A medical expert has called for total reform of the health system in a presentation to MPs in which he blasted the Government for "squandering" New Zealand's main geographical advantage in the fight against COVID-19.
Auckland University Medical Professor Des Gorman told the Epidemic Response Committee New Zealand was not "adequately" prepared, the border was not closed soon enough, and the nation should have had a central agency to manage it.
"I think we squandered our main advantage which is our geography because we did not have a hard, early border closure," Prof Gorman, who has been involved in audits and reviews of various jurisdictions, told the committee.
"If the pandemic response strategy was and is to keep itout and stamp it out, then the hard work we have had to do to stamp it out clearly shows that we materially failed to keep it out."
Prof Gorman said he stopped off in Singapore on his way back from the Middle East in February, and noticed that the military had been mobilised at Changi Airport and that thermal screenings were in place with people being closely monitored.
"By contrast, I arrived home to no meaningful management of passenger movement, hence my comment that I think we squandered our main advantage of geography."
Prime Minister Jacinda Ardern closed the border to New Zealand except for returning Kiwis on March 19, as all of the cases of COVID-19 identified had related to people travelling and bringing the virus with them.
But not everyone returning to New Zealand was being quarantined, prompting National leader Simon Bridges to launch a petition signed by tens of thousands of people urging the Government to quarantine all arrivals, which was eventually adopted on April 9.
The Prime Minister defended the Government's response in a speech to Parliament, highlighting how the border was closed to all but returning Kiwis within 25 days of New Zealand's first case, compared to Germany which took 49 days and Australia 55.
But Prof Gorman said the pandemic has also underlined "significant problems" in the way New Zealand's health system is structured, governed and operated.
He said "systemic inefficiency" became evident as problems emerged in the supply of swabs, personal protective equipment (PPE) and influenza vaccine, as well as contact tracing inefficiency highlighted in an independent review.
"Ironically, the current situation also provides an opportunity to accelerate system reform... though I might suggest we temper our enthusiasm since the last comprehensive reform of our health system was in 1938."
He said the current 20 district health boards (DHBs) are largely autonomous, telling MPs: "What you're looking at is the success of provincialism over rationalism."
He said to get commissioning and purchasing of healthcare right, a fluid health system is needed where some services exist at a national level, some regional, some district, and some right down to people's homes.
Labour MP Liz Craig agreed that the pandemic has "started up the historic debate about how the Government should invest in public health infrastructure".
But she said there have been contrasting calls for more centralisation as Prof Gorman suggested and also calls for strengthening public health units - which were given a $55 million boost last week to improve contact tracing.
The Government invested $500 million into the healthcare sector in its initial COVID-19 response package unveiled in March.
"In the last few weeks we've put significant investment into central functions, but also strengthening that public health response in those units," Craig said.
Prof Gorman agreed that the public health units have been neglected and he acknowledged that there is no simple solution - but warned that if we don't get it right, a far worse pathogen could come along and push the health system to the edge.
"I think the COVID-19 pandemic gives us a chance to identify what we need to do better before we encounter a potentially much worse pandemic," he told the committee.
"Without being melodramatic, if we don't seize this opportunity, I think our children and our grandchildren have every right to judge us very harshly."