Over the next few weeks we will be publishing letters that Dr Nick Chamberlain, chief executive of Northland DHB has written to all Northland DHB staff, primary and community care providers, Māori providers, aged care and home and community support providers as well as iwi and social sector and council leaders.
They form an ongoing series and will continue until the Covid-19 crisis is over.
Chamberlain describes them as letters to those who will become our "war heroes" as they fight to save lives and keep you safe. "They will hopefully give you an insight into the amount of planning and preparation required and also provide reassurance that we are doing everything we possibly can".
The first one is from the Tuesday, March 24, the day before the lockdown started
Even though I was expecting the announcement and hoping it would happen all weekend, I couldn't help fighting back a tear and felt a real lump in my throat when I heard the words from our Prime Minister.
Who couldn't feel something? The biggest thing to happen in NZ in my lifetime and the biggest health crisis for 100 years.
This will be a huge test of character - most will respond with kindness, courage, optimism and innovation. And a few will disappoint, but I know that won't be amongst the health sector. Already you've all stepped up.
ICU staff/medical teams/surgical and theatre teams/ED staff all our nursing and allied health, lab and radiology, clerical and support staff are changing the way they work and repurposing various areas.
Have you seen the Facebook post? We chose our very best looking ED people to hold up a sign saying "We are here for you, please stay home for us." Yesterday most General Practices learnt and implemented a completely new way of working with phone triage and telehealth consultations.
Over the weekend the GP College instructed GPs that 70 per cent of their consultations should be virtual. With our Community Based Testing Centres being the main place for community testing we are hoping to ensure that General Practices can safely care for their other patients and continue to provide essential services (including flu immunisation). Pharmacists are doing the same, and have also developed creative ways of caring for their patients.
Despite huge change and challenges, almost no one is complaining: they are all just getting on and doing it.
For all of you who are required to now work virtually as much as possible, we are hoping to get various software, IT and if necessary, hardware support to you in the next couple of days. We already had a plan to do it this week but I know you all appreciate that the speed of change means, despite all our planning and preparation we are having to play catch up. Over the weekend we managed to secure 75 tablets (the ones with screens not the pills) and one of our staff went down to Auckland yesterday to pick these up. Hospital specialists are also seeing many more patients virtually.
Māori heath providers and iwi have been visiting their vulnerable whānau, kaumātua and kuia, distributing packs and ensuring they are taking preventative measures and know when and how to access help. They are our most vulnerable group and unless we do something differently we will see worse outcomes for Māori from Covid-19. Please remember what we have learned about engaging effectively with Māori and ensure our services are accessible and acceptable for Māori.
Our aged care services are all looking at new ways of working, and we are ensuring all aged care residents have a current advanced care plan in place. In Northland we have been a bit ahead of many other parts of the country with our preparation with our Incident Management Team (IMT) meeting for a number of weeks and then full time since two Saturdays ago.
Prior to yesterday's announcement, we had already gone to Level 3 across the health system. We had already cancelled non-urgent electives and all outpatients were being done virtually.
Today I saw the Whangārei Hospital plan for the next phase - green and red areas will ensure we completely separate those patients with coronavirus and those who have all the other health problems that will continue without any care for the virus. It includes closing off certain areas of the hospital, having a dedicated lift. Despite the design flaws and age of Whangārei Hospital, this plan is really well thought out and is going to work.
Ironically, it was only an hour earlier that I'd seen the concept design for our new hospital. Some of our team are pressing on with plans and getting approval for this, because as you know, there will be a time after Covid-19. Although it's hard to see right now - "this too will pass." So many questions, and despite all the preparation, we don't have all the answers yet. Many are dependent on national guidance from the National Health Co-ordination Centre (NHCC) which is the top down command and control entity which guides much of the work that your IMT are doing.
However, many solutions need to come from us, not from Wellington. What do we do with our staff who need childcare and both work in health? We are trying to get answers today, but one thing is clear, our plans to have a health school and creche (which have occurred overseas) is not likely to be allowed, so we are exploring other alternatives.
What about all our vulnerable workers? There are 150-200 DHB staff over 70 or immunosuppressed or more at risk from the virus as well as many others working in other health settings. We have a plan for you based on national guidance released yesterday afternoon and we will be identifying everyone in that situation ASAP and ensuring they are safe. The plan is a nationally consistent one and we will share it with all our primary and community providers including aged residential care to ensure they are also kept as safe as possible.
Should we be closing roads into Northland? Police are working with iwi on this. When will our Community Based Testing Centres also provide full assessment? Is eight enough and when will we need to increase that number?
So, uncertainty and rapid change and innovation is the "new normal". Speaking of new normal, some words have taken on a whole new meaning.
"Flattening the curve", "suppression" rather than "mitigation", "unprecedented", "panic buying" mean something very different in March to what they meant in February.
There's a phrase that the Prime Minister has used that I've been using for some time. "We are all in this together", and for the health sector, we really are. Many things that seemed like good ideas but that we didn't dream were possible have already been implemented in a couple of days.
Let's not lose the good will, energy, and receptiveness to change, because there will be much more to come. Look after yourselves - a marathon not a sprint - ensure you're getting breaks, that everything you're reading or watching is not about Covid-19, exercise and eat well, keep connected with your loved ones, and remember that family at home have very different pressures and fears, and they will need your patience and kindness.