Covid 19: Ministry of Health criticised for Covid-19 handling

A report into the management of testing for Covid-19 in the community and at the border has slated the Ministry of Health for bad communication around the criteria for testing, and keeping ministers in the dark about concerns raised by other government departments.

The report was prepared by the COVID-19 Surveillance and Testing Strategy advisory group, co-chaired by Heather Simpson and Sir Brian Roche.

The group set up in August after the breakout of a Covid-19 community cluster in Auckland and the discovery only about 40 per cent of staff working at the border and in managed isolation and quarantine hotels had been tested for Covid-19, despite a Government edict for regular testing.

It was released today, along with a funding announcement of a further $2.8 billion to keep the Covid-19 border controls and 14-day isolation facilities going until at least June 2022.

The report gave a brutal assessment of the Health Ministry’s control of the Covid-19 response up to the time of the August outbreak in Auckland, pointing to confusing and mixed messaging and bad coordination.

The report’s authors said that while the August outbreak had not been picked up at the earliest opportunity, it had been brought under control quickly and credit had to be given for that.

It also noted that many changes were already underway at the time the report was being written following that August outbreak.

On testing, it found the health sector was frustrated at receiving “last minute instructions for changes which they believed did not recognise much of what was already happening on the ground”.

District health boards and public health units were charged with implementing testing regimes but “too often” were given little warning about changes to target numbers.

“Similarly delays in making payments to service providers has increased dissatisfaction with the system and at times made for reluctance to increase testing rates, consequently reducing access.

“Providing easy access to testing must become business as usual and for this to happen funding regimes should be stabilised.”

Written communication from the Health Ministry was “confusing” and didn’t clearly identify changes to testing criteria.

This echoes the Auditor General’s report on PPE which slammed the ministry for its “mixed messaging”.

The Ministry of Health’s lead role.

The report said the pandemic meant the lead agency was the Ministry of Health, “as it should be.”

However, it found other government agencies and the private sector reported being locked out of talks and struggled to have their views heard.

“The Ministry of Health is the principal advisor to the government as it is essential that decisions taken as part of the response are firmly grounded in the best public health science.”

“At times, however, this seems to have been interpreted as meaning that advice should not be influenced by information or legitimate concerns expressed by other sectors.”

Decisions went to Cabinet without Ministers being properly informed of concerns and opinions from officials and stakeholders outside the Health Ministry.

“It is imperative, with an emergency of this magnitude, that government decisionmakers are exposed to advice which considers all aspects of the issue. While it is true that the rapidly changing nature of this threat makes wide consultation difficult at times, that very urgency heightens the need for quality engagement and advice.

“Too often decision-making papers have gone to Cabinet with little or no real analysis of options and little evidence of input from outside health or even from different parts of the health Ministry or sector. While this may have been understandable in the first weeks of the response it should not be continuing eight months into an issue as we are currently facing.”

It recommended that all Cabinet papers on Covid-19 be put to the All of Government group.

“This would at least alert Ministers to any issues.”

Covid Minister’s response:

In response to the report, Covid-19 Minister Chris Hipkins said many of the improvements the report called for were already being worked on before it was produced. Of its 28 recommendations, 25 were the responsibility of the Ministry of Health. Five of the recommendations had been acted on, and a further 23 were underway.

He said New Zealanders should have confidence in the Ministry of Health, saying it had continued to improve its response and the containment of subsequent community outbreaks was a result of that.

The report said it was increasingly clear that Covid-19 will be present in New Zealand for the foreseeable future and its recommendations were based on a time frame of potentially up to 36 months.

The extra funding Hipkins announced today includes $1.12 billion for up to 7000 tests a day, contact tracing, and supplies of personal protective equipment. $1.74 billion will be to pay for the managed isolation and quarantine system, including accommodation, food and other costs.

Hipkins said the funding announcement and establishment of a specific Covid-19 oversight team recognised Covid-19’s was likely to be with New Zealand for some time. Until now only short-term funding has been allocated

On the report he said it highlighted areas where things could be done better, but he did not want to “skip over” what had been achieved.

He said the problems highlight with testing guidelines had been resolved and the testing regime was now much stronger.

He did not believe he had given confusing information to the public.

He acknowledge the contact tracing teams in Auckland were under pressure in August, but had performed well.

He said the Ministry of Health had been under more pressure and scrutiny than any other government department this year and has been open to reviews of its performance

He said while there had been developments in vaccines and travel ‘bubbles’ with other countries, New Zealand’s elimination strategy meant it was still important to ensure the health system could manage strong contact tracing and testing practices.

The Government was also refining the management of Covid-19, including setting up a Covid-19 Response unit to take an overall lead, based in the Department of Prime Minister and Cabinet.

The Ministry of Health would be charged with managing the public health response, while management of the borders would be led by Border Executive Board of government department chief executives.

In June,Cabinet had instructed health officials to regularly test all staff at the border or who had contact with people arriving in New Zealand.

In mid-August the Government moved to make it mandatory after Prime Minister Jacinda Ardern said it was clear routine testing was not being rolled out as quickly as desired.

The group was charged with checking the effectiveness of testing in the community, at the border, and at managed isolation and quarantine facilities, and making recommendations for improvement.

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