Media statement - joint chief executives

Published: December 1, 2022

A joint chief executive media statement in relation to Malachi Subecz and his whānau. Changes agreed to following independent cross-agency child abuse review.  

1 December 2022

Six government agencies say they’ll make changes following an independent review into the way they identify and respond to suspected child abuse.   

The review, led by Dame Karen Poutasi, is in response to the death of five-year-old old Malachi Subecz in November 2021. 

It was commissioned by the Chief Executives of Oranga Tamariki—Ministry for Children, New Zealand Police, the Department of Corrections, and the ministries of Social Development, Education and Health.* 

‘We recognise Malachi’s life was cut short and acknowledge the deep grief his whānau will no doubt feel for the rest of their lives,’ say the Chief Executives. This was an horrific tragedy and we must all do better.’ 

Dame Karen, who has extensive public sector experience including roles as Chief Executive and Chair, looked at whether the system as a whole should have done more to prevent harm being done to Malachi, and what improvements can be made. 

Her report identifies five critical gaps in the system and makes 14 recommendations to close those gaps. 

‘At the heart of Dame Karen’s findings is that agencies failed in their duty of care for Malachi. The system focused on the adults around Malachi rather than on him and what he needed,’ say the Chief Executives. 

Malachi was let down by the system that should have protected him and we are determined to do everything in our power to learn from this and keep children safe.’ 

The Chief Executives say some of the report’s recommendations are operational and already being worked on; for example, a project is under way to join up medical records. 

They have committed to taking forward other recommendations including ensuring proactive information-sharing across agencies.  

Some recommendations would require legislative change before they could be implemented. Chief Executives have agreed to provide advice on these and will report to Ministers in the New Year. 

And there are other recommendations – including the introduction of mandatory reporting where there is a high risk of abuse – that will require further consideration and Cabinet approval. 

‘We thank Dame Karen for her clear-eyed and thorough review,’ say the Chief Executives.  

‘It is only by everyone working together – whānau, communities and government agencies – that children and young people will be kept safe. We must do better to protect our Tamariki.’ 

Dame Karen’s review and the agency reviews which contributed to it are attached. 

*The Chief Executives are: 

  • Oranga Tamariki—Ministry for Children: Chappie Te Kani 
  • New Zealand Police: Andrew Coster  
  • Department of Corrections: Jeremy Lightfoot 
  • Ministry of Social Development: Debbie Power 
  • Ministry of Education: Iona Holsted  
  • Ministry of Health: Dr Diana Sarfati 


Read the independent joint agency systems review and Q and A.