From the archives: All eyes on Dr Bloomfield

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Rumour and dismay have been rife in recent years when health pro­fessionals talked about the Ministry of Health. Recur­ring themes were low morale, lack of direction, faulty implemen­tation of programmes and poor communication.

New Zealand Doctor has heard sector experts describe the min­istry as a disaster zone in which capability and credibility were destroyed.

The boil was lanced in Decem­ber 2017.

The State Services Commis­sion rated as weak the ministry’s leadership and governance, val­ues and culture, people manage­ment and staff engagement, and collaboration and partnerships. It came in the commission’s five-yearly review of perfor­mance.

Although some health organ­isations say they had no prob­lems in their relationships with the ministry, many of them say the opposite.

The new holder of the seat of power works in a modest office on the first floor of the minis­try’s Wellington headquarters, with no glorious harbour views. Director-general of health and ministry chief executive Ashley Bloomfield says it’s an improve­ment on an aged DHB building he has recently worked in.

From that “side of the fence”, he had a strong sense that peo­ple wanted the ministry to be deeply engaged and to succeed, Dr Bloomfield says.

“Because, actually, they see that a successful and effective ministry is fundamental to the wider sector being successful and effective.

“So there is enormous good­will for the ministry to, in effect, up its game and work differently with the sector.”

On primary care: The stated intention of a more prominent role for primary care hasn’t eventuated

DR BLOOMFIELD, a 1991 med­ical graduate with a master of public health, has lived in Wel­lington for most of the past 20 years. He is married to an Auck­land Medical School classmate, Libby; they have three children, one at university and two at sec­ondary school.

He says he wasn’t confident of selection against the 26 other applicants to head the ministry. He had missed out on jobs in the past but had long thought that, “if the opportunity came up, I would see where I was at”.

That opportunity arose with the resignation last December of Chai Chuah, two years before his contract would have expired.

Dr Bloomfield, meanwhile, was about to start as acting chief executive at Capital & Coast DHB on secondment from the top job at Hutt Valley DHB. He “abso­lutely loved” his job.

Earlier in the year, he had un­dertaken additional training in strategic leadership at Oxford University. He threw his hat in the ring, the commission got en­thusiastic endorsements from his referees and the job was an­nounced as his in May.

What Dr Bloomfield is con­fident about is the “suite of experience” he brings to the job. It comes from being “a lif­er in health”, as he puts it. (See “Bloomfield in brief”, this page.)

Speaking in his first media in­terview since starting in the job on 8 June, he says he has fol­lowed on from Stephen McKer­nan – who acted in the role for four months – in shifting the way the ministry was relating to the sector.

In describing his expectation of “how we are going to work with the sector...in every interaction we have”, Dr Bloomfield’s key word is “respectful”.

The leadership is “not about command and control, but con­vene and collaborate”, he says.

“The ministry has got a crit­ical role in convening people to help achieve outcomes, solve problems and progress the sec­tor. And that, for me, summarises it, and I have been able to make that really clear to staff.”

On health care homes and similar new approaches: It wouldn’t be of any value whatsoever, if it wasn’t changing the way practices feel about their ability to deliver services to their population

LEADING PUBLIC health aca­demic Peter Crampton has (in his own words) “a great interest in and engagement with health policy”. In recent years, Profes­sor Crampton says, he has strug­gled to engage with the ministry.

He and University of Otago colleagues want to support Dr Bloomfield in his challenging task. Professor Crampton finds him approachable and commit­ted to a highly performing health system, saying he has integrity, deep insight, system and poli­cy knowledge, and management skills.

Similarly impressed, Bridget Allan, chief executive at Hutt Valley’s Te Awakairangi Health Network, is sad to have lost Dr Bloomfield from her local DHB.

“I have always found him ex­tremely constructive and for­ward-looking, and he has a good understanding of primary care,” Ms Allan says.

That understanding has deep­ened across DHBs, she says, with Nick Chamberlain (Northland DHB boss and former GP) lead­ing the steering group for DHBs’ national work on primary care; Dr Bloomfield was his deputy.

He was also a DHB member of the PHO Services Agreement Amendment Protocol (PSAAP) group, which negotiates contract changes in primary care and gen­eral practice.

In a former life, Cathy O’Mal­ley, a Nelson Marlborough DHB senior manager, moved from Compass Health PHO to the ministry in 2012. Ms O’Malley arrived to find Dr Bloomfield re­garded as legendary for his work on tobacco control.

Alongside the fact he has since run a coalface organisation, his experience of the political process is crucial, Ms O’Malley believes, saying many people underesti­mate the importance of working closely with ministers.

She expects he will make a “fantastic” director-general.

On the latest Health and Independence Report 2017: Our big challenge is around ongoing inequities

DR BLOOMFIELD acknowledg­es GPs have high expectations of a “fundamental look at the way primary care is funded”.

It’s an ongoing discussion with primary care, he says.

Health minister David Clark has already moved a promised primary care funding review into the broader sector review being led by public service vet­eran Heather Simpson.

Ms Simpson’s interim report is due in a year’s time, but the final report won’t reach Dr Clark until about January 2020.

The reviewers have been asked to consider the importance of primary healthcare as the foun­dation of a person-centred health and disability system.

Primary care people expect their part of the sector will be looked at early in the review pro­cess, Dr Bloomfield says. Again, “that conversation is ongoing”.

He sees the ministry as play­ing a key role “facilitating really good primary care input into, and engagement with, that review”.

Dr Bloomfield admits the stat­ed intention of a more promi­nent role for primary care hasn’t eventuated. The incentives and pressures haven’t allowed it to happen, he says.

“There probably wasn’t the fo­cus on what would be needed in terms of workforce – not just the general practice workforce, but creating a wider range of roles – nursing, pharmacy and allied health – to support that model.

“I think we are in a different place now.”

IN SOME DHBs, strong prima­ry–secondary alliances are en­couraging and are paying off, Dr Bloomfield says.

DHBs that have funded health care home-type approaches are “shifting the game”. They’re the way of the future, he says. While not yet fully evaluated, research into health care homes so far has had promising results.

“But most profound for me is the feedback you get from prac­tices who embark on this process. It does, from their perspective, make a difference...

“It wouldn’t be of any value whatsoever, if it wasn’t chang­ing the way they feel about their ability to deliver services to their population.”

Elements such as GP triage, long-term conditions care plan­ning and extended hours, coupled with patient portal use, help pri­mary care to deliver services dif­ferently, at quite a modest DHB/ PHO investment, he says.

Dr Bloomfield sees an even bigger opportunity ahead: ena­bling district nurses and other allied health professionals to be “deployed much more around a primary and community service, rather than accessed through the hospital”.

Beyond this, he would like to see the ministry let go of many of its contracts with local providers, so DHBs and PHOs can do the job in a more locally aligned way.

A “devolution of funding” pol­icy is being considered, although this can’t pre-empt Ms Simpson’s review and would require approv­al from the Cabinet.

WHAT IS THE RISK that new initiatives will continue to roll out but not make as much, or perhaps any, difference to the outcomes for the treaty part­ner, Māori? How concerned is Dr Bloomfield at the equity gap for Māori and Pasifika compared with the New Zealand European?

He says he felt fortunate to be able to put his signature to the newly released Health and Inde­pendence Report 2017, and that it shows the health of New Zea­landers is continuing to improve.

That document shows amena­ble mortality for Māori and Pasi­fika, on latest data, is more than twice the rate of other groups.

Of the report, Dr Bloomfield says: “Our big challenge is around ongoing inequities.”

He says a ministry work pro­gramme specifically targets equi­ty, “and not just because it’s one of our minister’s high priorities”.

“This is work that we under­stand is fundamental to us being able to improve the health and the experience of healthcare in New Zealand.

“The way I would describe it is, it is not okay just to achieve something for the whole popu­lation. Achievement incudes de­livering for Māori and Pasifika and, if you haven’t delivered for those groups, then you haven’t delivered.

“We will be working really closely with the sector with that expectation...where we look to see improvement happening across a range of domains.”

Dr Bloomfield also says he is seeking views from the ministry’s Māori leadership and staff to ad­vise how best to strengthen the organisation’s Māori capacity and capability. “So you can expect to see some action around that.”

Equity of access to healthcare and wellbeing support was one of the challenges emphasised in the performance review that con­firmed the sector’s fears back in December 2017. It will be all eyes on Dr Bloomfield.

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