Reti Shane; Hipkins ChrisDr SHANE RETI (National—Whangarei): Thank you Madam Chair. I'd like to extend a question that we did raise generally in the Estimates in the area we were talking about—testing—and it's an area that I raised last week. It's around testing at the border particularly testing in isolation and the concern that I continue to have that there is some sense of autonomy under duress. I know the Minister's been concerned about this because we've had some dialogue. I want to approach it from a different angle because maybe I wasn't clear from how I did last week and I'll talk to some of the notes. It's like this. We know that the legislation allows four sorts of tests in isolation. It allows you to ask about coronavirus symptoms listen to the chest temperature and to do a swab. OK we know that that's what's allowed.My question partly then is around what is required for informed consent from someone who's in isolation—more specifically in writing. It was written to me that informed consent is only required in four situations: the consumer is participating in research; the procedure's experimental; consumer's under a general anaesthetic; or the significant risk to adverse effects on the consumer. My question then is: which of those criteria does nasal swab testing meet? Because you wrote to me in written questions saying that that is the only form of written informed consent that occurs with nasal swab testing. So which of those four criteria do nasal swabs meet?Hon CHRIS HIPKINS (Minister of Health): I'm not entirely sure what the member means. There are a variety of different rules at play here. The rules around nasal swab testing are clearly articulated and are subject to a separate arrangement. In terms of any other tests that might happen in managed isolation or quarantine facilities of course they are governed by the same laws and the same professional standards that would apply if someone was being subject to those tests around consent—you know the same rules around consent—as if someone was being subject to those tests in an outside facility such as going to visit their GP. But of course if as I've written to him the member has any evidence that people are being subjected to tests in a managed isolation or quarantine facility that they have not consented to then of course I would expect him to if not supply that to me—he doesn't have to supply that to me—to supply it to the appropriate people who could investigate it because that would be a very serious matter.Dr SHANE RETI (National—Whangarei): Great. So I want an understanding here. I guess my question is: how come there's written consent for nasal swabs—or for throat swabs or whatever—but not for blood tests? How do we explain that? And then secondly does he really get the importance here? This is a unique situation. There is a sense of duress because if you're not compliant the duress is that you'll have another 14 days in isolation. Otherwise you could say Well how is this different to a prison?" Well in a prison you can do a cost-benefit analysis and decide whether to say yes to a test and there's really no other consequence. In managed isolation or quarantine there is a consequence. There's a punitive sense of duress. Something will happen if you're not compliant with the behaviour being asked of you. I think that in that environment great care needs to be taken around consent and that different sense of autonomy. I'm just getting a sense—does the Minister understand it's a different sense of autonomy in restrictive isolation compared to out in the environment?Hon CHRIS HIPKINS (Minister of Health): Yes yes I absolutely do. One of the differences between blood tests and nasal swabs of course is that we expect most people to do nasal swabs all people to do nasal swabs. They do have the ability however to say no to those tests. But of course the consequence of that is that we expect everybody to get a clean bill of health before they leave a managed isolation facility. If they are not willing to consent to nasal swabbing then the period of time that it takes for us to have absolute confidence that they've got a clean bill of health will be longer. So that's ultimately a trade-off that every individual in that circumstance can make for themselves.Dr SHANE RETI (National—Whangarei): I want to come to extend from what my colleague the Hon Michael Woodhouse was speaking about regarding some of the DHB financials and talk about Capital and Coast District Health Board which more recently have announced their financials which are significantly different to what was announced earlier in the year. We did touch base on Christchurch specifically in the Estimates and a number of the other DHBs. This is one that more recently has shown a significant variance to what was projected. I also note the comment that the DHB must also pay $10 million in payroll breaches made by the Government. Is that holiday pay or what is being meant there by "payroll breach"? Can the Minister explain that please?Hon CHRIS HIPKINS (Minister of Health): Yeah look I don't have the particular piece of paper in front of me that the member has in front of him but I would say it is highly likely to be payroll breaches. These payroll breaches have accumulated over a period of time. Resolving issues around the Holidays Act is something that we're grappling with across Government. It's clear that for a period of time well before we even became the Government many public sector agencies—and private sector agencies too I dare say—have not been paying people in compliance with the Holidays Act. Sizing and scoping that problem and finding a way out of it is a very complex process and the Government across the board is engaged in that process at the moment.Dr SHANE RETI (National—Whangarei): Thank you. On 9 June the policy for the border was that people would be coronavirus tested around day three and day 12 and this was discussed in Estimates as well. I want to ask the Minister in the chair the Hon Chris Hipkins—because I still don't understand—why day three testing is not compulsory. Particularly if we look at the majority of cases from 9 June that have been positive they've all been day three positive. The majority of positive cases have tested positive at day three. We may have different numbers but I checked this last week and that's how I see it but I'm prepared to hear a different explanation. So the day three test would seem to be absolutely critical and yet the argument that I'm hearing is "Oh don't worry; they're having a day 12 test." If you have a day three test and you're positive—like the people in Hamilton not last weekend but the weekend before—what happens is that you escalate if you're in managed isolation to a higher level of security in full quarantine. That's very clear as to why you'd do that: because if you're positive you don't want to be mixing and mingling with others in the managed isolation facility. If we don't test by compulsion on day three how will we know that? Surely we've got a huge risk of day three people who aren't being tested who may be positive who are then infecting others in the managed isolation facility. How hard can it be to make day three compulsory just like it is for day 12?Hon CHRIS HIPKINS (Minister of Health): I think the member perhaps based on the previous discussion we had might be misusing the word "compulsory". Actually the vast majority of people do have tests on day three and there are a significant number of cases—and there have been cases of those ones and twos that we're getting in recent days—where people have tested negative on day three and positive on day 12 which highlights the importance of the day 12 test because we are picking up people who—if we just went on a day three test and then said "You're still not showing symptoms. You can leave on day 14." we wouldn't be picking up some of those positive cases. In some cases they've been asymptomatic for the entirety of their stay tested negative on day three and positive on day 12 and if we did not do that testing on day 12 we wouldn't pick that up. I think that that is very very important.Now of course we want everybody to do both tests. The consequence of not doing tests is that you'll ultimately end up being in those facilities for longer than you might need to be.Dr SHANE RETI (National—Whangarei): Thank you. The Minister's talked about those who were negative at day three and then positive at day 12 maybe the false positives. He wrote to me when I asked that question—what is the rate of false positives—and the reply to me was 30 percent. That's a big number. It's not your fault or anyone's fault but it's still a big number—one in three who test and say "I'm negative; I'm fine." but in fact may be positive. What plans does the Minister have to address that? How do we look at the impact of that? What do we do about that other than sequential testing of some duration?Hon CHRIS HIPKINS (Minister of Health): Sequential testing is the best answer at the moment. There is no foolproof solution here. Obviously a lot of work is going on in New Zealand and around the world on testing regimes and on how we can get faster testing results testing results that don't require being taken off to a lab—more instant test results. The advice that I've received so far is that the rapid tests results are even less reliable than the polymerise chain reaction (PCR) tests. Those tests that we're getting at the moment are quite reliable. They're the most reliable that we've been able to identify so far. Of course we're keeping an eye on what the testing solutions are that might be available here and around the world. Where good solutions emerge of course we'll aim to be fast adopters of them. But at the moment one of the best things we can do is test more frequently in order to eliminate false positives.I do just want to highlight this because actually it's come up just in the last 48 hours again with the case that's in the media today about the person who left New Zealand and arrived in South Korea where they got a positive result there. That was from a rapid test and those rapid tests are internationally recognised as being less reliable than the PCR tests. We have been in this boat once before with someone who left New Zealand arrived in Singapore and got a false positive off a rapid test when they arrived and the PCR test highlighted them to be negative which is one of the reasons why if we see any people leaving New Zealand and getting a positive where they arrive we ask automatically for a PCR test to be taken because that means that they're being tested at an equivalent level to what the test would be if they were in New Zealand and that gives us better data thus far. It will be interesting to see what the case in South Korea highlights in the next 48 hours if we can get a PCR test done there. But the only other case that I'm aware of it highlighted that it had been a false positive that they received in the rapid test.Dr SHANE RETI (National—Whangarei): Is there any position then for exit testing from New Zealand whether or not this comes up positive from South Korea? Is there any work being done—modelling any thinking—around exit testing bearing in mind we do that for Samoa already? You have to have a medical certificate within three days showing you are PCR negative to go to Samoa—so it's not new this precedent. But is there any work being done towards that being rolled out more fully as we depart as an exit test?Hon CHRIS HIPKINS (Minister of Health): Yeah one of things that we will be looking at of course is we look at the overall border arrangements that we have in place as we talk about things like safe zones where we may be opening up the border to isolation-free travel for some areas such as potentially some parts of the Pacific Realm countries and so on—very active consideration about whether or not testing should be part of that conversation. I think the last thing anybody in New Zealand wants is to see us spreading something into the Pacific. We have a bad history in New Zealand and Australia of doing that in the past and I don't think anyone wants to see that repeated. So of course we'll have conversations about testing and that would include a conversation about exit testing as well. In terms of the conversation about broader exit testing at this point no we don't have plans in that space for countries where someone is leaving New Zealand with no intention to return. However I'd never say never."