Response of the Ministry of Health

15 March 2024

Leeanne McAviney
Assistant Auditor-General
Sector Performance
Office of the Auditor-General

Tena koe Leeanne

Following up on the performance audit of the co-ordination of the all-of-government response to the COVID-19 pandemic in 2020 report

Thank you for your letter dated 26 February 2024 requesting a description and explanation of actions Manatū Hauora (Ministry of Health) has taken to implement the recommendations in the performance audit and, where known, the impact of those actions.

We have interpreted the recommendations in the context of our broader health response rather than just emergency management, which we have confirmed with your office. This is given the shift from an emergency response to an environment focused on future pandemic preparedness, informed by COVID-19 lessons and other relevant inputs.

Since the release of the performance audit, three key developments have helped to guide the direction of a health response to any future outbreak. The developments are:

Cabinet approval to transfer the all-of-government function from DPMC to Manatū Hauora in April 2023: This function adds to, and strengthens, our influence across government beyond our current operating environment on pandemic preparedness. It is with in this new role that we have been considering how best to progress the recommendations made in the performance audit.
The publication of the Aotearoa New Zealand Strategic Framework for Managing COVID-19 in September 2023: This strategic framework sets the direction for the long-term management of COVID-19 for our country as we transition to a business-as-usual environment. It reflects the lessons learned from the evolution of our COVID-19 response, over the course of the pandemic.
The publication of the Likely Pandemic Agents and Scenarios - an Epidemiological and Public Health Framework developed by Te Niwha and the Public Health Agency in November 2023: This framework provides a comprehensive approach that considers a range of scenarios and agents, new technologies, and COVID-19 lessons. This will help to inform work going forward.

In addition, Manatū Hauora has had comprehensive work underway that will give effect to the recommendations, particularly recommendations 3, 4 & 5 pertaining to workforce planning and capability, continuous system improvements and resilience, and transparency. We believe that recommendations 1, 2 & 6 fall within the purview of other agencies that lead this work such as the Department of the Prime Minister and Cabinet and the National Emergency Management Agency, who will respond directly in due course.

The activities that we continue to deliver that give effect to recommendations 3, 4 & 5 include, but not limited to, the following:

Leading the health response to the Royal Commission of Inquiry into COVID-19 Lessons Learned (RCOI)
Leading advice and analysis on the legislative framework for future pandemics
Leading advice on budget and funding for ongoing COVID-19 activities
Leading the all-of-government function for coordinating COVID-19 strategy and policy across government, including the Strategic Framework
Leading advice on public health measures to manage COVID-19
Lead on vaccine advice and settings
Leading strategic approach to health at the border work
Leading and supporting international engagements to update the International Health Regulations and Pandemic Treaty negotiations
Leading the update of the New Zealand Influenza Pandemic Plan
Lead on future isolation and quarantine work
Leading and stewarding emergency management across health system
Leading the National Public Health System monitoring, reporting and intelligence
Lead to support strategic priorities and pandemic preparedness in the Pacific (Samoa, Tonga, Tuvalu, Niue, Cook Islands and Tokelau).

Moving forward, Manatū Hauora is progressing a comprehensive pandemic preparedness work programme, which links into a broader all-of-government risk and emergency management architecture. This work programme will continue to implement recommendations 3, 4 and 5 of the performance audit, and be guided by the outcomes in the COVID-19 Strategic Framework and other relevant frameworks including the ongoing implementation of the International Health Regulations 2005. The work programme includes:

Strategy - shepherding the Aotearoa New Zealand Strategic Framework for Managing COVID-19 across government and leading the development of a future pandemic preparedness strategy and/or plan, building on the existing influenza pandemic plan and framework (noting that some preliminary work has already been undertaken on updating the influenza plan including a focus on respiratory illnesses more generally).
Legislative review - reviewing the COVID-19 Public Health Response Act and broader legislative instruments to ensure that they are fit for purpose.
Institutional arrangements - planning for governance arrangements for pandemic preparedness, and emergency responses in the event of future pandemics.
Domestic and international public health settings - we have a range of other issue specific pandemic preparedness or emergency management related activities (e.g., leading and supporting international engagements to amend the International Health Regulations and negotiations for a proposed Pandemic Treaty; and leading and stewarding emergency management across the health system) that are ongoing.
Royal Commission of Inquiry - leading the health response to the Royal Commission of Inquiry into COVID-19 Lessons Learned that is scheduled to release their report in September 2024.

These activities have been informed by a range of COVID-19 response reviews, including the Royal Commission of Inquiry into COVID-19 Lessons and the performance audit, so that they are embedded across the health system. Further information on pandemic preparedness activities is available in the transcript of Manatū Hauora's annual review hearing at the Health Select Committee which can be found here.

The anticipated impact of the activities outlined above is that New Zealand will be more prepared through having strategies and/or plans, legislation and established cross-government governance to support an immediate and effective response in the event of any future pandemic. This work is ongoing across Manatū Hauora.

Thank you again for taking the time to write. I hope this information is useful. Should you require any further detail, please feel free to contact Stephen Glover, Group Manager, COVID-19 Strategy, Legislation and Royal Commission by email.

Nāku noa, nā

Dr Diana Sarfati
Director-General of Health
Te Tumu Whakarae mō te Hauora
Manatū Hauora

30 April 2024

Jason Hewett
Manager
Performance Audits – Sector Performance
Office of the Auditor-General

Tēnā koe Jason

Additional questions related to co-ordination of the all-of-government response to the COVID-19 pandemic in 2020.

Thank you for your email of 11 April 2024 to Stephen Glover, Group Manager, Strategy, Policy and Legislation directorate within Manatū Hauora - Ministry of Health (the Ministry). I understand that Stephen has responded to one of the questions raised relating to Co-ordination of the All-of-Government response to the COVID-19 Pandemic in 2020. The remaining questions were transferred to the Public Health Agency within the Ministry, and I trust the below responds to your questions.

We note that the Ministry has started updating the current pandemic plan. Further to our question in our initial letter, have the recommendations from previous pandemic exercises been systematically implemented?

Exercise Pomare was an all of government pandemic readiness exercise conducted as part of the National Exercise Programme between 27 October 2017 and 7 May 2018. The exercise was delivered as 4 workshops based on the New Zealand Influenza Pandemic Plan 2017, designed to ensure government agencies understood their roles and responsibilities during the different response phases. The intention was to address issues identified during the exercise in a subsequent review of the pandemic plan. Unfortunately, 2019 proved to be a disruptive year, with the response to the White Island eruption and the largest measles outbreak in 20 years taking priority. This was of course followed by the COVID-19 pandemic. Given the real world experience gained by responding to the COVID-19 pandemic over a period of years, that is now forming the basis of further work, as opposed to the earlier desktop exercise workshops.

The Ministry is currently engaged in a two-stage process to review and update the New Zealand Influenza Pandemic Plan. The first stage of the review is limited in scope and mainly reflects the structural changes to the health system and new legislation enacted since 2017. It explicitly addresses respiratory pathogens more generally, and captures some of the early lessons identified from the COVID-19 response. The interim review is expected to be completed by mid-2024.

The second stage review will be more fulsome. It will include substantive engagement with other departments and agencies and is likely to incorporate changes to structure and content across the 11 inter-agency workstreams currently provided for in the pandemic plan. These changes will be directly informed by the all of government experience with COVID-19 and the findings of the Royal Commission of Inquiry into COVID-19 Lessons Learned (expected in late 2024).

The stage two review will also consider recent reports published on pandemic preparedness including the Te Niwha report Likely future pandemic agents and scenarios, the WHO’s new framework on Preparedness and Resilience for Emerging Threats, and the Asia Pacific Health Security Action Framework. The second stage review will also consider the ongoing work to amend the International Health Regulations 2005, proposals for a treaty on pandemic prevention, preparedness and response.

Can you provide more detail on how you are addressing recommendation 3, “develop and maintain workforce plans for sustainably staffing long-term emergency responses (which should include appropriate mechanisms for recruitment, redeployment, training, and supporting staff well-being).” It would be good to better understand the practical things the Ministry is doing to be better prepared for future events.
Can you provide more detail on what your role entails, and the actions you have taken, relating to stewarding emergency management across the health system?

Impact of the health and disability system transformation

As a result of the health reforms, half of the Emergency Management function within the Ministry was transferred to Health New Zealand – Te Whatu Ora (Health New Zealand). Following this, an interim operating model for emergency management was put in place in July 2022 to ensure that all parties could collaborate and fulfil emergency response requirements. This model remains in place and is a practical measure providing direction about critical roles and responsibilities in emergency response. Whilst it works as intended, it needs to be more sustainable to provide the ability for the health system to contend effectively with significant concurrent events.

The Ministry’s Emergency Management Team (EMT) continues to rely on support from the wider Ministry to provide staff during a large-scale response. Currently the Ministry is undergoing a change process in response to the Governments public sector savings requirements. The full impacts of this are unclear as it is still subject to final decisions, but it is likely to reduce previously planned investment in Emergency Management capability.

Practical activities for better preparation for future events

In July 2022, the EMT developed a future governance and operating framework for emergency management across the health and disability system. In partnership with the new health and disability system entities, the Ministry established the Emergency Management Steering Committee as a governance mechanism to provide system-level guidance and direction for health emergency management.

Further practical steps include the reorientation of the Ministry’s Emergency Management function to achieve a cohesive health and disability system approach to emergencies and a clear, robust, and accountable system. The system must be capable of providing a comprehensive understanding and response to the aggregated risks associated with the mitigation, preparation, response, and recovery from emergencies.

In addition, the Ministry’s emergency management reorientation is to ensure we can meet legislative obligations. Doing so requires emergency management mechanisms that provide decision makers with timely and accurate information. Structures must be relevant and decision makers must understand and mitigate all risks, as reasonably practicable. A phased approach to reorientating commenced in July 2023, scheduled for completion in June 2025.

Health New Zealand

Health New Zealand’s emergency management function is also working to implement their Developing Emergency Management Workforce capability framework. As part of this framework, Health New Zealand has a designated Emergency Management function led by their General Manager Emergency Management. This role has nationwide responsibility for leading the direction of its operational emergency management function across the Health and Disability System. In addition, the role is responsible for maintaining and enhancing the capability and capacity of health emergency management and, leading the operational level emergency management function, ensuring preparedness, responses, and recovery from emergencies and critical incidents. This role is supported by National, Regional, and District roles across the motu.

Following the COVID-19 response, the National Public Health Service, within Health New Zealand, has a range of national and regional capabilities that can surge as required to mount a graduated response. These capabilities include Environmental, Border, Communicable Disease, Contact Tracing, Clinical, Isolation/Quarantine, Incident Control and Intelligence.

Delineation of roles and responsibilities

On behalf of the Minister of Health, the Director-General of Health has overall legislative accountability for health and disability services in all phases of emergency management.

The Ministry’s EMT contributes to strategic crisis management (ie, the sum of activities and functions that allow government agencies to plan, prepare, and respond, as well as learn lessons from nationally significant crises). Post health system reform, the Ministry’s EMT focuses on emergency management stewardship, strategy, policy, and being a system enabler. In an emergency, being a system enabler includes providing assurance to the Director-General of Health, ensuring appropriate connection with the National Security architecture (Officials Committee for Domestic and External Security Coordination - ODESC System). It also means ensuring appropriate connection and collaboration with other health and disability system agencies (Health New Zealand, Te Aka Whai Ora (pre-disestablishment), the Cancer Control Agency - Te Aho o Te Kahu). We also engage with Whaikaha – Ministry of Disabled People, and both they and Ambulance services are represented as core members of the Emergency Management Steering Committee mentioned earlier.

At sector level, the Ministry is also a member of the National Emergency Management Agency-led Emergency Services Leadership Board, which provides a focal point for emergency management sector-level leadership.

Health New Zealand is legislatively responsible for co-ordinating the local health sector response to emergencies, ensuring appropriate co-ordination of all health and disability service providers, maintaining close liaison with Civil Defence Emergency Management (CDEM) groups and local authorities, and continuing its services including managing any increased demand.

Impacting factors

System-level vulnerabilities remain which are compounded by an almost continual response to emergencies, the impact of the health and disability system transformation, under-resourcing of emergency management capability and capacity, and the unprecedented scale of the impacts of recent emergencies.

Since 2022, the Ministry’s Emergency Management function has been involved in multiple responses (a mix of concurrent and sequential), including the North Island severe weather events (which includes Cyclone Gabrielle) and Tropical Cyclones Hale, Judy, and Kevin impacting the Pacific region.

All these responses draw staff away from development activities, which slow progress on capability and capacity enhancement. This includes the implementation of the Emergency Management Future Operating Framework as teams have diverted staff from business as usual activities and development to support responses.

Acknowledging the above challenges, the Ministry’s EMT has reprioritised work and between now and June 2025 will focus on:

compliance with the Emergency Management legislation (including implementation of the EM Assurance Framework)
catastrophic event planning
New Zealand Medical Assistance Team (NZMAT) capability and capacity enhancement
National Reserve Supply policy and use cases.

I hope this information is helpful.

Nāku noa, nā

Dr Andrew Old
Deputy Director-General
Public Health Agency | Te Pou Hauora Tūmatanui