The Ministry of Health didn't know how much personal protective equipment DHBs had in the early stages of the Covid-19 response, a review has found.
The review by the Auditor-General found the ministry did not regularly review DHBs' plans to ensure that they were kept current and aligned with the overall plans.
"We found some misalignment in the plans about roles and responsibilities for both planning for, and providing PPE in a pandemic, which led to confusion," it said.
The review found that the gaps in the planning also meant the ministry was not well positioned to ensure PPE was available in enough quantities throughout the country to meet the demand caused by the pandemic.
In addition, it noted in early February 2020, the ministry did not know what PPE stock the DHBs held in their reserve supplies or have a system to forecast demand.
Once the ministry started receiving regular information from DHBs about stock levels, it emerged that a significant amount of stock had expired.
Fourteen DHBs informed the ministry that they were holding either expired national reserve mask stock or no national reserve mask stock.
Auditor-General John Ryan said the ministry moved quickly to set up a new centralised system for procuring, prioritising, and distributing PPE stock.
"Ideally, that system would have been better planned for and tested as part of the health sector's emergency readiness," he said.
The review has put forward 10 recommendations to help strengthen the management of PPE.
This includes the ministry regularly reviewing DHB's health emergency plans to ensure that they are complete, up to date, and consistent with each other and with the overarching Emergency Plan.
It also recommended the ministry work with other government agencies to determine how workers and providers not currently covered by the national reserve of PPE access it in the future.
Ryan said it was important to note that there was still a risk that Covid-19 would re-emerge or another pandemic occur.
However, he said much had been learned through the initial response.
"To be sufficiently prepared in the future, the health and disability sector needs a clear understanding of what PPE is held where, who it should be provided to, a way of forecasting demand, and a scalable system for procuring and distributing stock," he said.
NZMA chair and GP Kate Baddock said there was no certainty accessing PPE in the early stages of the response and it varied greatly among practices.
"Some practices had reserves themselves and could use those while waiting for stock to arrive, others literally had no stock and they were either borrowing from other practices or they were simply having to decline to see people who were at risk from covid because they couldn't protect themselves or their staff," she said.
Dr Baddock said it took about two to four weeks for the situation to be remedied, depending on where practices were located.
She said if the conditions were different it could have become a 'worst case nightmare', but said there was extremely good management of early Covid-19 cases by front-line health workers and the public.
Dr Baddock supported the recommendations in the report to review health emergency plans.
"There needs to be regular stocktake of what is available, there needs to be a regular churn so that it doesn't become obsolete or out of date, or deteriorate to the point of not being able to be used and the plans themselves need to be regularly reviewed and updated when necessary," she said.