for engagement with Māori, Te Arawhiti, 2019

He Ara Hauora Māori: A Pathway to Māori Health Equity, Te Kaunihera Rata o Aotearoa / The Medical Council of New Zealand, October 2019

He Korowai Oranga & the Māori Health Action Plan, 2020

He Ritenga – an audit template to assess Te Tiriti o Waitangi responsiveness, Sonya Hawkins, 2019

Ramsden, I. (1990). Kawa Whakaruruhau: Cultural Safety in Nursing Education. Wellington, New Zealand: Ministry of Education

Ramsden, I. (1992). Nursing Council of New Zealand: Kawa Whakaruruhau Guidelines for Nursing and Midwifery Education. Unpublished document

Māori Engagement Framework: He Ritenga Mahitahi – A guide for Waikato Regional Council Staff, 2017

Nga Rerenga o Te Tiriti: Community organisations engaging with the Treaty of Waitangi, 2019

Statement on cultural safety, Te Kaunihera Rata o Aotearoa / The Medical Council of New Zealand, October 2019

Nation and government - The origins of nationhood, Te Ara - the Encyclopedia of New Zealand, http://www.TeAra.govt.nz/en/document/4216/the-three-articles-of-the-treaty-of-waitangi John Wilson, (accessed 27 January 2020)