The Ngāti Hine Health Trust was established in 1992 following the health reforms which fostered Māori to deliver health services. This organisation began in Mōtatau, the heart of Ngāti Hine, and was born from marae committee discussions on health of the Ngāti Hine community.
Although the Trust began as a Ngāti Hine initiative, the demand for its services soon extended beyond Ngāti Hine's traditional boundaries. The Trust now services the mid North and has a registered client base of 7800 with potential to grow to 25,000.
Erima Henare was the Deputy Chairperson of the Ngati-Hine Health Trust from 1994 to 2001 when he became General Manager of Hauora Whānui, the Trust's Company that manages its health services. Erima is a former diplomat and was a key driver in the establishment of the Trust. He continues to be a key driver in the Trust's development.
Christine Henare is the General Manager of the Trust. Christine was brought on board in 1994 to project manage the establishment team created to set up the Trust's business infrastructure. She has been intimately involved in the development of the Trust's business since then, responsible for its contracting arrangements, financial, IT, general administration and human resource management.
The Ngāti Hine Health Trust is a Charitable Trust governed by the Charitable Trusts Act. It is not a Runanga and is covered by the general laws dealing with Trusts. The Trust holds all contracts and assigns management to one of its appropriate subsidiary companies: Hauora Whānui, core business health; Mātauranga Whānui, core business education and training; Whanau Whānui, core business social services; Ngāti Hine Ltd, core business iwi radio; or Northcorp, core business property ownership.
In the beginning the Trust adopted its particular structure to separate governance and management. Its charitable status also secured a tax advantage. Today the structure continues to separate governance and management but is also seen as a key risk management strategy as it gives the Trust the ability to control its business efficiently. Christine noted that Ngāti Hine explored a lot of options and sought advice from people with expertise before deciding on the final structure. The structure has been the subject of external review four times during the last nine years.
The core purpose of the Ngāti Hine Health Trust is the provision of holistic health services. Holistic health involves all the health, social and economic aspects that touch the lives of people living within its community.
The Trust's core business is regulated by the same rules and regulations that govern the provision of services by any Māori or mainstream provider of services in the fields of health, education and training, social services and iwi radio. The Health and Disabilities Support Services Act guides the provision of health services whilst the Children, Youth and Families Act guides the provision of social services.
In achieving its core purpose, the Trust has identified its key stakeholders as being the various hapū within the Trust's operational boundaries, funders, the local communities in which the Trust operates, the individual users of the service and the staff who provide the services.
The Trust's relationship with Te Tai Tokerau MAPO has been critical to its development. Te Tai Tokerau MAPO is the Māori co-purchaser of health services in the North responsible for resourcing the development of Māori providers as well as ensuring an appropriate level of funding of Māori health services. It has concentrated on developing a small number of robust providers and Ngāti Hine's growth has benefited from this strategy.
Both Christine and Erima noted, "As an organisation we have tended not to get involved in tribal politics but maintained a core business focus."
The Ngāti Hine Health Trust consists of 10 trustee positions. This number has decreased from a board that once had 21. Christine notes that the smaller board is preferable as it has improved business expedience without compromising adequate consideration of governance, including representational, issues.
In the early days of establishment it was decided that the board should be representative of the communities and marae it served. As different marae communities became involved representation was seen as necessary. This led to the board of 21. However, about 1997 the board was slimmed down. The Trust changed its trustee criteria from representation to skill and knowledge bases. Christine notes that although this is the aim, it has raised issues with obtaining a board with the appropriate balance and set of skills.
The Ngāti Hine Health Trust is a closed trust and does not hold elections. Representatives are nominated and appointed by the hap?community. Trustees are sought with standing in the community and Christine believes this is one of the main reasons why Ngāti Hine Health Trust has progressed. According to Christine, the trustees are the "salt of the earth" and help to "keep us grounded". Trustees hire in professionals and have a strong reliance on their managers. A critical factor for trustees is a commitment to the kaupapa and a strong sense of Ngāti Hinetanga.
The Trust has found it difficult to find trustees with health sector skills, yet all are actively involved in their communities and this brings its own advantages. Although the Trust employs a trustee training programme it has found the most effective tool has been "business on the hoof" or learning the business by doing the business. The trust has sought to extend trustees' understanding of the different aspects of the business by appointing every member of the board to act as a director of one of the subsidiary companies.
Communication has not been a strength of the organisation. In recognition of this the Trust has recently developed a communications strategy, a major aspect of which is to consult with its client community in regard to services delivered and services to be delivered. The Trust recognises it has not been strong on communication but puts this down to a combination of being too busy focusing on business as well as having insufficient resources to devote to this activity.
The Trust undertakes annual strategic and business planning processes which it views as vital to the operations of the organisation. All staff have performance agreements and everything is measured against the plan. Progress is reviewed regularly at individual, unit and organisational levels.
In terms of an ideal board member, Christine and Erima believe trustees need to be of high standing in the communities where they live, they should understand the role of governance and know the difference between governance and management. Trustees should also demonstrate a thorough understanding of business principles and best practice. A mix of gender and age is also preferable.
The Trust's business environment is highly competitive. Competition comes from various other community health providers and "would-be service providers" as well as long established providers such as Plunket and the local hospital based services provided by Northland Health. Christine explained that the emergence of the Ngāti Hine Health Trust had a major effect on the market and forced other agencies to serve the community better.
At the end of the day the aim of the Trust is to improve Māori access to health services by making them affordable, reachable and culturally appropriate. Ngāti Hine's entire service is mobile and while successful this has financial implications. The Trust is now looking at establishing outreach centres as a way of dealing with the burgeoning cost of managing a mobile service. Christine notes that managing expectations can be difficult.
The expectation of the people is wide yet the resources provided to fund the service are narrow. The Trust would welcome less Government interference and believes Government needs to know what makes a Māori provider different.
As a provider, the Trust must comply with all the legislative health regulations in order to carry out its business. However, this is made easier by recruiting appropriate staff and training them to a high level to satisfy these legislative requirements. Erima explains that this process is an ordeal in the north where there is no easy access to training facilities.
The Trust puts a lot of effort into its strategic planning process in order to maintain a competitive edge. It does not have any particular process for community involvement in this process but has always used outside facilitation in developing strategic direction. Erima notes that when an "organisation is tasked with responsibility of looking after funds and caring for the health of people you must engage in formal strategic planning - we are fortunate to have a large body of staff able to pick up on this direction."
Both Erima and Christine praise the Trust's staff. Christine also notes that a large part of the Trust's success is due to having good strong leadership known by the people and community leaders.
Management reports monthly to the Trustees. Reports cover finance, staffing, service delivery and any other risk management issues that might require board input. Management is in regular communication with subsidiary boards of directors to ensure they are always up to date with issues. The Trust's accounts are audited every year.
Should conflict or issues arise, the Trust always tries to deal with it as a whānau. However, as Erima notes, in a Māori paradigm the issue of whānaungatanga can sometimes create complicating communication factors. Discussion is always used in the first instance as this usually proves to be effective. Non-Māori conflict resolution techniques have been employed in the past as a last resort. In the past the Trust has been able to resolve issues through hui and formal reporting.
Despite its successes the Trust sees its inability to communicate directly as a major fault which it is moving to address. It has also taken advice on succession planning. Representation is seen as an issue. When the organisation was a uniquely Ngāti Hine organisation the Trust found it an easy matter to deal with. However, when it was widened out it became unwieldy. Although some might be critical of the Trust's lack of an election process, Erima questions the integrity of voting process when only 50 people show up to vote. In terms of Northland takiwā and marae - how representative are these hui - given the population and the dynamic nature of the communities? Erima believes this is why the board has tended towards a skill-set preference.
In terms of impediments to the Trust, Erima notes that none of the Quality Health Standards reflect Māori models but are all uniquely Pākehā models. "In this nascent period we are wanting to reinforce our rangatiratanga and so we try to do that. Plunket sees babies a particular way, we see babies differently. We are trying to find ways to get government to understand the unique Māori factors in health provision."
There are relatively few people on the ground delivering health services in terms of a kaupapa Māori framework. The Trust has participated in reviews on Māori health providers and it was found difficult to draw a comparison with the Ngāti Hine Health Trust. Erima notes there seems to be a total absence of understanding on Māori management and governance. In discussing the notion of whānaungatanga in health service provision, Erima noted, "some might view it as nepotism, but it is not unreasonable if you can trust your whānau and they have the skills to deliver."
The Trust continually seeks to get smarter at doing its business. The organisation's offices are also used for a number of other Ngāti Hine purposes such as facilitating the Ngāti Hine Treaty claim. Christine recognises a need to put in place a system for ensuring that the core business is not jeopardised by this.
The Ngāti Hine Health Trust came under intense public scrutiny following the demise of Te Hauora o Te Tai Tokerau. The Trust withstood the scrutiny and was entirely comfortable being scrutinised due to its robust and accountable systems. Erima puts these systems down to the excellent management and accounting skills Christine brought from the public service. According to Erima, "Funders recognise these skills and now people are lining up wanting to do business with the organisation. We have robust and excellent systems and it is these systems which have enabled our survival."
In terms of government support, Christine and Erima believe government needs to actively listen. The Trust has invited government agencies including the Ministry of Health, Te Puni Kōkiri and Ministry of Social Development to put policy people in its offices to view how they operate. The Trust has offered to assist in the development of policy for Māori community development, yet these offers have not come to fruition.
The Trust is keen on developing a whole of government proposal to address the issues within our communities that have their genesis in social and economic deprivation. The challenge will be to get government agencies to examine issues in a whole of government manner. The way they are structured forces them to be agency role-focused.
Erima believes "there are some good organisations around and government would do well to resource those better to enable them to achieve rather than dispersing valuable resource over a lot of organisations." He sees the Treaty settlement process as becoming a critical environment and he believes government should be placing resources into groups where settlements will occur to develop their infrastructure and potential trustee governance.
The Ngāti Hine Health Trust has developed a reasonably strong capital base through stringent financial management. The Trust has found it hard to keep up with maintenance. The Trust has found that when the organisation is seen to have ability to do certain things it creates a huge demand which is difficult to keep up with. The Trust's success meant that the business grew quickly but, its infrastructure has not kept pace. The Trust is now in a phase of consolidating and it has been difficult to get funding for this aspect of operations. Administration is a legitimate and vital part of operations but allocating funding on this area is seen as taking away from health provision. The Trust in the past allocated approximately 8-10% of its budget on administration but this has increased to 12 to 18% in the past year. Erima says this compares well with mainstream health enterprises.
The organisation began to get the speed wobbles because the administrative structure, originally designed to cater for 30 staff, is currently catering for 120 staff (plus 250 part-timers). For example, the basic IT infrastructure support does not exist in rural areas, so instant support is not available in the regions and everything is dependent upon in-house skills.
From a health provision perspective, Erima believes a critical factor of Māori business is the ability to maintain "holism". One thing is no more important than another as there is a matrix of issues involved. Health is dependent upon everything. "Our core business is people and a holistic environment can be a rod to break your back with or it can give character and growth."
The Trust has had critical people involved. These key individuals have brought in other key people, creating a network of excellence and competence. These people have national profiles as leaders and have reputations for competence, trust and integrity. They have also been supported by local community leaders. An important aspect of their character has been their willingness to bring in external expertise to assist the Trust to become an innovative organisation in the truest sense of the word.
The Trust saw itself as the new kid on the block dominated by mainstream providers but it has successfully created its own niche. Relationships have been key to achieving this. The Trust realised it was a small fish in a big bowl but simply put its nose down, backside up and got on with doing the work.
Christine believes it is a "real buzz that our people and organisation are recognised". The Trust now has a substantial asset base considering it began with nothing. Erima notes: "Politicians might ask why we are acquiring capital assets but rural communities must create their own infrastructures because there is no other option available to us." Property might be a safe bet, in terms of capital gain in Lambton Quay or Queen Street, but it's not necessarily the case in the regions."
In terms of real success measures, Christine comments, "When your local hospital tells you that admissions have reduced by 70% you know you are being successful. Also, $4.5 million goes into the local community in the form of salaries and wages, which makes us the largest employer in Northland outside of Whangārei. This is a massive contribution which is not always appreciated by critics. A key indicator of success is in the kai that is now served at local Marae - lean meat, salads, fruit and generally more nutritious food, and in the number of Marae that have adopted an 'Auahi kore' stance. Those things are real success that will contribute to a healthy environment for our mokopuna."
Both Erima and Christine believe the Trust is on the road to becoming a successful Māori organisation - against all odds. As Erima notes, "The development we've achieved over the last 10 years makes the mind boggle. It makes me wonder what we'd have been like if we had this opportunity 160 years ago. In terms of success it depends on what measure you use. If the measure is growth, we are on the way."
Last modified: 7/06/2011
