Introduction

The Model of Care Framework adoptedprovides a guide to the development of a specific model of care and health service delivery for New Zealand’s population. It is based on a collaborative and inclusive approach to objectively examine how current services are provided, how the workforce can be sustainable now and into the future, how it can be flexible to meet the changing needs of health care, and how there can be embedded and accountable clinical leadership for designing and implementing sustainable services within New Zealand. Manatū Hauora is keen to partner with sector stakeholders to facilitate a solution focused approach that supports a consumer centric and evidencebased health and disability system.

It is recognised that health faces several challenges in delivering effective, efficient, and responsive services to our population. These challenges include high escalating demand for services, limited published peer reviewed evidence about optimal workforce utilisation and ongoing system and process changes. As our workforce continues to evolve, and the global pandemic impacts on the pipeline to supply trained professions, there is a need to proactively work towards reviewing and implementing evidence-based models of care. This Model of Care Framework takes the opportunity to standardise and align process, to optimise the use of available workforce resources which can more effectively respond to increased demand and better utilise resources to improve outcomes provide greater value for money.

To address chronic pain in New Zealand, Manatū Hauora requested a multidisciplinary representative Expert Advisory Group (EAG) to develop a National Model of Care for chronic pain services.

This document aligns to the ICD-11 classification of chronic pain

Chronic pain, also referred to as persistent pain, is defined as pain that recurs or persists longer than three months. It is defined as a health condition in its own right.

It is also referred to as ‘persistent pain’ in the literature and by those living with pain.

Commitment to Te Tiriti ō Waitangi

The New Zealand health and disability system is committed to fulfilling the special relationship between Māori and the Crown specified under Te Tiriti ō Waitangi (Te Tiriti). Meeting our obligations under Te Tiriti is necessary if we are to realise the overall aims of He Korowai Oranga: Māori Health Strategy (Ministry of Health, 2020a) and improve outcomes for the health and disability system as a whole. This includes a desire to see all New Zealanders living longer, healthier, and more independent lives.

Te Tiriti obligations underpin Whakamaua: Māori Health Action Plan 2020–2025 (Whakamaua) (Ministry of Health, 2020e), which sets the government’s direction for Māori health advancement over the five years from 2020 to 2025. As part of the Allied Health Strategy 2021-2023, The Model of Care Framework will support the implementation of Whakamaua and work to identify opportunities to partner with Māori health professionals as we deliver on our objectives.

Where the principles of Te Tiriti underpin the Ministry’s commitment to Te Tiriti and guide the actions outlined in Whakamaua, they also apply to the wider health and disability system (Ministry of Health 2020c, 2020e). The Office of the Chief Clinical Officers (OCCO) seek to fulfil their obligations to Te Tiriti with reference to Whakamaua, pae ora and Tā Tātou Rautaki (Ministry of Health, 2019, 2020b, 2020d).

In aligning with Whakamaua, OCCO seeks to fulfil Te Tiriti principles through the following five strategic intentions.

Hauora Māori Models: Te Whare Tapa Whā

One model for understanding Māori health is the concept of te whare tapa whā – the four cornerstones (or sides) of Hauora Māori.

For many Māori modern health services lack recognition of taha wairua (the spiritual dimension). In a traditional Māori approach, the inclusion of wairua, the role of the whānau (family) and the balance of hinengaro (mind) are as important as the physical manifestations of illness.

This model was developed by Sir Mason Durie, it has been widely taught within New Zealand health professions, is easily accessed and well understood within New Zealand. Te Whare Tapa Whā and has been a cornerstone to the chronic pain EAG’s thinking and model of care development:

With its strong foundations and four equal sides, the symbol of the wharenui illustrates the four dimensions of Hauora Māori.

Should one of the four dimensions be missing or in some way damaged, a person, or a collective may become ‘unbalanced’ and subsequently unwell. This is reflected in a contemporary understanding of pain, with strong evidence that mamaenga roa affects taha tinana, taha wairau, taha whānau and taha hinengaro and, in turn, these factors also influence pain and pain-related disability.

Taha tinana (physical health) The capacity for physical growth and development. Good physical health is required for optimal development. Our physical ‘being’ supports our essence and shelters us from the external environment. For Māori the physical dimension is just one aspect of health and well-being and cannot be separated from the aspect of mind, spirit and family.

Taha wairua (spiritual health) The capacity for faith and wider communication. Health is related to unseen and unspoken energies. The spiritual essence of a person is their life force. This determines us as individuals and as a collective, who and what we are, where we have come from and where we are going. A traditional Māori analysis of physical manifestations of illness will focus on the wairua or spirit, to determine whether damage here could be a contributing factor.

Taha whānau (family health) The capacity to belong, to care and to share where individuals are part of wider social systems. Whānau provides us with the strength to be who we are. This is the link to our ancestors, our ties with the past, the present and the future. Understanding the importance of whānau and how whānau (family) can contribute to illness and assist in curing illness is fundamental to understanding Māori health issues.

Taha hinengaro (mental health) The capacity to communicate, to think and to feel mind and body are inseparable. Thoughts, feelings and emotions are integral components of the body and soul. This is about how we see ourselves in this universe, our interaction with that which is uniquely Māori and the perception that others have of us.