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The Government's ongoing Covid-19 response group criticised it for a "top-down" approach to the Omicron outbreak, the way it funded Māori providers, and urged it to grow testing capacity by inking a contract with Rako Science.
Those criticisms were made at a time the Ministry of Health realised it hadoverstated the national Covid testing capacity.
The Government has recently released documents from Sir Brian Roche's rapid response group, which is in charge of the ongoing review of the Government's Covid-19 response.
During February and March, as New Zealand grappled with the first Omicron wave, Roche wrote nearly every week to the minister, evaluating the ongoing pandemic response and suggesting where the Government could improve.
On February 16, Roche's group warned existing equity issues were "amplified by the Omicron wave".
Roche raised concerns that the "proportionality by ethnicity of cases and hospitalisations in the Auckland region" did not "resemble the demographic makeup of the District Health Board areas" and that Māori and Pasifika were disproportionately presenting as Covid patients.
"For example, as of 16 February, 14 of 19 cases in Middlemore Hospital are Pasifika, four are Māori, and one is Pakeha," he wrote.
Roche warned that of the cases that were being identified as "high-risk", relatively few were from the Pasifika community, despite the fact they represented a relatively large number of cases.
This meant Pasifika patients might not have been getting the "high-risk" care they needed and could be receiving less intensive in-home care.
"The low numbers triaged as high-risk, combined with expected large numbers of Omicron cases, means the burden of death may well fall upon those outside of the high-risk group as currently defined," Roche wrote.
He criticised the Government for what he said was a lack of monitoring of the issues.
"It is not clear to us how this issue is being monitored," Roche wrote.
"We strongly urge you to seek assurance that there are processes in train to independently evaluate the application of the high-risk criteria," he wrote.
This was not the first time Roche had raised equity concerns - on February 8, he warned the Government was taking an overly centralised approach to commissioning Māori and community providers.
He said the funding model for these providers "does not seem to be fit for the purposes of responding to Omicron".
"Resources should be front-loaded and flexible to ensure that whānau and providers are prepared and have the tools they need," he wrote.
He suggested the flexibility the Government takes to contracts with MSD should be applied across other funding models.
"Continuing a reactive approach to funding may lead to unnecessary strain on the system and harm to individuals," he wrote.
There were wider problems with centralisation, particularly around distributing RATs.
The letter added that "[c]entral system control" was "reducing the autonomy of the delivery arm and by extension the delivery of the response".
Sir Brian Roche has been providing an ongoing review of the Covid response. Photo / Mark Mitchell
"As an example ... the process for critical workers who under the ... Test to Return scheme have to travel to a collection site to access (RATs). The centre should facilitate not impede."
In other areas, Roche recommended greater centralisation, not in operations but in oversight and communication.
He advised "the establishment of a small group of DHB leaders to strategically oversee the operational response against Omicron within the next week".
"The group would essentially drive real-time quality improvement, monitoring and responses to trends.
"The authority for any such group to make changes to the operational response is critical to gain the pace needed," Roche wrote.
On February 16, Roche also recommended targeting RAT resources on Auckland.
"With the high numbers of cases in Auckland, and the strain on testing already occurring, it should be urgently considered to supply as many RATs as possible to the region," Roche wrote.
"While we have previously advised that RATs utility is limited for asymptomatic cases and prior to the onset of symptoms for symptomatic cases, it is a good use of RATs to test close contacts who become symptomatic," he said.
A review of the Ministry of Health's testing capacity, released this week, showed officials became aware in February they were having issues with testing capacity, which had been overstated.
Also in February, Roche recommended the Government swiftly conclude a deal with Rako Science to bring on another testing provider.
"Government processes are continuing to hamper the speed of the response," Roche wrote.
"An example is the ongoing negotiations with Rako Science indicating that we continue to apply pre-Covid-19 procurement models that are incompatible with the speed and agility needed.
"We have reached a critical point in terms of testing capacity and traditional procurement processes hamstring our ability to meet the needs of the response," he wrote.
Roche advised the minister to seek assurance from the ministry that "processes are being expedited" and that "there are enough personnel to meet the critical needs around testing".
National's Covid-19 response spokesman Chris Bishop said the documents showed the Government's continued reluctance to implement saliva testing.
"It beggars belief that at the time we were facing a PCR testing crisis the Ministry still wasn't reaching out to Rako science despite, at that point, 18 months of Brian Roche's continuous improvement group recommending saliva testing be brought on," Bishop said.
It wasn't all negative, on February 22, Roche wrote that Aotearoa should not let "significant countrywide outbreaks of Covid-19" allow people to "lose sight of our success as a nation".
He warned a "focus on the negative aspects through the media, including social media" could allow people to lose sight of that success.
Roche was also supportive of the Government's health reforms, saying the ongoing review presented the opportunity to implement lessons learned from the response.
Covid-19 Minister Ayesha Verrall, who succeeded Chris Hipkins in the role this week, was approached for comment.
