28 May 2020

Review highlights need for cohesive national contact tracing system

4:55 pm on 28 May 2020

Stronger links between public health units, the national tracing service, and Healthline are needed to improve rapid contact tracing, an independent review has found.

Healthcare staff, doctors, nurse, working on laptop.

Photo: 123RF

The review by consultants Allen & Clarke, commissioned by the Ministry of Health in April, followed at least one district health board's refusal to use the national contract tracing software citing concerns with its ability to deal with complex cases or clusters.

The review assessed how well three public health units - Hawke's Bay DHB, Auckland Regional Public Health and Southern DHB - are positioned for rapid contract tracing.

Those assessments were now completed but the Ministry of Health (MOH) was refusing to release the reports because it is "still working through the recommendations" with individual units, a ministry spokesperson said.

However, the latest Hawke's Bay District Health Board (HBDHB) paper provides some details on the work.

The paper from the board's 20 May meeting noted the "Rapid Response Report" by Allen & Clarke highlighted the need to improve public health units' readiness - planning and modelling and cultural responsiveness - before concluding a more cohesive national contact tracing system was needed.

"The link between PHU, National Close Contact Service (NCCS) and Healthline needs to be strengthened with a better end to end national system."

The review looked at "what works well, what changes or resources might be required to ensure rapid and nationally consistent contact tracing."

"In addition, MOH is seeking to review the operating models used in different PHUs to determine national consistency."

As a result, the ministry identified issues at the three boards for "follow up" work.

"These PHUs were identified as they cover a large urban area (Auckland), a large rural and remote area (Southern) and have a high percentage of Māori (Hawke's Bay).

"Each of these PHUs have also dealt with a cluster of cases."

None of the public health units would comment on the reviews, referring all RNZ's inquiries to the Ministry of Health.

The Ministry told RNZ the board that had initally refused to use the app was now doing so. 

Tracing software concerns

Meanwhile, the government was pouring money into improving contact tracing software, the National Contact Tracing Solution, but at least one district health board was refusing to use it.

Southern District Health Board chief executive Chris Fleming

Chris Fleming. Photo: Supplied / Southern DHB

Southern District Health Board chief executive Chris Fleming cited his "concerns over visibility" of the software in a recent paper to his board.

With 215 Covid-19 cases in total, Southern DHB had the second highest number of Covid-19 cases after Waitematā and had the Bluff wedding cluster, the country's largest.

But in a report to the board on 5 May, Fleming said the DHB had used the national contact tracing service only for a "small number of cases."

"We have had concerns over visibility of when all close contacts were traced. For complex cases and clusters it is important to have the capability to see all aspects of investigation and contact tracing."

Updates being made to the national contact tracing solution software would address some of these concerns, but not all, Fleming said.

"Until all the functionality of current systems are in place, Southern [DHB] will not be using it."

What the Ministry of Health says

The Ministry of Health later confirmed the Southern DHB would be using the National Contact Tracing Solution (NCTS) from Friday.

A Health Ministry spokesperson said: "It is our understanding the comments by the Southern DHB are historical and a reflection of the early implementation of the National Contact Tracing Service, prior to improvements"

"We now have a much more comprehensive system."

The MOH was "confident" its National Close Contact Tracing Service and public health units could meet the needs of contact tracing as they arose.

"The number of close contacts associated with each case will vary under the different alert levels. Therefore, we are working to have national capacity for contact tracing of cases under different scenarios.

"Seven of the DHBs are now using the NCTS, with four still to be onboarded, with Southern PHU going live tomorrow. We will continue to work with the remaining PHUs to support and onboard them when they are ready to do so."

"In cases where a PHU is not using the NCTS this is generally because they have developed contact tracing systems that have important integrations with the local system, or the PHU requires additional functionality to be developed to support local variation.

"We are working through these with the PHUs concerned and are also working with these PHUs to build a direct data feed to enable monitoring of performance and uploading, or entering, of close contacts.

"Regardless of what technology system the PHU is using, the Ministry and the PHUs have the capability to continue contact tracing as the need arises."

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