Equity, regulation and Te Tiriti o Waitangi: a rapid review of Putting Patients First

The Crown's health workforce reforms, Putting Patients First: Modernising health workforce regulation (PPF),1 emerge in a political climate that is actively dismantling Māori health gains, undermining tino rangatiratanga and reframing equity as "needs not race". Using rapid Tiriti review-an adaptation of critical Tiriti analysis-we assessed the proposal's alignment with Te Tiriti o Waitangi. We found that PPF did not align well with the preamble or the articles of Te Tiriti. There was no equity analysis; no acknowledgement of hauora as taonga, limited Māori involvement in decision making, erasure of tino rangatiratanga and entrenched health inequities were disregarded. These findings highlight systemic silences and risk embedding monocultural practice, weakening accountability and further marginalising kaupapa Māori health models. We recommend that genuine patient-centred regulation must embed Te Tiriti, cultural safety and antiracism into regulatory standards and governance. Without these commitments, health workforce regulation perpetuates rather than remedies inequities, failing Māori and the wider population.