WHāNAU ORA: The theory and the practice
Full colour PDF of the pages as they appeared in ‘best practice’.
Printer friendly PDF.
If there is one thing that we have learnt out of the devastation, the suffering and the chaos associated with the Christchurch earthquakes, it has been to reacquaint ourselves with our neighbours, to come together as communities, and most of all, to reach within our families to find the greatest source of strength.
Whānau Ora is that source – a source of comfort, of motivation, of encouragement.
Whānau Ora is about whānau being empowered to develop a plan for our future; and to trust in our own solutions.
It is about restoring to ourselves, our confidence in our own capacity to provide for our own – to take collective responsibility to support those who need it most.
I believe that Whānau Ora represents a major transformation in the way services are designed and delivered, contracts arranged and the way providers work together.
Whānau Ora taskforce
It has been close to two years (June 2009) since Cabinet approved the establishment of the Whānau Ora Taskforce, chaired by Professor Sir Mason Durie.
The Taskforce held 22 regional hui with a range of urban and rural whānau, iwi and service providers during October and November 2009. Approximately 600 people attended these hui. The Taskforce also received more than 100 written submissions on its document, “Whānau Ora: A whānau-centred approach to Māori wellbeing”.
Government has appointed a Governance Group to oversee implementation of Whānau Ora. The Governance Group is comprised of three community representatives and three agency Chief Executives.
Over the past year, I have watched Whānau Ora gain considerable momentum and I have been overwhelmed by the enthusiasm of stakeholders, whānau, communities, providers, practitioners, government departments and my own ministerial colleagues. What could be more inspiring than witnessing whānau being empowered to take control of their future?
Selection of Whānau Ora collectives
In October 2010, Government announced the selection of 25 Whānau Ora provider collectives, which between them bring together 158 providers across Aotearoa (including four Pacific providers in Auckland, Wellington and Christchurch).
It has been wonderful to see the high number of provider collectives which in itself expresses Government’s desire for providers to be more effective and efficient by working collaboratively.
I have heard it described as moving from “five cars up the driveway” to one car containing a navigator and four passengers. The shift in mindset is a shift from multiple agencies working with individual family members often in isolation of each other, to instead a bold and innovative approach which places the aspirations of whānau at the centre of service planning and delivery. Everyone is facing the same direction; the focus firmly fixed on outcomes.
For whānau – the outcomes we seek are that whānau will be:
- Living healthy lifestyles
- Participating fully in society
- Confidently participating in Te Ao Māori
- Economically secure and successfully involved in wealth creation
- Cohesive, resilient and nurturing
Programmes of action
Provider collectives must therefore align all of their interactions to best support whānau wellbeing. Programmes of Action outline a planned approach by provider collectives to respond to whānau aspirations, and, where necessary, to provide whānau-centred services.
Officials from Te Puni Kōkiri, Ministry of Health and Ministry of Social Development are working with the Whānau Ora provider collectives to progress their Programmes of Action. These Programmes serve to inform the “business cases” that identify the resources required by provider collectives. They include a focus on relationship management, infrastructure, integrated contracting, workforce and practice development, monitoring and evaluation and action research.
Regional leadership groups
Alongside these collectives, there are ten Regional Leadership Groups which are championing Whānau Ora within their respective regions. Each Regional Leadership Group comprises community representatives and officials from the three lead agencies. Their existence serves to remind us that local solutions are determined at the local level through collaboration and cooperation of whānau, hapū and iwi.
Central to the development of more holistic service delivery to whānau is the concept of integrated contracting. The Ministry of Social Development is currently leading work with 22 providers and their funders with the aim of having 20 signed integrated contract agreements this year.
Essentially, we envisage the transitioning of existing service delivery contracts into an integrated contract within the Whānau Ora framework. These outcomes-based integrated contracts will bring funding currently received from government funders together into a single contract.
I have always believed that Whānau Ora needed a framework to measure progress toward achieving outcomes for whānau. The last thing I would want is for bean-counting, silo by silo: how many meetings had; how many people served; how many booklets distributed. So Whānau Ora will be underpinned by a comprehensive research, evaluation and monitoring programme that will measure the success of the approach for whānau, for providers, and in terms of value gained for government investment. It is about outcomes that are influenced by the needs that whānau identify and choose.
In Budget 2011, Government invested another $30 million in Whānau Ora. The emphasis of this new investment will go towards developing providers in regions of high need and where there are currently no provider collectives. These locations include; Kaipara, Hauraki, South Waikato, Taupō/Tūrangi, Palmerston North, Wairarapa, Levin/Kapiti Coast and Murihiku.
But if I was to be asked, I would say Whānau Ora is not about the funding. It is about all of us picking up on our responsibilities, rather than picking up the phone to ask the health provider or CYF to take up a role which is rightfully ours.
Whānau Ora is possibly the first time in which Government has been able to measure value for money against a cultural construct.
It is about our transformation; celebrating the power and potential of a whānau-centred approach which will enable our people to flourish.
Whānau Ora is the ultimate expression of our survival.
Tēnā tātou katoa.
Whānau Ora – A General Practitioners perspective
Dr Glenn Doherty is a General Practitioner and clinical director for specialist Whānau Ora provider Te Whānau o Waipareira in west Auckland. Affiliated to the East Coast tribe of Ngāti Porou, Dr Doherty has worked at the Wai Health Clinic – now known as the Whānau Centre Health Clinic – for the past three years. He has practised consistently as the only Māori male General Practitioner in west Auckland for the last 11 years and has been working in health management, policy and research and clinical medicine roles for the past 28 years. Dr Doherty has a special interest in adolescent and youth health and has been the school doctor at Kelston Boys and Henderson high schools in recent years. He is also on the Clinical Governance Board for the Waitemata PHO and a newly developed National Māori Health Advisory Council. He talks to Best Practice Journal about his work at the clinic.
What is the Whānau Centre Health Clinic?
“The new centre has been expanded to include more comprehensive services than before and in time, will be operating under a ‘Whānau Ora, Whānau Tahi’ kaupapa. We have expanded to include a dental service and on-site pharmacist and are in the process of co-locating various Waitemata District Health Board services. We are also negotiating with a radiology service and will be co-locating WINZ, CYF and ACC within the centre. Visiting specialists and a birthing unit are also in the process of being developed.”
What does Whānau Ora mean to communities?
“Whānau Ora is about co-ordinating care on behalf of patients and ensuring care plans and Whānau Ora plans comprehensively address client needs. It is a whānau-centric model of service integration using a Māori kaupapa to improve all outcomes for our registered clients. Primary care practitioners will, over time, have centres in their neighbourhoods and communities like this one that matrix across sub-regions to provide services that may have been traditionally provided under and by mainstream services or providers.”
What are ”wrap-around services”?
“Apart from primary and secondary health care services within the centre, we have a large amount of education, social services, justice and mental health services, which are known as wrap-around services. This means that whānau that access our services are looked at comprehensively – not just snapshots of care or contact. Over time, we will develop a referral triaging process, clinical and non-clinical, that ranks client priorities based on needs. Access and socio-economic issues will be taken into account and care plans and Whānau Ora plans will be developed around those needs. There will be a fostering of new models of service delivery that will focus around using Whānau Ora and Whānau Tahi models to add value to client outcomes. We will also be concurrently developing how we measure our performance to achieve improved outcomes for clients.”
How will General Practitioners be involved?
“The primary care strategy set the scene for ‘better, sooner, more convenient services’ so these Whānau Ora centres implicitly will be ‘one-stop shops’ with most services co-locating under one roof. This approach capitalises on critical mass and economies of scale in communities within the context of primary care. Ultimately, there should be Whānau Ora clauses in contracts with General Practitioners to ensure these principles are manifested in clinical pathways to these centres. In addition, General Practitioner Clinical Networks will be required to work closely with these centres and ensure they are meaningfully engaged and aligned with these centres.”
What other services does the Whānau Centre Health Clinic offer?
“In addition to core general practice and nursing services, the centre offers podiatry, midwifery and dietician services. We are about to employ a General Practitioner to run a chronic care clinic and we are looking at working with an endocrinologist to run virtual and on-site clinics for our difficult diabetic clients. We also have a family violence service, Māori mobile nursing services, cardiac rehabilitation services and oral health services integrated with the clinic. The centre offers a suite of ten services under the ‘Services to Improve Access’ contract. Finally, a Māori mirimiri service (traditional massage) is also being developed. Service navigators will also work to align and engage clients with appropriate and relevant services.”
What is your outlook for the future?
“This is an exciting time for this urban Māori authority in west Auckland, to provide services within the Whānau House and for staff working in the centre and for our community. Waipareira is the only service entity of its kind in New Zealand run and operated by Māori for all people wanting new approaches to their personal care and the care of their whānau.”
Te Whānau o Waipareira - Auckland
Te Whānau o Waipareira in west Auckland – part of the National Urban Māori Authority (NUMA) – has been operating a “Whānau Ora, Whānau Tahi” approach to service delivery since January 2011.
As a specialist Whānau Ora provider, Waipareira is offering families wrap-around services tailored to their needs. A kaiārahi, or navigator, will work with whānau to identify the aspirations and outcomes they seek, develop an outcomes focused plan to achieve them and then broker their access to a range of services available both internally and externally in the wider community.
More than 200 staff have taken part in training and developmental workshops focused on understanding outcomes, whānau-centred practice and understanding the requirements of privacy and confidentiality when working with whānau.
Waipareira has also opened a one-stop frontline Whānau Ora hub integrating health, social, justice and education services. The Whānau House – a four-storey complex in the central business district of Henderson – is the home of the trust’s new-look workforce: kaimahi (service workers), kaiārahi (navigators) and kaiwhakahaere (leaders).
NUMA is the parent body for the Whānau Ora provider collective that includes; Waipareira, Manukau Urban Māori Authority (South Auckland), Te Rūnanga o Kirikiriroa (Hamilton) with approved affiliate Te Kohao Health and Te Roopu Awhina ki Porirua (Wellington) which is in development.
The collective has an enrolled health population of 95,000 and provides whānau residing in the five main urban centres with nearly 300 individual services across education, health, housing, justice and social services. Services include public health; mental health; primary care; drug and alcohol addiction; Strengthening Families; Family Start; Parents as First Teachers (PAFT); breast screening; nutrition; smoking cessation; 24/7 accident and medical; ACC support; whānau housing; mentoring; holiday programmes; kaumātua support; child advocacy; restorative justice; violence prevention; funeral; housing initiatives; diabetes; Māori men’s health; budget advice; financial literacy; youth services; youth justice; social work support; day activities and life skills programmes for adolescents; and tikanga Māori.
For more information about NUMA, visit: www.numa.org.nz.
Kōtahitanga – Whānau Ora inspired innovation
Kōtahitanga is a Whānau Ora collective of four Māori health and social service providers in South Auckland: Turuki Health Care Trust, Papakura Marae Trust, Huakina Development Trust and Te Kaha o Te Rangatahi Trust. The collective employs more than 285 staff and provides services to over 22,000 multi-ethnic whānau including 16,000 Māori.
Kōtahitanga has developed a new whānau-centred model of practice, Mana Tiaki, to address the unmet needs of whānau. The model is applied across a network of providers and is evidence-based, outcomes-driven and strengths-focused. It is based upon the premise of supporting and enabling whānau-centric practice and can be applied to any whānau who chooses it, although it is not exclusive to Māori.
Mana Tiaki also enhances provider member capacity to deliver high quality services to whānau as it supports improved and coordinated access to a range of niche or specific services that are delivered by the network.
As with other Whānau Ora collectives, Kōtahitanga provides a range of health and social services across a continuum of care. The collective also provides innovation across areas such as te reo-based rangatahi services, specialist cultural needs assessment for kuia and kaumātua, wahine and pepi services that have world class accreditation, marae-based and integrated services, intersectoral service delivery, a mix of rural and urban services, iwi and mata waka networks and cultural competency systems.
Alliance Health+ Trust – a Whānau Ora Collective meeting the needs of Pacific peoples
Alliance Health+ Whānau Ora Collective represents six providers including: Auckpac, Bader Drive, Healthstar Pacific, Penina Health Trust, Southseas and Tongan Health Society.
For the past 20 years, members of this provider collective have customised services to meet the needs of Pacific peoples and high needs populations in Auckland. In doing so, the collective have long-established relationships with Pacific churches and community interest groups to ensure the voices of these groups are represented
In 2010, Alliance Health+ was established in response to the Ministry of Health policy – Better, Sooner, More Convenient Health Care in the Community – which resulted in the consolidation of three Pacific-led Primary Health Organisations (PHOs): Ta Pasifika (Bader Drive and Southseas), Auckpac PHO and Tongan Health Society PHO.
Whānau Ora is a concept that strongly aligns with Pacific values and provides an exciting opportunity to enhance primary care. The inclusion of other Pacific non-government organisation (NGO) providers such as Healthstar Pacific and Penina Trust helps achieve the holistic outcomes for whānau.
The collective has developed O Le Aiga mā le Fanau ia Ola Pacific framework for Whānau Ora which describes health and wellbeing in the context of relationships, social environments and the wider determinants of health. It takes a long-term perspective of building for future generations.
Alliance Health+ is focused on greater co-ordinated and integrated care through the delivery of wrap-around services that meet the needs of the consumer and their family.
Within a year, Integrated Family Health Centres (IFHCs) will be a central hub in which some of the collective’s model of care activities will occur. The centres will offer a range of services for whānau to easily access in one location across the health and social sector, and externally with key government agencies and NGOs.
Looking ahead, Alliance Health+ plans to continue to focus on key areas: structural change by strengthening the Alliance Health+ clinical governance programme; establishment of integrated family health centres and nurse-led clinics/networks; development of population health programmes for communities; Whānau Ora (enhanced primary care); and acute demand management.
Turning to Whānau Ora in times of need
Renee Muru is the primary health care manager for Turuki Health Care in South Auckland – part of the Kōtahitanga provider collective.
Renee says that meeting people and home visits are a key part of their Whānau Ora service approach which aims to put a complete package of support around people’s health and social needs.
“In simple terms, health problems are often closely related to things like housing, income, education, transport, employment, nutrition and smoking cessation,” she says.
“It’s important to see the whole individual in the context of their whānau. By collaborating with other agencies we can address the factors that contribute to ill health, make a positive difference and get some great outcomes for whānau.”
As part of the Kōtahitanga collective, Turuki worked with more than 20 individuals who arrived in Auckland after the Christchurch earthquake in February.
As well as no food or accommodation, and no knowledge of local support systems, their social and health needs were varied. They underwent needs assessments driven by their own goals and aspirations with access to services across a network of providers.
Turuki helped the whānau in a number of ways, including; enrolling their children in schools, assessing immediate health needs as many came without vital medication, providing support with counselling services and helping to secure accommodation.
“A number of these clients have never been beneficiaries and using the services of WINZ and Housing New Zealand were very foreign to them,” says Renee.
“This work is ongoing and we are continuing to support a number of families with their short term, medium and long term goals.”