WHAT THE DOCTOR ORDERED
Ashley Bloomfield: The man behind the lectern
It’s as if Dr Ashley Bloomfield’s entire life was on a trajectory to meet Covid-19 and help guide New Zealand through it. Fate is a fanciful notion but there he is, 1pm each day, offering a steady and sure message for a country in lockdown with a lifetime’s worth of experience, skills and training geared towards the crisis we are now experiencing.
It’s been years since the Ministry of Health was led by a medical doctor. Years, too, since that doctor was someone who had trained and worked in the specialist discipline of public health.
What’s more, Bloomfield arrived at the ministry in June 2018 at a time when relationships across the public health system were strained. The 20 district health boards had been locked in an adversarial struggle with government and somehow the Ministry of Health had become the fulcrum on which Treasury would lever its budgetary demands.
In the tumultuous world of health bureaucracy, the ministry’s purpose had become muddled and the areas in which it was providing leadership — and the type of leadership it gave — seemed contrary to that those at the coalface of the health sector wanted.
Just months after starting as Director-General of Health, that top level of health bureaucracy was redesigned. Bloomfield finished the work begun by his friend, interim director-general and experienced health sector manager, Stephen McKernan.
By the time the 2019 measles epidemic was underway, Bloomfield had been in the job for a year. In press conferences on the outbreak, he was able to lean on his public health background with authority and talk with personal experience of the benefits of targeting those hesitant about vaccination.
Bloomfield came to the Covid-19 crisis with knowledge, and time to prepare. He had the management team he wanted, organised how he wanted. He had a practice run. Through a lifetime of work, he had developed the skills needed.
“Ashley is absolutely the right guy for this time,” says former health minister Jonathan Coleman, who went to medical school at the University of Auckland with Bloomfield.
“It’s like you train for something and then you have that ultimate challenge. For a public health physician, you couldn’t have a bigger challenge than leading the response to a pandemic.”
From Coleman, who has texted Bloomfield his appreciation, comes this assessment: “I think he’s doing a superb job in difficult circumstances. Everyone in New Zealand appreciates the work he and Ministry of Health officials are doing.”
Two weeks into Stage 4 alert level lockdown there is a petition calling for him to be the 2021 New Zealander of the Year, fan Twitter accounts tweeting Bloomfield memes and fans who have dubbed themselves “Bloomers”.
There is even a love song for Bloomfield on YouTube from young musician-composer Maxwell Apse that includes the lyric, “the way he speaks makes me feel like it’s gonna be okay”.
Apse says the song came out of a family discussion about Bloomfield — who he calls a “cultural phenomenon” — weeks ago.
“He knows what he’s talking about, doesn’t sugarcoat how it is and he has answers for questions. It’s what we need.”
SO, WHERE did he come from? Bloomfield, now 54, was one of three children born to Allan and Myreine Bloomfield. He has an older brother who is a law lecturer and a sister who is a nurse.
Both parents have since died, most recently Allan Bloomfield in 2017. His mother had been a teacher and his father a Lieutenant-Colonel, who went on to run Mitsubishi Motors in Porirua until manufacturing gave way in the late-1990s.
Those who worked for Allan Bloomfield remember him fondly as a gentleman with a sharp intelligence. One of those later worked for his son, too, and recognised traits that had created bonds of loyalty between Bloomfield snr and his staff. A number who knew Bloomfield snr remarked on how proud he would be now, if he could see his son.
Damon Plimmer grew up with the Bloomfield children in Tawa, a slice of middle New Zealand from a time made distant by the huge changes of the 1980s. Plimmer, now an Anglican vicar, recalls it as a suburb that hosted many of Wellington’s larger companies, with a prison at one end and a psychiatric hospital at the other.
Bloomfield was schooled out of the area — as was Plimmer — at Scots College, the independent Wellington school founded on Presbyterian values that still holds the Christian faith as the core of its values.
Plimmer remembers Bloomfield finishing school as head prefect before leaving for medical school at the University of Auckland. In his time at school, he was shown to be academically, athletically and musically capable.
Bloomfield started university a year ahead of Coleman, taking a year off after qualifying to travel and then returning to continue his studies in the same year as the future health minister. He met his wife Libby at university — she is also a doctor — and they married the year he qualified.
There were periods after working in hospitals here and in the United
Kingdom but — upon being made a Master in Public Health in 1996 — his future medical path was set.
Public health is a discipline that aims to improve health outcomes as broadly as possible across a population. Where a GP will focus on one patient at a time, a public health specialist will have a wider view, taking in communities and even entire societies and working to find ways of improving the health of as many as possible.
Where a GP or clinical doctor might be focused entirely on medical solutions, a public health specialist will look more laterally to study the impact of factors such as poverty and housing.
It’s a health intervention that aims — to use current lingo — to get ahead of the curve. Bloomfield was working in this space for about 30 years when the greatest of challenges fetched up on his watch.
In that time, he has built a career and a family and been involved and contributed to community.
During and after university there was hospital work as any fledgling doctor would do and a spell in United Kingdom hospitals before a return to New Zealand and shift back to Wellington about 1999.
Bloomfield and wife Libby have raised three children in the time since. The three are either nearing the end of secondary school or studying at university.
Home is Eastbourne, that secluded community on the western side of Wellington Harbour. They moved there about the time Bloomfield was settling into the bureaucracy of the
Ministry of Health.
He worked a few years for the National Screening Unit, which aims to provide screening for illnesses in a way that flattens the provision of care on the basis of need, rather than location. Bloomfield was identified as fiercely bright, passionate and hardworking — potential engaged through a State Service Commission-run leadership programme.
About that time, he was made
Chief Advisor Public Health in 2005, leading the country’s Tobacco Control programme. He was, according to NZ Doctor, “legendary” for his work in the area. It was a role he held through to 2010, taking on greater responsibilities during that time.
Plimmer — who is now in Wanaka — had lost contact with Bloomfield after school but connected again when the family moved to Eastbourne where he was vicar at the Anglican church, St Alban’s.
“There’s an incredible congruity between what he thinks and how he lives his life.
“He’s a person of incredible integrity, with regard for others, and humility,” says Plimmer.
“He was able to balance work life and home life so well for someone whose job makes such demands.”
The
Bloomfields’ connection to the church was a path to faith but also to community. It’s a link both Plimmer and former Presbyterian vicar Reuben Hardy recall. Bloomfield’s days across the harbour at the ministry blended with community and family activities, roles with the local Butterfly Creek Theatre Troupe and youth
It’s like you train for something and then you have that ultimate challenge. For a public health physician, you couldn’t have a bigger challenge than leading the response to a pandemic. Former health minister Jonathan Coleman
programmes.
Libby Bloomfield threw herself into roles that connected to the children and to the community. She began with their preschool and is now on the senior leadership team at Wellesley College with responsibility for chaplaincy and pastoral care. The family’s faith connection continues through St Alban’s Church, where Libby Bloomfield is a member of the vestry.
Bloomfield and Hardy would run in the mornings with their dogs — a labrador and a beagle. Plimmer occasionally joined the pair for the
30-minute trot to Pencarrow and back.
Hardy likes to tell the story of his first marathon. He ran with Bloomfield, who had previously completed one. It was Rotorua, about
2004 and they were aiming for three hours. “I hit a significant wall,” he says, but his mate Bloomfield was fine.
He could have gone on but he slowed his pace and stuck with Hardy. Somewhat ruefully, Hardy recalls “it took about four hours” before they finished, as they had begun, together.
“There’s no hidden agenda with Ash,” Hardy says. “He’s in that role for the right reasons. He’s very easy going, gets on with everyone.”
Plimmer watches the 1pm updates and sees the Bloomfield he recognises from Eastbourne, “with a sense of humility and service”.
Then he says: “This isn’t about him. It’s about the wellbeing of this country. I have a huge amount of confidence and trust in Ash. I can’t think of a better person to be DirectorGeneral of Health at this time.”
BLOOMFIELD’S ROLE at the Ministry of Health took him to Geneva for a year in 2011 where he worked at the World Health Organisation. If you want to see what a functional, smooth bureaucracy looks like, he joked years later, go to WHO, then come back to the Ministry of Health and you’ll be a lot happier about what we’ve got here.
When Bloomfield returned in 2012, he became an acting deputy director-general at the ministry before leaving for the coalface of health as the senior executive managing population health across Hutt Valley, Capital and Coast and Wairarapa district health boards.
He spent five years in district health boards, becoming chief executive of Hutt Valley District Health Board in 2015 and then being parachuted in as acting chief executive of Capital & Coast District Health Board in 2018.
The experience at a health board is invaluable for those intending to work at a higher level of the central bureaucracy, says Stephen McKernan, who was Director-General of Health from 2006-2010 and a former chief executive of DHBs.
“You get very strongly into operational management,” he says. “It requires you to prioritise — to make difficult decisions.”
Bloomfield with Prime Minister Jacinda Ardern at the daily press conference, left; and right, Libby Bloomfield.
It is understood at the Ministry of Health that such decisions are made. It pushes the mantra that the health dollar is not endless. But at a DHB, the reality of the decisions you make is often just an elevator ride away — or in the community you drive through on your way home.
“Real-life experience” is how Northland District Health Board chief executive Dr Nick Chamberlain describes it.
And relationship management is difficult. Everyone is competing for money and services in their area, but not all will get what they want.
McKernan was drafted in as acting director-general after the incumbent, Chai Chuah, resigned in December 2017. An accountant and technocrat, Chuah’s time running the ministry came during the National government’s strenuous efforts to repress health spending across DHBs. His exit came after bungles over allocation of cash to DHBs and just months after the Labour administration took over.
The hunt for a new, permanent director-general was extensive. There were 27 candidates who applied. Of those short-listed, they faced an interview panel of four and an hour on the end of a Kim Hill inquisition, with psychologists looking on.
Ultimately, it was Bloomfield who took over. “I thought he would be perfect,” says Chamberlain. “I encouraged him to take it and I’m sure others did as well.
“Ashley was the perfect mix of having worked in the ministry, being a public health physician and having then worked in DHBs and done a good job there as well.
“He also knew the machinery of government and how government works. So he went eyes open as well.”
Chamberlain says the workload also requires a fine balance. “You’ve got to understand the requirements of politicians. You have to balance political wills . . . you can’t always do what you want to do from a public health perspective.”
McKernan, having performed the role on two occasions, is well placed to describe the extraordinary workload which comes with it.
“I don’t think people really understand the busy-ness of it. On a normal day, you can get a pile of reading that’s 12 inches thick.”
And there’s people waiting outside your office wanting to kick ideas around, to get sign off, for scheduled meetings. The director-general needs to be across new research, reports, 20 DHBs, the wider government’s requirements and the narrowly focused needs of every sector.
“It feels at times Wellington can just descend on you.”
The Director-General of Health is many creatures.
They are the chief executive of the Ministry of Health as an agency, which carries responsibility for the 1100 staff and the work they produce. They are also the ultimate manager for the “plethora of contracts with various providers” for a vast range of health services. They manage and then account for a substantial part of a $16 billion health budget.
There is the responsibility to provide good strategic guidance on policy to the government, while also monitoring and reporting on the performance of the system. Beyond all this, the director-general is the government’s key adviser on health issues.
Bloomfield, he says, has the ability to see all sides of the health system. “He is able to understand the place of clinicians, NGOs and public health plays in the system.”
McKernan describes Bloomfield — who he has known for about 20 years — as “a fantastic operator”.
“He’s incredibly bright, articulate. He’s a fantastic human being. A good team player with a fantastic sense of humour. He understands Wellington, the ministry as an agency and understands the sector.”
And now, like others, he tunes in for the 1pm briefing. “I look at Ashley in full admiration and think, ‘Go for it, mate.’”
FOR A nation trying to track the progress of the virus, there is comfort in the solid regularity to Bloomfield’s 1pm appearances.
It’s not just the time slot, although this is a factor. On one occasion, the briefing was set at a different time, which prompted intense speculation and worry. Bloomfield’s decision to take a day off a few weeks ago was initially startling to Bloomers.
This Easter weekend, there was no briefing yesterday and will be none today. Bloomfield intends to rest, in his bubble, with his family.
Those briefings were unfamiliar when they began in January. Few turned in then but now, half the nation seems to have stopped for the Bloomfield Briefing, which delivers calm, informed and intelligent authority.
“People are looking for strength and certainty,” says Massey University professor David Johnston, an expert in disaster management. “Part of that is strength in leadership and certainty of leadership.”
People seek out that certainty in uncertain times, he says. Such a person doesn’t have to be perfect, he says. British Prime Minister Winston Churchill, for example, had the characteristics needed to take the country through World War II with deep flaws that, at that point of crisis, had little impact.
Where we are now is New Zealand in 1939, he says. This is wartime. It’s a time for the right leadership, not the search for perfect leadership.
Fifteen days on from the lockdown beginning, the public can also take confidence that New Zealand’s leadership has made good decisions by looking to other countries. “It’s pretty clear the consequences of not doing things just by turning on the news. You’re realising, ‘We don’t want that.’”
People develop confidence in leadership when they can see it is delivering. “The loss of life not happening — that’s an easy sell to convince people the lock-in is a good thing.”
Also, Johnston also makes the point that leadership is not just an individual. “Leadership is a system as well. It’s a ministry that’s doing it — it’s the team that’s wrapped around it.”
Just a few months after taking on the director-general’s job, Bloomfield told a University of Otago gathering in Wellington: “Leadership is about ensuring direction and very clearly not giving direction. It’s about generating energy and getting focus and commitment to deliver.”
“Partnership,” said Bloomfield. “You can’t do anything without others. Success is around bringing talent together, a lot of hard work and really high ambition. Ambition is a good thing. It’s about seeing possibilities and not being prepared to take anything less than the possibilities you’re anticipating.”
With Covid-19, we have a possibility in New Zealand many other countries missed out on. From the top of one DHB — Chamberlain at Northland — to the emergency room of another, there is a satisfied confidence among those who know Bloomfield well that he will work to make the most of it.
A former medical school classmate and now president of the Australasian College for Emergency Medicine, Dr John Bonning, works as an emergency doctor at Waikato Hospital. This is the part of the health system bracing to catch the brunt of an outbreak.
“[He] is doing an absolutely phenomenal job from our perspective,” says Bonning, speaking as college president.
Bonning rang Bloomfield shortly after the pandemic was declared. “We both thought, ‘We’re in for a bit of a ride here.’” And yet, so far, it hasn’t happened. It will, he believes. “It’s going to be busy and it’s going to be tough and be worse than it is at the moment.”
But not now, or at least, not yet. Until then, Bonning says Bloomfield’s clarity and leadership is keeping us on the course we need. Running through attributes Bloomfield brings to this “utterly career-defining” moment, Bonning rattles through his friend’s clarity of mind, ability to understand multiple different viewpoints and a mix of being world-wise and down-to-earth.
And there’s always public health, the job Bloomfield always wanted in medicine. If any doctor wanted to do the greatest good for the largest number of people, wrestling with a deadly pandemic would be right up there.
Bonning laughs. “Public health is not the sexiest of specialties. But, goodness me, it’s come into its own now.”
Public health is not the sexiest of specialties. But, goodness me, it’s come into its own now. Dr John Bonning