Introduction by Croakey: Legislative and policy changes introduced by the Coalition Government in Aotearoa/New Zealand – including the abolition of the Māori Health Authority – adversely impact Māori and may deepen existing inequalities, according to an analysis by The Guardian in 2024.
Now, health leaders in Aotearoa and Australia are sounding an alarm about the Luxon Government’s moves to undermine the independence of medical regulators and to dismiss the importance of cultural safety for healthcare practice and regulation.
Health Minister Simeon Brown has been accused of political interference after declining to reappoint the first wahine Māori chair of the Medical Council of New Zealand (MCNZ), head and neck surgeon Dr Rachelle Love, and deputy chair Simon Watt, saying the regulator had become distracted by politics and an “ideological agenda”.
Te Ao Maori News reports that senior doctors and health leaders say the Minister is undermining the independence of the Council, which is responsible for registering doctors, setting professional standards and ensuring practitioners are competent and fit to practise, while dismissing efforts to address longstanding Māori health inequities.
Explaining his decision, Brown pointed to the Council’s recent consultation on cultural competence, cultural safety and Māori health and wellbeing, and said the Council had “become increasingly distracted by politics instead of focusing on its core responsibilities of improving patient outcomes and ensuring New Zealanders can get the care they need, when they need it”.
The Association of Salaried Medical Specialists executive director Sarah Dalton said the Minister’s suggestion that cultural competency isn’t important was “a direct attempt by a politician to intervene in clinical standards”, according to a report in New Zealand Doctor Rata Aotearoa.
The Association was also deeply concerned by proposed changes to the Health Practitioners Competency Assurance Act that would allow Ministers to direct independent regulators to implement government policy.
“This approach could leave us in a situation where medical standards chop and change with every new government,” Dalton said. “It also sends a worrying signal to other regulators: if you don’t do what the Minister wants, your people will be replaced.”
The Royal Australasian College of Physicians (RACP) has issued a statement raising concerns about the Minister’s comments describing cultural safety as an “ideological agenda”, saying these comments risk undermining patient care.
Expectations that doctors examine “privilege,” challenge the “dominant culture” of the health system, and address systemic barriers reflect core elements of modern clinical practice, grounded in evidence and directly linked to improving patient safety, quality of care, and health outcomes, not ideology, the statement said.
RACP said it strongly supports MCNZ’s role as an independent regulator responsible for setting standards for competent and ethical medical practice, including its work on cultural competence, cultural safety, and Hauora Māori.
RACP Māori Health Committee Chair Dr Matt Wheeler said: “Describing cultural safety as an ‘ideological agenda’ misunderstands its role in healthcare. This is evidence‑based clinical practice that supports patient safety, quality care, and better outcomes. Putting patients first means ensuring care is safe, equitable, and culturally responsive, these are not competing priorities, they are inseparable.”
Meanwhile, the authors below examine the history of cultural safety and its importance to clinical care, as well as the rationale for maintaining the independence of regulators. Jayde Fuller is a Gamilaroi woman and health regulatory specialist at Indigenous Regulatory Practice. Dr Curtis Walker (Te Whakatōhea rāua ko Ngāti Porou ngā iwi) is a renal and general physician, former chair of the Medical Council of New Zealand, former deputy Chair of Te ORA, the Māori Doctors Association, and served on the founding Board of Health New Zealand.
Jayde Fuller and Curtis Walker write:
Kawa whakaruruhau (cultural safety in a Māori context) was developed by the late Irihapeti Ramsden (Ngāi Tahu, Rangitāne) through the 1980s, built into New Zealand’s nursing curriculum in 1992, and adopted across the world – including in the Australian National Registration and Accreditation Scheme one of us has worked within.
To call that an “ideological agenda” insults the intellectual lineage of Aotearoa’s own health system.
Nor is it only custom; it is statute. The Health Practitioners Competency Assurance Act (2003) requires health practitioner regulators to set “standards of clinical competence, cultural competence, and ethical conduct”. In 2019 the New Zealand Parliament amended the Health Practitioners Competence Assurance Act so that “cultural competence” expressly includes “competencies that will enable effective and respectful interaction with Māori”.
Far from Council “being distracted” from its “core business”, as the Minister claims, Council is simply following its Act – an inconvenient truth that has been conveniently absent from any ministerial communications to date. Such criticisms being used to justify the purge are, as one of us said this week, “dangerous and dystopian“.
Cultural safety is essential for quality care. It is not a worldview. The most-cited definition – from a 2019 review in the International Journal for Equity in Health, co-authored by one of us – requires professionals to examine “their own biases, attitudes, assumptions, stereotypes, prejudices,” and to be accountable for care “as defined by the patient and their communities, and as measured through progress towards achieving health equity”.
The standard is set by the patient and judged by the outcome. It is not a belief system the practitioner must profess.
Power first, law later
On 18 May, the Government introduced the Health Practitioners Competence Assurance Amendment Bill. Its new section 126 would let the Minister direct one or more authorities to give effect to government policy, which is to say, the Bill sketches a future in which ministers steer regulators before Parliament has even finished writing it into law.
At the same time, the Bill still leaves regulators responsible for setting standards of clinical competence, cultural competence, and ethical conduct.
And yet clause 20 would strip out the exact words Parliament added in 2019 – “including competencies that will enable effective and respectful interaction with Māori” – as if precision, accountability, and Māori engagement were expendable extras rather than core public protections and responsibilities under Te Tiriti o Waitangi.
Critics say standards that ask doctors to examine their “privilege” or to help “dismantle” systems cross the line from competence into compelled belief.
We take this concern seriously and the line is clear: registration should never turn on a doctor’s private politics, only on whether they can practise safely with the patients in front of them.
But the 2019 definition already makes the deeper point plain – it is the patients and their community, not the regulator and not the clinician’s worldview, who decide whether care was safe.
Where a draft standard overreaches, the remedy is redrafting. That was the process underway. The remedy is not for a Minister to dissolve the leadership and pick up the pen himself.
A tale of two regulators
What sharpens this moment is that Australia has spent the past few years walking the other way with considerable care.
Through amendments to the Health Practitioner Regulation National Law that took effect in 2023, cultural safety became “a guiding principle and objective” in that law – defined, as in Aotearoa, by the patient: “cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities”.
In barely three years, two neighbouring regulatory schemes have diverged at a right angle – one placing cultural safety at the centre of public protection, the other removing it and the people who championed it.
There is a bitter symmetry: Australia enshrined a framework Aotearoa invented, and now Aotearoa is moving to disown its own creation, while that protection beds in across the Tasman.
The politics underneath
The historian Professor Ibram X. Kendi argues that we usually get the chain of racism backwards: we assume ignorance breeds racist ideas which breed racist policy, when in fact power devises the policy first, out of self-interest, then manufactures the ideas to justify it.
Put another way, this is “policy-based evidence” – the antithesis of evidence-based practice.
Read the decision to change the Council leadership that way, and the official story inverts. We are told an idea came first – the “ideological agenda” – and the Minister merely responded. But the policy direction was already set: a government narrowing Tiriti-based and equity measures and concentrating regulatory power in its own hands.
“Cultural safety is ideology” is not the reason for that project; it is the slogan manufactured to sell it, and to steer public resentment away from those doing the dismantling (not to mention it’s a useful distraction from an anaemic economy and a struggling health system).
Independence is the firewall
It would be easier to dismiss this as a business-as-usual ministerial appointment decision if it stood alone. It does not. Days earlier, all six members of the Psychotherapists Board resigned at once, unable to say publicly why. The wahine (female) Māori chair of the Nursing Council of New Zealand was not reappointed last month. Such purges of independent expertise is an authoritarian trait that rarely ends well.
Regulators are independent for the same reason courts are: so the standards that protect the public don’t swing with the politics of the moment.
A minister who can replace a regulator’s leaders over the content of their standards has, in effect, made himself the regulator.
Today it is cultural safety; the machinery, once built, does not care what it is pointed at next. That is why doctors who have never written a word about cultural safety should be uneasy this week.
Already, we have seen the unusual step of a ban on puberty blockers in transgender care. What’s next – a minister popping in during a delivery to tell the midwife where to place the forceps? Which antibiotic should be prescribed for a skin rash? Or, in a real world example, harmful suggestions that bleach or ivermectin were effective therapies for COVID.
Patients are safest when professional standards are set independently, transparently and in the patient interest. The Minister mistakenly says cultural safety is an ideology. We say it’s about giving power to patients — and we will keep saying so.
Meanwhile the country’s health practitioners will keep delivering care that is safe for every patient, especially those the system has failed, because that is the job, whoever holds the portfolio.
Author details
Jayde Fuller is a Gamilaroi woman and health regulatory specialist at Indigenous Regulatory Practice.
Dr Curtis Walker (Te Whakatōhea rāua ko Ngāti Porou ngā iwi) is a renal and general physician, former chair of the Medical Council of New Zealand, former deputy Chair of Te ORA, the Māori Doctors Association, and served on the founding Board of Health New Zealand. He is also a co-author of the 2019 cultural safety review cited above.
Additional commentary
See Croakey’s archive of articles on cultural safety
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