The Silent Pandemic Called Inaction

By Terry Taylor, New Zealand Institute of Medical Laboratory Science (NZIMLS) President

Since the start of the pandemic there has been one consistent message coming from our parliamentary representatives. The government blaming the opposition for the state of the medical workforce and conditions, and the opposition blaming the government for throwing massive funds at it without a plan. Here is a glimpse into the previously hidden world of Aotearoa New Zealand’s diagnostic laboratory services that suddenly when needed by our country has highlighted some eye opening truths about one of the most neglected front line health services. Being hidden behind plain sight leads to a lot of assumption and guarded information being let into the public domain.

When the Labour led coalition took power in 2017 there were 1794 practising Medical Laboratory Scientists (MLS) in NZ. When the pandemic hit in early 2020 there were 1823 MLS and after the most demanding year in medical laboratory history there were 1845 MLS. This equates to a 1% increase in the expert workforce that were charged with maintaining the COVID testing response as well as the day-to-day diagnostic work that still had to be performed. The APEX union had given a conservative estimate that our laboratory workforce was already 10% below optimal level before the pandemic. That effectively meant our diagnostic laboratory expert workforce was already down 180 scientists before we rolled up our sleeves for the most demanding and vital period of our history.

For perspective, each year the government allocates around 800 million for publicly funded diagnostic testing services in Aotearoa New Zealand. During the current pandemic it is difficult to exactly nail how much extra funding has been allocated for COVID PCR testing but most estimates point to around a 250 million to 300 million per year for doing this extra work. Remember COVID PCR testing was and is performed on top of the workload that laboratories were performing. That clearly raises some serious questions with regards to transparency and disclosure that need to be forthcoming from the MOH and government.

MLS training takes four intense years of university medical undergraduate study with 6 to 12 month employment supervision to become a fully registered MLS. To become a specialist scientist takes another five years to learn the technical and clinical knowledge needed for sectors such as molecular genetics, blood coagulation and cancer diagnostics. MLS training has at best been marginal and extra funding non-existent despite organisations like the New Zealand Institute of Medical Laboratory Science (NZIMLS) lobbying over the past five years. The average age of our expert scientist workforce is over 50 and the institutional knowledge held is one of the major reasons this country succeeded with the elimination strategy. Our NZ trained medical laboratory scientists are in hot demand all over the world where pay and conditions are in many cases twice what are offered here.

Our medical laboratory workforce has every right to feel cynical as the testing side of the pandemic falls away and once again the doors will close behind the laboratories and their concerns will again be locked away until the next crisis hits. For the record, the sweeping laboratory reforms that started in 2005 were under a Labour led coalition and further signed off by National led governments. In 2005 every DHB had at least one public hospital laboratory, when the pandemic hit 11 out of 20 DHB’s had contracted out their full laboratory services to commercial providers. Of the other DHB’s virtually all have contracted out part of their region’s laboratory services to commercial providers. This is not to say this wasn’t a good move but periods of intense service pressure such as pandemics do expose significant failings when a coordinated national response is needed.

‘Our diagnostic laboratory pandemic response has ended up being what is known as a provider based effort. Each provider has their own logistical and business-based approach, and has financial and strategic independence from DHB’s and other providers’, says Terry Taylor NZIMLS president.

‘Early in the pandemic I used to cringe when the government and MOH would always say the DHB’s have the testing all under control when the reality was exactly the opposite. There would be a lot of DHB management who had no idea who their laboratory provider was and, in some cases, where the lab physically was’, says Taylor.

On any given day our diagnostic laboratories perform 200, 000 tests nationwide. During January 2022 it was being promoted that these same laboratories should be able to perform between 50, 000 and 78, 000 COVID PCR tests on top of the other demands that laboratories have. That is an increase in workload of between 25% and 40% for a tired workforce that was already significantly below optimal expert scientist levels. Throw in another 10% to 20% of staff being unavailable due to COVID infections and other leave, and even for those with no mathematical sense the outcome was only going one way.

‘For someone like me in professional leadership role to see the lack of action and planning and the expectation that our medical laboratory workforce and providers should just put up with what they have endured during the pandemic and in the past, has been so dam frustrating’, says Taylor.

Every practitioner, every stakeholder, and every laboratory provider deserve a future with full transparency and commitment as we move to the new era of Health NZ governance.

‘There needs to be a full and comprehensive independent review into the diagnostic laboratory industry to identify the key strengths and weaknesses so an effective plan is put together that ensures that diagnostic services never get put in the situations they have in the past and during the pandemic. The health reforms are designed to address equity and strengthen coordination, the figures don’t lie, it is way overdue to address the inequity that our expert scientists face every day’, says Taylor

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