Opinion: Attacks on cultural safety in health highlight politicians’ ignorance

This opinion piece was originally published in The Post.

I recently watched ACT MP Todd Stephenson deliver a speech in parliament outlining his concerns that health professionals are required to practice in a culturally safe manner and that this requirement is embedded in measurable competencies. Clearly the concern of Mr Stephenson and his colleagues in the ACT party underpins the current coalition’s drive to ‘modernise health workforce regulation’.

Submissions on this proposal are currently open, aimed at the public and presented as a set of very disingenuous questions which work to capture the very answer they wish to hear. Working on the same assumptions which underpinned the proposed Treaty Principles Bill, they suggest, innocently, that everyone should be treated the same. On the face of it, this is a seemingly compelling argument designed to capture the support of those who have not thought deeply about this nor been closely involved in providing health services.

I describe the questions as disingenuous because while it is named as seeking patient-centred regulation, it is really Government-centred asking of regulatory agencies to act in accord with Government direction rather than evidence, which is horribly reminiscent of the current chaos in the United States. Importantly, there is a fundamental tenet that any changes in regulation should be addressed to solving an identified problem. In this instance, there is no identified problem. Changes to regulation will not increase the number of available health professionals and will certainly not make them safer to practice.

Such concerns by the ACT party and many of their coalition counterparts demonstrate a spectacular level of ignorance. Listening to Mr Stephenson took me back to the early 1990s when there was a similar uproar. MPs (of similar right-wing persuasion) became exercised about the requirement for nurses to have awareness of the impact of colonisation, the cultural needs of Māori patients and to understand biculturalism as an appropriate foundation for also acknowledging the multicultural needs of Aotearoa New Zealand’s diverse population. During the 1990s, we fought a tedious battle to protect the right for nurses to be educated according to overwhelming evidence. Such evidence shows that unless healthcare regards a person’s context and culture, it is likely to be less effective. I am not referring to surgical processes and medical procedures. I am talking about how we relate to people, what we know to be important for that person and what the context is that shapes their health literacy and their options and choices. Without this knowledge and awareness, our efforts are often cruel and often wasted.

Ironically, Mr Stephenson noted that in his view nurses just really need skill and a big heart. He drew on the concerns of the inevitable few nurses who have expressed their outrage at needing to be culturally competent. Nursing is a very large professional group, and it is sadly true that there are those amongst us who choose not to understand.

Having a big heart in nursing means delivering a high level of knowledge-based expertise with deep compassion and consideration for those we care for. If we act in a way that is oblivious to ethnicity, sexuality, power differentials and difference of any sort, then our hearts are closed and our care will be less than that person needs.

It is hugely annoying to watch MPs pontificating on something they have a very superficial understanding of. It is also frustrating that when we are currently struggling to deliver care in very difficult circumstances, we must yet again defend the safe regulation of health professionals. The only reason for regulating health professionals is public safety. The regulatory process is how we ensure that the education is fit-for-purpose and that the incoming, internationally-qualified workforce meet our standards, in order to ensure that the few unsafe practitioners are managed out of patient care. It is beyond foolish to endanger that process through an ideological drive to remove our commitment to Te Tiriti.

For Māori as tangata whenua of Aotearoa, our drive to provide culturally-safe care is a matter of obligation to Te Tiriti and simple respect.. It is a matter of being effective rather than failing. It is based on compassion rather than disregard. Above all, it is based on evidence that culturally-competent care produces better results. This is obviously cost effective, and this if nothing else, should interest the coalition.

Jenny Carryer CNZM is a Professor in the School of Nursing at Te Kunenga ki Pūrehuroa Massey University, and an honorary professor at Waipapa Taumata Rau Auckland University’s School of Nursing.