The Director-General of Health has spent 25 years working in the health system and says his one year in Geneva with the World Health Organisation highlighted that no country has worked out a perfect delivery model.
“The issues that are the ones that are creating the challenges now around workforce, service delivery, the inequitable experience of people in the system in terms of access … to care – they’re all issues that have been around for at least the 25 years I’ve been there,’’ Doctor Ashley Bloomfield told Newsroom.
The Ministry of Health, which under the reforms introduced on July 1 has been stripped back to a policy entity rather than a commissioning one, has been under Bloomfield’s helm since 2018.
When he leaves the job on Friday, the big challenge ahead for the health sector, which he says everyone will be watching under the new structure, is “how you get that balance right between the things you do nationally, or even regionally, and then being responsive at a local level”.
The reforms, which are the biggest in three decades, have scrapped all 20 localised District Health Boards and moved to a more centralised system with regional hubs called Health NZ.
A Māori Health Authority with commissioning powers has also been introduced.
“We’ve got a workforce and we’ve got communities that are rightly pretty knackered after two years of the pandemic – not just because of the challenge of all the work but the uncertainty that’s gone along with that.”
– Ashley Bloomfield, Director-General of Health
Bloomfield told Newsroom there is merit in having local people on the ground who have relationships with communities.
“If you think about our experience with the pandemic, the one-size-fits-all aspects of our vaccination programme worked really well for the first 70 percent of people. They’re the ones ready to push the button at midnight and book their appointment and crash the system.
“But then you have to be able to complement that with those very localised initiatives that are quite intensive and require a lot of trust building between providers and whānau,’’ Bloomfield said.
His time as chief executive of the Hutt Valley District Health Board is three years he looks back on fondly, telling Newsroom it was a “fantastic role, I really loved it’’.
“Getting that balance right, I think, is where the DHB model was quite good, because you had those strong local networks and I know that’s what the intent is of the localities work that is being progressed as well in the new system.’’
Bloomfield said striking that balance between national and local delivery will be “absolutely fundamental to the success’’ of the reforms, particularly reaching communities that haven’t always had access to services in the past.
The other factor that will be fundamental is buy-in from the health workforce and those communities receiving care.
“It will be about the extent to which the workforce and communities are engaged and really feel that what is being done, the content of it, is actually going to improve access to health services and then outcomes from it.
“Therein lays the biggest challenge,” Bloomfield says.
While he doesn’t feel burnt out, having made the decision to leave the job before the fatigue truly set in, Bloomfield says plenty of others are.
“We’ve got a workforce and we’ve got communities that are rightly pretty knackered after two years of the pandemic – not just because of the challenge of all the work but the uncertainty that’s gone along with that.
“That takes its toll but it’s how to move on and rise above that, that will be really critical to the success of the reforms and achieving what the Government has set out to do.’’
Bloomfield says he hasn’t tested the appetite for the reforms with the health workforce but has spoken to those in leadership positions both in the community and in Māori health and believes there’s “enthusiasm and optimism about the potential of the reforms’’.
“But of course, very often with big change, the challenge is always in the implementation, and it goes back to requiring a really concerted effort on engaging workforce.”
Bloomfield is staying mum on what his next plans are, other than to say he is having a break and wants to continue working in health.
On whether there’s anything he’d do differently if he had his time again as Director-General during a global pandemic, Bloomfield was adamant.
“No, I’m a firm believer that we live life forwards, but only understand it looking backwards.”