Waitangi Tribunal research report

8 February 2019

[Name and contact details redacted]

Dear [Name redacted]

REQUEST FOR INFORMATION

Thank you for your request dated 20 December 2018 under the Official Information Act 1982 (OIA) for information relating to health services and outcomes for Maori. 

Set out below is the responses to the information you requested. You asked for:

1. For the Pharmac Board and each of Pharmac’s advisory committees:

• How many members are Māori.
• How many members are non-Māori.
• How many members are disabled Māori.
• How many members are disabled non-Māori.

We do not hold this information. We do not ask Board or advisory committee members for information on their ethnicity or disability. For some advisory committees, some members are chosen for their experience with specific ethnic groups. 

1. Does PHARMAC offer the Board, and its advisory committees any training to build their skills and expertise in cultural safety / competence and in disability responsiveness? Please provide evidence of this.

There is no training to build skills and expertise in cultural safety/competence or disability responsiveness offered to the PHARMAC Board and PHARMAC advisory committee members.

1. How did Pharmac ensure the participation of disabled Māori in the development of Te Whaioranga (2012-2023)?

We worked with a range of government and non-government organisations, regional and local Māori health providers, and relevant Māori organisations, and with PHARMAC staff, to develop Te Whaioranga (2013 – 2023). This involved reviewing the previous version and developing a new action plan. We undertook a variety of activities to consult widely and gain participation from a broad range of stakeholders, however we did not specifically ensure participation of disabled Maori.

1. What mechanisms does the organisation use to ensure disabled Māori are involved in its strategy, policy, implementation, service design, delivery, evaluation and monitoring? Please provide any terms of reference or supporting documents.

We have no formal policies ensuring disabled Māori are involved in these areas.  

PHARMAC uses its Factors for Consideration when making funding decisions. The health need and suitability segments may be particularly relevant to people with disabilities. These require us to consider the impact of the disease, condition or illness on the person, their family or whānau, and also to consider the non-clinical features of medicines or medical devices that might impact on health outcomes.

Some examples of activities we have undertaken to meet the needs of people with disabilities include:

• working with the Blind Foundation to get advice on blood glucose meters for visually impaired
• testing that the packaging of medication used for arthritis could be opened by an arthritis sufferer, when we were changing the brand.

1. What training does Pharmac offer staff to build their skills and expertise in cultural safety / competence and disability responsiveness? Please provide evidence.

*PHARMAC has offered Te Reo lessons with Piripi Rangihaeata since 2015 on an on-going rolling basis.  However in 2018, we moved to an 8-week block course structure. Only the current block courses are noted in the table above.

During an employee’s induction, they receive the attached PHARMAC documents (Te Whaioranga 2013-2023, Te Ara Poutama reference book, and Lifeline, which includes a section on Te Whaioranga and other aspects of our Māori responsiveness) to support their cultural competence in their employment at PHARMAC.

PHARMAC has a close relationship with its Kaumātua who provides advice and support to the Chief Executive and to staff.  PHARMAC’s Kaumātua and senior Māori staff member, its Kaiwhakahaere Whakarata Māori, provide advice, support and coaching on kawa and tikanga to staff across the organisation as required. PHARMAC celebrates a calendar of events including Waitangi, Matariki, te wiki o te reo Māori and Mahuru Māori with culturally appropriate processes, including waiata, mihi whakatau and pōwhiri.  These provide additional opportunities for staff to gain cultural knowledge and understanding and to learn from our Kaumātua and Kaiwhakahaere Whakarata Māori.

During 2018, PHARMAC celebrated Waitangi, te wiki o te reo Māori and Mahuru Māori and also held seven pōwhiri or mihi whakatau with all, or some staff.

1. What proportion of staff (by profession) have undergone 1) cultural safety / competence training, 2) disability responsiveness training and 3) both cultural safety/competence and disability responsiveness training?

PHARMAC does not hold this information broken down by profession. Staff are not employed in public-facing clinical roles.

1)    Cultural competency training: All staff are offered cultural competency training as part of their induction. As noted above, all staff receive informal cultural competence training from the PHARMAC Kaumātua and Kaiwhakahaere Whakarata Māori in the context of cultural events.

In addition, 75% of current permanent staff completed Te Tiriti o Waitangi Workshops from 2015 to 2018. A further workshop is planned for March 2019. All staff are expected to complete this training in their first year at PHARMAC. New staff who have completed this training in another organisation are offered the opportunity to attend a Te Tiriti o Waitangi workshop at PHARMAC.

We do not offer cultural safety training.

2)    and 3) PHARMAC does not offer disability responsiveness training.

1. How much did Pharmac spend, for each of the past five years, on “contractors and consultants”, “staff” and “training and development” broken down by:

• Māori.
• Non-Māori.
• Disabled Māori.
• Disabled non-Māori.

We do not ask contractors or consultants for information on their ethnicity or disability. We do not ask staff for information on their disability. We ask staff for information on their ethnicity, but staff can choose not to disclose this. 

The figures for Māori include all those who identified as Māori. This group includes people identifying with multiple ethnic groups that include Māori.

Non-Māori includes all other staff, including those who have not specified their ethnicity.

1. How does Pharmac ensure disabled Māori benefit from action it is taking to achieve equity in medicines access by 2025?

As PHARMAC is early in the development of its medicines access equity work programme, at this stage we do not have specific actions underway aimed at improving medicine access for disabled Māori.  Given the compounding barriers to healthcare faced by disabled Māori, PHARMAC will seek to actively engage with disabled Māori, particularly as we take forward our consumers voices work programme, which is aimed at developing a greater understanding of the views and needs of consumers and potential consumers.  

1. How does Pharmac ensure its decisions advance disabled Māori staying well with medicines?

PHARMAC uses the Factors for Consideration as a framework for making decisions about funding medicines. These require us to consider the impact of the disease, condition or illness, and also to consider the non-clinical features of medicines or medical devices that might impact on health outcomes.

In particular, the Needs dimension of the Factors requires us to consider the needs of the people with the disease, condition or illness and the needs of the family, whānau and wider society. The Factors for Consideration also require us to consider broad suitability of the treatment, beyond its clinical aspects, that can impact on health outcomes. This can include the relative impacts of different presentations of treatments and different delivery mechanisms.

When making decisions PHARMAC also specifically considers the Hauora Arotahi (the health areas of focus that Māori communities have told us are important to them) and impacts for population groups that experience health disparities.

More information on the Factors for Consideration can be found on our website.

1. For combined pharmaceutical budget, for each of the past five years, how much was spent on:

• Māori.
• Non-Māori.
• Disabled Māori.
• Disabled non-Māori.

The figures for Māori include all those identified as Māori. This group includes people identifying with multiple ethnic groups that include Māori.

Non-Māori includes all those not identified as Māori, but have identified themselves as European, Pacific Island, Asian, and/or MELAA (Middle Eastern, Latin American, African).

Not specified includes anyone who has not identified themselves as either Māori, European, Pacific Island, Asian or MELAA.

We do not hold information on spending for disabled people. We do not yet have complete data for 2018.

We trust that the provision of this information assists with your research, if you have any further questions please feel free to contact us again.

Yours sincerely

[Alison Hill's signature]

Alison Hill
Director, Engagement and Implementatio