5.1 The health system response Te urupare a te pūnaha Hauora
Introduction | Kupu whakataki
In addition to preventing people becoming sick and dying from COVID-19, part of the rationale for the elimination strategy and the wider response was to ensure the health system was not overwhelmed by COVID-19.1 By the time the virus reached Aotearoa New Zealand, its potential to do so – and what an overwhelmed health system looked like – was already apparent. Graphic images from hospitals in Italy and elsewhere showed every available bed occupied by COVID-19 cases, operating theatres turned into makeshift intensive care units, and patients being treated in overflowing corridors and administration areas. Meanwhile, the wider health needs of many citizens in those countries went unaddressed due to the cancellation of nearly all ‘planned care’ (that is, specialist medical and surgical care for people who do not need to be treated right away).
For Aotearoa New Zealand, it was a frightening demonstration of what might lie ahead. If the sophisticated health systems of developed countries like Italy and France could be so quickly swamped by surging COVID-19 case numbers, what would happen here?
As described in the pre-pandemic context chapter in Part One, this country’s health system comprised a large and complex network of organisations. In 2020, publicly-funded specialist and hospital care was overseen by 20 district health boards (DHBs), with control of communicable diseases (such as contact tracing) sitting with 12 public health units spread throughout the country.i Primary care – delivered by a range of private, non-governmental organisations (NGOs) and not-for-profit providers – sat somewhat apart from hospital-based services. The Ministry of Health provided overall system leadership, including policy and regulation, high-level pandemic preparation, and monitoring. This chapter focuses on the health system response to COVID-19 in relation to these publicly-funded functions.ii
If the sophisticated health systems of developed countries like Italy and France could be so quickly swamped by surging COVID-19 case numbers, what would happen here?
What’s in this chapter?
This chapter starts by considering how ready the health system was for the emergence of a global pandemic of the nature of COVID-19.
Then, in the ‘What happened’ section we focus on three things:
- The activation of public health services and public health and social measures to respond to the virus itself – early steps taken, testing, contact tracing and, briefly, vaccination (which is addressed in detail in Chapter 7).iii
- How the wider health system geared up to respond to COVID-19 cases, including the steps taken by DHBs, hospitals and other healthcare settings to manage potential cases safely, and how services and resources were reprioritised and deployed to be ready for an influx.
- The provision of non-COVID-19-related healthcare throughout the pandemic. We look at what was done to ensure people could still access health and disability services, including steps to prevent further outbreaks within services, reorient service delivery and preserve workforce capacity for non-COVID-19 services. We also address disruptions to healthcare delivery resulting from efforts to prepare to respond to COVID-19.
Finally, in section 5.6, we assess how all three areas impacted the health system itself, the population at large, and its most vulnerable members.
i This devolved model has since been replaced with a single planning and funding agency, Health New Zealand | Te Whatu Ora, including a National Public Health Service.
ii From time to time, we touch on – but do not comprehensively address – the pandemic response in other important parts of the health system (like disability support services, oral health care, and ambulance services). We do not cover the parts of the health system that are entirely private. Furthermore, while primary care is a vital part of the health system, data on delivery models and service provision are less accessible for primary care than for specialist and hospital-based services. Discussion of primary care is therefore less prominent in this chapter.
iii We do not, at this stage, look at decisions to mandate these measures in certain circumstances or for certain groups of people: vaccine and testing mandates are addressed in Chapter 8.