The final report from the Government's COVID-19 Contact Tracing Assurance Committee (CTAC) wants "urgent attention" to be given to which health agencies should be held responsible in New Zealand's pandemic response.
The committee - which is chaired by Sir Brian Roche - said the country's 12 Public Health Units (PHUs) work "quite autonomously" and are more focused on their local communities. In a past Government committee report, PHUs have come under fire for often not using the National Close Contact Tracing Centre or the Government's tracing software.
The report said a "downside" of the PHUs' approach means there can be a lack of clarity within the health system as to which agency is accountable for contact tracing.
Some of the focuses at the 12 public health units across New Zealand are environmental health, communicable disease control and health promotion programmes.
CTAC was appointed in May and was tasked with identifying any emerging risks or issues, and reviewing progress against the recommendations of an earlier report - the Verrall report.
On Thursday, the committee released its final report, but it is dated as July 16. Health Minister Chris Hipkins said during a press conference on Thursday he would've liked to release the report earlier, but it was delayed due to the recent Auckland outbreak.
While the report pointed out that "considerable progress" had been made by the Ministry of Health with regards to contact tracing, it also urged that "accountabilities and decision rights" be clarified since the system can "ill afford confusion as to who is in charge and who does what in any given circumstance".
"A national public health crisis requires a nationally-led response with strong coordination and leadership," the report said.
"Further work is needed to build upon the gains and strengthen the collaborative working arrangements that evolved between the Ministry [of Health] and PHUs during the initial phase of the COVID-19 response."
The report said the accountabilities need to be clarified in border controls, testing and contact tracing.
"The operating environment is dynamic and the processes and associated accountabilities need to reflect that. Clarity on the command and control structure is critical. Recent events at the border have highlighted the need for clarity in this area."
Since the report is dated July 16, it doesn't cover August when it was revealed by Newshub that nearly two-thirds of border and isolation staff hadn't been tested for COVID-19.
The report goes on to say that the command and control structure and decision-making rights need to be transparent and understood by everyone who's likely to be involved in a COVID-19 response.
"Management of a potentially fast-moving outbreak should be led by an appointed person with training in public health and outbreaks of infectious diseases who has the authority to act quickly using all the tools available, with the involvement and confidence of Cabinet and the Director-General of Health," the report said.
"It is acknowledged this is a very sensitive area, but it is one that must be confronted and clarified."
The report clarifies it doesn't want the health system taken over by the Ministry of Health, but instead there should be a more specific understanding of how the system "harnesses the skills of the centre and the distributed PHU network recognising the criticality of local knowledge".
"Both elements are critical to a successful contact tracing system and need to be addressed to strengthen and de-risk the process," the report said.
Hipkins defended the Government's contact tracing efforts and said they had "hugely improved" throughout New Zealand's pandemic response.
"There are much more streamlined whole-of-government processes getting in behind and supporting contact tracing," he said.
"The contact tracing centres are working really closely with other government departments who also have access to information. For example, the lines of decision making are much more clear, the Ministry of Health has been working to make sure our PHU are operating on a coordinated nationwide basis rather than in isolated silos. So a lot of progress has been made in that area."
A previous report released in April - called the Verrall report - found the Ministry of Health's contact tracing system was understaffed and lacking cohesion.
Further recommendations Roche gives in Thursday's report includes stress-testing and scenario planning of a range of probable outcomes. Once completed, he said this will give Hipkins "a high level of assurance" that New Zealand's health system abilities can be deployed and will be successful.
Hipkins said there were plans to stress-test the system and they were "about 24 hours away" from starting that process.
"We wanted to do that before we released the report recommending it be done, and of course we ended up dealing with a real-life event instead," he said.
"It would've probably been released a couple of weeks back had we not been dealing with this current cluster."
To date, the Ministry of Health says it has identified 2455 close contacts of cases in New Zealand, of which 2404 have been contacted and are self-isolating. It adds it is in the process of contacting the rest.
