Little AndrewHon ANDREW LITTLE (Minister of Health): Thank you Madam Speaker and can I begin by firstly acknowledging the tragedy of this situation and of these two deaths and express my condolences to the families and whānau of these two men who lost their lives when they were isolating at home with COVID.It's important as indeed the member who has just resumed her seat Brooke van Velden says that there is transparency and openness and it was because of those deaths—it was straight after the first death that the investigation which is the subject of this report was commenced. It was a day later that the second death happened and the report was amended to include that second death as well. The report was conducted by a group of people a number of clinicians as well as those working in the welfare front line as well. They have concluded their report. They've made their findings and they've made some recommendations and they have done that in a matter of weeks and we now have the benefit of their report. The report writers of course acknowledge that their review and their focus was on the processes from the time at which these men entered the care in the community system to the time of their deaths but it is for the coroner to rule on cause of death. So I think we do need to pay heed to the content of the report in terms of the processes that they examined for two patients who came under the care of the care in the community system. I should acknowledge also that the DHBs who are responsible for the organisation that provides the care in community service the Northern Region Health Coordination Centre—those DHBs have apologised for the failings of that system. Indeed the DHBs said—and I quote—We unreservedly accept the findings of the review and apologise to the whānau for the shortfalls in the response provided." The DHBs go on to acknowledge the input that whānau had into the completion of the report. It was interesting to note that writers of the report made a comment about the speed with which things were happening and indeed at the time they were writing their report they made the comment and I quote "The panel acknowledges that changes to the care and community systems are being introduced daily informed by the issues that are arising. We are acutely aware that even in the few days of the review period some of the recommendations we will make are becoming a reality." So the review panel was aware that as a consequence of these events changes were already being made. The review panel also acknowledged the speed of change that was happening around this time and they acknowledged that the speed with which the number of daily cases was rising in Auckland had overwhelmed the system. They pointed out for example that at the time that they were writing the report the system was supporting 1255 patients with COVID and their whānau and close contacts: a total of 2835 people in 885 households. And just a matter of weeks before there was one organisation being required to support just 50 families at the commencement of the programme. That is how quickly things changed. For the record there are now over 6500 people being supported in the system and that is requiring a daily programme of a size that has never had to be geared up before. None of that is comfort to the whānau and families of these men who have died. The Government has been acutely aware since the beginning of the pandemic last year and since the beginning of the August outbreak in Auckland that the measures that the Government supports and the measures that the health system has to put in place have to prioritise preserving life and that is what we have done and that is why the track record of this country when it comes to the management of COVID has been to see one of the lowest levels of mortality and one of the lowest case numbers of any country in the world. As Delta arrived and we managed our response to that we knew that we had to adapt our system to allow for more people to recover from COVID in the community. That planning started in September. On 14 October myself and some colleagues confirmed the model that we were adopting the care in the community model which was very much based on models that had already been put in place in Canada and in New South Wales. That was the model that was being put in place as Auckland in particular was adapting to the rapid rise in case numbers that were experienced at that time. The reality is the system as it was and during its adaptation was being overwhelmed and tragically the steps that ought to have been taken in relation to these two men were not taken. The Government had made clear its expectation that the priority is a clinical assessment of those who are being required to isolate at home or to remain at home while they are being cared for. Because the first question is is that the right place for them to be and have all the relevant factors been taken into account—both them their health and their health profile the rest of the household and indeed other personal circumstances that might be applicable? So the first question that the system needs to answer is should the person even be at home? The system was used to referring anybody with COVID immediately to a managed isolation facility but that wasn't going to continue and it never was going to be a permanent feature because at some point as the population became vaccinated and as we became used to COVID and as more therapeutics came on that could help us manage COVID we knew that we had to prepare for more people being able to recover at home. Those are all the steps that this Government has backed and supported and financed in preparation of a change of mode in response to this virus. So in addition to prioritising the clinical assessment we also had to prioritise a welfare assessment. There are some who can look after themselves at home but not everybody is in that circumstance. There are some people who have a number of other issues including whānau members it might be pets it might be their personal circumstances and their employment relationships and what-have-you that have to also be taken care of. If they are living on their own and they can't go out and get food then that has to be supplied and they have to be supported for that as well. So all of that was part of the model that was being put in place and is in place now. I think what became clear is that the transition from the public health assessment which was what the system was geared up to do primarily because they knew that once a person had returned a positive test they'd be whistled off to managed isolation or to hospital—but the shift from public health assessment to personal clinical and welfare assessment was too slow. The system did not keep up and so the right assessments were not carried out by the right people at the right time. But the reviewers as they recorded in this report have noted that changes that they have recommended should be made were already being changed at the very time that they were examining the processes. And I can say with confidence that those processes have changed and when I see the way the system has responded in other places where the outbreak has just emerged—so for example in Nelson last week where an outbreak emerged I'm confident that the DHB which like all DHBs had engaged in the preparation planning was prepared was ready was waiting and was able to respond effectively and quickly and properly to the needs of that community and those who returned positive tests. And that has happened. There are a number of things that the report has highlighted where there were inadequacies in the system. The reality is some of these have been historical problems the relics of an extended period of time where the investment in health infrastructure was at an appallingly and embarrassingly low level—so little or no investment in our IT platforms and our health system. So we're meant to have a national health system but we allowed 120 different systems to set up because the previous Government just didn't have its eye on the ball just ignored the problems. So we now have—we've started the investment in an IT platform that means that all the systems talk to each other and are accessible wherever you are in the country. But it wasn't ready. It hasn't been ready. We had to build a system especially for our border management when COVID arrived—the border case management system. We had to build that especially for COVID in New Zealand a system that is accessible nationwide and can track cases coming in. But that was to map people crossing the border who had COVID. That was all it was set up to do and it had to be adapted and it has taken time to adapt it to do a much more complex and comprehensive function. But see that's what happens when you run down a health system and even with the best effort that has been made in the last four years to massively increase investment and do the massive catch-up job sometimes you just don't catch up fast enough. But I acknowledge the work that the health system has done: the Ministry of Health DHBs and an amazing health workforce that has frankly been under the pump month after month after month since this virus arrived to provide the best care possible. But it hasn't been perfect—but it hasn't been perfect—and I again acknowledge the tragic loss of these two men. If there is a lesson in this anywhere at all—and there is a lesson actually—this virus has highlighted a number of things about our health system. One is that you cannot year after year short change our health system and expect a world-class health system 10 years later. Also we know there is inequity in our health system—huge inequity in our health system—and the light has been truly shone on it in recent months and indicated by these two cases as well where it is pretty clear according to the report that the proper cultural responses were not made; that two Māori men who needed care were not communicated with in an appropriate way. Community organisations who could have provided appropriate intervention were not plugged into the system sufficiently to enable that to happen. So those things have been acknowledged and those things are known and the system has adapted and continues to improve and will always continue to improve. When we have events like this—tragic events such as this—we need to know and the system needs to have confidence that it can examine itself that it can find its shortcomings and that it can be given the opportunity to overcome its shortcomings and at the very least honour the loss of these two men in the improvements that will be made that will be for the benefit of everybody else in Aotearoa New Zealand. I'm confident that those who have led the system at the DHB level at the regional health coordination centre level and at the ministry level have understood what the gaps were and were rapidly trying to deal with them as case numbers were rising and have taken the steps and made the measures with the support of Government with the support of additional investment to ensure that everything that can possibly be done to prevent this sort of thing happening again has been and is being and will continue to be done. That is what we owe people—that is what we owe people. The member who opened the debate was right when she said that people put their faith in Government to act with best intentions especially in a crisis like this and that in exchange for the sacrifices that people have made and are making every effort is made to ensure the system is as effective as possible. I can assure the member and I assure this House that is what has happened. Every person every public servant every clinician every person on the end of a phone every person involved in the community the community organisations the NGOs who have been involved and everybody in this precinct who gets to be involved and gets to make decisions that is the value that has underpinned everything we have done. But tragically it will never be perfect and we have discovered imperfections and the clinicians and others who put this report together have revealed those imperfections and steps were being taken at the time have been taken since and are being taken now to make sure we have the best system possible to respond to COVID not just in Tāmaki-makau-rau any more and Waikato but right around the motu right around Aotearoa New Zealand and I'm confident the system is a good one."