Throughout history, pivotal decisions have profoundly shaped societal norms and public welfare. For example, New Zealand’s groundbreaking 1893 decision to grant women the right to vote significantly advanced gender equality. Similarly, measures like raising the age of consent, tightening restrictions on tobacco sales to minors, and mandating seatbelt use have collectively enhanced societal safety and welfare, setting precedents for future generations. Today, we face a similar crossroads with regard to children’s access to smartphones.
The Government’s decision to ban the use of phones in schools is a significant and commendable step. While I deeply appreciate this move, I would urge the Government to go even further by implementing a ban on smartphones for children under 16.
As a parent of three, with an almost-12-year-old, my husband and I have consistently taken a stricter approach to limiting our children’s exposure to digital devices. When our son turned 11, we gave him a basic Nokia brick phone rather than a smartphone. This decision reflects our commitment to delaying his exposure to smartphones while ensuring we can still stay in contact with him during his hour-long daily commute.
However, most of his friends already have smartphones.
Research from the UK states a staggering 97 per cent of 12-year-olds in Britain own a smartphone. This widespread access has not come without consequences. Research reveals the detrimental effects of these devices, such as exposure to inappropriate content, increased risk of addiction, and significant mental health issues. These problems are exacerbated by the omnipresence of social media that can lead to cyberbullying, body image issues, and overall lower self-esteem.
Moreover, the social implications of restricting smartphone use are also significant. For instance, our son, starting at a new school, found himself somewhat isolated because most of his new friends communicated primarily through platforms such as Snapchat. This dichotomy between connectivity and isolation poses a complex challenge for parents navigating the digital landscape with their children.
Most parents want to do the right thing and believe they can effectively regulate the content their children access online, but this often proves to be a misconception. Several of my friends have recounted instances where their children circumvented parental controls, either by altering the settings themselves or by finding loopholes in the safeguards meant to protect them.
This challenge underscores a broader dilemma many parents face: the fear of social isolation if their child does not have a smartphone. Consequently, many parents yield to peer pressure, choosing to provide smartphones to avoid this isolation. In our family, addressing this complex issue has required us to maintain open and honest communication with our son. This approach is vital, particularly in an environment where many parents are battling their own smartphone addictions.
In fact, tech companies invest billions in making apps and devices intentionally addictive, affecting young brains in ways similar to gambling. One disturbing statistic from a study is that one in five teens engages with YouTube “almost constantly”. This level of engagement has tangible effects on mental health, with heavy social media use linked to a 50 per cent increase in depressive symptoms among girls, compared with 35 per cent for boys, highlighting a gender disparity in the impact of these technologies.
In my role, I am confronted daily with the rising tide of mental health issues among youth. This is occurring in an environment where our healthcare resources are already stretched thin. Given this context, it is critical to re-evaluate the role of potentially harmful digital tools in the lives of our children.
Opponents argue phones are essential for classroom research, yet viable non-smartphone alternatives exist. I believe reliance on smartphones is unnecessary before age 16. Furthermore, education on responsible device usage should be introduced after age 16, when the brain is better equipped to handle the digital world.
Meanwhile, the evidence is clear and compelling — as a society that has historically regulated substances such as alcohol and tobacco to protect our young, it is logical and necessary to extend these protections to include the risks associated with digital device use among youth.
Therefore, I urge the Government to take a bold step further by considering a ban on smartphones for those under 16 in New Zealand. This measure would not only safeguard our children’s mental and physical health, but could set a global precedent similar to the way we led the world in granting women the right to vote.
Let’s start a movement to make New Zealand the first country to regulate smartphone use among children. Who’s with me? Together, we can make the decision to help protect our young generation from excessive digital exposure and set a positive example for the world, significantly enhancing the health and wellbeing of our children.
The recent issues surrounding the new Tōtara Haumaru hospital on the North Shore, which remains unopened due to staffing and budgetary issues, serve as a poignant reminder of the misplaced priorities in our healthcare spending.
While it’s tempting to invest in grand new facilities like Tōtara Haumaru, with its innovative healing garden and state-of-the-art surgical suites, these investments miss the mark if the basic healthcare needs of the community are not met first.
It is well known that primary care is the cornerstone of a functional healthcare system. It is where prevention happens, where chronic diseases are managed, and where minor issues are treated before they escalate into emergencies that require hospital care.
By strengthening primary care, we can reduce the demand for hospitalisations, and emergency department visits, thereby easing the burden on our healthcare infrastructure.
Highlighting the critical role of primary care in preventing escalating healthcare demands, a reduction in GP consultations could potentially double emergency department presentations. Moreover, the financial disparities in delivering primary care versus tertiary care are well documented; for instance, in Australia, the government spends about $595.17 on a non-admitted emergency department visit compared to just $76.95 for a GP consultation.
In Canada, improved access to primary care is linked with up to a 30 per cent reduction in hospitalisations for conditions such as diabetes and hypertension. This dramatic difference highlights the economic benefit of strengthening primary care to address health issues before they escalate into costly hospital care. Investing in primary care yields substantial returns, significantly reducing hospital stays and thereby not only saving costs but also improving health outcomes.
This investment strategy extends beyond mere financial savings, fostering a healthier population and enhancing overall quality of life, making it a pivotal and life-enhancing approach to healthcare management.
The benefits of robust primary care are even more significant for underserved communities, such as Māori, Pasifika, and those living in rural areas. These groups often face the greatest barriers to healthcare access and have higher rates of health inequities.
Strengthening primary care can not only help reduce these inequities but also supports the health system’s sustainability by preventing manageable conditions from becoming acute crises. For a government that is focused on outcome-based initiatives, primary healthcare should be an easy investment thesis. In the upcoming healthcare budget, the Government stands at a pivotal crossroads, with an opportunity to make a transformative investment in our nation’s health.
Should the proposed increase in funding be minimal, it will not adequately address the profound challenges facing our primary care system. An underwhelming allocation of resources risks leaving primary care facilities unable to maintain access or enhance services and risks having long-standing GPs exiting the profession faster than anticipated.
Consequently, this limitation could place undue strain on already overstretched hospitals and aged care services, inhibiting their ability to deliver comprehensive care.
A substantial boost in funding for primary care is not just a matter of budget allocation; it is an investment in the very fabric of our society’s health and wellbeing. Without it, we risk continuing the cycle of reactive healthcare, where more resources are consistently funnelled into emergency and acute care settings — areas that could have been less burdened had there been adequate preventative care measures in place.
In addition, once the funding has been confirmed, it’s crucial to scrutinise the funding distribution process, as too often, the intended funds do not reach primary care providers directly. This issue is especially evident with mental health and health improvement practitioners, including health coaches, who are vital in primary care settings but the primary care provider, not receiving the direct funding instead these are provided by PHO’s, without the funding reaching frontline primary care. This gap underscores the need for a more transparent and effective distribution mechanism to ensure that resources are utilised where they are most needed.
So, while new hospitals like Tōtara Haumaru are impressive, they should not come at the expense of primary care—the real frontline of health prevention.
We need a strategic shift in our health budget to prioritise primary care, ensuring it receives the support necessary to fulfil its critical role. This is how we build a healthcare system that not only saves money but also, more importantly, saves lives.
- Cecilia Robinson is a founder and co-CEO of primary care provider Tend Health
We are beyond thrilled to announce that our co-founder and CEO Cecilia Robinson has been named New Zealand Innovator of the Year at the Kiwibank New Zealander of the Year Awards. This prestigious recognition is a testament to Cecilia's leadership, vision for the future of healthcare, and steadfast commitment to making a difference to the lives of all Kiwis.
Cecilia is a true entrepreneur at heart and has a remarkable ability to inspire and empower people. She leads by example - with her unwavering determination, infectious energy, and relentless drive to innovate. Cecilia's personal health experiences have motivated her to dedicate the rest of her life to improving healthcare outcomes for our tamariki.
Also humble, Cecilia extended the award to the entire Tend team, recognising that innovation doesn't happen in isolation, it is a reflection of our combined mahitahi.
We are incredibly proud to work alongside such an exceptional leader and are excited to continue our mission of making New Zealanders the healthiest people in the world under Cecilia's guidance.
An excerpt from her acceptance speech:
“I wanted to share one of my favourite quotes by Swedish author Astrid Lindgren:
"Allt stort som skedde i världen skedde först i någon människas fantasi."
In English, it translates to, "Everything great that ever happened in the world, first happened in someone's imagination."
This quote holds true for our journey at Tend. However, innovation and progress never occur in isolation. They are the result of our mahitahi - our collaboration of diverse backgrounds, skills, and perspectives.
When you ask "Do we need to innovate, everyone says YES," but leading innovation takes courage. The team at Tend’s commitment to innovation is inspiring and crucial to shaping the future of healthcare. Thank you for your dedication and creativity in pushing boundaries and making a positive impact.
Tend isn't your regular Kiwi start-up, we're not talking about going global. Instead, we're innovating in a category that impacts each and every one of us. We're rebuilding our healthcare system from the ground up.
Healthcare may not always seem glamorous; it exposes our country at its most vulnerable. Every day, we tackle some of New Zealand's biggest and most complex issues. But amidst the challenges, we are making progress. We are innovating - together.
Let's continue to collaborate, innovate, and push boundaries as we work towards our shared vision of a healthier future for all.”
Tend and Innovation
Operating at the forefront of primary healthcare and technology innovation, Tend has rapidly emerged as one of Aotearoa's largest primary care providers in just three years. With over 130,000 patients enrolled across 25 clinics and nearly 500 team members, Tend is revolutionising a sector grappling with challenges.
Innovation lies at the heart of Tend's mission to transform healthcare. By harnessing cutting-edge technology, Tend is reshaping primary care delivery and addressing critical areas of need.
Tend’s commitment to innovation spans three key pillars: access, equity, and workforce enhancement. Recognising the pressing need for improved access to healthcare services, Tend has improved and streamlined processes to significantly reduce wait times.
The team at Tend is dedicated to promoting health equity by addressing disparities in healthcare access and outcomes. Their targeted initiatives have led to remarkable improvements, including a sevenfold increase in Pacifica enrolments and more than doubling Maori enrolments at one of the recent clinics that was integrated.
Furthermore, Tend prioritises their workforce, understanding that empowered and satisfied clinicians are essential for delivering quality care. By leveraging technology Tend aims to reduce administrative burdens, boost clinician satisfaction, and use AI to enhance workforce productivity. Through these efforts, Tend is making tangible strides towards a more inclusive and effective healthcare system for all.
Cecilia Robinson, Founder & Co-CEO of Kiwi-owned healthcare company Tend Health, expressed her dismay at the Pāpāmoa Pines Medical Centre's closure, stressing its significant impact on the local community. "Closing Pāpāmoa Pines is a major blow, particularly to the 6,000 patients," she noted, citing GP shortages and funding issues as critical factors."Our sympathies lie with the Pāpāmoa Pines team, whose dedication to healthcare in this rapidly growing area has been unwavering," she added.
Robinson also outlined Tend's proactive approach to this situation, confirming that the centre will reopen with a Tend medical centre. "In response to the closure, we have been working alongside the Pāpāmoa Pines team to reach a practical solution for quite some time. I'm pleased to share that we plan to reopen the medical centre in June 2024, confirming our commitment to ensuring that Pāpāmoa residents continue to receive the essential healthcare services they deserve, within their own community," she stated, reflecting Tend's dedication to meeting the healthcare needs of the Pāpāmoa community.
"Our preparations are already well underway," stated Ms Robinson, as she shed light on the dedication to the local community and the ongoing integration already underway to integrate the four local Tauranga clinics, Chadwick Healthcare, with Tend. "We are already deeply invested in this community and are committed to integrating our Chadwick practises with our technology and operational process. We recognise the significance of this transition period and are acutely aware of its potential impacts on both our team and the community we support."
Robinson asked for support from the community, emphasising the importance of keeping medical services open and accessible in Aotearoa. "In these times of change, we urge the community for support and patience. Change is challenging, but we're dedicated to a smooth transition," she stated. "We have evidence that post integration satisfaction and timely access to care will improve for our patients."
Robinson said that Tend's dedication to tackling systemic issues within the healthcare sector, highlighted the organisation's comprehensive strategy. "Our focus stretches far beyond merely reopening the centre," she remarked. "We're actively addressing the wider systemic challenges inherent in primary care. Our efforts are centred on enhancing accessibility, improving health equity, and, crucially, alleviating the administrative burdens for clinicians."
"Our technology aims to alleviate the administrative burden on healthcare professionals, enabling them to devote more time to patient care," Dr Graham Denyer, Tends Chief Medical Officer added. "Following the launch of our app's test results feature, we've seen a 59% reduction in clinicians' time spent informing patients of their results."
Another cornerstone priority for Tend is the commitment to health equity which has seen a significant ethnic shift in enrolments following integration of a medical centre into Tend. The share of new Māori enrolments have more than doubled and for Pasifika it has increased seven times more than the existing patient cohort" "Tend Health is committed to using our technology to improve health equity and enhance healthcare accessibility, particularly in underserved communities and rural areas," stated Robinson.
Tend is also showcasing the potential for shorter wait times, both in-person and online. Dr. Denyer highlighted the efficiency of Tend's digital healthcare services, which make up 35% of all consultations. The "Online Now" urgent care service has transformed consultation access, offering virtual appointments with an average wait time of just 2.4 hours.
Dr. Denyer elaborated on the initiative's goal to ensure prompt healthcare access and lessen the burden on urgent care centres and A&E departments for conditions that can be effectively managed online. "Our prompt access approach allows patients to receive care swiftly, with 95% of patients stating that their needs were met through this channel," he said.
"Our commitment to delivering the best healthcare experiences is at the very heart of what we do. We believe healthcare should be equitable, accessible, and designed for you and your whānau," Robinson concluded, “We hope that the planned reopening of Pāpāmoa, coupled with the integration of Chadwick Healthcare Group in the Bay of Plenty, offers hope to the local community”.
Tend Health, has become one of the largest primary healthcare providers in Aotearoa through the full acquisition of Better Health group, focusing on how technology can play a crucial role in addressing the challenges facing primary care.
"The group encompasses 17 medical centres with over 90,000 patients, positioning it as a leading healthcare provider in New Zealand with over 130,000 patients across the group of practices" says Cecilia Robinson, Founder & Co-CEO of Tend Health. She further adds," Tend is committed to providing better access to primary care and improving the health and wellbeing for people across Aotearoa."
Dr Graham Denyer, Chief Medical Officer at Tend Health, described Tend’s progressive care model as addressing the systemic challenges faced by both clinicians and patients, whilst maintaining the core values of primary care. "Our innovative approach to care is yielding promising results, as seen in our recent clinic integrations.”
Following integration to Tend, enrolments at one Tend medical centre saw a significant ethnic shift, indicating improved accessibility to healthcare. Pacifica enrolments rose from 2% to 13%, and similarly, Māori enrolments saw a significant increase, from 8% to 18% all of new enrolments post Tend integration. This underscores Tend's commitment to addressing healthcare disparities and ensuring easier access for underrepresented communities.
Ms. Robinson stated, "Tend Health is committed to using our technology to foster health equity and enhance healthcare accessibility, particularly in underserved communities and rural areas. Our proactive approach has resulted in notable achievements, such as a 20% higher immunisation rate among tamariki Māori in Auckland compared to the district average."
In Aotearoa, where patients may wait up to three weeks for a GP appointment, Tend is proving that shorter wait times are achievable, both in-person and online. Dr. Denyer highlights the efficiency of Tend's digital healthcare services, which constitute 35% of all consultations. The "Online Now" urgent care service by Tend has revolutionised how consultations are accessed, providing virtual appointments with an average waiting time of merely 2.4 hours.
Dr Denyer elaborates, "This initiative is aimed at ensuring prompt access to healthcare, avoiding extensive waiting times, and lessening the burden on urgent care centres and A&E departments for conditions that can be competently handled online. Our prompt access approach allows patients to receive care swiftly, avoiding unnecessary visits to urgent care with 95% of patients stating that their needs were met through this channel."
Moreover, "Our technology aims to alleviate the administrative burden on healthcare professionals, enabling them to devote more time to patient care," Dr Denyer adds. "Following the launch of our app's test results feature, we've seen a significant 59% reduction in clinicians' time spent informing patients of their results."
Dr. Denyer highlighted the role of telehealth in Tend's healthcare framework, describing it as a clinical tool that improves patient access without supplanting face-to-face consultations." Telehealth is an additional mode of care delivery, suitable for certain situations, offering considerable access advantages for patients” Denyer elaborated. "Our aim is to create a comprehensive primary healthcare network that utilises intelligent technology, ensuring a full range of services where telehealth complements traditional in-person care."
The integration of Better Health's clinics into the Tend model will commence with Linwood Medical Centre in May 2024. This strategic expansion builds upon the successful integration of Pakuranga Medical Centre into Tend Pakuranga in May 2023 and the recent acquisition of Chadwick Healthcare Group in the Bay of Plenty, which is poised for integration in March 2024.
"Our commitment to delivering the best healthcare experiences is at the very heart of what we do. We believe healthcare should be equitable, accessible and designed for you and your whānau" concluded Cecilia Robinson. "We’re building a 100-year, Kiwi owned healthcare company for our future generations."
As featured in Caffeine Daily, written by Fiona Rotherham
In a world where serial female entrepreneurs are rare, Cecilia Robinson has garnered plenty of attention in New Zealand, including around her and her co-founders’ exit from listed My Food Bag (MFB).
The co-founder of Au Pair Link, MFB and Tend Health has won a number of plaudits including the Supreme Woman of Influence in the New Zealand Women of Influence awards in 2017, NEXT Businesswoman of the year in 2014 and EY Young Entrepreneur of the Year in 2013.
But it hasn’t all been plain sailing. Robinson was co-founder in MFB with her husband James, businesswoman and investor Theresa Gattung, and celebrity chef Nadia Lim and her husband Carlos Bagrie.
They’ve copped flak that the listed food delivery company’s 2021 initial public offer (IPO) was fundamentally overpriced, and some brokers and investors were critical of the large number of shares being sold by exiting shareholders.
MFB was then valued at $449 million and is now valued at under $36 million at the time of writing (more on this later). The husband and wife duo’s first venture was Au Pair Link, New Zealand’s largest au pair agency, which they set up in 2007.
Robinson says they started considering an exit after about three years. However, it wasn’t until they had already co-founded MFB in late 2012 that they actively pursued a sale.
The Robinsons have three children themselves and she says the childcare industry does well in good times and bad, because in good times people want childcare in order to have more of a lifestyle balance and in bad times they need it in order to work more.
“It’s actually a really interesting category to be in but at the same time we didn’t see ourselves doing it for the next 20 to 30 years of our life, so we started looking at what our options were.”
A potential sale to a German partner didn’t pan out and the Robinsons appointed a business advisor to run a tender process for the in-home childcare company in 2014.
At the time they were based in Australia setting up MFB there, had one young son and Robinson was five months pregnant.
“It was just an insane period for us. We’d put out this document for people to tender on the business and to provide us with an offer and we had our stillborn daughter that week. It was a very intense period professionally and personally.”
While there were no offers from the tender, a new buyer, Evolve Education Group, emerged shortly after and bought the business for an undisclosed sum in late 2014 on the eve of Evolve listing on the NZX and ASX.
Unusually for a founder-led company, the Robinsons were able to walk away without any further involvement. She says that was because they were able to demonstrate that the business was being largely run by a general manager they had already appointed.
Having such a clean exit was hugely beneficial, says Robinson.
“Even if you love this business that you’ve built, you've handed it over and you don’t have that accountability any more, it’s not your decision making. While it was hard to say goodbye to our team, which was a good team, it was the right thing to do.”
Cecilia and James Robinson pictured with one of their three children
The next exit
MFB grew quickly with a first-mover advantage in what was then a fledgling industry. The Robinsons had put in $60,000 of their own capital and the whole founder group invested a total of just $250,000.
“From that we created a business that when we left as CEOs [in 2018] was turning over close to $160 million worth of revenue and doing 10 percent EBIT on that,” says Robinson.
Within four years the co-founders had sold a near 70 percent stake to private equity firm Waterman Capital.
When asked why they went for private equity (PE) so early, Robinson replied “naivete and poor advice. If I could do things differently, I probably would.”
Having gone through that experience, she says, the company’s founders are now a lot more savvy. “I don’t think we ourselves fully appreciated the attributes and how successful MFB had been in such a short period of time and we were given really poor advice as part of our process as well.”
Robinson says they had an approach from a would-be investor just six weeks after the business launched.
“You’re the person everyone wants to date and at the end of the day you feel almost pressured to run a process because you’re almost constantly being inundated with requests to form a partnership or to buy a stake. When we ran the process it was genuinely because we’d had so much reverse interest that it would have been foolish to not even consider it, but I think we could have run a better process.”
Robinson says around that time they had turned down an offer from an overseas investor for around twice the price Waterman paid because they didn’t want to sell a New Zealand business to an overseas PE firm.
“It was the right decision at the time because we didn’t want to sell a loved New Zealand brand to one of the big US or Asian PE firms, but we should have reflected on that journey a bit more and what the right thing was for the long term.”
She advises other founders being courted by investors to consider whether they have good alignment on the startup’s vision and values.
“We should have done better due diligence,” she says.
Co-founders from left: Nadia Lim, Theresa Gattung, Cecilia Robinson
The IPO
After the November 2016 transaction with Waterman Capital, Robinson says she and her husband gave themselves 12 months to continue as co-CEOs to see if it would work out. “We resigned 12 months later to the day and saw out an orderly transition to appoint a new CEO. It’s clear that it didn’t work for us.” Robinson remained a director until shortly before the listing.
Any questions about the pricing of the IPO at $1.85 per share (with shares now trading at around 15 cents at time of writing) should be posed to Waterman Capital, she says.
“They’re the people that made the decisions around that. It was a drag and tag process.”
Drag-along and tag-along rights allow a majority shareholder to force minority shareholders to consent to the sale of a company to stop them holding up a promising deal. But the rights also ensure the minority shareholders sell on the same terms and conditions as majority shareholders.
Most of the $342 million raised at IPO went to existing shareholders with just $55 million going to the company in new capital; $38.2 million repaid bank debt and $16.7 million funded the IPO costs. Waterman Capital sold down its stake from 70 percent to 15 per cent.
To put it bluntly, a group of men listed MFB and the women who were the founders of the brand, copped criticism for it, says Robinson.
“I wonder if the founding group hadn’t been female, I wonder if the same approach would have been had. There are lots of examples of other businesses that have listed, not necessarily on the NZX, with male founders that haven’t received the same kind of targeted abuse or criticism.”
Waterman Capital didn’t respond to Caffeine’s request for comment.
Robinson rejoined the MFB board in mid-2022, hopeful her institutional knowledge would help boost the business’ performance.
Returning to MFB has been a positive experience, says Robinson, and she holds the new CEO Mark Winter in high regard. His vision is closely aligned with the company’s original objectives and focus, she says.
In the IPO, the Robinsons’ stake dropped from 11.8 percent to 3 percent. They increased it again to close to 8 percent at the end of last year “as testament to my belief in its potential and direction”, says Robinson.
“Serving again as a director, I am committed to showcasing this belief to our stakeholders. Moreover, during the past year, my confidence in Mark’s leadership as CEO, along with the dedication and expertise of the wider leadership team, has only strengthened,” she says.
Former MFB Co-CEOs: James and Cecilia Robinson
Retirement? Hell, no
The plan for the husband-and-wife duo was to retire after MFB. Robinson recalls soon after sitting opposite James in their home office and posing the question of whether they should do “this health idea” they had been talking about.
“He was like ‘just give me a break before we even consider something like that’.”
The break involved doing largely charitable activities but Robinson was itching to get back into the startup world where she could utilise her skills as well as her money.
“I’m really rubbish at tennis – I tried to pick up tennis and go for coffees and it didn’t really suit me as a person. I don’t even drink coffee.”
In 2019, prior to the Covid pandemic, the pair, along with Dr Mataroria Lyndon and Josh Robb, started work on primary healthcare provider and technology company Tend Health. It allows patients to make appointments and have online video consultations with doctors and nurses through the Tend app.
Backers include Gattung and former Infratil CEO Mark Bogoievski (the latter got involved when Tend did a $15 million closed capital round in January 2021).
The experience and lessons from their past endeavours have been crucial in shaping the philosophy behind Tend, says Robinson.
The board is not only capable and supportive but also shares their vision – a dynamic Robinson says is vital for any founder.
“Their advice challenges us constructively, fostering a relationship based on respect and mutual growth.”
This time around it is a startup with a purpose: to make a tangible difference to New Zealand’s health system.
“We are building what we want to be a 100-year-old Kiwi-owned healthcare business. We’re not looking to sell this business to a big overseas party. That’s intentional language that we use with our team and our board to be very clear about what we are building. It is a legacy.”
The Robinsons are the largest shareholders in Tend with a near 49 percent stake and she says it is always different when your own money is at stake.
“It was easy for many years just to raise capital and deploy it but when you’re dealing with your own funds – and we’ve always done that – every cent matters, every dollar matters. You work really hard to deploy in a way that makes sense and is going to get the best return from a healthcare outcome.”
The Robinsons have no exit plan for Tend, despite swearing after the sale of their early childhood company that they wouldn’t have anything to do with government funding in future businesses.
Robinson says she wants to spend the rest of her working life with Tend where she says both her and James’ skill sets and experiences are well applied.
“It is unusual to do what we have done – three very different categories – and it would have been far easier to go and set up another food business after MFB, because we had all the relationships, but it wasn’t what we wanted to do for the rest of our life. We have found our calling.”
With the new government pledging to scrap the Māori Health Authority, board member Dr Mataroria Lyndon tells Ronan Payinda that while the exact path forward may not yet be known, there’s no stopping the fight for Māori health equity.
Dr Mataroria Lyndon (Ngāti Hine, Ngāti Wai, Ngāti Whātua, Waikato) is a senior lecturer in medical education at the University of Auckland, co-founder of Tend Health, and board member of Te Aka Whai Ora – Māori Health Authority.
Mataroria credits te reo and tikanga Māori as his tūāpapa – the underpinning of his identity and career successes, passed down to him by his elders. Amid growing disquiet over the coalition government’s approach to Māori issues, I spoke to him about the future of Māori health in Aotearoa.
We’ve been hearing a lot about the new government’s plans to abolish the Māori Health Authority. If Te Aka Whai Ora is disestablished, what is the path ahead for Māori health?
Māori health still very much remains. Whether we have Te Aka Whai Ora in place or not, future governments will still need actions to address health inequity for Māori. The work of Te Aka Whai Ora has been about how Māori can have greater decision-making and authority over hauora Māori – giving Māori autonomy over setting strategy and policy and commissioning of Māori health services, and monitoring the outcomes of the health system.
It is up to the government to lay out their view of the road ahead, but in terms of the important mahi, both Māori and non-Māori allies will carry forward the aspirations and the vision for Māori health equity and wellbeing into the future.
Dr Mataroria Lyndon, far left, at the launch of Te Aka Whai Ora, July 2022 (Photo: Skye Kimura / Supplied)
Can you explain the core reasons behind why Te Aka Whai Ora was established in the first place?
The 2019 Waitangi Tribunal report into health services for Māori was a game-changer. It identified a number of inequities for Māori – the lack of decision making, lack of accountability and monitoring, inequitable resourcing, the under-representation of Māori within the health sector workforce. The tribunal stated that these inequities were breaches of Te Tiriti and it recommended the creation of a Māori health authority.
Secondly, the 2020’s health and disability system review recommended a Māori health authority as well. So these reports are one basis, alongside many pioneers and health leaders in Māori health that had been calling for a Māori health authority over the last few decades.
We’ve had decades of work by Māori health advocates calling attention to the need for a Māori health authority. Those reasons haven’t gone away, have they?
Alongside those reviews and reports, the health inequities still remain. And the aspiration and the work continues, irrespective of whether there is a Māori health authority or another entity to address these issues.
What I would also like to highlight is the iwi-Māori partnership boards established by the Pae Ora legislation. They have a key role in reflecting whānau voice within the health system, as well as monitoring the performance of health services in their localities. Even if Te Aka Whai Ora is disestablished, iwi-Māori partnerships are another mechanism of Māori health leadership.
I don’t know personally what the road ahead will look like – that’s ultimately the job of the new government. But I know that iwi decision-making in the health system is here to stay.
With decades of work and advocacy, why are inequities still here? Why are they so entrenched in our health system?
One of the core reasons is the wider social determinants of health. But we know that it’s not just socioeconomic factors alone, because Māori still have worse health outcomes even within the same deprivation brackets as non-Māori.
So there is an analysis around poverty, income, employment, education, but that’s only part of the issue. We also need to look at the health sector – there are inequities in access to care, quality of care, and the under-representation of Māori in the health workforce.
And then we also need to look at the health system level. The Waitangi Tribunal found a lack of Māori decision-making, a lack of accountability for Māori health, in our health system.
These are just some of the issues that have been identified. But there has been progress made, such as through the likes of the Māori and Pacific Admission Scheme (MAPAS) programme, there has been increasing numbers of Māori students and graduates coming through. But the issue still remains, and the job now is to keep going.
A simulated treatment session at the Māori/Indigenous Health Institute, University of Otago (Image: supplied).
You were brought up in Whangārei and in South Auckland. Here in Te Tai Tokerau Northland, there’s a disproportionately high health need, especially among our Māori communities. How did your upbringing influence your advocacy for Māori health equity and your career direction?
My parents were a big inspiration to me. When I was young, my mum, who had a teenage pregnancy, went back to school to get her high school certificate, and I was a kid going along with her. There was always a sense instilled from my parents of wanting to get a good education, wanting to do better for their family, for their whānau, their tamariki.
But always remembering our roots, of being from where we’re from, who we are, of growing up in te reo Māori – my dad’s first language that he passed onto us. Te reo Māori is an important connection to our whānau, to our whakapapa, and that’s something that I’ve always been able to take forward with me in the work I do.
We moved around a lot growing up because my parents were always finding work. Coming back to South Auckland, which is where my dad was teaching, where I went to school at Tangaroa College, it was an example to me about different communities. Whether that be rural Northland where we whakapapa to, or deep in South Auckland, in a heavily Pasifika and Māori community, a high-needs community – seeing what those different needs were was a good experience during my upbringing.
I’ve worked previously across the health sector, from a frontline doctor, a DHB board member, and now as a Te Akai Whai Ora board member. These different experiences, alongside my own upbringing, made it clear to me that we need to address Māori health inequity.
A Whānau O Waipareira team helps with a Whānau Ora vaccination campaign in Papakura, Auckland, in November 2021 (Photo: Fiona Goodall/Getty Images)
Some people don’t see the need for Māori health programmes because they think the impacts of colonisation on our health system are long in the past. Can you explain why there’s still a pressing need today?
Having a one-size-fits-all approach is not a good way to address health inequities or differences in health needs – that’s one explanation for why Te Aka Whai Ora was put in place, to identify solutions that work for Māori.
Secondly, it’s not a level playing field when it comes to everyone’s health. There’s an assumption that if the health system is just based on need alone, then we’re all going to have the same health outcomes.
But we know that because of the issues around poverty, housing, education, employment, income – those necessities that people need to lead healthier lives – these aren’t the same, particularly for Māori. It’s not a level playing field, hence the need for more targeted support and action to tackle these health inequities.
We need to acknowledge that the health system was constructed to benefit some more than others. That’s why there’s a need for greater Māori decision-making, design and delivery of our health services.
There is a saying that what works for Māori works for everyone. I’ve seen that throughout my career. With the Māori health team at Counties Manukau DHB, we held hapū wānanga on marae for pregnant mums and whānau. And there were non-Māori accessing that marae programme as well, because they really enjoyed the Māori approach of whanaunga, having it in a marae-based setting, connecting to whānau.
And we saw the same for Covid outreach done by Māori health services – we had iwi health services running vaccination programmes across New Zealand. Many iwi health services probably vaccinated more non-Māori than Māori, because it was a service that went out to the community and was open to everyone.
All these examples show that when Māori have decision-making and accountability over their own services, they’re effective at bringing healthcare to our communities. But Māori health services are also still open for others to access as well. So when we fight for Māori health equity, we’re also going to uplift all of Aotearoa.
Following the previous government spending nearly $71 billion on its Covid response – a figure significant even by international standards – it’s disheartening this colossal investment has not led to tangible improvements in our hospital system.
This reality hit home for me on an otherwise typical Tuesday morning. Amid a flurry of work meetings, a phone call from my daughter’s school abruptly shifted my focus from the professional to the personal. A playground fall and a broken arm resulted in a trip to the emergency department and a first-hand experience of the system. As I worked through the options regarding picking her up, I opted against calling an ambulance to avoid overburdening emergency services, deciding instead to drive her to Starship Hospital.
As we arrived, the difficulty of navigating the crowded parking area was just the first of many challenges. The initial struggle to even bring her safely into the emergency department (ED) was a precursor to the systemic inefficiencies in a system that is no longer fit for purpose. Following an X-ray which confirmed the need for a temporary cast and subsequent surgery, we faced a lengthy wait.
The postponement of the cast application process until the late afternoon was due to a shortage of available resources and personnel.
Despite low expectations for surgery to be performed that same evening, my daughter was kept fasting into the early evening in case a slot became available. Regrettably, the surgery did not go ahead. In today’s era, where technological advancements have transformed every aspect of our lives, it’s reasonable to expect that healthcare systems should also embody this progress.
The lengthy delays and uncertainties experienced in the system underscore the pressing need for a healthcare system that leverages technology to enhance efficiency and patient care. The glaring lack of technology at Starship was strikingly apparent, with staff members relying heavily on paper records and hand-written notes.
This outdated approach led to repetitive information exchanges and underscored the critical need for more efficient, modern systems. It was clear the staff, despite their best efforts, were constrained by a system that has not kept pace with technological advancements, leaving them to tirelessly work around its limitations. In a modern hospital system, we should see seamless integration of technology in everyday operations.
This would include the use of electronic health records as a standard practice, eliminating the outdated paper-based system. Implementing this transition is vital not only for minimising human errors, but also for enabling swift and precise communication among healthcare professionals.
Proper utilisation would lead to improved health outcomes and enhanced productivity. This approach is essential in reducing waiting times and elevating the standard of patient care to meet expectations. Not to mention the opportunities that arise from today’s technology - advanced triage systems, powered by AI, should be able to prioritise cases more effectively, ensuring timely treatment. Automated scheduling systems for surgery can prevent prolonged delay, while telemedicine for post-operative care should offer an avenue for earlier discharge.
The lack of a digital system was starkly evident when a visiting doctor friend was horrified to find my daughter had been receiving medication for the past 30 hours without an admittance bracelet - a basic yet crucial lapse in protocol.
In our daughter’s case, the reliance on a paper-based system led to a chaotic rush of last-minute surgery preparations, further exacerbating inefficiencies. This situation starkly demonstrated the necessity for a more streamlined and technologically advanced system.
Speaking to a senior health official from overseas, they compared our hospital infrastructure to that found in developing countries, a remark that resonates with our experiences. It’s clear there’s an urgent need for a healthcare system that embraces technology in tandem with the expertise of our hard-working healthcare professionals. As we were leaving the hospital, a nurse diligently verified my contact details.
She mentioned the common occurrence of errors when transcribing information from hand-written notes to their digital system. Skimming the form, I wasn’t surprised to notice an error in my phone number, a critical detail for next week’s follow-up appointment.
This minor but important mistake highlighted a larger concern: the importance of enabling patients to input and update their own details wherever feasible. A world-class hospital system, bolstered by advanced technology, is crucial for more than just efficiency; it’s fundamental to delivering the care and respect every patient deserves. In addition, technological integration is also vital for supporting our clinicians, who are at the centre of a healthy population.
Amid the backdrop of a pandemic that cost our nation nearly $71b, our healthcare professionals, the unsung heroes, remain underappreciated and are saddled with an undeniably obsolete system. Following our daughter’s extended hospital stay, which incurred substantial taxpayer expense, I am hopeful about the new Government’s vision to improve healthcare spending.
The commitment to modernising the system is evident in initiatives like revising Pharmac’s decision-making model to better reflect patient perspectives, mandating the Ministry of Health to regularly publish a Medicines Strategy, and expediting Medsafe’s pharmaceutical approvals.
This marks a pivotal move towards a patient-centric, strategically enhanced healthcare system, presenting the Government with a golden chance to create a lasting, positive legacy. However, it’s crucial this transformation also embraces technological advancements.
Now more than ever, it is essential to upgrade our technological infrastructure to reflect the commitment and expertise of our invaluable healthcare workers. We must dedicate ourselves to equipping them with the advanced tools and support they truly deserve, ensuring they can deliver the best possible care.
Cecilia Robinson is a founder and co-CEO of primary care provider Tend Health.
When it comes to health; are you squeamish or a health junkie? Take our fun quiz to discover your health personality and unlock helpful tips on how to stay on top of your health.
There are six health personalities. Find out if you are...
1. Health shy.Your preferred idea of a health screening is an episode of Shortland Street, Grey’s Anatomy or Scrubs. There’s enough comedy and drama packed into those shows without needing your own health check up to amp things up!
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5. A health investigator. For you it is important to know all the facts. There’s nothing that will stand in the way of you and a bit of independent research (hello, Dr Google!)
6. Health passionate. There’s a new book about sleep science on your bedside cabinet, next to the Himalayan salt lamp, and a meal is not complete without a side of flaxseed oil!
Disclaimer: This is a fun quiz, it is not intended in any way to diagnose or treat any condition or provide health advice. This quiz is anonymous and does not collect your personal health information. The circumstances described in this quiz are hypothetical and are not intended to create expectations of health outcomes or recommend that you take any particular actions. There is no judgement or pressure on you to use Tend's services if you do not want to, but if you have any health concerns you can talk to one of our doctors.
