Te tikanga mō te mahi tahi a ngā hinonga hauora ki ngā kiritaki me ngā whānau
Code of expectations for health entities’ engagement with consumers and whānau
The code of expectations for health entities’ engagement with consumers and whānau (the code) sets the expectations for how health entities must work with consumers, whānau and communities in the planning, design, delivery and evaluation of health services.
This code is required by the Pae Ora (Healthy Futures) Act 2022 and is underpinned by the health sector principles. All health entities must act in accordance with the code and are required to report annually on how the code has been applied.
The health sector principles incorporate Te Tiriti o Waitangi (the Treaty of Waitangi) principles identified by the Waitangi Tribunal in its Hauora Inquiry. These include the principles of tino rangatiratanga (self-determination), ōritetanga (equity), whakamaru (active protection), kōwhiringa (options) and pātuitanga (partnership).[1]
This code does not replace the Code of Health and Disability Services Consumers’ Rights (Code of Rights).[2] The Code of Rights specifies important rights that providers must uphold when delivering services directly to consumers, and the code of expectations sets requirements for how health entities must work with consumers, whānau and communities in the planning, design, delivery and evaluation of health services.
You can read the full code of expectations in a variety of formats here.
References
[1] Principles described in: Waitangi Tribunal. 2019. Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry (Wai 2575). URL: https://waitangitribunal.govt.nz/inquiries/kaupapa-inquiries/health-services-and-outcomes-inquiry. (Accessed 12 April 2022.)
[2] Health and Disability Commissioner. 1996. Code of Health and Disability Services Consumers' Rights. Wellington: Health and Disability Commissioner. URL: www.hdc.org.nz/your-rights/about-the-code/code-of-health-and-disability-services-consumers-rights/. (Accessed 12 April 2022.)
Frequently asked questions
The code of expectations for health entities’ engagement with consumers and whānau was tabled in Parliament on 9 August 2022 and formally launched by the Minister of Health on 25 August 2022.
Manatū Hauora is the code monitor and health entities required to implement the code will report regularly on their progress in implementing the code from September 2023.
This code applies to 'health entities'. These are Te Aka Whai Ora | Māori Health Authority, Te Whatu Ora – Health New Zealand, Te Tāhū Hauora Health Quality & Safety Commission, Pharmac and New Zealand Blood Service.
The code applies to health entities under the Pae Ora (Healthy Futures) Act 2022, but the principles and intent of the code are more broadly relevant and are linked to the health sector principles. The code can therefore be viewed as offering guiding principles for consumer, whānau and community engagement in the health sector.
The consumer engagement quality and safety marker is a mechanism to assess what successful consumer and whānau engagement looks like and how it improves the quality and safety of services. You can access it here.
An implementation guide has been developed with representatives from health entities and consumers. This comprises a series of webpages with consumer videos and other information and resources. It is a ‘living’ guide, updated with additional resources as they are developed by and with the sector and consumers.
You can view the implementation guide here.
Under section 59 of the Pae Ora (Healthy Futures) Act 2022, Te Tāhū Hauora was tasked to develop a code of expectations for consumer and whānau engagement in the health sector.
The code was initially developed in collaboration with the Te Tāhū Hauora consumer network and advisory group (kōtuinga kiritaki and te kāhui mahi ngātahi) and a subgroup tasked with designing the principles and concepts. Some high-level concepts were also discussed with the chairs and deputy chairs of consumer councils. The Te Tāhū Hauora board and the board’s Māori advisory group, Te Rōpu Māori (now called Te Kāhui Piringa), provided further input and advice.
Consultation on the draft code began in September 2021 and concluded on 31 March 2022. A range of approaches were used to collect feedback, including wānanga with whānau, hapū and marae, meetings with stakeholder groups, two interactive forums (consumer and professional organisations), social media campaigns, newsletters and awareness-building through stakeholders, and one-on-one interviews. A key focus was engaging with Māori and Pacific peoples and disabled people.
In total, 169 submissions were received. These comprised 66 formal submissions, 44 individuals providing anonymous feedback through an online form and the balance providing individual feedback directly to Te Tāhū Hauora staff. Submissions were received from consumers and consumer groups, including consumer councils and providers and other responsible authorities.
The final code presented to the Minister of Health for sign-off was informed by these multiple perspectives.
Tino rangatiratanga (self-determination): The guarantee of tino rangatiratanga, which provides for Māori self-determination and mana motuhake in the design, delivery and monitoring of health services.
Ōritetanga (equity): The principle of equity, which requires the Crown to commit to achieving equitable health outcomes for Māori.
Whakamaru (active protection): The principle of active protection, which requires the Crown to act, to the fullest extent practicable, to achieve equitable health outcomes for Māori. This includes ensuring that it, its agents and its Te Tiriti partner are well-informed on the extent and nature of both Māori health outcomes and efforts to achieve Māori health equity.
Kōwhiringa (options): The principle of options, which requires the Crown to provide for and properly resource kaupapa Māori health services. Furthermore, the Crown is obliged to ensure that all health and disability services are provided in a culturally appropriate way that recognises and supports the expression of hauora Māori models of care.
Pātuitanga (partnership): The principle of partnership, which requires the Crown and Māori to work in partnership in the governance, design, delivery and monitoring of health services. Māori must be co-designers with the Crown of the primary health system for Māori.
In the first instance, you can contact the relevant health entity directly.
Each entity is required to have a clear procedure in place to respond to your query and keep you informed about how your complaint or query is progressing. You should explain your query or complaint and what you would like done to see it resolved. You should receive acknowledgement of your query or complaint within five working days.
For more guidance, please contact: consumers@hqsc.govt.nz.
If your complaint relates to a health service you have received directly, this falls under the Code of Health and Disability Services Consumers’ Rights. More information on making a complaint to the office of the Health and Disability Commissioner can be found here.
Consumer
The term ‘consumer’ refers to anyone who has used, is currently using or is likely to use a health service. This includes but is not limited to individuals, community members, whānau and family, carers, patients and tangata whaiora. ‘Consumer’ includes voices of Māori, Pacific peoples, people living with disabilities, migrants, refugees, rainbow communities and people living in rural areas. The term resonates with some people more than others. It is important that people and communities use the language they feel most comfortable with and whichever term resonates with them.
Co-design
Co-design is an important part of a process to identify a challenge or opportunity to engage people, consumers, whānau, family and staff; to capture their experiences and ideas; to organise the learning to create new understanding and insight from the perspective of the care and emotional journey; to stay together in partnership to review learning and ideas; to plan and implement improvements; and, finally, to review the difference made (adapted from Dr Lynne Maher, Principal Co-design Counties Manukau, presentation, 2020).
We use co-design as an umbrella term. It includes several participatory, co-creation and open design processes. Co-design in the health sector should involve consumers, whānau and staff in the designing of solutions. Design decisions should only be made once feedback has been gathered from all participants (Ko Awatea 2022).
Cultural safety
‘Cultural safety’ is a term pioneered by Dr Irihapeti Ramsden (2002) that became embedded in nursing practice. In time, it has broadened to mean ‘a concept whereby we think more about the power relationships between the patient or professional and the client or patient. We like the professional person to think about their own culture, their own biases, the way they think about the interaction and how their biases affect the outcomes for the patient’ (Tipene-Leach 2019).
Equity
Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically (World Health Organization 2017).
In Aotearoa New Zealand, people have differences in health that are avoidable, unfair and unjust. Equity recognises that different people with diverse levels of advantage require different approaches and resources to get equitable health outcomes (Ministry of Health 2019).
Health entity
Entities responsible for planning, designing and evaluating the health system. In Aotearoa New Zealand, these entities are as follows: Te Aka Whai Ora | Māori Health Authority, Te Whatu Ora – Health New Zealand, Te Tāhū Hauora Health Quality & Safety Commission, Pharmac and New Zealand Blood Service.
Health inequities
Systematic differences in health outcomes that arise from the social conditions in which people are born, grow, live, work and age (World Health Organization 2020).
Whānau
Describes an extended family or a family group. Whānau is a familiar term of address to several people and is the primary economic unit of Māori society. These days, whānau sometimes also includes friends who may have no kinship ties to other members (Te Aka).
References
Ko Awatea. 2022. Co Design. URL: koawatea.countiesmanukau.health.nz/co-design (accessed 18 April 2022).
Ministry of Health. 2019. Achieving Equity in Health outcomes: Summary of a discovery process. p.7. Wellington: Ministry of Health. URL: health.govt.nz/system/files/documents/publications/achieving-equity-in-health-outcomes-summary-of-a-discovery-process-30jul2019.pdf (accessed 14 April 2022)
Ramsden IM. 2002. Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. Thesis. Victoria University of Wellington. URL: croakey.org/wp-content/uploads/2017/08/RAMSDEN-I-Cultural-Safety_Full.pdf (accessed 18 June 2022).
Te Aka: Māori-English dictionary (nd). URL: maoridictionary.co.nz/search?&keywords=whanau (accessed 6 April 2022).
Tipene-Leach D. 2019. Understanding Bias in Healthcare. Wellington: Health Quality & Safety Commission. URL: hqsc.govt.nz/our-work/system-safety/aotearoa-patient-safety-day/previous-patient-safety-week-campaigns/patient-safety-week-2019-understanding-bias-in-health-care/cultural-safety-and-cultural-competence
World Health Organization. 2017. Health Equity – Overview. URL: URL: who.int/health-topics/health-equity#tab=tab_1 (accessed 20 April 2022).
World Health Organization. 2020. Fast Facts on Health Inequities. URL: https://www.who.int/activities/breaking-barriers-towards-more-equitable-health-systems-for-everyone# (accessed 19 April 2022).
When did the code of expectations come into effect?
The code of expectations for health entities’ engagement with consumers and whānau was tabled in Parliament on 9 August 2022 and formally launched by the Minister of Health on 25 August 2022.
Manatū Hauora is the code monitor and health entities required to implement the code will report regularly on their progress in implementing the code from September 2023.
Who does the code apply to?
This code applies to 'health entities'. These are Te Aka Whai Ora | Māori Health Authority, Te Whatu Ora – Health New Zealand, Te Tāhū Hauora Health Quality & Safety Commission, Pharmac and New Zealand Blood Service.
The code applies to health entities under the Pae Ora (Healthy Futures) Act 2022, but the principles and intent of the code are more broadly relevant and are linked to the health sector principles. The code can therefore be viewed as offering guiding principles for consumer, whānau and community engagement in the health sector.
How can our organisation measure our progress in applying the code?
The consumer engagement quality and safety marker is a mechanism to assess what successful consumer and whānau engagement looks like and how it improves the quality and safety of services. You can access it here.
What guidance is available to support our organisation’s implementation of the code?
An implementation guide has been developed with representatives from health entities and consumers. This comprises a series of webpages with consumer videos and other information and resources. It is a ‘living’ guide, updated with additional resources as they are developed by and with the sector and consumers.
You can view the implementation guide here.
Why and how was the code of expectations developed?
Under section 59 of the Pae Ora (Healthy Futures) Act 2022, Te Tāhū Hauora was tasked to develop a code of expectations for consumer and whānau engagement in the health sector.
The code was initially developed in collaboration with the Te Tāhū Hauora consumer network and advisory group (kōtuinga kiritaki and te kāhui mahi ngātahi) and a subgroup tasked with designing the principles and concepts. Some high-level concepts were also discussed with the chairs and deputy chairs of consumer councils. The Te Tāhū Hauora board and the board’s Māori advisory group, Te Rōpu Māori (now called Te Kāhui Piringa), provided further input and advice.
Consultation on the draft code began in September 2021 and concluded on 31 March 2022. A range of approaches were used to collect feedback, including wānanga with whānau, hapū and marae, meetings with stakeholder groups, two interactive forums (consumer and professional organisations), social media campaigns, newsletters and awareness-building through stakeholders, and one-on-one interviews. A key focus was engaging with Māori and Pacific peoples and disabled people.
In total, 169 submissions were received. These comprised 66 formal submissions, 44 individuals providing anonymous feedback through an online form and the balance providing individual feedback directly to Te Tāhū Hauora staff. Submissions were received from consumers and consumer groups, including consumer councils and providers and other responsible authorities.
The final code presented to the Minister of Health for sign-off was informed by these multiple perspectives.
What are the principles identified by the Waitangi Tribunal in its Hauora inquiry?
Tino rangatiratanga (self-determination): The guarantee of tino rangatiratanga, which provides for Māori self-determination and mana motuhake in the design, delivery and monitoring of health services.
Ōritetanga (equity): The principle of equity, which requires the Crown to commit to achieving equitable health outcomes for Māori.
Whakamaru (active protection): The principle of active protection, which requires the Crown to act, to the fullest extent practicable, to achieve equitable health outcomes for Māori. This includes ensuring that it, its agents and its Te Tiriti partner are well-informed on the extent and nature of both Māori health outcomes and efforts to achieve Māori health equity.
Kōwhiringa (options): The principle of options, which requires the Crown to provide for and properly resource kaupapa Māori health services. Furthermore, the Crown is obliged to ensure that all health and disability services are provided in a culturally appropriate way that recognises and supports the expression of hauora Māori models of care.
Pātuitanga (partnership): The principle of partnership, which requires the Crown and Māori to work in partnership in the governance, design, delivery and monitoring of health services. Māori must be co-designers with the Crown of the primary health system for Māori.
What can I do as a consumer if I feel the code is not being followed?
In the first instance, you can contact the relevant health entity directly.
Each entity is required to have a clear procedure in place to respond to your query and keep you informed about how your complaint or query is progressing. You should explain your query or complaint and what you would like done to see it resolved. You should receive acknowledgement of your query or complaint within five working days.
For more guidance, please contact: consumers@hqsc.govt.nz.
If your complaint relates to a health service you have received directly, this falls under the Code of Health and Disability Services Consumers’ Rights. More information on making a complaint to the office of the Health and Disability Commissioner can be found here.
Useful definitions
Consumer
The term ‘consumer’ refers to anyone who has used, is currently using or is likely to use a health service. This includes but is not limited to individuals, community members, whānau and family, carers, patients and tangata whaiora. ‘Consumer’ includes voices of Māori, Pacific peoples, people living with disabilities, migrants, refugees, rainbow communities and people living in rural areas. The term resonates with some people more than others. It is important that people and communities use the language they feel most comfortable with and whichever term resonates with them.
Co-design
Co-design is an important part of a process to identify a challenge or opportunity to engage people, consumers, whānau, family and staff; to capture their experiences and ideas; to organise the learning to create new understanding and insight from the perspective of the care and emotional journey; to stay together in partnership to review learning and ideas; to plan and implement improvements; and, finally, to review the difference made (adapted from Dr Lynne Maher, Principal Co-design Counties Manukau, presentation, 2020).
We use co-design as an umbrella term. It includes several participatory, co-creation and open design processes. Co-design in the health sector should involve consumers, whānau and staff in the designing of solutions. Design decisions should only be made once feedback has been gathered from all participants (Ko Awatea 2022).
Cultural safety
‘Cultural safety’ is a term pioneered by Dr Irihapeti Ramsden (2002) that became embedded in nursing practice. In time, it has broadened to mean ‘a concept whereby we think more about the power relationships between the patient or professional and the client or patient. We like the professional person to think about their own culture, their own biases, the way they think about the interaction and how their biases affect the outcomes for the patient’ (Tipene-Leach 2019).
Equity
Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically (World Health Organization 2017).
In Aotearoa New Zealand, people have differences in health that are avoidable, unfair and unjust. Equity recognises that different people with diverse levels of advantage require different approaches and resources to get equitable health outcomes (Ministry of Health 2019).
Health entity
Entities responsible for planning, designing and evaluating the health system. In Aotearoa New Zealand, these entities are as follows: Te Aka Whai Ora | Māori Health Authority, Te Whatu Ora – Health New Zealand, Te Tāhū Hauora Health Quality & Safety Commission, Pharmac and New Zealand Blood Service.
Health inequities
Systematic differences in health outcomes that arise from the social conditions in which people are born, grow, live, work and age (World Health Organization 2020).
Whānau
Describes an extended family or a family group. Whānau is a familiar term of address to several people and is the primary economic unit of Māori society. These days, whānau sometimes also includes friends who may have no kinship ties to other members (Te Aka).
References
Ko Awatea. 2022. Co Design. URL: koawatea.countiesmanukau.health.nz/co-design (accessed 18 April 2022).
Ministry of Health. 2019. Achieving Equity in Health outcomes: Summary of a discovery process. p.7. Wellington: Ministry of Health. URL: health.govt.nz/system/files/documents/publications/achieving-equity-in-health-outcomes-summary-of-a-discovery-process-30jul2019.pdf (accessed 14 April 2022)
Ramsden IM. 2002. Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. Thesis. Victoria University of Wellington. URL: croakey.org/wp-content/uploads/2017/08/RAMSDEN-I-Cultural-Safety_Full.pdf (accessed 18 June 2022).
Te Aka: Māori-English dictionary (nd). URL: maoridictionary.co.nz/search?&keywords=whanau (accessed 6 April 2022).
Tipene-Leach D. 2019. Understanding Bias in Healthcare. Wellington: Health Quality & Safety Commission. URL: hqsc.govt.nz/our-work/system-safety/aotearoa-patient-safety-day/previous-patient-safety-week-campaigns/patient-safety-week-2019-understanding-bias-in-health-care/cultural-safety-and-cultural-competence
World Health Organization. 2017. Health Equity – Overview. URL: URL: who.int/health-topics/health-equity#tab=tab_1 (accessed 20 April 2022).
World Health Organization. 2020. Fast Facts on Health Inequities. URL: https://www.who.int/activities/breaking-barriers-towards-more-equitable-health-systems-for-everyone# (accessed 19 April 2022).
Last updated: 19th June, 2023
