A comprehensive report looking at the effects of COVID-19 on the quality of Aotearoa New Zealand’s health system has been released today by the Health Quality & Safety Commission (the Commission).
A window on quality 2021: COVID-19 and impacts on our broader health system – Part 1: March 2020 to August 2021 looks at the effects of Aotearoa New Zealand’s response on selected aspects of the functioning of our health system during the 2020 lockdown to help the health sector learn from it and shape resilient system responses in the future.
Commission director of health quality intelligence Richard Hamblin says, ‘This report looks at a selection of areas where data is available and robust. A further report next year will examine the effects of the Delta variant on other services including mental health.
‘This report focuses on some key themes including the distraction from our system’s business-as-usual work in primary care and the impacts of this on prevention and screening. It also addresses differences in the experiences of primary health care among different population groups, emergency department delays, deferral of scheduled care and elective procedures and delivery of cancer care.’
He says while the COVID-19 global pandemic has dealt a series of radical shocks to our communities and to our health system, it won’t be the last shock. This report examines some key parts of our health system to understand both what happened and what we can learn to address health inequity, improve health and respond more resiliently to future shocks to our system.
‘The report is also brought to life with a number of first-hand accounts from consumers with lessons of resilient success. These stories may guide the way we work in future, helping us to navigate the challenges and opportunities ahead and create the high-quality care we all want.’
The report makes half a dozen recommendations, mostly for district health boards and Health New Zealand to address issues of equity, clinical governance and data and insights.
‘The COVID-19 pandemic presents an opportunity to think about what a future health system in Aotearoa New Zealand can look like. We cannot return to “normal”. We need a system that is underpinned by a whole-of-government approach to health, is pro-equity and meets the Crown’s obligations of Te Tiriti,’ says Mr Hamblin.
‘The New Zealand Health and Disability System Review and current ongoing system restructure are a chance to build in a pro-equity, pro-resilience approach to our health care with all we have recently learned in mind.’
Key findings in the report
Distraction from the health system’s business-as-usual work in primary care and the impacts of this on prevention and screening:
- In March–April 2020 and August 2021, breast screening was paused nationally, however, women with a high likelihood of malignancy were prioritised for assessment during that time. National breast screening data shows a sharp decline in coverage in 2020. For most ethnicities, this decline slowed in August 2021, however, coverage of Pacific women continued to steeply decline. Coverage of Māori women remained lower than for all other ethnicities. It is a similar picture for cervical screening, where coverage of women fell from 2020 from an otherwise sustainable rate.
- Reduced access to primary care during lockdown periods impacted the percentage of two-year-old babies who were fully immunised. This has been declining since 2017 but rates have fallen even further (below 90 percent) since the 2020 lockdowns, the lowest in a decade. A similar trend is seen in immunisation rates for six-month-old babies.
- Aotearoa New Zealand has opportunities to address the issues this report has identified. In particular, there is now a well-trained and expanded vaccination workforce across a range of primary care services (such as pharmacy) that could be put to good use.
Difference in the experience of primary care for different parts of our population, in particular for different ethnicities, age groups and people who identify as being disabled:
- Around 26,000 people responded to the Commission’s one-off COVID-19 patient experience survey in June 2020, which sought to understand patients’ experience of accessing health care during all alert levels but particularly during alert level 3. One-third of them (35.4%) waited longer to seek care than usual or rescheduled their care.
- Experiences of telehealth differed for different people during lockdown periods. During lockdowns, access to in-person appointments must remain equitable for those who want or need them, as these have distinct advantages over telehealth appointments in some instances.
- Disabled people were more likely than non-disabled to report they found barriers to accessing care during the lockdown period. (See report here for more information)
Delay in needed care in emergency departments:
- In general, the response to COVID-19 in early 2020 caused dramatic falls in emergency department activity in both Aotearoa New Zealand and comparable countries. That was followed by slow returns to historically expected activity and, in some cases, periods when presentations of more acute cases increased beyond expected activity.
- To remain resilient, emergency medicine services may need to factor in these findings to be able to meet this demand in addition to the demand on services due to COVID-19 directly in the months and years to come. Existing inequity is part of these predicted trends.
Deferral of scheduled care in terms of the backlog of cancelled, delayed and deferred elective procedures:
- Many planned care services or elective procedures performed in hospital were cancelled, delayed and deferred because of pandemic restrictions. Two different sorts of data show different views on this backlog.
- One data set implies that COVID-19 measures had no long-lasting negative effect on the delivery of elective care in that about 15,000 more planned care interventions occurred than DHB plans projected.
- However, it seems at least possible that over-delivery of minor procedures hides the challenges that some, if not all, DHBs experienced in delivering their expected numbers of more complex inpatient surgical procedures during COVID-affected periods. It also seems clear that, whatever is happening, inequities in access have not improved in the last 18 months.
Delivery: an examination of the method and results of the effective and resilient cancer care response to prevent interruptions to the care of people with cancer:
- In the first alert level 4 lockdown in April–May 2020, new cancer registrations dropped steeply (by 40 percent) in comparison with 2018 and 2019 (approximately 1,000 fewer). The sharp fall led to concerns that lockdown and reduced access to care had caused significant numbers of missed diagnoses.
- However, in the later months of 2020, cancer registrations rose above 2018 and 2019 levels. Taken over the whole year, trends remained similar.