- Today on Newshub Nation, revelations about vulnerable patients discharged in the middle of the night. We have the exclusive figures. - Minister Peeni Henare with his response and Minister Ayesha Verrall on women's health. - And two countries, two couples, a pandemic and a baby. A story of modern surrogacy. Kia ora, good morning, I'm Tova O'Brien. - And I'm Mihingarangi Forbes. Welcome to Newshub Nation. Jacinda Ardern accused the MIQ worker with COVID this week of lying about their vaccination status. The prime minister later said she may have been a little blunt. - The electoral commission has referred the Maori Party to police after it failed to declare more than $300,000 in donations. Maori Party vice president and donor John Tamihere isn't commenting while police investigate. - And the government has outlined a range of proposals to end smoking in Aotearoa, including cutting the nicotine in each cigarette by up to 95%. First up today, revelations district health boards are routinely discharging elderly patients in the middle of the night. - Figures released exclusively to Newshub Nation show that in January alone, 156 people over 80 were sent home from hospital between 1am and 8am. I spoke to National's health spokesman, Dr Shane Reti, earlier and asked, 'What's going on?' - Yeah, that's really hard to explain. I mean, that is the worst time to discharge an older person, for any number of` There's nothing good about discharging older people at that time of the morning. Amongst other things, in the darkness, they're more inclined to be disorientated and confused. Where do you go and get your discharge medicines? All the pharmacies are shut. Absolutely nothing good to that. So we need to understand why that might be. And I think part of the questions are that ED is probably overloading so much, emergency department, that they're realising they're short of beds, and so they're discharging people out at hours that they shouldn't be discharging at. - And with your GP hat on, what concerns you about discharging the elderly in the middle of the night? - One of the big risks is what we call the transition ` the transition from hospital to home. And if you discharge them that early in the morning, what do you discharge them to? Their social networks are still asleep. Like I said, the pharmacies aren't open for their discharge medicines. It's poor lighting. They're disorientated. They're more likely to trip over a rug, and get a hip injury or other sorts of things. Not one single good thing about discharging older people between 8am and 1am. Nothing good. - And given that potential to be disorientated, do you think that there's a risk that elderly people are being taken advantage of here? - Look, I worry about that. I was contacted by people ` this is how I came to look into this ` by a older lady, 83, a kuia, who was discharged. And that was the concern for her family and her community ` that maybe she wasn't able to enunciate a reason why she shouldn't be discharged back to a rural environment. That she wasn't able to express herself adequately and make a persuasive argument why she shouldn't be discharged. So, it's possible they could be taken advantage of. It's possible. - And what were those numbers` the number of people being discharged in the middle of the night. What were those numbers like when you were in government? - Between what, sorry? - What were those numbers like when you were in government? - I have to say, I don't know. Because what I did was I asked for what were the latest, and the latest was actually back to January. And so I was able to say, 'Oh, this is what we did in the month of January.' So, I would need to ask again to see going further back. I actually don't know what it was when we were in government. - Are you confident it wasn't a problem under your watch? - Well, look, what I would say is I'd still stand by the policy, is that there's nothing good at discharging people from 1am to 8am in the morning. - And do you make a commitment then, if you are health minister after 2023, that there will be zero discharge rates of this type under your watch? - What I make a commitment to is addressing that policy, making it very clear to DHBs that it is unacceptable to discharge older people in these hours. - And, surprising, in a way, as well, traditionally, we see Maori disproportionately represented in health statistics for the wrong reasons, but this is predominantly non-Maori elderly who are being discharged from hospital in these early hours. Why do you think that is? - I've looked at that, and I don't have an explanation. It's not intuitive for what I was thinking, and certainly not the case that was brought to me that got me looking in this area. It was a Maori kuia discharging through remote environment. And that's why I asked, show me Maori and non-Maori. - And on that Maori inequality within the health system, why don't you support a Maori health authority? - Because, for us, health resources need to be distributed on the basis of need. And so` - The need is with Maori. - Okay, so if we stay with that principle, then Maori are generally in front of any health metric you want to talk about. So if we stay at a high level, a principle level, whoever has the greatest need` - With respect, that's not being borne out in the statistics, though, is it? Because Maori have more limited access to medicines, for example, than non-Maori. So it's not being borne out in the reality? So why not have an overarching body which is ensuring Maori are prioritised when they need to be? - But we can do that in other ways. We could do that with a required legislative Maori strategic plan for every DHB. So, yes, I agree with parts of what you're saying, but I don't think this may be the perfect mechanism to do that. I think there are other ways to do that. - Dr Shane Reti (SPEAKS TE REO) Joining me now to respond to those figures is Associate Health Minister Peeni Henare. Nau mai e te minita. - Kia ora. - Are you comfortable with that kaumatua kuia, elderly people being released over 80 between 1 and 8 in the morning. - Yeah, none of us should be comfortable with that. You know, I think about my own whanau, and I'd be absolutely mortified if that happened to my grandmother. So, yes, we do need to do better there. - Would you look into it? - Oh, I'm more than happy to. - And, as I say, Shane Reti, he's committed to making it clear to DHBs it's unacceptable. Would you make the same commitment? - Look, we've got high expectations of our DHBs. And we'll see coming up this week, the announcement with respect to our health reform work, which will place, might I suggest, the health sector as a whole into a different space. - Looking forward to that. We've got the briefing for Health Minister Andrew Little about the shape of the fund, the future of the Maori health authority. Maori health experts wanted a ministry of health by Maori for Maori. Will they get that? - They'll get an independent Maori health authority that they've been asking for. We've been quite clear about that. The challenge is as we get into the details about what does that look like and what they're able to do. And we're confident that come Wednesday, when the announcement is made, our people will continue to have a sense of optimism, but know that there's more work to be done. - So you're here now. So what about some of those details? Will it be independent? Will it be directly funded? Will they` will Maori have the commissioning powers that they need to make a real difference with those poor health outcomes? - We know we need to do something major to turn the dial for Maori health outcomes. And Minister Little has already made it clear that our expectations is that it will have commissioning powers. It does need to have the level of independence. But we've also been clear that it must still continue to have influence throughout the entire health sector, otherwise it stands out on its own. And we know that approximately 80% of our people continue to receive mainstream services. - So when you talk about commissioning powers, I understand that as they will be Maori, or some form of Maori ` and perhaps it'll be these iwi Maori partnership boards ` will be able to make decisions about and purchase the health services specifically for the needs of the people that live in their regions. So we're talking money. - Correct. - And if you consider that Maori make up 25% of the health system, it would be only fair, right, that they're spending 25% of the health funding, which would be about five billion. - Well, I expect that they will have a lot of money. I do. But what we know is`. - 5 billion? - We're not going to commit to a number now. But what we know is` - Is it close though? - While we transition, because it's not going to turn the switch on and the lights are going to be on in a building for the Maori health authority, we know that we've got to have a continued care for our whanau, wherever they might be, while growing this transition into the Maori health authority. My expectation is that in the future, it will have the resources it needs to turn the dial on health outcomes for Maori. - Maori can't make changes in health when they've got ghost dollars. So what kind of funding are you expecting? Even if you can't tell me the number; roundabout. Is it going to be equitable? Is it going to be equitable? - Yes, because it has to be. Otherwise, we won't get the outcomes. You'll see in the Wednesday announcement that the commitment to the Maori health authority is there. Then what we have to do as a government, and that's the challenge in front of us, is to make sure it's resourced. - Okay, let's talk about one of the other` some of the other advice that's in that paper is the shape of` the structures, the iwi Maori partnership boards. It suggests that these boards should be entrenched into law, because as we know, now we have the DHBs, and then we have a Maori advisory board, that really doesn't have a lot of teeth to it. So are you committed to entrenching those boards into law so that they stay? - That's always been my expectation and that's what I've been sharing, as well as hearing from our whanau, like the claimants to the Waitangi Tribunal with respect to hauora. That's the only way that, should any future government come in, they can't easily wipe it off the table. It's got to go through a process in-house. - And does the Health Minister support that? - The Health Minister has been hugely supportive of not just the work agenda that I've been progressing, but, of course, the agenda right across the board. He's engaged directly with some of our claimants and our Maori health providers to make sure we've got the right mix. - So in terms of Maori representation, and we're looking at these completely new structures in regions, we're looking at possibly a law change? - Most definitely. I think with the announcements that are scheduled for this week coming, the expectation is that there will be some legislative changes, and even perhaps even new legislation that will need to be done. But we'll leave that for the announcement on Wednesday. And from there we'll progress the legislative agenda. - Yeah, I guess, you know, for an example, in terms of why Maori need to have commissioning powers and authority and direct funding is because, let's take cervical cancer. Maori women dying two to three times the rate of other women. There are barriers to screening. I mean, simply just can't get there. So if a Maori health authority or a iwi Maori partnership board was able to purchase its own services and the argument from the experts, like the college of Maori doctors, is simple ` it would save lives. So are we going to be able to see that happening in this new structure? - As Minister for Whanau Ora, commissioning has been there for 10 years. So I'm a champion of that. - In Whanau Ora, it's quite a different budget to health. - No, you're right. But commissioning is the same. It's a different style of doing things that allows our people by Maori for Maori. And so I'm totally supportive of that. And you will see that. - Ka pai. Vaccinations, now. You have said that you're going to vaccinate tangata whenua in a different way, and that's because you're going to recruit Maori vaccinators. - Correct. - How many have we got? - Right now, we've gone through a number of training to make sure that we increase our Maori vaccination workforce. Off the top of my head, approximately 140 at the moment. But we're actively working with our Maori health providers to identify them, to bring them in. As I've been around the country, our Maori health providers have been pushing their people forward to do it. Not just the vaccination itself, but kaiawhina role. And I'm confident that as we look towards the second half of the year of the max vaccination of the entire population, we'll have those pieces in place. - 140 in a few months. Is that disappointing? - No, actually, because we know we've got a health sector that's under the pump. We've got a health sector that's tired and exhausted. And I don't blame a number of our whanau who just don't want to have to have an added responsibility. So we're working with our communities to make sure we get them. I'm confident we'll have them. But more importantly, what we need is a Maori way to be able to deliver it. And we've` as I've been around the country, we've talked about having it on marae. We know it's already on some marae. And we're looking forward to making sure that those services reach our people. - Yeah. Te Ropu Whakakaupapa Uruta, the Maori pandemic group, they've said that the government needs to be creative in the way that they've reached kaumatua kuia and Maori around the country, suggesting perhaps marae carparks and having volunteers with some doctors there to monitor in the part where you have to wait for 20 minutes. How creative have you been? What are some of your ideas? - Yes, so, marae. Actually, these ideas have come from the grassroots, if you like. Marae, re Maori only, because some of our kaumatua kuia, when I was in Kaitaia, only want to be dealt with in te reo Maori. So those initiatives are actually for our people to design. Our job is to empower them. What I don't want to see, however, Mihi, and I'll be quite clear, is the kind of cones in a car park, drive in, roll your window down and put your arm out. That is not a whanau-centred approach to making sure our people don't just receive the vaccine, but are also cared for on the journey. Because if we think it's hard bringing them in for the first shot of the vaccine, it's even harder to bring them back for the second three weeks later. - So Pfizer actually` Let's, on that, Pfizer's said that we may need a third shot. Are we prepared for that? Have you budgeted? What are the plans? - For the research, at the moment, for us here in Aotearoa, and Medsafe have been quite clear with us, is we'll continue to push out on our current vaccination programme, and monitor more of that research that comes in like the suggestion you've just made. But for now, we're still focused on our current plan. - I want to talk to you about a recent mental health report, which shows Maori are three times more likely to undergo mental health treatment from a court order. Five times more likely to be secluded. You know, is this really the best way, in this day and age, to be dealing with Maori who are mentally unwell? - No. And what we've always tried to push through a number of sectors, whether it be police, justice, and other places, is that we've got to take a health approach first and not a` and one that doesn't see them, you know, simply pushed through the justice system. - Why are Maori five times more likely to be locked up when they're in mental health services? Is it a relationship breakdown, or are they just more difficult patients? - I do think it's a relationship breakdown, in the first instance. There's a big challenge for trust with respect to our people and institutions, whether they be government or not. So we've got a relationship challenge there. But what we also know is we've got an infrastructure challenge. We simply do not have enough services at the moment to meet the need and demand of, not just Maori, but the general population. So we've got one hell of a job to do, I'll acknowledge that. - But this government pledged $1bn to mental health. Where is it? - Over five years, let's be clear. So for my part, as minister responsible for the Maori aspect of that, ring-fence was just over $60m. We spent, and we were quite deliberate in the first year, looking towards how we support and craft our function to be able to support kaupapa Maori initiatives in that space. At the moment, we've seen just over $11m go out the door. By June, my expectation, and what I've been advised, is it'll be closer to 15 million. And we'll continue to work on that. - What does that equate in beds? Maori are saying, you know, that they are struggling with their whanau who have addictions to P and the rest of it. And they're living in the same homes with them. They can't find places for them. So, I remember Meka Whaitiri talking about a couple of beds that were being developed up the coast. Do you have a number on beds now? - I don't have a number on beds, but we were committed to rebuilding that infrastructure. The money that I just spoke about isn't for those beds. It's for particular kaupapa Maori initiatives in our community. - You're the Minister for Whanau Ora. It was this week revealed that the National Maori Urban Authority, which is the collective of Whanau Ora providers, donated $50,000 to the Maori Party election campaign. Are you comfortable with that? - Well, look, what the National Urban Maori Authority does is entirely up to them. - Is it? - It is. Look, you know, and what I've made clear in the past as` through elections, is for Maori organisations to pick a side or to pick a team, I think is probably more an ethical challenge. For example, where I come from, if they only put up hoardings of myself, my expectation is that they give the other Maori candidates the same chance. - The National Urban Maori Authority is a collective of organisations that deliver social services. They are government-funded. - Part government-funded. They get money elsewhere, too. - So you're okay with that? - As minister for Whanau Ora, we contract our services directly to the Whanau Ora commissioning agency. I'm comfortable, and as I've mentioned recently, all the reports I've seen and the engagements I've had with the commissioning agency providers and whanau, we smashed it in the last 14 months with respect to COVID. Whanau Ora has been the highest performing, one of the highest performing portfolios in this government, as far as I'm concerned. - So those Whanau Ora providers have said they don't have enough money to deliver their services yet. They're able to give $50,000 to an election campaign. - Well, they'll have to take that up with the National Urban Maori Authority. I've got no say over the National Urban Maori Authority, but happy to work with them. - Tena koe te minita. Tena koe mo to haere mai. - Tena koe. - If you've got something to say about what you see on our show, let us know. We're on Twitter, Facebook, Instagram ` Newshub Nation New Zealand. On our Twitter panel this morning are Tim McCready and Bevan Chuang. (SPEAKS TE REO) We dissect this week's news with our political panel. But first, Tova goes live to Dr Ayesha Verrall on the crisis points in women's health. Associate Minister of Health Doctor Ayesha Verrall. She's responsible for much of women's health and, of course, is fresh from the public health front lines herself. Thanks for joining us this morning, Minister. Kia ora. - Morena. - You've just launched your big plan to get New Zealand smoke-free. But if you lower nicotine in cigarettes, won't those who are addicted just end up buying more cigarettes to get the same hit? - There's been quite a few published studies on doing this, and that might happen if you only lower it a little bit ` say by halving the amount of nicotine in cigarettes. So if you go ahead with a measure like that, and remember, in our smoke-free document these are all proposals. If you do go ahead with something like that, it has to be very low nicotine content ` lowering it by 95%, or something like that. So this has been tried in studies, but it hasn't been rolled out in the community. One of the purposes of taking this to consultation is to see how people think it might work were we to take that measure as a form of harm minimisation in New Zealand. - I suppose, given that we haven't seen it borne out in reality or done in practise before, you can't guarantee that people won't be just buying so many more durries to get that same hit. - No, I think we do` we can say that from the published data. If you have a very low quantity of nicotine in there, then people don't compensate and smoke more. But I think the questions I have about this policy are more about whether it can be scaled out in the community outside of just smaller trials where it's been used. So that's why we're interested to hear from people on how they think it'll work in real life. - I suppose that given that Maori and Pasifika people are more likely to be smokers, isn't there a risk that the unintended consequence could mean that those households end up financially suffering? - I think the main thing we can do to address the financial hardship caused by the high cost of cigarettes is support people in quitting, and that's at the heart of the proposals that we've launched. So that includes making sure that people who are addicted to nicotine are not confronted by tobacco on every street corner, which is the current situation. And secondly, we're able to be much more forward-thinking in what we do about quit services now, because we have the availability of vapes as a more realistic alternative for people to move on to. So, I feel like we're at a stage now where we can regulate more because there's a humane alternative to cigarettes that can support people in their quit journey better. - But on vaping ` isn't there a risk that you're creating a whole new generation of nicotine addicts? Nicotine as addictive as cocaine and heroin, just a different delivery method? - Yeah, I agree with you, Tova. It's a really important point that nicotine is as addictive as cocaine and heroin. The point about vapes, though, is that we can regulate how available they are so that we optimise their use as a quit tool and not as something that's available for young people to get hooked on. We're currently` - But right now, smoking cessation` Sorry to interrupt, but right now your smoking cessation campaign looks a bit like an advertisement for vaping. And vaping ` we don't know the long term effects, do we? How do you know it's safe? - So we know it is far less harmful than tobacco, and I think that is absolutely clear. 5000 people die a year from smoking tobacco in New Zealand. So it is a legitimate harm minimisation approach to use vapes. And we have the option to regulate how they're used in our society now that we have the Smoke-free Vaping bill passed last year, and now we have the ability to regulate where vapes are sold so that they're not as accessible to children as they currently are, but they can be used as a quit tool. - We've got a lot to get through so I want to` - Those regulations are` Sure. - I want to move on to midwives. Shortages right across the country. At Capital Coast, there are 30 vacancies. 10 midwifery roles are being filled by nurses. Are we failing mothers and babies? - We have to make sure that we improve the sustainability of the midwifery workforce, absolutely. And` Though, there's a number of things we're doing in midwifery. We, in the last term of government, put over, I think, $240 million into maternity. And that included` We've already increased the amount that midwives are paid. We're working through the practicalities of making sure they're paid for the complexity of the women they look after, and if they're in rural areas, paying them more for that. We also have long term sustainability issues with the workforce, which is behind those statistics you mentioned. A couple of weeks ago, I launched a programme in midwifery schools to improve that ` particularly building up the recruitment and retention of Maori and Pasifika midwife students. Almost half of the Maori and Pasifika midwifery students that enter midwifery school don't complete. And we've got a really practical solution for that ` making sure there are Maori and Pasifika leaders in midwifery schools, making sure that we build a network of support around those students, and that small matters of financial hardship don't make them drop out. - I mean, that's a really good point, because 50% of those Maori trainees going into midwifery training ` they're not leaving with the qualification. Why is there that disparity, and are you acting fast enough to address it? Because Maori midwives are saying they don't feel culturally safe during that training process. - Well, precisely. I think it is an issue of cultural safety, so we can build up the numbers, make sure that you're not alone if you're a Maori and Pasifika midwifery student. And part of that is connecting those students to a national network. They go on hui together during their semester breaks. But, also, these are the initiatives government is doing. We're also depending on faculty to show leadership, and they are, in re-doing the curriculum in conjunction with Maori midwives to make sure that it is culturally safe. Every woman deserves clinically and culturally safe care in New Zealand, so it really is about changing the way that we're teaching midwifery to be more inclusive. - Because, at the moment, they're not getting it. ACC's decided, Minister, not to fund women with perinatal tears ` an injury during childbirth that is clearly an accident. These women aren't doing it on purpose. Shouldn't the public system be there for them? - Yeah, so let's just be clear ` ACC is about how your treatment is funded, and there can be advantages of having your treatment funded by ACC. But if you need treatment, it is available in the public system, whether you're ACC funded or not. But, in any case, I agree. There is a point here about women's health, and we need to make sure that women are being treated equitably here. I know Minister Sepuloni has sought further advice on how we can progress on this issue. As she's minister of ACC, she'll be taking that forward. - In France, all women have access to physiotherapy after giving birth. Here, if we break a bone, we get it. Why that disparity? Why for people` Think about, you know, old blokes on the rugby field on the weekend, maybe drinking beer, not looking after themselves ` they're getting ACC. Why are women injured in childbirth not getting ACC? - Yeah. So, I think, just to unpack that ` you're right to point out that if you have access to ACC, you often can get physiotherapy more easily. So that's precisely the issue that Minister Sepuloni will be getting further advice on, because we do want to make sure this is equitable. - OK. So you'd like to see free physiotherapy for women after childbirth, yes or no? - I want to see women treated equitably in the system. - OK. I'll take that as a yes. Cervical screening ` why isn't it free, Minister, for all women? - Yeah. So it's run` It is true that some women have to pay a part charge when they go for cervical screening. I think that is` - Someone told us this morning they paid $68 for their last smear. - Yes, and that is how much I paid for my last smear as well. The issue here is that we have part charges throughout our system. Just` You know, every time you go to primary care or go to a pharmacist, you pay a part charge. Is there a particular impact on women in this? I think one thing to bear in mind is we do factor in women when we fund health services. Women have a slightly higher amount of funding in the population-based funding model that DHBs use. But nonetheless, there are these charges. We recognise that is a barrier` - Back of the envelope maths ` if you gave free cervical smears to every woman between 25 years old and 70 years old, at 40 bucks a pop, that would cost just $18.5 million. 50 women are dying every single year. Are those 50 lives not worth $18.5 million? - I think I am determined to improve our cervical screening programme, and that might require action on a number of barriers. - Free smears? - We do fund` We do fund free smears for women from low income and Maori and Pacific backgrounds in many DHBs. We have initiated that` - It's not across the board, though, isn't it? It's not across the board, though. - No. - So even if you just honed in on Maori women, because they're twice as likely to not be diagnosed, they're far less likely to go and get a cervical smear, that would be just $2.5 million. That is a drop in the bucket. Just commit to funding it for all Maori women. - I think, Tova, I'd like us to look across the different range of barriers to accessing cervical screening, not just funding. And I think we need to be looking at how we're running that service, whether we're able to use information technology better to make sure we're reaching everyone, and I'm also working very hard to make sure that we're able to progress the move to HPV screening. So there's action required on a number of fronts, and I don't think funding is the only one. - OK, so what about rolling out self-swabbing for all women? Make that happen. Commit to that at least. - Yeah, so. So, what we` We're working very hard on that, Tova, and I'm afraid I can't commit to it today, but I do want to take the time to explain it. - It's already been delayed. It was supposed to be rolled out years ago. - I want to take the time` I want to take the time to` Well, unfortunately, it was committed to by the National government in 2016 with no money allocated to it. - You lot have had a whole term now. - Let me explain a little bit about how this will be going forward, because I think it's really important that women understand. We have a really good cervical screening programme at the moment, and I encourage everyone to get smears in it now, even before HPV screening is available. If we had HPV testing, that would improve the performance of the test somewhat, and that would mean we'd pick up more people. I think some people assume as soon as we get HPV screening, we'll be able to operationalise self-testing for women and hopefully break down some of the barriers of going to a clinic for that. That's an area` - I'm afraid we have to leave it there, Minister. That's all we have time for but we're very grateful for your time. Kia ora. - Kia ora, Tova. - Up next ` news and politics with our expert panel Brigitte Morton, Lady Tureiti Moxon and Doctor Rhys Jones. Plus ` a story of modern surrogacy spanning two couples, two countries and one global pandemic. Dr Rhys Jones, who is the senior lecturer in indigenous health at Auckland University, former National staffer turned political commentator Brigitte Morten, and chair of the National Urban Maori Authority, Lady Tureiti Moxon. Tena koutou. Can I just dive into the elephant in the room there? As the chair of the National Urban Maori Authority, I just heard the minister, Peeni Henare, say that it's actually up to you whether you support a political party. But I guess is it acceptable that $50,000 went to the Maori Party? - Well, in actual fact, as you know, there is an investigation before the police at the moment. Goodness knows why they're wasting taxpayer's money on that. But, anyway ` in terms of the Maori Party. But, you know, Maori have supported things that are Maori Mana Motuhake, tino rangatiratanga, by Maori, for Maori. All... All the time, and that's what we've been talking, that's what we've been saying, and that's what we will continue to say. And as far as I'm concerned, our... our people are the most important to us, and we will do everything in our power to support them. - We will wait for that investigation, then maybe we'll talk to you about it at the end of that. You're an advocate for the Maori Health Authority to have direct funding, to have autonomy. What are your thoughts? Are you optimistic come Wednesday after hearing the minister? - Well, the minister has been saying all along that we are going to have a standalone independent Maori health authority. But as he said, and as we all know, there hasn't been a lot of detail around that, and how that looks going into the future ` I'm very optimistic, because if we don't change things now, it's never going to change. And as you know, and you've heard it already from both ministers, that things are not looking good for Maori. - And Rhys, what are you expecting in terms of the power-sharing arrangement? - Well, we'd certainly like to see, you know, a lot of power invested in the Maori health authority. But what I would also say is that Maori health authority really is a step in the right direction, but I think it doesn't go far enough, really, towards a really Tiriti-compliant health sector. And so, I think that's reflective of the health system review in broad terms that it's really rearranging the deck chairs. It's not addressing the fundamental crises that we have in the health system. - Brigitte, Maori account for 25% in the health system. The minister wouldn't say whether it would be 25% of the funding, but it has to be fair and equitable. What would be fair and equitable in terms of direct funding? - Well, I think what is key here is not necessarily how much funding, but how it is actually delivered, and that's what's making a difference on the ground. And I think what has been missing is ` exactly right ` it's the detail. It's to stand up on a Wednesday and show us the legislative reform. That's kind of the easy part. That actual function of, actually, what will that mean on the ground? Who has authority? Who can make decisions? That is the key, and that will be the only way that makes a difference. - Do you agree that it has to be treaty-led, though? Treaty-based? - Well, I think, absolutely, you've got to look at what is going to make the most difference to people's health, and if that is going to make the most difference, then absolutely we should be focussing on that. - Can you give us an idea of what more you'd like in terms of a treaty-based framework? - I would really like to have seen the health system review done in a treaty-based process. So, rather than being led by, you know, the usual suspects who were trying to solve the problems that we have within the same kind of thinking, the same worldviews that have led to the crises in the first place, I'd rather have that set in a treaty-based partnership and coming up with, you know, fundamentally looking at what do people need to achieve well-being? And then basing the way we fund, deliver, and hold to account those who are providing services to meet those needs. - I guess some of the examples we can use are actually from Dr Ayesha Verrall, when we're talking about the massive gaps in cervical smear testing and the rest of it. So, a Maori health authority, right, would be able to purchase its own health for their specific people. Would that be how you see it? - Absolutely, and I think one of the areas that we are missing in is really around the diagnostics ` diagnostic X-rays and all that, all of that kind of thing. Pathologists, radiologists and surgeons being in the same room as where we want to head and we want to go, and absolutely I think... you know, it's timely that we change things, and that Maori started to lead out what is right for us in a treaty-based way, in a treaty-based... with a treaty-based lens. - And it's bonkers as well, isn't it, that women are dying from a preventable disease? The government's been talking about rolling out self-swabbing for years, since 2017, 2018. Why, Brigitte, the hold-up? Why still, after all of this time, when we know that this works and this is a way to reach some vulnerable communities? - Yeah, I think there's actually a cultural issue happening here around how women's health is treated. And, you know, it really shined the spotlight, unfortunately, as a result of Kiritapu Allan's diagnosis with cervical cancer. But the number of conversations I've had with women over the last few weeks about the difficulty they have had as professional woman, as women that are able to advocate for themselves and accessing their health services and being able to be taken seriously for the health problems they have. So I don't think it's just` I would love to see, you know, more diagnostic tests and I'd like to see people have more access and easier access. But actually, I think, fundamentally, we have to be saying in this day and age, women's health ` we shouldn't just say, 'This is the normal.' - So, on top of, you know, these issues like the access and all those kinds of things, when you add the layers of poverty and your inability and the barriers to get there, how do you` I mean, does the government just have to make this an absolute priority? Were you disappointed that there's no commitment? - Absolutely. And I think, as, Brigitte said, it's reflective of, I think, a culture and a basis of our health system within, you know, sort of colonial, patriarchal norms and values that mean that we have a problem like cervical cancer, you know, disproportionately affecting Maori women. We have a great intervention here ` potentially life-saving intervention ` it's been rolled out in other countries, and yet we're seeing delay after delay. And I think, you know, if this was a problem that, you know, that predominantly affected Pakeha men, we wouldn't be seeing these inexplicable delays. - And what about those things around ACC ` the lack of physio for women after childbirth, the lack of ACC for perinatal tears, Lady Tureiti? - Yes. Well, I think things need to change desperately there, and especially given that Maori have been sort of locked out, really, of contracting with ACC over many, many decades. And so I think that it's timely. It's timely right now that we change the way things are being done, and certainly, as you were saying, that women take more control around what's right for us, and I think that that is where we are heading to now. - We might need a hikoi to Parliament. - Oh. (ALL CHUCKLE) - National Party leadership rumours are swirling again this week that Judith Collins won't last as the National Party leader. Do you think she will? - Well, I mean, every time after an election, there's always discussions about leadership. Could it have been dealt with better in terms of squashing these rumours this week? Absolutely, and I think there's a clear signal that came from the electorate, you know, in the election last year and the National Party membership that they don't want these discussions. They want to see the opposition doing the opposition job. - And does this just become self-fulfilling? Is the National Party just going to be in a death spiral until it can actually cauterise these leaks and these rumours and these murmurings and whispers? - Well, I think that that's going to be the case for a while yet. And because we were all so focussed at the moment on COVID and the vaccine rollouts and all the things that have been taking our attention lately. But I think that she's got some trouble there. - And I know you don't want to get too into the politics, but it's important, especially given all of the things that we've traversed this morning, right? It's important to have a strong opposition to be able to hold the government to account. - Absolutely. And I think we have seen failures as part of the COVID response, for example, and we've seen sort of almost a culture of trying to deflect that responsibility, and I think, for those reasons, we certainly need to have strong opposition to hold the government to account. - Tena koutou. E whai ake nei, our special report on modern surrogacy. Plus, jeers and tears in the halls of power this week. - If you want to have a surrogate carry your baby in New Zealand, there are no specific laws, only adoption laws that date back to 1955. - The law commission is reviewing it, and MP Tamati Coffey has written a member's bill to try and make the process easier ` changes that would be welcomed by one extraordinary family that managed to bring a baby into the world via two countries and a global pandemic. Simon Shepherd has their story. - Hello, sweetie! - Vera. Hi! Hi. - (VERA COOS) - (LAUGHS) - Two women and one baby ` Vera Grace. Ashlynn is her mum. It was her egg. She lives in America. - It was such an amazing gift that we were given. Given by her sister-in-law, Rebecca, who lives in New Zealand. - It is a big thing. You can't deny that. I like to say, 'No, it's not,' but it is. You're dead right. It is a big thing. You know, it's nine months of your body being occupied by someone else. And then there are the men ` Rebecca's husband, James. - Look at you, blowing bubbles. - And baby Vera's dad, Tim. - Oh, she's doing good. Yep. We ran a couple of errands this morning, took her to Briscoes and to Bunnings. - So, it's really four adults and one baby and a surrogacy story that started when Ashlynn and Tim lost their first child. - So, these are Grace's footprints. So, this is Vera's big sister. - Grace was stillborn at 23 weeks and five days ` only just too young to survive. We still have Grace, just in a different way, and she's led us to Vera. So, you know, quite amazing. - Because when Grace died, Rebecca immediately offered to be their surrogate. - No, I like a challenge. (LAUGHS) - Understatement of the day. - Because a lot of women would say, 'I've had three kids. I've done my time with having children.' - Yeah. - Why would you want to do it again? - It's a way we could help them have a family, and they wouldn't have been able to achieve that otherwise. - Not one of those things you think you're going to hear from your sister, but, um, just, you know, an amazing offer, and once we found out that we didn't have many other options, it just became, you know, the ultimate gift and offer. So it was awesome. - But what lay ahead was two years of twists and turns. Ashlynn and Tim live in Delaware in the United States. Through IVF, they managed to create five viable embryos. - We thought, how do you choose just one? Do you pick a boy? Do you pick a girl? Do you just go for the strongest one? And our clinic was wonderful, and they decided for us and chose to utilise our strongest one that was frozen first. Back in New Zealand, Rebecca was preparing her body. - That was injected into my stomach each night. That was to prep everything, make sure the lining was nice and ready and what have you. This beauty, I had to inject into my rear end. - So the embryo was chosen. The plan was a family trip to Disneyland while Rebecca was implanted. But then came a shocking letter from the Blood Foundation for James. - Effectively, it just said that you need to go to the doctor because we've detected leukaemia in your past donations. - And we knew that it was gonna be one of the two strains of what he had, and with one of them, you would have probably been dead in three months, and the other one has a fairly good life expectancy with the right medication. - But that didn't deter the couple. - We were still doing it. I wasn't giving up on taking the children to Disneyland because of cancer. (ALL LAUGH) - No, and I had sat down and had a heart to heart with myself, and I couldn't... I couldn't bring myself to let that get in the way of allowing them the chance of being parents. - So the holiday went ahead. Rebecca was implanted and carried Ash and Tim's hopes back to New Zealand, and then a two-week wait until a blood test to see if she was pregnant. She wasn't. - I think I probably had a good 24 hours or so of, you know, crying and thinking, 'This sucks and life's not fair,' and, you know, all the normal things you think when something like this happens. And then I was like, 'OK, let's do this.' - Of course, you know, we're a bit hesitant because we're a bit guarded because of losing Grace, and now we lost this embryo. We thought, 'OK, we have four more chances to make this happen.' - So Rebecca went back for round two. This is the moment of implantation. And this time, it was different. - I rang` Skyped them, and I held the pregnancy test up and I said, 'I think I'm pregnant.' They're like, 'Are you sure? It's too soon to know.' I said, 'How quickly that line came up.' I said, 'Yeah, I'm sure I am.' - It felt how we expected we'd feel. You know, a little... well, very excited, but also a little strange and a little distant. But no. Overall, very happy and very excited with what was about to come. - That was January 2020, just before COVID took hold. New Zealand shut its borders, the death toll in America skyrocketed, and Ashlynn and Tim were on the other side of the world. - Yeah, there's nothing quite like growing a baby in somebody else's womb across the world in a worldwide pandemic. You just can't make these things up. - But there were weekly Instagram updates, pictures after every scan, and an opportunity for James to have a joke. - 'Congratulations.' 'Oh, it's not mine.' - As unusual as the situation was, the pregnancy was smooth. But getting to the birth was not. Ashlynn, an American, had to get a compassionate visa to come here, then the couple had to stay in managed isolation, and that was the first time they saw their baby. - So, Rebecca was able to come and visit us, and so we were able to see Vera as a baby bump through the fence. - Then it was time, and in September 2020, Vera Grace was born. Four parents in the birthing suite debating who gets to hold the baby first. Ashlynn did. But is there an overriding urge as a mother just to have that bond with that baby that you've born? - I've created this amazing, beautiful child, and I love her to pieces, but as I... But she's not my baby. - And that should be the end of the story ` Ash and Tim finally had their baby. But it wasn't theirs. Under New Zealand law ` the Adoption Act of 1955 ` Rebecca and James were the legal parents. Yeah. How crazy is it that` well, in your view, that you have to adopt your own biological child, Tim? - That's kind of a kick in the pants, really. I know the laws are very old and they're in the process of looking at them and trying to change them. But, yeah. It's just` It makes things` (VERA SCREAMS) Sorry. (LAUGHS) It makes` - Do they frustrate you? - Yeah. Yeah? - The politician trying to change the laws is Labour MP Tamati Coffey. He has a member's bill suggesting amendments born out of his own experience of using a surrogate to have a baby with partner Tim. - To become a surrogate parent is really, really hard. You have to go through so many processes. - Currently, surrogates in New Zealand cannot be paid, but Coffey wants the law to allow payments of reasonable costs like lost income. He also wants a surrogate registry to make it easier to find a woman willing to carry your baby, and he wants to replace the adoption process with a court order so the intending parents are the legal parents from birth. That way, no one can back out. - There have been case studies where baby has been born via a surrogate, and actually, the intending parents find out the baby has an intellectual disability and there have been complications through the birth. As the law stands, there is no protection whatsoever for the surrogate. So the intending parents can actually just walk away. - And there's one more process he would like to get rid of. Currently, people like Ash and Tim, who want to use a surrogate, have to receive approval from an ethics committee and prove to child welfare agency Oranga Tamariki they will be suitable parents. - Anyone can get pregnant and pop out kids as long as they like without any sort of prerequisites or proving that they can be a standard... (LAUGHS) parent of a good standard, and that kind of thing. So it is, you know, pretty frustrating. - That's quite confronting ` sitting there in your house, having somebody with a clipboard sitting there, asking you quite probing questions about yourself, about your health history, about your relationships. - Tamati Coffey is not the only one looking at surrogacy laws. The Law Commission is conducting a review and hopes to begin its public consultation in either August or September. But Coffey believes that process will take some time and is hoping to get his bill before Parliament a lot sooner. Ash and Tim say the law change could help other would-be parents. For them, it took several months in New Zealand to adopt Vera and then get her an American passport. But finally, it was time to say goodbye to the woman who brought Vera into the world. How do these last kisses feel, Rebecca? A bit bittersweet. - Yeah. - I knew it was coming. (ALL CHEER) - Ash, Tim and Vera made it back to America in March. COVID is still out of control there, so Vera met her relatives from a distance and had masked cuddles. But it's likely she will be back in New Zealand because she may get a brother or a sister. Would you do it again? - Absolutely. In a heartbeat. - Why? - Because I love a challenge. (LAUGHS) - You're a remarkable person for offering to do it again. - I think she is. - Yeah. - You have to say that. You married me. (ALL LAUGH) I... I like to think that I'm just... It sort of boils back down to the golden rule, doesn't it? That I'm treating someone the way I'd like them to treat me if the roles were reversed. - Stay with us. We're back after the break. - Dr Rhys Jones, Brigitte Morten and Lady Tureiti Moxon. Before we move on from the National Party issue, I wanted to know, if Simon Bridges, from my iwi of Ngati Maniapoto, was to make a comeback, do you think he'd be more popular this time around? - Well, I think leadership is not just about who the person is. It's about timing as well. And we saw last year that, you know, Simon Bridges was a very good leader of the opposition pre-COVID. You know, we were looking down the barrel of an election that, you know, could've been a first term, one-term Labour government. But unfortunately, then COVID, and the combination of that with Prime Minister Ardern, both those factors still exist. So I think until that sort of moves on, it's going to be difficult for him to make traction. - The government's planned smoking, proposed smoking changes ` on the face of it, do you support them, Lady Tureiti? - Well, I think we have to do something better than what we've been doing all along. And especially if we're going to meet the targets that have been set. The issue is that, previously, they took away all of those contracts away from Maori providers. So, in actual fact, we were actually left out in the cold. So, vaping. Well, I'm not sure, you know. You're just exchanging one habit for another, I think. - And do you think that Maori could disproportionately be impacted financially, given that they're reducing nicotine in cigarettes? I mean, the minister's saying it won't make much of a difference, but it's hard to see it not, really. - Absolutely. So there are some really sensible policies or, you know, suggestions within that package. But they could certainly disproportionately impact on Maori. Not just financially, but in other ways as well. We've seen, you know, pretty much everything that comes out from the Ministry of Health in terms of population health programmes has disproportionately adverse impacts on Maori, and tends to preferentially benefit Pakeha. And so, yes, whatever happens needs to address those inequities. - If we had a Maori health authority with all the bells and whistles, how would you address Maori smoking? - Well, I think that's a very complex question, but I think addressing it from a kaupapa Maori perspective is the answer. And it's likely to include a lot of the things that are being done. For example, reducing the availability, getting it out of our sort of socialised norms, I guess. And so part of the whole process is to reduce the social licence of tobacco industry to operate. And that's where I would see kaupapa Maori approaches coming from that perspective. - Shall we talk a little bit about hate speech? There was a cabinet paper that was released this week which showed us that the government's looking at moving hate speech offences from the Human Rights Act to the Crimes Act, which could see some people penalised. Brigitte, is that a good move? - I'm really concerned, actually, about what has been put on the table here, because it really looks like a punitive approach to trying to manage what should be actually about education and communication. Trying to take an approach in which we penalise people with up to three years on a really drastic thing like freedom of speech issue is really drastic. And I think it needs to be done really carefully, really slowly, and being done with a lot of consultation. - Don't we need to be protecting some of those other vulnerable groups, though, like the rainbow community, people with disabilities who aren't currently covered by the legislation? - I think we have to be very careful in the way in which we do it. And I certainly am not in favour of any kind of hate speech going on anywhere, absolutely anywhere. But I think we do need to consult. We do need to talk more, because otherwise what that does is it just brings out more negative defensible people or offensible people. And, I think, in our country, we can work on that and we can do some good things. - We know that, you know, people who are doing hate speech often move on to do something more violent, but difficult would it be to, kind of, pick out the hate speech from all the other freedom of speech? - Incredibly difficult, but I think it's an important thing that we need to do, particularly as Lady Tureiti said, to, you know, extend that to groups who aren't currently very well protected. - Just quickly on that ` because, you know, when we did introduce the Terrorism Act, it was actually Maori that were targeted. And is that an issue here? That it would be Maori that would be targeted with that? - Absolutely, and so we'd have to be very careful to ensure that the right people are being targeted. - All right. Kia ora koutou. Thank you very much for joining us, Dr Rhys Jones, Brigitte Morton, Lady Tureiti Moxon. Kia ora koutou. There were tears, jeers and awkward silences in the House this week with accusations of lying, and one leader almost crying. Here's Finn Hogan with the week that was in Wellington. - Haere, haere atu ra. - An unusually sombre start to our week in the House as MPs paid their respects to the late Prince Philip, with even Judith Collins holding back tears. - I thank him for his service. I thank him for his courage. I thank him for being outspoken, and I thank him for his wit. Rest in peace. - And, of course, it wasn't long before we were back to scenes like this. - Is it a fresh point of order or is it the same thing being re-argued? - It's just` It's just a clarification, Sir, because` - Well, there's no such thing as a point of clarification. The member knows that. - There was even a rare moment of quiet as Rawiri Waititi stumped the chamber with this question. - What does unconscious bias mean? Does that mean bias whilst asleep? - And it was the accusation heard around the country ` Jacinda Ardern being unusually blunt about the COVID-positive MIQ worker. - That it is obviously quite difficult when an individual, as we've been advised, has lied about being tested. - ALL: Ooh! - It wasn't all drama this week ` ACT's Nicole McKee kicking back with a spot of knitting. Well, you have to take your breaks when you can get them in this business. And the house isn't sitting next week so there'll be plenty of time for this... and not so much of this. - Order, order, order. Order! - That's all from us for now. Thanks for watching, and thanks for joining me, Mihi. - Well, tena koe whaka wa. Thanks for making space for me. - Hei kona mai, I'll see you here again next weekend. Captions by Steffi Dryden, Lillie Balfour and Cameron Grigg. Captions were made with the support of NZ On Air. www.able.co.nz Copyright Able 2021 This programme was made with the assistance of the New Zealand on Air Platinum Fund.