Monday 12 July 2021

Holes in the MIQ bucket

Thomas Coughlin reports that the reason the government cannot expand MIQ capacity is that they can't source enough nurses and haven't enough testing capacity. 

Now documents released to the Herald under the Official Information Act show officials have been considering long-term purpose-built MIQs since July last year.

But each time a new idea was floated, it hit a brick wall: the country does not have the health or security staff to sustain more MIQ places and building new purpose-built MIQ spots could create as many problems as it would solve.


Ironically, MIQ, which is often held responsible for restricting the flow of labour into the country, was itself a victim of the labour shortage.

A "key constraint for increasing capacity for MIQ is the availability of workforce to provide wrap-around services, such as health care workers and security guards.

"Appropriate health workforce, and laboratory testing capacity needs to be available to MIQ facilities without undermining the provision of broader health and disability services," officials said.

"Even if additional new types of accommodation can be found, these workforce constraints remain and are likely to place an absolute limit on the supply of MIQ spaces unless they can be addressed," they said.

It's impossible to believe that security guards would be the binding constraint; training more can't be that hard. They may have to offer higher pay to attract more people but that's fine. 

I've heard the worries about bidding nurses away from the rest of the health system before; it had been raised when we'd suggested some of the kinds of options Coughlin canvasses. 

But there are two big problems with this. 

First, and most obviously, the government is acting as a monopsonist. The government is the largest employer of nurses. It is worried that MIQ facilities offering higher pay to attract nurses would bid nurses away from the rest of the health sector, and then force the government to pay nurses more to avoid that happening. For all the government's push for Fair Pay Agreements and utterly implausible arguments about 'monopsonistic' employment conditions requiring a benevolent state to come in and force new pay relations under an Awards system, the only parts of the labour market that work like that are the ones where the government is the monopsonist: teaching and nursing. And in those sectors, the government behaves exactly as you would expect a monopsonist to behave. Maybe that's why the government sees monopsonists everywhere - it extrapolates from its own conduct.

But second, and more currently important, you can scale up MIQ without massive increases in nurse demand. MIQ puts a lot of demand on nursing and testing because the government has chosen to keep going with massively resource intensive swab testing. Rako has been ready to deliver swab testing at scale since January. It doesn't require nurses to take the samples, and the test capacity can scale up to whatever is needed. 

BusinessDesk reports on the latest in that saga. It looks to me like the government ran a near-corrupt tendering process resulting in contracting with a provider who doesn't even have a validated test, because the Ministry of Health was embarrassed that Rako showed them up. It hasn't been deployed at anything like scale, and nobody knows whether the test would actually work. 

This article all on its own is worth the BusinessDesk subscription. Please subscribe and read it. 

I have a short snippet here but the whole thing is damning. 

The covid-19 saliva test being rolled out under a health ministry contract constitutes “a risky strategy” in which “border workers must pay the price” if it fails, says one of the country’s top saliva testing experts.  

In a June 21 email obtained by BusinessDesk to Sue Gordon, the health ministry’s deputy chief executive for covid-19 health response at the time, Victoria University’s associate professor of biological sciences, Janet Pitman, claims health officials “actually have no idea whether the test(s) will indeed work accurately". 

Pitman is the principal academic adviser to Rako Science, an unsuccessful bidder for the national saliva testing contract let by the ministry in late May to Asia Pacific Healthcare Group (APHG). 

“The saliva tests to be rolled out by the MoH are not diagnostically validated and the accuracy of these tests are completely unknown,” wrote Pitman (her emphasis) on June 21. “I remain at a complete loss to understand why these unvalidated tests are being used on our most vulnerable people at the border.” 


We can't expand MIQ capacity because the government doesn't want MIQ to be pushing up the cost of nurses for the rest of the health system - and again the Commerce Commission can't go after this kind of anticompetitive practice, because State protects State. 

And we can't have better testing methods that won't put pressure on nursing and current testing capacity because the Ministry of Health is embarrassed that Rako could do something that ESR couldn't manage, and because demonstrating competence in delivery just isn't the way things are done in New Zealand.  

Remember that old "there's a hole in the bucket" song? It's that, except there's a bung for the hole sitting right there, and MoH refuses to use it and prefers to bleat endlessly about the axe not being sharp enough, the whetstone being too dry, and there being a hole in the bucket preventing getting the water to wet the stone.  

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