Reti Shane; Salesa JennyDr SHANE RETI (National): Thank you Madam Speaker. I te tuatahi ki ēnei mate haere ki te kāinga tūturu o tō tātou Matua i te Rangi moe mai moe mai rā.[Firstly to those who have passed go to the permanent dwelling place of our Father in Heaven; may you rest in peace.]First of all I want to acknowledge these two people who have succumbed to this terrible disease and extend thoughts to them and particularly to their family. I want to in this offering address several parts around these very sad reports. First of all why did this happen? Secondly what actually happened? And third most importantly where to from here?The question of why this happened—well this is a sad tragedy of being underprepared through this report. The Government was underprepared for increasing community cases and while it's alluded to in the report I actually find the answers in written question No. 52015 which asks questions around home isolation. The answer to this question was this: A rapid increase in COVID-19 cases during the August 2021 community outbreak put pressure on managed isolation and quarantine (MIQ) places and it was necessary to quickly implement a community isolation and quarantine option."—it was necessary to quickly implement a community isolation and quarantine option.This Government was unprepared. They had 18 months from the first COVID outbreak in 2020 and yet when COVID cases went up this year in August 2021 18 months later they had to quickly look at implementing a community isolation programme—hospital at home. When did we start doing ICU-lite? Surely that's an oxymoron in itself. When did we start pushing cases out into the community and saying "Oh by the way our health system's unprepared so you just help yourself."? "Oh by the way we'll give you one of these things." which is the pulse oximeter that I keep in Parliament for who knows when. When we say "Here's your hospital at home. Good luck to you. God bless you. Figure it out." when did that happen? When did we start saying to the community "You're responsible because we don't prepare the health system properly and you just figure it out." Because that's what it looks like through these cases here.If we look at what actually happened—reading through the cases themselves is quite revealing and there's a number of points but I've broken it down to two: first of all the risk factors and secondly communication. In case A the risk factors were very clear. The person was living alone and they were unvaccinated. So the risks start going up just by virtue of that quite aside from any of their personal demographics how old they were what other pre-existing conditions they may have. That was risk enough as is being pointed out in the case review.Then secondly for me it's the communication aspect. What didn't we learn from the KFC worker in South Auckland who could not be contacted? They didn't bother to turn and knock at the door. Three or four days later as I recall was when they were first contacted and we've revisited that same mistake. We have not been a learning enterprise during coronavirus.Here's what the findings from the case reviews are for case A around communication: there was a five-day delay in the COVID Healthline making the first attempt at phone contact. How can that be? Discharged home sent home and five days before Healthline makes contact. Then when that failed case A's whānau were not contacted. How can that be? Written contact—and I'll come back to primary care—with case A's last known GP was not made until many days later. Secondly the information that was seeking to be collected was poor quality it wasn't clear it was inconsistent. We should have learnt from the outbreak last year many many things that would have helped this time. Again communication. If I look at case A I pull out two things: risk factors and communication.If I look at case B there's two slightly different things here—a little bit different. I need to acknowledge it's always hard when a person self-discharges against advice. That's challenging. They're making a call of their own autonomy and it's against medical advice. That just raises the risks. It is what it is. That was the call. That raises the risks. It should have raised the response as well. But in fact what happened was the public health team weren't aware of the self-discharge status and when they were sent home they were sent home with a pulse oximeter by all accounts looking at the findings with really not much health literacy around what that means.I think we need to be careful we don't overreach with pulse oximeters. They're just one measure one tool to assess a person's status. For example you've got to think of it like a thermometer. If I take someone's temperature and they're a normal temperature if they look sick they're sick. I don't care what their thermometer is saying. So you've got to weigh up a whole lot of other things not just the oxygen sats or the pulse that the pulse oximeter is telling you.If I wanted to make it something more ubiquitous in the environment I think of it like a peak flow meter. People will have more of a sense of that. Those people with asthma who blow get a peak respiratory flow rate through their peak flow meter. A pulse oximeter is just like that. It's just a measure. If the person's short of breath and they've got other things going on with them actually that's the whole picture we need to be talking about. So I don't want to be distracted. This is not a hospital in the home. It's not ICU-lite. It's just one tool that needs to have a lot of health literacy around it to do a good job. I accept some of the overseas studies that have shown that it's important and I think it probably is but we've got to wrap around the other education parts to make it really effective.So then what also happened was it failed to have primary care involved. So on 18 October Allan Moffitt from ProCare goes to a meeting with the Northern Region Health Coordination Centre (NHRCC) and he's angry. He's angry because primary care haven't been involved because what the system tried to do initially was say "Nah we're not going to involve primary care. What we'll actually do is we'll use the doctors in MIQ. The few that we've got who are managing MIQ they're going to be our response. They'll do the hospital at home." and that failed miserably. GPs were telling them "This will fail. If you don't involve us what's going to happen is when you get overwhelmed it will drop back on us. We will again be the safety net." Sure enough that's what played out.So Allan Moffitt goes to a meeting with NHRCC on 18 October and he's ready to do "battle" with the system to say "We have to be involved." Thankfully when he got there by all accounts they'd also figured it out—"Oh we're going to have to have primary care involved. Yes Allan you're right. Let's sweep in behind ProCare. Let's bring others on board." Late again—just as late as primary care has been to give the vaccine like pharmacies have been late to give the vaccine.Big shout-out to pharmacies printing out the COVID passports by the way. My goodness we'd be struggling if they weren't doing that for older people and laminating it. Shout-out to pharmacy. Thanks for doing that. That's really helpful. But again they've been late to other parts of this response.So we need to get to the "What next?" What learnings are we going to take from this? What do we understand could be a better response than what has been? So we already said it was hopeless it was late it was underprepared—yeah yeah yeah. So what are we going to do tomorrow? I must admit some of the recommendations in the investigation are useful: the piloting of new models with Māori and Pasifika providers to provide holistic clinical social welfare and mental wellbeing support—that's a good idea. I'm a big fan of treating people in a culturally competent context. You get a better outcome.Immediate clinical assessment using information already available—so this is going to be integration with primary care databases. What we're struggling on one level with Whānau Ora and John Tamihere—struggling with that. But one of the cases it was very clear that the information was held in the primary care database. The discharge summary hadn't got out to the public health people and that would have been extremely useful if it had.Reduction of the time taken between a positive test and the first clinical assessment—that must be another key performance indicator (KPI). As we're assessing the system as we're assessing contact tracing—that should be a KPI. Give it a number something that people can be accountable for. From your positive test to the time you're first called for a clinical assessment it should be this and then report it. Put it out in the public domain. Be transparent with it so we can all hold ourselves accountable.The launch of a hospital in the home initiative across all three DHBs for cases needing a lot of health support—that's what we're talking about. Door knocking for those who are not able to be contacted particularly those isolating alone. We should have learnt this from the KFC worker in South Auckland a year ago. This was exactly that situation. We did not learn. When they cannot be contacted a certain number of times hop in the car and knock on the door surely. The establishment of a Community Supported Isolation and Quarantine System clinical governance group with the purpose of identifying emerging risks and trends—that's just appropriate self-monitoring.Here's one of my concerns: so this whole philosophy of hospital at home. On one level it does have a place. But here's my concern—because this is fundamentally what the business case for the whole health sector reforms are predicated on: keep people at home don't send them to hospital kick them out early so you've got an early discharge and push them back into the community. Look at the business case. Look at the business case and the risks for the health sector reforms and it is exactly this. My concern is this is what we're going to see because this is how capable they are at managing health at home this is how capable they are at managing hospitals at home and this is what the business case—have a look at the risks. It's really clear for both the Māori Health Authority and for Health New Zealand. This is where the money's going to be made. This is the big saving. Oh and by the way there's no mention of primary care or how exactly this is supposed to roll out. But that's where the cost-benefits lie in this keeping people at home. I'd have to say the track record from this Government in these two cases of doing that successfully gives me a sense of foreboding for the whole health sector reforms.This has been a fail. Pick up the learnings. Do a better job. We're happy to help with that but we need to do a better job. Thank you Madam Speaker.ASSISTANT SPEAKER (Hon Jenny Salesa): Members the time has come for me to leave the chair for the dinner break. I will resume the chair at 7 p.m.Sitting suspended from 6 p.m. to 7 p.m."