Slow movers on PPE called out
The Aged Care Association names two DHBs dragging the chain on distributing protective equipment. David Williams reports
At Parliament’s Epidemic Response Committee last week, Simon Wallace was asked about problems rest homes were having getting protective equipment.
Wallace, chief executive of the Aged Care Association, which represents more than 600 rest homes, said it took significant effort to ensure his members had access to personal protective equipment, or PPE. The issue was largely under control but there were “one or two pockets” where supply was difficult.
The point was pressed by committee chair Simon Bridges, the National Party leader. Bridges recalled that in March director-general of health Ashley Bloomfield reassured the country there was enough personal protective equipment, or PPE, to go around, and it was available right across the system.
That wasn’t the case, Wallace said – at least, not in March. It might have been in the country but it wasn’t reaching the frontline. His organisation and its members had to agitate, in each district health board (DHB) area, to get that equipment.
“The supply and distribution chain has not been working as it probably should have been”.
It’s a theme Newsroom has picked up for more than a month, with medical professionals and frontline healthcare workers, including midwives, pooh-poohing official pronouncements on PPE availability. A quartet of anxious rest home workers have also detailed their experiences, including patchy access to PPE.
Wallace admitted last week there had been improvements to PPE supply, but there were still one or two problem DHBs. “We shouldn’t be, even now, having to quibble with DHBs about our access to that equipment.”
Now, Wallace is prepared to call out the worst DHB, according to his members. The DHB has two significant clusters at rest homes and the most deaths of any area.
“Canterbury would have to be the standout.”
The area was one of three accused earlier this month by the Public Service Association of rationing PPE. The Ministry of Health set up a new national distribution system after Easter, which was widely seen as an acknowledgement the DHB system wasn't up to scratch.
Last Thursday, Health Minister David Clark ordered a “rapid stocktake” of PPE distribution, two days after the Auditor-General launched a review.
“We ordered stock back in early January to maintain our regular PPE usage and have not been able to get any delivered.” – Canterbury rest home
A rest home, which Wallace declines to name, wrote on April 14: “We have only received 700 masks from the Canterbury DHB, nothing else. Please note that we ordered stock back in early January to maintain our regular PPE usage and have not been able to get any delivered so have needed to use our outbreak [emergency] stock.”
There hasn’t been great access, either, Wallace says, to N95 respirator face masks – designed to better protect the wearer from liquid or airborne particles than standard masks. It took a week after a Covid-19 cluster was identified at one Christchurch rest home for N95 masks to arrive at the facility, he says.
That can mean only two facilities – Rosewood Rest Home and Hospital, which has 10 deaths out of a cluster of 54 cases, or George Manning Lifecare, which has 20 cases.
Wallace: “I don’t know which one it is. That’s the information I have.”
Canterbury was also slow in meeting aged residential care providers, he says, taking until the end of March to meet them when, at the beginning of March, he called for those meetings to happen urgently.
But the South Island DHB isn’t alone. Last Thursday, a rest home in the Counties-Manakau area wrote to Wallace: “I still have to beg for supplies I need from the DHB. We are being exhorted not to be greedy, asking for more than needed. If I could get as much as I need, I would be perfectly happy.”
Meanwhile, a larger aged residential care company, spanning multiple DHB areas, said last Wednesday – the day Wallace appeared before the Epidemic Response Committee – that it continues to buy PPE privately.
“The DHB distribution is like a trickle, ie. sending 20 or 50 masks to a facility is completely inadequate.”
Wallace says the mantra from Wellington has been there’s PPE available to those who need it but there appears to be a disconnect between the Ministry of Health and DHBs. The situation has improved, he says, while adding: “I would describe the whole situation as being haphazard.”
Good progress made
Canterbury DHB’s Covid-19 response controller Sue Nightingale says it distributes PPE to health and disability providers as per ministry guidelines.
“While we recognise there have been challenges in meeting demands for PPE, good progress has been made since your comment dated April 14 and we do not believe that comment fairly represents the overall picture today.
“Canterbury DHB continues to work with the Ministry of Health to ensure ongoing security of PPE supply chains and to streamline processes for ordering and distributing it.”
Additional support has been provided to rest home facilities over a number of weeks, Nightingale says, to reinforce correct use and best practice for putting on, taking off and disposing of PPE. A ‘PPE Champions’ pilot has been launched at four facilities. Other facilities, meanwhile, are using a buddy system to ensure staff are donning and doffing PPE gear correctly.
The accusation of being slow to meet aged residential care providers went unanswered.
Questions about Counties Manukau’s distribution were answered by an anonymised statement from a northern region DHB spokesperson.
Over the past four weeks, the Northern Region Health Coordination Centre has sent almost 5.5 million items of PPE to community-based providers such as aged residential care, general practice, and ambulance.
A team reviews PPE requests and sends orders to be filled and dispatched, with priority orders scheduled for same-day or next-day delivery, and others within two days.
“We have not received any formal complaints relating to PPE delivery,” the statement says, adding that complaints can be made by phone or through a dedicated portal set up for community care providers, including rest homes.
National ordering system established
The Ministry of Health’s group manager of quality assurance and safety, Emma Prestidge, says PPE for health and disability sector workers is ordered by DHBs.
“A national distribution system has been operating for the past two weeks. On 14 April, a national ordering process was established for the health and disability sector for placing orders for masks with other PPE products added from this coming week.
“$200 million has been allocated to the supply of PPE stock, of which just under $140 million of orders have been placed to date. Over the next eight weeks, we expect delivery of 75 million PPE items to come into New Zealand.”
The ministry’s PPE guidelines for frontline workers, “developed in consultation with sector representatives”, have been updated, Prestidge says.
“It’s important that everyone receives the necessary training and follows the guidance on the ministry's website for using PPE correctly. Basic hygiene measures such as frequent hand-washing, physical distancing and sneeze and cough etiquette are the mainstay in our defence against Covid-19.”
Protecting the elderly during the pandemic is a global problem.
The World Health Organisation says up to half of all coronavirus-related deaths in Europe are in long-term care facilities, including nursing homes.
Now, British health workers are able to be tested for the virus at mobile, drive-thru sites. Earlier this month, Austria announced plans to test all retirement home residents. Australia’s chief medical officer Brendan Murphy has called for care home workers to be tested – while simultaneously arguing for the relaxation of restrictions on visitors to aged care homes.
In this country, the Aged Care Association has called for new admissions or re-admissions to rest homes to be tested for Covid-19 – something also backed by unions.
Wallace says there’s a double standard, because people in carparks, with sniffles and slightly sore throats, are being tested, “but we’re not testing old people who are really, really sick and frail.”
The tests – about 700 a week – would come on top of a 14-day isolation period at rest homes, he says. (Isolation isn’t being strictly enforced by some facilities, workers say.)
There are signs the stance against testing rest home residents might be softening.
At Monday’s Government briefing in Wellington, Bloomfield said he was considering what ongoing testing was appropriate in the high-risk facilities, considering some residents who test positive don’t show symptoms or can’t describe them.
“I’ve reached out to the Aged Care Association to look at a piece of work as we move through alert Level 3 and into alert Level 2 as to what we really do need to do.
“We’ll have learnt a lot about what’s happened over the last few weeks with our clusters in aged residential care facilities – not just about the residents but about staff as well, and how we need to support staff, including both at work and outside of work, to reduce any onward infection.”
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