I don’t know where we could find 300 nurses and paramedics who could work seven days to undertake these checks
Andrew Slater is grateful the COVID-19 mask hides the bags under his eyes, after what has been a roller-coaster year for him and the team he leads.
The national telehealth service Whakarongorau Aotearoa, which runs Healthline and the COVID Healthline, has had a year of broken records.
Since April, every record for the number of phone calls and contacts made with New Zealanders over the provider’s 20-plus-year history has been beaten. In late August, early September the number of contacts peaked at nearly 35,000 – beating the previous busiest day on more than 30 occasions.
“It’s been a really tough year of constantly pivoting and responding to the needs of New Zealanders,” chief executive Mr Slater says.
A relatively drama-free Christmas period flowed into two stints of Alert Level 3 in February and March.
“On our sixth birthday [last month], we spoke to around 40,000 people and had 3500 team members delivering care. Rewind six years, it was about 800 people that we connected with.”
Iwi-led partner contact centres have been established with Te Hau Ora O Ngāpuhi in Kaikohe, Northand; Ngāti Whātua – Te Hā Oranga in Auckland; Te Arawa Lakes Trust in Rotorua; and Te Taiwhenua o Heretaunga, Hastings.
COVID-19 was good for its PHO owners’ bottom lines, as New Zealand Doctor Rata Aotearoa has reported. Whakarongorau Aotearoa made a $3.2 million profit in the year to June, up from $2.3 million the previous year.
Three further telehealth services have been added: the COVID Healthline, the COVID welfare team for people in self-isolation, and the COVID Vaccination Healthline.
When the first community case was announced on 17 August, Whakarongorau Aotearoa was feeling fit for whatever Delta had to throw at it.
But, as Mr Slater says, a lot can change in 100 days.
In the immediate aftermath of the shift to Alert Level 4, Healthline had the three biggest days in its 20-year history.
“Since then, I think we’ve had our 30 biggest days,” he says.
The rapidly rising number of community cases saw the capacity of Managed Isolation and Quarantine (MIQ) facilities exceeded by October.
Being able to provide options for people to isolate at home became paramount, so community supported isolation and quarantine (CIQ) was developed. This brought together existing structures and organisations to provide clinical oversight and assessment to patients isolating at home.
Mr Slater calls the current model a “transitional” one with Whakarongorau Aotearoa in partnership with the Northern Region Health Coordination Centre. “The future model is quite different,” he says.
CIQ is delivered within the existing National Telehealth Service staffing which has some built-in capacity for unexpected spikes in demand.
To date, 60 per cent of the COVID positive cases in Aotearoa have been cared for through the transitional CIQ model. Whakarongorau Aotearoa’s current role is to undertake an initial phone assessment of COVID patients with a clinician, followed by daily phone check-ins on their health.
The daily assessments can escalate cases to a Whakarongorau clinician for a consultation, and lead to HealthPathways activation and various supports, often including virtual consults with the patient’s GP.
Whakarongorau Aotearoa works with DHB public health units to “release” the patient at the end, says Mr Slater.
Non-clinical staff members conduct the daily assessments and are to follow tight protocols; they can bring a clinician on to the call in cases at higher risk.
Daily clinical assessments would be great, Mr Slater says, but, unfortunately, there isn’t the workforce capacity to allow this. Around 350 non-clinical staff and 80 clinicians are rostered for this work every day.
“I don’t know where we could find 300 nurses and paramedics who could work seven days to undertake these checks,” he says.
At the time of deadline for this edition, three people had died while in CIQ. Mr Slater acknowledges the lives lost and expresses his unreserved sympathies to their whānau. (See “COVID at home: GPs not yet playing full part”, page 5.)
He says the organisation has been constantly improving: “It’s a very different operational model today to what it was three days ago, to what it was three weeks ago. One of the challenges with COVID is no part of the health system had the benefit of time to plan and be 100 per cent ready for when it arrives, and when it does arrive, it does tend to be bigger than you ever expected.” He adds that the CIQ system is getting better every day, with processes continuing to improve and scale up.
Whakarongorau Aotearoa will be there throughout the holidays, supporting the health sector as well as the public, Mr Slater says. He hopes 2022 is kinder to all.
