His predecessor’s tenure ended early on the back of a particularly prickly 12 months at the Ministry of Health. Now, two months into the director general role, Dr Ashley Bloomfield is focused on running a steady ship – with changes at regional level on the horizon. Teuila Fuatai reports.
It doesn’t take long for Dr Ashley Bloomfield’s regional background to shine through. After five years at the Hutt Valley and Wellington district health boards, the public health specialist is clear that DHBs hold the key to getting the most out of New Zealand’s $18 billion health budget.
“There are still opportunities for … providing services in a much smarter way across DHBs, to get rid of duplication, and that necessarily means probably aggregating some services on one site, rather than across a whole lot of sites,” Bloomfield, the new Health Ministry boss, says.
Yes, it will lead to fewer places having specialist-level services, but that shouldn’t be written off because it means longer travel times for some people, he says.
“If you’ve got services that might be led just by one or two specialists in a small DHB, they’re quite vulnerable – they’re very vulnerable – if that person is either sick, or on leave, let alone if they go.”
In his work with the Capital & Coast DHB, cardiology services for the entire lower North Island area – spanning three DHB areas – came under scrutiny.
“The challenge is how you line up the incentives in those individual DHBs to fund and support the infrastructure build and deliver those services in a much more regional way, rather than as a collection of individual DHBs,” Bloomfield says.
While a more coordinated cardiology service across the three DHBs is still a work in progress, ensuring those types of projects are completed, and also explored at all DHBs, is high on Bloomfield’s agenda.
“[It] means you can probably attract people more to come and work in those services, but also it means they’re more sustainable,” he adds.
When asked about the impact on people’s access to services, particularly those in more rural areas, Bloomfield points to examples like the country’s two, highly-specialised spinal rehabilitation units in Christchurch and Auckland for the pros and cons.
“What both those [spinal rehabilitation] units do is bring together very specialised expertise to ensure that people with spinal injuries get the best possible recovery. Again, that is actually helped by having that arrangement [ensuring] access for all New Zealanders to a really high-quality service. Of course, it necessarily means that anyone living outside Christchurch or Auckland has to travel, as per their family/whānau.
“There’s always this balance between ensuring a service is … high-quality and sustainable, and there will always be a necessity for people to travel. It’s trying to get the right balance there.”
Better balance is also a priority in addressing mismatches in mental health needs and available services – at all levels of the health system.
“I think there’s a clear need for developing new models and investing in those so people can access support and care in the community … when they have mental distress, or when they’ve got mild to moderate mental health conditions that can be managed in that setting.”
Improving how acute mental health care is provided is also a priority, as well as looking at “step-up, step-down” services which cater to those who can receive specialist mental health care in a community setting.
“I’m interested to see what comes through from the [mental health] inquiry report – but that’s already part of our thinking. Of course, if it requires more funding, than that has to go into a budget process,” Bloomfield says.