Draft code of expectations – welcoming feedback

7 Oct 2021 | Partners in Care

Tēnā koutou katoa,

The Commission is developing a code of expectations (the code) which will set how health and disability service providers and organisations will involve and work effectively in partnership with consumers and whānau.

Below is the first draft of the code, which the Commission is welcoming feedback on.

You can submit your feedback in whichever way suits you best: 

Feedback on the Code of Expectations is open till 31 March 2022.

The Commission will also be hosting in-person and Zoom feedback hui. For more information on these you can email us: consumers@hqsc.govt.nz

Thank you for taking the time to review this draft and help create a code that will shape how all health services engage with consumers and whānau.

The Commission recently launched the consumer health forum Aotearoa. This network of health consumers aims to make the health system consumer focused by sharing health experiences and connecting with all levels of the health and disability system. To find out more about the forum, click here.

Draft for development: Health and disability code of expectations for engaging with consumers/whānau (code of expectations)


The Code of Expectations sets how health and disability service providers and organisations will involve, share decision making and work effectively in partnerships with consumers/whānau. It is essential that health and disability providers apply the principles of Te Tiriti o Waitangi in every engagement with consumers/whānau.


A ‘consumer’ is a person who has used, is currently using, or is entitled to use, a health, mental health, or disability service. The term ‘consumer/whānau’ refers to a consumer, and those identified by the consumer as people (whānau, family, aiga, friends or others) they want involved with their ongoing support, treatment and care.

Consumer/whānau involvement in healthcare services improves the relevance and quality of services and improves service ability to meet consumer/whānau needs (Bolz-Johnson et al 2020).  Health and disability services perform best if they engage well, understand experience and act on what the people and communities who use them say (Doyle et al 2013). Consumer/whānau engagement is a powerful mechanism for improving services and systems (Thorstensen-Woll et al 2021)

Te Tiriti o Waitangi

Te Tiriti o Waitangi provides the basis for shared partnership and leadership between tangata whenua and the Crown.  The following five principles of Te Tiriti o Waitangi underpin this Code of Expectations. The principles come from the latest decision relating to the WAI 2575 Health Claim to the Waitangi Tribunal and are outlined in the Hauora Report and the Ministry of Health’s Māori Health Action Plan (Ministry of Health 2020).

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 and disability 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 Treaty 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 and disability 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 and disability services. Māori must be co-designers, with the Crown, of the primary health system for Māori.


The Code of Expectations applies to direct care, policy, governance, leadership, commissioning, design, planning, development, delivery, measurement, and evaluation undertaken within the health and disability system.

The Code of Expectations works with the Code of Health and Disability Services Consumer Rights (The Code of Rights) to support quality care for consumers and whānau. Whereas the Code of Rights specifies important individual rights a consumer has when they use a health or disability service, including the right to complain (Health and Disability Commission 2021), the Code of Expectations sets how those working within the health and disability system will engage with consumers/whānau to effectively understand and meet their needs.


The following values describe and guide effective engagement with consumers/whānau.  These values are not presented in order of importance.

Relationships of mutual respect and inclusiveness:

Engagement is built on trust, authenticity, reciprocity, transparency and a willingness to share and learn from each other.

Processes are inclusive of all population groups and of those with specific needs.

Engagement includes a process of reciprocity as an expression of gratitude for the knowledge of the consumer/whānau.  Reciprocity can happen at multiple points; before, during and after engagement with consumer/whānau.

Partnership supporting shared decision making and shared leadership:

Consumers/whānau partner in shared decision making and shared leadership with providers and the health system.

All relevant information is shared and understood, so that fully informed decisions can be made about all options.


Health services and the system recognise engaging appropriately with consumers/whānau will support appropriate responses to greater health need, assisting in better outcomes and greater health equity.

There is a clear committment to achieving equity of health outcomes.

Effective outreach to less engaged sections of communities occurs.  

Valuing consumer/whānau contribution:

Knowledge and expertise drawn from lived experience is valued alongside clinical and other knowledge and expertise.

Consumers/whānau are appropriately reimbursed for their expertise. 

Consumer/whānau expertise is developed and fostered. 

Workforce ability to support consumer/whānau engagement and leadership is developed.

Commitment to quality, safety and cultural safety:

Health services and the system are able to respond to the specific needs of consumers/whānau.

Consumers/whānau experience and partnerships underpin quality, safety and equity.

Consumers/whānau experience safe care and are not harmed.

Consumers/whānau experience culturally safe engagement to support their participation.

Efforts to analyse, understand and share/ cede power are made by health services and the system, to support the effective participation of consumers/ whānau. 

Engagement expectations

The expectations of the health and disability system for engaging with consumers/whānau are based on processes that support and facilitate engagement, partnership and shared decision making. These processes support and work alongside other responsibilities and expectations of health and disability services and the wider system.


Consumers/whānau are asked about and supported to be present to engage in ways that are the most effective for them.


Consumers/whānau co-design the development of shared purpose for any intervention or process they participate in.


Consumers/whānau partner and co-design plans for intervention and measures to be used as indicators of success.


Consumers/whānau partner and share oversight of implementation.


Consumer/whānau measures, such as patient experience and reported outcomes are used to better understand quality and where improvement is needed.


Consumers/whānau share oversight of evaluation and partner in deciding what has worked well and where improvement is needed.


Consumers/whānau partner in closing the loop and determining next steps, if any, when an intervention completes.


Last updated 20/01/2022