Part 1: Introduction

1.1
For decades, the public health community has warned about the risks of a pandemic from a new virus. SARS (severe acute respiratory syndrome), a type of coronavirus, emerged in 2002. In 2005, a highly pathogenic strain of avian influenza called H5N1 emerged. Fortunately, it was limited in its spread.

1.2
Following the emergence of the 2005 avian influenza, the Ministry of Health (the Ministry) prepared a national health plan outlining how to mobilise and co-ordinate the health and disability sector to respond to a pandemic.

1.3
Following the 2005 avian influenza outbreak, Cabinet agreed to funding the Ministry to establish a national reserve of supplies – such as personal protective equipment (PPE), antibiotics, and antiviral medication – to mitigate the risk that a pandemic would cause a spike in demand that our usual international supply chains would not be able to meet.

1.4
The Ministry also contracted a private firm, Safety & Medical Manufacturers Limited, trading as Quality Safety (QSi), to domestically manufacture N95 masks (a type of face mask with a 95% efficiency rating) and general purpose (surgical) masks for the national reserve of PPE. This was to offset the risk of having difficulty procuring these masks internationally during a pandemic.

1.5
District health boards (DHBs) held operational supplies of PPE for day-to-day use and some national reserve supplies of PPE.

1.6
In early 2020, PPE was needed in large quantities and at short notice to safely manage the health risks posed by an aggressive strain of coronavirus that the World Health Organization (WHO) named Covid-19.

1.7
Despite the planning and preparation measures, during the Covid-19 response, the media reported concern about whether there was enough PPE, whether the guidance on when and how it should be used was clear, and whether it was getting to all the health and disability workers who needed it.

1.8
As the response progressed, these concerns were raised not only by those working in hospitals and primary care settings but also by community-based health and disability providers, people with disabilities receiving assistance from those providers, and non-health workers.

1.9
Essential services outside the health sector were turning to the Ministry to provide PPE. There appears to have been an expectation that the Ministry was responsible for providing PPE in circumstances that had not previously been contemplated.

1.10
To provide assurance to Parliament and the public, we agreed with the Ministry to provide an independent targeted review of the Ministry’s overall approach to managing the PPE that was needed for the Covid-19 response.

The scope of our work

1.11
Our review examined the system for managing the stock of PPE and how well that system could be mobilised to adequately supply and effectively distribute PPE. We assessed the systems for procuring PPE, distributing it to DHBs and others, and managing the stock levels.

1.12
The short time frame for completing this work meant that we have not been able to form a complete picture of what happened when health and disability providers, private sector health workers, or other essential services workers tried to access PPE.

1.13
However, some of what we have learned about how the national reserve system was originally set up and then operated may shed light on the experiences that people have reported.

1.14
We have identified features of the national reserve system that, in our view, warrant revisiting to make sure that the system is ready to respond to any further wave of Covid-19 and the next pandemic.

1.15
We did not physically inspect stock levels for two main reasons. First, our staff were unable to visit storage locations while non-essential workers were asked to work from home. Secondly, we understood that stock levels were changing from day to day, if not hour to hour, as supplies arrived and were distributed. There was little or no value in physically inspecting stock levels at one point in time.

1.16
We are not clinical specialists, so we did not review the appropriateness of the Ministry’s clinical guidance on PPE use. However, we looked at the timing and clarity of the guidance and how that affected health workers’ understanding of, and expectations about, their use of PPE.

How we carried out our work

1.17
To carry out this work, we spoke with a wide range of people involved in supplying, managing, and distributing PPE. We requested, reviewed, and analysed a large volume of documents from them and the Ministry and DHBs. We checked our understanding of the responsibilities, systems, and processes with those involved and asked for further information where necessary.

1.18
To understand the context the Ministry and DHBs were working in, we looked at the plans and policies that govern pandemic emergency preparedness in the health and disability sector. Our focus was on the national reserve of PPE. We looked at the extent to which the plans were followed before Covid-19 and sought to identify any critical gaps in the plans.

1.19
We gathered information from five DHBs – Auckland, Waikato, Capital and Coast, Canterbury, and Southern – because these DHBs had been assigned as leading the procurement for aspects of the Covid-19 response.³

1.20
We did not seek views from the health and disability sector outside of the Ministry and DHBs or from members of the public. However, several individuals and organisations approached us and shared their experiences and observations.

1.21
In some instances, our work supported the observations that people made. We could not substantiate some of the comments, and others were outside the scope of our work. In forming our views, we have relied primarily on the evidence we collected.

1.22
Appendix 3 lists the organisations we talked to.

Structure of our report

1.23
Part 2 describes the plans that were in place to guide the health and disability sector’s response to a pandemic.

1.24
Part 3 discusses the clinical guidance on PPE, including how it changed and was communicated during the pandemic.

1.25
Part 4 describes the national reserve system for PPE, and Part 5 discusses what the Ministry knew about those supplies.

1.26
Part 6 covers the systems for ordering and distributing PPE and how those systems needed to change as part of the response to Covid-19.

1.27
Part 7 describes the systems for purchasing PPE and how they also needed to change during the response to Covid-19.

3: We note that Auckland DHB and HealthSource jointly managed procurement.