“In times of crisis, there must be absolute public confidence in the systems there to protect them,” Ryan said. As the COVID-19 pandemic accelerated, there were “a variety of stories” circulating about availability of PPE, from a range of essential workers and organisations.
Despite being in the middle of lockdown, Ryan said it felt “important for us to get involved” and release its findings quickly. The OAG worked with five district health boards (DHBs) and the MoH, which were “extremely open” to an independent viewpoint, he said.
Reviewers found the MoH did have a plan for DHBs’ response to a pandemic and a national reserve of PPE, but both were several years old. COVID-19 has been the “first real test” and the plans did not prove adequate, Ryan said.
Some were out of date and hadn’t been checked, there was “misalignment” between the DHB and MoH plans, and assumptions around procurement and distribution of PPE, which proved unworkable. “We felt there were roles and responsibilities which were not clear enough for people to be able to stand up and operate quickly in that situation,” Ryan said. “It’s one thing to put a plan in place, it’s another to make sure… they operate.”
A national response was needed, but DHBs were procuring PPE by themselves or regionally. Suppliers were getting multiple orders from DHBs and didn’t know how to prioritise them. All the while, clinical guidelines were changing, he said. The MoH centralised its procurement by mid-March. While it should have happened sooner, it ended up “reasonably effective”.
There were “weaknesses” in stock management, with expired PPE and lack of knowledge about how much PPE was available across DHBs.
Clinical guidance, too, was fast-changing and confusing, he said. Comments from director-general of health Ashley Bloomfield on March 31 that people not only needed to “be safe and to feel safe” but follow clinical guidance, caused confusion. “I think that was probably a difficult message to understand clearly.”
The OAG made 10 recommendations, including regular MoH reviews of DHB emergency plans, guidance on who is responsible for procuring and distributing PPE, review of PPE clinical guidelines and their communication; and clarity on roles for maintaining PPE reserves. The MoH had accepted all 10 and he was confident they would be adopted. “We’ll be keeping watch”, Ryan said.