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Some of those on the front line of health say they are near the breaking point as representatives exposed their frustrations with the Covid-19 crisis response to the Epidemic Response Committee.
General practices, which perform word of mouth operations, are on their knees while dental surgeries are in crisis due to lack of funds and the inability to treat people during closure.
Those caring for the New Zealanders most vulnerable to Covid-19, the elderly and the disabled, have fought against district health boards for access to personal protective equipment (PPE).
And our contact location problems were due to regional units using outdated systems, said epidemiologist Sir David Skegg.
Sir David, a professor at the University of Otago, said these problems were the result of our public health system “being reduced to an extremely dangerous level for several years.”
However, despite all those problems, we could achieve a historic and unique victory to eliminate Covid-19, he said.
“If we are successful, this will be one of New Zealand’s greatest achievements.”
Representatives from various sections of the health system appeared before the Epidemic Response Committee to express their frustrations with the response to Covid-19.
Some of the clear problems were lack of funds, access to the EPP, conflicting advice from the Ministry of Health, and concern about the deluge of care awaiting on the other side of the closure.
New Zealand Medical Association
The cabinet’s move to block a second tranche of funding for general practitioners has left some practices in dire straits, said Kate Baddock, president of the New Zealand Medical Association.
the Herald yesterday revealed that the second half of a $ 22 million financing package had been blocked by the government even though it had been promised.
Baddock said the decision should be reversed by the end of the week, or the practices and doctors would be out of a job.
Many GPs were dependent on copays and were “word of mouth,” so declining appointments and some people who were unable to pay for a consultation meant their cash flow had run out, Baddock said.
Many relied on that additional financing to stay afloat.
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Prime Minister Jacinda Ardern said this funding was part of an “ongoing conversation”.
Baddock also described the deployment of the flu vaccine that left his own practice without a 10-day supply despite the need to vaccinate 4,000 vulnerable patients as a “debacle.”
Ardern later disagreed with this opinion, saying they had started the vaccination program to ensure that people at risk were vaccinated.
Baddock told the committee that it was not a supply problem, but a distribution on a first-come, first-served basis.
the Herald previously reported that the Ministry of Health discovered that some private providers had stored the first shipment of vaccines and has since nationalized the distribution chain.
“”[It was a] total, total disaster, “Baddock said.
Elderly Care Association
Despite being publicly promised a good supply of PPE, senior care facilities had to shake DHBs for action, said Simon Wallace, executive director of the Elderly Care Association.
The supply problem has greatly improved, but there are still pockets around New Zealand struggling, and facilities should not have to “discuss” with health boards, he said.
Wallace also wants mandatory testing of each of the 700 people who enter a facility on average each week.
Because there was clearly capacity within the testing regimen, Wallace said he did not understand why the Ministry of Health was not changing its position.
Director-General for Health Ashley Bloomfield has previously rejected testing for every incoming resident, but anyone with any symptoms should still be tested.
“If the probability is low, but the severity is high, as with Covid 19, why wouldn’t they do the test?” Wallace said.
“We just don’t understand the reasons for not taking the test.”
Wallace said three reviews in the elder care sector at the same time only increased the stress of the facility.
DHBs are auditing infection control and procedures, there is a review of the six care homes that have had outbreaks, and the Ombudsman is inspecting the facilities with detained residents.
Again, methods varied widely among DHBs with a manager of a facility in Nelson crying over an auditor’s confrontation while nursing homes in Southland were being virtually audited, Wallace said.
“The moment itself is insensitive. We want to work and we want to cooperate, but there are great concerns.”
Pharmacy Guild of New Zealand
The $ 5 copayment for prescription drugs should be removed because it was leaving pharmacies out of pocket and causing people in need to leave, said Andrew Gaudin, executive director of the New Zealand Pharmacy Guild.
Many people were no longer able to pay for prescriptions and if the conditions were not treated, that would mean patients could overwhelm hospitals, Wallace said.
Community pharmacies were also struggling under the financial burdens caused by Covid-19, and some could close, which would be a great detriment to the health system, he said.
They urgently needed more funds.
“This is delicate, pressing and urgent and needs immediate attention … we are pulling our hair out.”
Gaudin said the union had tried to meet with Health Minister David Clark and Bloomfield, but neither had been made available.
Pharmacies have also struggled to obtain the proper PPE for their front-line staff, who serve 1.5 million people each month, he said.
“That has already been resolved, but it took too long.”
Many pharmacies had to pay for themselves, which only increased their financial pressures, he said.
“Community pharmacists have felt undervalued and under-recognized. I take my hat off to them.”
The disability network
Disability support workers have struggled with “slow and contradictory” decision-making by the Health Ministry, said chief executive of the Disability Support Network, Garth Bennie.
For example, disability support workers were originally not recognized as essential workers and had to fight to change their status.
There was also “considerable” confusion around the guidance on PPE, Bennie said.
Bennie said there were contradictions within the Ministry itself and significant delays in obtaining council approval.
Disability support providers also had to fight individual DHBs for PPE who were unaware of the scope and scale of the disability sector.
The PPE situation was “definitely a work in progress” and, although it had improved, there were still problems with supply, Bennie said.
Some had to ration the PPE themselves because “they don’t feel they have an adequate source” while a supplier had not yet received one, Bennie said.
Bennie said the disability sector had entered the pandemic under already well-documented financial stress and that services would suffer as they spread further.
The largest individual cost to providers was staff, Bennie said.
Some lost 30 percent of their workforce during the shutdown because the workers themselves were vulnerable and were told not to apply for the wage subsidy scheme as staff would be provided.
That hasn’t happened yet, so providers had to hire workers at their own expense, Bennie said.
However, there was flexibility under the Covid-19 crisis about how the staff and resources the sector had been asking for “for years,” Bennie said.
He hoped that would continue after the pandemic.
The dental association
A massive dental care crisis is looming after restrictions are lifted, said Dr. Katie Ayers, president of the Dental Association.
A man was already in an intensive care unit after an infection spread from his mouth to his neck, needing urgent surgery under general anesthesia.
The surgeries expected strips of patients who had been left unattended under the closure, Ayers said.
“People in their despair will resort to tooth extraction, which will create problems, especially for children.”
Dentists were not allowed to unlock, except in emergencies due to the risk of transmission that came with their work.
And they have yet to find out if they can resume below alert level 3 or 3, as they have not yet received clear guidelines, Ayers said.
The dental sector in Australia was allowed to work according to its own guidelines and there people could receive treatment on Monday.
New Zealand dentists needed guidelines in a few days, Ayers said.
Ayers also said they were desperate for more funds, and a survey of their members showed that more than half would have to go into debt to keep their doors open.
Considerable progress towards elimination.
Sir David said New Zealand had made “considerable progress” towards elimination, demonstrated by the drop in cases, quarantine at the border, expanded and more liberally conducted testing criteria and deficiencies in our localization capabilities of contacts being addressed.
Changing the goals to eliminate Covid-19 instead of simply deleting it was “an ambitious decision” by the government, he said.
But elimination was within reach.
“I think we have a better elimination opportunity than any other western country.”
He agreed with national health spokesman Michael Woodhouse that the blockade would not have had to be extended if contact tracking was where it should be: the gold standard.
Sir David said Australia was also looking to eliminate the virus and this gave him hope for an “Australasian bubble”.
Other countries, such as the United Kingdom and the United States, had zero chances of elimination.
“I fear that much of the world will look like a slow motion train wreck.”
Sir David said that to achieve that, there must be timely case identification, rapid contact tracing and contact isolation.
But perhaps the most important measure would be for New Zealanders to continue to physically distance themselves from others and keep their bubbles tight, he said.
New Zealand had also accomplished a great deal despite the fact that the public health sector has been “neglected in recent decades by Labor and national-led governments,” said Sir David.
There were very few countries in the world where the central government’s capacity for public health surveillance and action was so weak, he said.
New Zealand’s problems with contact tracing were due to “outdated tracking systems that cannot link data between regional public health units and the central contact tracing service,” said Sir David.
Opposition leader Simon Bridges asked if Australia was in a better position to assess and contact the trace because they had adapted their health system more quickly.
Sir David replied that they could only do so because their health sector was much healthier than ours to begin with.
“The specific problem I am talking about is public health, the preventive side, it has been reduced to an extremely dangerous level for several years.”
Bridges said decades of trouble would not be resolved before midnight Monday, when the blockade will be lifted.
“No,” agreed Sir David.
“But I think our health authorities have done a remarkable job of bringing us to the position we are in, which by global standards is exceptionally good given the lack of staff, personnel and experience.”
