5.7 What we learned looking back Ngā akoranga i te titiro whakamuri

1. Aotearoa New Zealand’s health system – like those of other countries – was not well prepared for a pandemic of the scale and duration of COVID-19.

• While the country had done fairly well in recent assessments of pandemic preparedness, meeting the demands of the COVID-19 response required ‘significant, extraordinary sector-wide effort’.
• Publicly funded health services faced long-standing challenges with workforce capacity, financial deficits and long waiting lists for some planned healthcare. These issues were exacerbated by the demands the pandemic placed on the health system.

2. The elimination strategy was highly effective in preventing the health system from being overwhelmed and protecting vulnerable groups, although there were notable costs.

• By preventing widespread COVID-19 infection until the population was vaccinated and the virus had become less deadly, the elimination strategy prevented the premature deaths of thousands of New Zealanders – particularly older people, Māori, Pacific peoples, and people living with disabilities or medical vulnerabilities.
• Peak hospitalisation rates in Aotearoa New Zealand (in March 2022) were around half those in the United Kingdom (January 2021) and the United States (January 2022). Unlike other countries, New Zealand recorded very few COVID-19 deaths among people living in residential facilities such as aged care homes.
• While strict public health and infection prevention measures were effective in keeping people safe from COVID-19, this came at a significant human cost. People who were in aged care, in hospital or who were sick or dying were isolated from families and loved ones, causing distress and suffering to many.

3. While many people and organisations worked hard to provide effective public health and clinical care, the pandemic exposed some key vulnerabilities and pressure points in our health system.

• There was a scramble to scale-up public health functions such as testing and contact tracing, which started from a low baseline. Given this starting point, the expansion of these functions was generally done well, although limited forward planning and flexibility caused problems in some areas (such as the shift in COVID-19 testing from PCR to RAT tests).
• Dated infrastructure made it difficult to apply best-practice infection control measures, including air ventilation, in many healthcare facilities. However, innovative approaches and substantial effort by staff produced good results.
• Although efforts were made to expand health system capacity in areas such as caring for ventilated patients, we did not find evidence of sustained increases in capacity during the pandemic.
• While the country’s health system was never overwhelmed by people sick from COVID-19 (as happened internationally), the pandemic took a substantial toll on healthcare workers. An already stretched health workforce is now in a worse position because of the pandemic, representing a key vulnerability for the health system going forward.

4. Provision of non-COVID-19 care was substantially disrupted during the pandemic, to a greater extent than was necessary.

• Many parts of the health system – including general practices, Māori and Pacific providers, emergency departments, pharmacies, midwifery, cancer services and others – worked extremely hard to deliver as much care as possible during the pandemic.
• With hindsight, the health system took an overly cautious approach to reducing non-COVID-19 care in order to protect its capacity to provide pandemic-related care. This resulted in avoidable delays or omissions in healthcare, with ongoing consequences for the health of those affected.
• Efforts were made to balance the risk of hospitals being overloaded with the need to continue delivering necessary care, but effective decision-making was hampered by a lack of real-time data on hospital capacity, occupancy and staffing levels. Improving data systems and infrastructure to support smart decisions about the utilisation of resources would be beneficial not only in a future pandemic, but in general.
• Delays in providing healthcare had significant negative impacts on the health of New Zealanders. The Health Quality and Safety Commission found the pandemic contributed to lower childhood immunisations, reduced participation in cancer screening programmes, and increased waiting times for specialist care and planned surgery.