April 6, 2025 • 40 mins
He was the Director-General of Health leading the country through the hardest health challenges New Zealand has faced in modern history.
Today, he's a Professor at the University of Auckland's School of Population Health.
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Speaker 1 (00:05):
You're listening to the Weekend Collective podcast from News Talk SEDB.
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I don't care if Monday, Tuesday is gray and Wednesdays Thursday.
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I don't care about youriv.
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I'm in Loday. You go for the Tuesday Wednesday break
my Heart.
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Of Thursday.
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Start spy. Yes, and welcome back to the show. I'm
Tim Beverage. This is the Weekend Collective. If you've missed
any of our politics, we were discussing tariffs with Shimmerer
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(01:00):
for the Weekend Collective on Newstalk SAIDB dot co dot
NZ or iHeartRadio. But now, well, welcome to the Health
Hub and we have a special guest today. A next guest,
by the way, chose the song just as a little
bit of trivia. This is the Cure Friday arm and Love,
because we like to offer our guest just a way
of easing into the with the choice of their song
to ease us into our conversation. So anyway, he didn't
(01:22):
know when he took up the job in twenty eighteen
that he would soon become a household name, and he
was direct to General of Health, leading the country through
the hardest health channel's hardest health challenges New Zealand has
faced in modern history. And today he's a professor at
University of Auckland School of Population Health. His formal title
is doctor Sir Ashley Bloomfield, but I think we can
(01:44):
get away with saying Ashley for today, good afternoon.
Speaker 4 (01:48):
Cure it's him, good afternoon.
Speaker 5 (01:49):
So actually, let's.
Speaker 3 (01:51):
Talk about your new job at School of Population Health.
What is sort of that encompass in terms of its
breadth of study and who's part of you? Your student population.
Speaker 4 (02:02):
Well, population health is a sort of another name for
public health. And the students range from all those students
who are doing their first year medical science is really
trying to get into medical school, many of them, and
I did election to three hundred and fifty of them
just last week and I asked for a show of hands,
most of them trying to get into medical school. So
(02:24):
that's like a first year paper. We also arrange of
courses postgrad students doing masters PhDs, so I do some
lecturing on global health, health leadership, health management as well.
Speaker 3 (02:36):
Do you completely draw from your experience up to date
or how much of your role is with the doing
this course involves you researching and updating yourself on the latest.
Speaker 4 (02:48):
Well, the role at the university now is actually, well,
I'm back to just half a day a week because
I've taken on something else. But I tend to draw
on my deep experience over twenty five thirty years working
in the health system. So I'm not coming to it
as an academic. I'm coming to it, you know, based
on my experience, and clearly a bit of that experience
(03:09):
was the COVID pandemic. But I'd worked for many years
in government out in the district health boards. I'd been
a DHB chief executive, and of course, originally I trained
in medicine and then specialized in public health.
Speaker 3 (03:21):
What actually got you interested in public health?
Speaker 4 (03:24):
You know, it's hard to put a finger on it,
but I was doing I was working as a doctor
in the hospitals, even doing a little bit of general practice,
and a good mate of mine from medical school started
the public health training. He just messaged me, well, actually
this was before messaging. I was chatting to him one
day and he said, you know, you should put your
hat in the ring to join this training program. I
think you'd like it. And so I took a bit
(03:45):
of a I did some research, obviously, took a bit
of a punt, and just found yep, this really did
press my buttons. And then when I joined the public service,
so joined the Ministry of Health originally in nineteen ninety seven,
and I found that sort of that interface between public
health and public policy and the politics was just rare interesting.
So that's where I stayed.
Speaker 3 (04:07):
So let's now that you're no longer in the thick
of it. By the way, just before we carry on,
we'd love you to join our conversation as well. I'm
going to a bit of a chat with Ashley about
his thoughts about the health system. But you can give
us a call on eight hundred eighty ten and eighty
in text nine two nine two. And I guess the
question we can explore is how are we going to
get on top of the health challenges that we face,
(04:28):
because the more we see of the headlines, it all
seems very doom and gloom. But Ashley, now that you're
no longer in the thick of it. Is it like
watching and observing the health system from the outside, do
you do you get a certain sense of clarity now
that you're not sort of tied up in the in
the sort of day to day frenzy that you've been
involved with in the past few years.
Speaker 4 (04:50):
Well, you can see it from a different perspective, and
you know, not being tied up in that immediate response,
particularly to the political process, gives you the opportunity to
read widely, have a look at what's happening and other
health systems, reflect on the issues, support your colleagues who
are still in there, because it's a tough job being
a leader in the health system. And so yeah, I've
(05:13):
developed some thoughts about that, and just over the last
few weeks, I've sort of gone out with this idea
of a ten year plan and we can come back
to that. But one of the things that's predicated on is,
as you say, the headlines tend to be pretty catastrophic.
You know, you look on the front page of the
newspaper every day and I'm one of those probably rare
people that still gets a newspaper delivered every day, and
(05:34):
it's unusual not to see a headline on the front
page that is about the health system. And you know,
the words crisis, failure, broken seem to be words that
come up a lot. And one of the arguments I'm
making is actually very challenging in the system, but I
don't think it's broken, and in fact, the challenges we
face here are neither new nor are they unique to
(05:57):
our country.
Speaker 3 (05:58):
Is that because and look, I'm not going to get
on the whole beating the media up or anything, but
I guess headlines are driven by hyperbole, And is that
a bit of a problem is that, you know, the
stuff that gets the attention is the sort of thing
with the most dramatic headline, where in christ is the
words you used failure? Is that a problem in a
way that we're not getting No, I don't want to
(06:19):
go down that rabbit hole either, but that we're not
getting a balanced reporting of maybe some of the successes
in the system as well.
Speaker 4 (06:27):
Well. You know, I've been around the system for a
while and it's always been hard to get coverage of
good news stories. We can speak a little bit about
what's going well, So that's not a new thing, and
that what's changed now is of course the pace of
the new cycle, and with online news, and with with
(06:48):
emerging events, with sort of coming out on social media.
So the new cycle is just so fast now, and
so to get attention, really the headlines have to be
in a way more and more sort of sort of
stark and eye catching. I think the biggest problem with
(07:08):
it is not so much the headlines, because there's still
some very good journalism. I went pretty closely with a
whole lot of journalists through COVID, and it wasn't always
a comfortable experience. I think I did twenty five interviews
with Mike Costking of a Thursday morning, and you know,
he would give me a run for my money. But
the key thing there was, of course turning up and
(07:29):
face and speaking about and being accountable for what we're doing.
And so in many respects New Zealanders are very well
served by our media. The challenges, of course that just
that need to kind of keep ahead of the news
cycle means there's a bit of catastrophizing and that turns
people off and that's not a good thing.
Speaker 3 (07:46):
I actually do recall that last interview that you had
with Mike, and he said, despite the crossing of swords
that you often had at times that you turned up
every time to answer the questions. And I guess, are
we still seeing that level of transparency from our politic
public health leaders.
Speaker 4 (08:01):
I do think that's still happening. Of course, they're much
less in the media themselves now. It was unusual for
me to be most as a public servant, to be
fronting so much media. That's not typical. When I first
started in the ministry in the late nineties and even
through to the sort of the mid noughties, even as
a technician in the Ministry of Health, I mean I
(08:22):
was a public health advisor, I would often front media issues.
But that's very seldom the case now. The media issues
are very tightly managed through minister's offices, even through the
Prime Minister's office, So it's not unusual now that actually
those health leaders are way less visible in the media.
Speaker 3 (08:42):
What do you think look on the big picture side
of things. By the way, I was just thinking reflecting
in terms of you were talking about normally people wouldn't
you wouldn't have been so accessible. I couldn't tell you
without googling it who the Director General of Health is
right now. And that's I guess the side side of
the times of what we've been through, isn't it?
Speaker 5 (09:01):
It is?
Speaker 4 (09:01):
Yeah, And in fact it's just changed because the d
after me, Dr Diana Safati stood down just maybe a
couple of months ago, and another chief executive, Audrey Sonison,
who was at the Ministry of Transport, has just been appointed.
She's been transferred into that role. So yeah, but most
people would have no idea about that, and that's usual.
(09:23):
I didn't start the role thinking it was going to
be spending quite so much time in the media. You know,
there was a significant event.
Speaker 3 (09:31):
Well what do you think what are the major pressure
points that we need to address with our health system?
Speaker 4 (09:39):
You well, that's a good question, and maybe just a
couple of comments on what's going well if I can
start there. Well, you know, life expectancy in Altero in
New Zealand keeps increasing, and so we're doing something right.
People value living long and particularly long healthy lives. So
even since the nineties we've had a six year increase
in life expectancy. It's pretty stunning really, So that's good.
(10:02):
We've got great staff, we're delivering ag more care to
more people than ever and so we should celebrate that.
When people get the care they need, you.
Speaker 3 (10:12):
Know, when they Once you're in the system.
Speaker 4 (10:14):
Once you're in the system, it's very you know, most
people are really impressed with the care they get. You
will hear that from people who've touched the system. So
that's good. What are the things that really need a
bit of focus. Well, the things that worry me most
are of course waiting times in hospitals, and so people
are waiting too long and often then their health is
(10:36):
deteriorating while they're waiting. One of the key drivers of that, though,
is that we've got a real problem in our general
practice workforce. So if you go back to the year
two thousand, about over thirty five percent thirty six thirty
seven percent of doctors we're working in general practice. That's
now down to twenty four percent now. Of course the
(10:57):
number of doctors has increased a lot over that time,
but increasingly there's an increasing proportion than working in the
hospital setting. And of course a good GP is able
to deal with those everyday common illnesses that come in
and experienced GP will know exactly where someone might need
to go for investigation or further referral or whether they
(11:18):
don't need that. So that's the part of the system
I'm probably most worried about, but usually what we hear
about the doctors and nurses and hospitals. You know, last
week it was Gisbon Hospital. Before that it was Nelson Hospital.
Whereas there's this ongoing real challenge in general practice, primary
care and our care sector as well our aged care
(11:39):
sector and those who are providing home and community support
services for frail older people. So there are a couple
of things. There's still some communities and some groups don't
get the access they need into the system, and that
could be you know, rural gaps in the rural healthcare area.
We know Marty and Pacifica tend to have trouble accessing
(12:01):
the system as well, and if they do access it,
sometimes they don't get as good as outcomes. So these
are things that need a lot of focus. And we've
also seen another thing that really worries me as a
public health doc is drop in immunization child immunization, and
this has happened around the world after through COVID because
all healthcare systems were put on hold a bit. And
(12:23):
of course one area that people will really be concerned
about is mental health as well.
Speaker 3 (12:29):
So just on the GPS did you what do you
think of the changes they're brought in enabling people to
get qualified by I can't remember the details, or people
working within GP practices to make more make it more
easier for people to become qualified from other countries.
Speaker 4 (12:46):
Yeah, well, I think that's an important part of the package.
And the current Minister of Health same and Brown announced
a series of interventions and initiatives just two or three
weeks ago. That was quite a good package, I thought,
and it was well welcomed, certainly by primary care. One
of them is training some more doctors through medical schools,
(13:07):
making it easier for overseas graduates to get into general
practice in particular. So those are all good initiatives, so
saying this will need a sustained and deliberate investment over
some years to turn that around. And one of the
things that you'll hear the College of GPS and other
general practice groups talking about is the aging general practice workforce.
(13:30):
So there's quite a proportion of them who are due
to retire in the next five or ten years and
there's a bit of a gap in that next you know,
the sort of actually the gen X is my age.
It's being filled again, but there was a period of
time when we weren't training enough GP. So it's going
to take a really sustained investment so that people can
(13:50):
get that access to the GP in a timely way
before their illness gets worse and then they end up
in an emergency department and or requiring admission to hospital.
Speaker 3 (13:58):
Is there an age limit on people practicing medicine? Is
it basically up to them.
Speaker 4 (14:04):
It's up to them really. Of course, every year you
have to get to your registration renewed. I'm about to
renew my practicing certificate. I'm still vocationally registered in public
health medicine. And there are really good programs that each
of the medical colleges runs to keep an eye on
people's fitness to practice, and that includes I guess as
(14:25):
people get older, you've got to make sure that whatever
age people are, but particularly as they get older, that
they're kind of their cognitive ability is still is still
up there. And of course there are new things happening
all the time, new advances, and so you've got to
keep up with your continuing medical education and achieve certain
standards every year.
Speaker 3 (14:43):
Just on them. Just before we go to the break,
the talk about workforce and that's mean the headlines a
lot lately. How are we respect to the rest of
the world, Because the gist I get is that we're
not alone. You hear England talking about people leaving to Australia.
Here Australia talking about people leaving to America. Or are
we all suffering? Are all oecd country suffering from a
(15:05):
shortage in the workforce.
Speaker 4 (15:07):
Yes, it's a global phenomenon. And yes, I read a
headline in The Times last year about I think it
was one in four mental health nursing vacancies in mental
health nursing roles was vacant in the UK and the
article said, and guess where they're going. You know, they're
going to Australia and New Zealand and Canada. So there
(15:29):
is that mobility of the workforce. One of the things,
and we might get onto this after the break, is
we needed just a bit more of sophistication around our
discussion around the workforce, because it's not just about numbers.
As I said, you know, we increase the number of
nurses and doctors every year working in health New Zealand
and our hospitals, and in fact, over a five year
(15:49):
period from twenty eighteen there was a twenty three percent
increase in both doctors and nurses and our hospitals around
them or too, but the population only increased six percent.
So it's not just about the numbers, it's about the
system they're working in, the express support they've got, you know,
the digital talks I've got, and of course there's the
bigger gaps in my mind are in the primary care
(16:10):
and community sector.
Speaker 3 (16:12):
All right, hey, look we're back in just a moment
where we're going to welcome some calls to Ashley Broomfield
as well, doctor Sir Ashley Bloomfield. Just to give the
correct title from time to time, I think we should
throw that in there. But the number is eight hundred
and eighty ten eighty. I've got a lot of things
to discuss with Ashley as well on basically just giving
ourselves and maybe a little optimism and what are the
things that are within our control that we can do
(16:33):
as a country to actually improve maybe our sense of
optimism for health outcomes in New Zealand. The number is
the numbers of eight hundred and eighty ten eighty. It's
twenty three past four news talks. The'd be yes, welcome back,
My guest is Sir Ashley Bloomfield, talking about the future
of our health system, and we're going to explore a
few ideas that might make us feel a little bit
more optimistic about the way forward. But let's take some
(16:54):
calls as well from you to join the conversation. Dallas,
good afternoon, Well.
Speaker 6 (16:58):
Good afternoon. Then. I want to thank you Ashley for
those COVID times, all the time you put it and
the effort. And I know that the Podium of Truth
has been criticized, but in those early days especially it
was in terms of New Zealand, it was the podium
of truth because it was the most reliable source of information.
(17:19):
There was so much misinformation flying around, So I have
no problem with calling it the podium of truth.
Speaker 3 (17:25):
Trying to trigger too many people, Dallas, But yeah, actually okay.
Speaker 6 (17:29):
But Ashley, looking forward to the next pandemic and looking
back on the last one, are there any lessons, any
regrets you have, or any lessons we could take forward
to the next pandemic?
Speaker 5 (17:43):
Oh?
Speaker 4 (17:43):
Look, thanks Dallas today and thanks for the feedback. Look,
if we go back five years, it was a pretty
frightening time and we could see what was happening around
the globe, and I guess we had to make some calls.
We chose a pathway and went down. And the thing
I'm most proud of is the way New Zealand is
the way kiwis actually rallied together, looked after each other.
And that's if there's anything that underlies why we did well,
(18:07):
particularly in those first couple of years, it's because of that,
because Kiwi's kind of you know, actually roll their sleeves
up and looked after each other. If we think, if
we look forward, is there a risk of another pandemic, Well, certainly,
and we should be prepared for it. Are we better
prepared than we were? Well, we've had a lot of
experience and we know some things that work, and we've
(18:28):
got some things in place that we didn't have, like
we've got a national contact tracing system. My current main
role at the moment, I'm working out at ESR, which
is the organization that does two interesting things. It does
all the forensics work for the police, but it also
does all the infectious disease surveillance and we're still doing
wastewater testing, we're doing whole genome sequencing and so we've
(18:50):
got these these kind of capabilities that we didn't have
five years ago. So in many respects, we're better off.
To your point about what might we learn, Well, that's
the point of the inquiries that have been done, and
we've had the first stage of the inquiry reported it.
It was a very long report, some excellent recommendations, and
I think, you know, government agencies are picking those up
(19:12):
and getting them underway. So I do often get asked
the question, have I got any regrets? Well, not so
much regrets about what we did at the time, but
I was asked this by well, I think I'm allowed
to mention his name on this on the show that
Patty Gower a couple of weeks ago, and you know,
I said, you know, one of the things we can
never do enough of and even in our daily lives
is listen. And you know, especially as things started to
(19:34):
get fractious and we started to get, you know, that
kind of unity coming apart, maybe if we'd taken a
bit more time just to listen and understand what people's
concerns were and really keep explaining the pros and the
cons and make it and just make them feel a
bit better heard. I think that that's something we could
never do enough.
Speaker 3 (19:53):
Of and to be clear, I guess and where that
one to reliterg at that stuff because as we've seen
Royal Commission reports and things. I mean, you advise you're
not necessarily the decision maker, so I guess you know
it's I don't know what the ROC commiss and said
about that. You know how often politicians could follow advice
because you might have a politician who doesn't care what
you think, what you say. That would be the biggest worry,
I guess, wouldn't it.
Speaker 4 (20:13):
Well, public servants are there to provide advice and support
the government's agendas. It's the politicians who go out to
the electorate every three years that are responsible and accountable
for making the decisions. You're exactly right, I think in
New Zealand, you know, we're fortunate with our politicians, and
certainly through COVID, I can say that they were extremely
open to our advice, our public health advice, and of
(20:34):
course we were all looking at what other countries were
doing and learning from them as well.
Speaker 3 (20:39):
Actually, of course, I mean. The only other point to
make is that I think sometimes I hear and discussions
around assuming that if there was ever another pandemic that
it would be like the one we've just seen, and
of course it could be completely different, you know, different
fatality rates or anything. I mean, so I don't know
how many lessons you can take from one pandemic to another.
If we do have something that's completely different threat, well.
Speaker 5 (21:00):
That's right.
Speaker 4 (21:00):
And one of the things going into this last pandemic
was we had planned for an influence pandemic, but it
was a coronavirus pandemic, and the virus, the virus, you know,
kinda operated differently. We also underestimated the role of that
aerosol spread and so we didn't advise masks. We were
probably overly focused on hand washing and those sorts of
(21:22):
things initially. But there are some basic things and one
of the things we do know is interestingly isolation and quarantine,
which is effectively what lockdowns are and what we did
at the border. They are centuries old ways now that countries, villages,
regions have actually dealt with highly infectious diseases like a pandemic.
(21:44):
So the basic stuff stays the same, but we also
learned a lot about you know, communication, leadership, decision making,
and those are the things that are going to serve
us well. If there is another pandemic When there is another,
one will say yes.
Speaker 3 (21:58):
And hopefully not in our lifetime, but you never know.
Now more, let's get back to focusing on the future.
If I like to sort of specialized sometimes in asking
sort of lay dumb questions. So I'm going to throw
something at you just as a suggestion. We have got
a major problem with obesity in New Zealand. And another
thing we've got a problem with is the poor rate
of childhood vaccinations. And the reason I mentioned those two
(22:20):
things as we can correct me on that if you
like as well, But is the key to better at
health outcomes essentially trying to get New Zealanders to take
better care of themselves. And we're all going to be
humanly fallible and we'll still have problems with alcoholism and
all sorts of things. But how easily I mean, is
that frustrating for you when you look at population health
(22:43):
that we wouldn't have the problems with the health system
that we have if maybe we took better care of ourselves.
Speaker 4 (22:50):
Well, there are a couple of things in here, Tom,
And the first thing is just to be really clear
that the key driver of increased demand on our health
services and increased. You know, kind of use of health
services is actually aging. It's aging population, and of course
this is happening around the globe. Now, let me be clear,
Aging is humankind's greatest achievement. We should be we celebrate it.
(23:12):
You know, we all actually want to learn to live long,
healthy lives. But with aging, because it's the strongest risk
factor for cancers, it's the strongest risk factor for cardiovascular disease,
for diabetes. And these are these what so called noncommunicable
diseases are the ones that put the pressure on our
health system. The are the ones that are responsible for
(23:34):
many of the admissions to hospital and a lot of
the presentations to general practice. Likewise, osteoarthritis, you know, so
people then need hip and knee replacements. These are these
the things that happen when as we age. So we've
just got to keep that in perspective. But as you
pointed out, we also know an awful lot about how
to keep ourselves healthy. You know, physical activity is amazing.
(23:57):
It doesn't matter actually what your weight if you are
physically active. Of course, being a healthy weight is a
good thing. But physical activity, if it was a pharmaceutical
and you could sell it you'd be wealthier than Elon Musk.
It's just amazingly good for your well being. And it
doesn't mean you've got to be exercising or you've got
(24:18):
to be an athlete. It's just things like walking and
gardening and so on and riding your bike. We started
doing a lot more of that during the lockdowns of course,
So physical activity we know, not smoking is it is
just really fundamental. And our adult smoking rate in this
country is now under seven percent. You know, when I
(24:38):
started kind of early in my career in the early
two thousands, our footing and fifteen year olds, the Maori
girls who were forwarding the fifteen were smoking over a
third of them, thirty seven percent were smoking daily. Well
it's now about three and four percent, so huge impact there.
The thing that is important to remember here though, it's
not just people making bad choices. It's not just we
(25:01):
decided in the eighties, oh, let's let's all eat too
much and get overweight about the environment, and that's where
that's what population health is about, and it's about making
it easy for people to make good choices and enable
them to kind of live healthy life.
Speaker 3 (25:14):
So obviously you don't want to distill these things in
an over simplistic fashion. But if you were to look
at one, because you're a strong and advocate for prevention
and prevention focused health system, so looking at all things
like sugar and saturated fats and alcohol and all that
sort of thing, would you put exercise at the top
of the list. If we could improve New Zealanders exercise habits,
(25:36):
we would see a vast improvement in our health outcomes.
Speaker 4 (25:41):
That would be something I would be really really strongly for.
All of them are important. You know, we've made great
in roads around reducing smoking. It's well that is having
a major impact. I'd hate to think what the demand
would be on our system now if we hadn't spent
the last two decades getting our smoking rates down. That
is having a phenomenal impact. Physical activity is really important
(26:03):
because it's just so beneficial for every for pretty much everybody,
whatever your age, whatever your size, whatever your ethnicity or gender.
But it does go hand in hand with a good
healthy diet of course as much as possible. And and alcohol.
You know, if people do drink galkhola, it is just
kind of moderating. It's just you know, not using it
(26:26):
in ways that are harmful to you and others. Don't
flog it, Yeah, don't flog it. It's like everything that's
the old old thing in moderation. And you know the
Greeks had this as well a health and the other
thing is about mental health. You know, it's a healthy
mind and a healthy body, so doing things as well
that help our mental health and well being. And that's
the other thing about physical activity is there's such good
(26:47):
evidence that it's good for our mental well being as well.
Speaker 3 (26:50):
It doesn't sound I mean, it's one of those things
you can recommend which doesn't sound particularly controversial as opposed
to some other topics.
Speaker 5 (26:55):
I guess, you know, I.
Speaker 4 (26:57):
No one really argue with it, and there's no kind
of major multinational industry that's trying to, you know, perhaps
work in the opposite direction. So it is a bit
of a no brainer.
Speaker 3 (27:07):
Just before we go to the break, is there any
country that you look at that's sort of no one's
nailing it? But which country do you think we could
look at as in something we might want to emulate
and maybe in terms of even just their population but
also their health system.
Speaker 4 (27:22):
Well, I mean, one of the things I've been saying,
and you know, over these last few weeks actually for
a week while is actually the building blocks of our
health system are really strong, and we should look to
other countries, but not try and replicate exactly what they've got,
because everybody's health system sits within a historical context, a
(27:43):
cultural context, and economic contexts and sort of the sort
of the values that a country has, Like for us
in New Zealand, fairness is a really important value, whereas
if you go to the US, you know sort of
that individual responsibility and individual freedoms is a much stronger value.
Now we have both in New Zealand, but we've sort
(28:03):
of built the country on a on a value of
fairness and that applies in our health system as well.
So we should look to other countries for ideas about
what we could do better, but we should also find
our own solutions because as I used to say to
my leadership team at the ministry, no one is coming,
you know, and actually we've got this.
Speaker 3 (28:22):
Yeh okay, Look, we'll be back in just a moment.
We're talking with doctor Sir Ashley Bloomfield about, you know,
looking for the way ahead in our health system and
what are the causes for maybe a little bit of
optimism amongst the doom and gloom as well. Well, we'll
be talking to Matthew soon eight one hundred and eighty
ten eight. You can give us a call. It's twenty
one minutes to five News Talks. He'd be yes. Welcome
back to the Health of My guest is Ashley Bloomfield,
(28:44):
former Director General of Health, discussing well, our health in
the future and looking ahead. Let's take some calls Matthew.
Speaker 2 (28:50):
Hello, Oh, good afternoon, gentlemen. Good afternoon, doctor Bloomfield. Thanks
for taking a call. I mean some might say you
got off a bit lightly with Hosking in some ways,
but I wouldn't say that. Thanks for listening though, because
you know, it's I think that we've got to address
(29:11):
what we got wrong during the pandemic before we can
move on from that and move forward. I think that
it's starting to be recognized that some big mistakes were made,
so I mean it's important that we addressed that if
we are to face another pandemic. But look, you said
that you were you were looking. You could see the
(29:33):
global picture as things are unfolding, and I've always sort
of wanted to ask one question around it because I
was looking globally too, And as you know, New Zealanders
didn't receive the vaccine roll out till later on in
the piece, and we could actually see some of the
data coming from other countries, and we could see that
(29:53):
there was clearly a cohort that were perhaps at more
risk from some of the safety signals that were starting
to show from the new mRNA products, the younger cohort.
And I'm wondering why, with the ability to see that
there was a safety signal there, why did you still
(30:14):
recommend that that younger cohort was to take the experimental
mRNA products.
Speaker 3 (30:21):
Okay, I've got a question there from Matthew there, Ashley's
what's your comment there?
Speaker 4 (30:26):
Yeah, well, thanks Matthew. And I mean, clearly you've got
a view on the mRNA vaccines and just some of
the terms you're using there. Can I sense where you're
coming from. And by the way, it didn't feel like
I was getting off lightly when I was talking with
my costing. It was pretty tough at the time.
Speaker 5 (30:46):
Look.
Speaker 4 (30:46):
Actually, New Zealand started its vaccination program worth the Pfizer
mRNA vaccine in mid February twenty twenty one, and the
first countries had only started using this vaccine within maybe
a few weeks, maybe a month six weeks prior to that,
and we were because we were smaller, and we also
(31:08):
didn't have the pressing need that other countries did because
they had rampant kind of infection in their communities and
also were wanting to protect their health workforce. So we
were a little bit after them. As soon as that
signal came out, in particular, I think you're referring to
that signal around you know, that safety issue around mayocarditis
and some younger population groups. We really took notice of
(31:32):
that because we had very active monitoring. We had a
group of specialists of experts that were monitoring all that
watching very closely, and so we immediately put in place
extra information that was being provided to everybody who was
having the vaccine. But one of the reasons we still included,
a key reason we still included, you know, younger people
even under thirty and down to about age eighteen and
(31:55):
then and further down to twelve, was there was still
expert advice both here and globally that the balance of
benefits versus risks in that in the cohort and that grouping,
and that age group was still the benefits outweighed the risks,
and that was that's a really key thing. And the
other thing is, you know, those early vaccines were also
(32:18):
quite effective at preventing people from spreading the disease. Not
so much now, but their effectiveness against the early types
of the virus, you know, the original virus was pretty high.
So always a balance in the advice you give.
Speaker 3 (32:33):
Hey, actually, just looking ahead technology and AI and innovation,
how what are the exciting sort of sparks on the
horizon that we look at which can make a difference
to the healthcare we get.
Speaker 4 (32:45):
I look, technology and really good use of data and
informationist is just fundamental to providing good care now and
it's going to be more so. And of course good
data is also fundamental to having effective AI when you
introduce it. There are two parts of this really and
the part that gets the you know, the the interest
going and you often see the stories is around the
(33:08):
use of AI and kind of very technical or diagnostic
type work, for example reading X rays or other radiology investigations.
But one of the really important uses, and this is
already happening particularly in general practice but elsewhere, is just
using simple AI to for example, transcribe consultations and summarize
(33:34):
them so instead of having instead of the clinician having
to recall at the end of the consultation, ah, what
were the issues? Bang, You know that it can be
summarized and then you can go through and say yep,
and they can even come up with you know, here's
a plan of what to do. If you have that
integrated with the notes, then what you can do is
absolutely reduce the administrative burden on your clinicians, your free
(33:56):
up clinical time. And actually it's a win win. So
those kind of less glamorous uses of AI could really
transform and take out a lot of the administrative burden
out out of our system. And I think that's an
area that is being pursued and that could make a
real transformation. And also you know you're freeing up workforce
capacity quite a lot.
Speaker 3 (34:17):
Does that make a big difference to our macro sort
of health outcomes as well? So as AI progresses and
it's knowledge, it gets exponentially well, we know it gets
just smarter and smarter. Does it mean that for instance,
the ability to en mass analyze breast cancer scans and
breast scans and X rays and things rather than having
(34:40):
I don't mean remove the human element, but be able
to sort of collate and manage that information in a
much faster fashion. Yeah, stule through that, you know what
I mean?
Speaker 4 (34:49):
I know what you mean. Look, it's absolutely complementary to
the human element. And so if you think, say around
in radiology, one of the things is when women have
a mammogram, that mammogram usually is read by two radiologists
and if they agree that's good, they don't agree that
a third person reads them. So you could potentially swap
(35:10):
out one of those initial radiologists with an AI program
that could be doing that reading, because many of them
have been validated and shown to be highly accurate. So
that the role of AI won't replace clinicians and clinical judgment,
but it can really complement it and also potentially do
some of the more complicated things that as humans, you know,
(35:32):
we may maybe struggle with. So real opportunity to improve
the quality, the efficiency and the outcomes of care.
Speaker 3 (35:39):
What about robotics and AI, I mean it sounds fairly
Star Wars sort of Star Trek sort of thing, but
it might not be that far ahead, is it.
Speaker 4 (35:46):
Well, not at all? And in fact of course we're
already using robotics in surgery and being able to get
really precision surgery done by the use of robotics. So
the advantage of AI and the sort of large language
models has just been able for them to be able
to learn and build that that knowledge based on in
(36:07):
sort of complementing the work of robotics. But you know,
just to go back, there's a real opportunity first up
just with that reducing the administrative burden on the system,
and that's that's an area that's that's right for development
right now.
Speaker 3 (36:20):
Right, we're going to take a moment. We'll be back
with you, Ashley Blomfield, and just to tick it is
eleven minutes to five, and we're going to have a
little bit a look ahead in terms of what actually
might do if he was advising the government now and
how we're all face shaping up. And we'll be back
in just to tick. This is news Talks, head b
it's ten to five News talks. He'd b look, well,
I've got a couple more questions to ask Ashley Bloomfield.
To Ashley Bloomfield, who is our guest right now? Will
(36:43):
to squeeze another call? Tim?
Speaker 5 (36:44):
Hello, Yeah, Good afternoon, Tim, Good afternoon, doctor Bloomfield. Uh,
doctor Bluefield, thanks for the advice he gave the government
to get us through COVID. He took a bit of flack.
I think looking back, anyone who did that might realize
(37:05):
they were overly harsh. I don't think anyone could have
done it better anywhere in the world. So yeah, I'll
leave that as a simple thank you. I'd like to
move on to a bit of a plug. To Towering
a hospital. I had occasion to present there on Wednesday
afternoon this week. I thought I'd had a heart attack.
(37:27):
Turned out it was symptoms of vanagina. I was there
until yesterday afternoon. Ultimately I received a heart scan and
an engine gram. What artery was narrowed, it opened up.
I feel like a champion now, just got to catch
(37:47):
up on a bit of sleep, so you know, I mean,
I could not fault the treatment I received, the care
I received at every step of the way in that hospital,
ed Ward three C, cat lab and coronary care, recovery.
(38:11):
Every staff member orderlies, it work beautifully, good stuff, and
I can only put that down to the guidance and
the information they receive from doctor Bluefield. And his staff
and thank you good stuff.
Speaker 3 (38:28):
Hey Tom. I guess actually that time ties into the
fact that once you're in the system, the quality of
the care we can get across New Zealand. Despite the challenges,
we've got the care. The professionals are great.
Speaker 4 (38:40):
Yeah they are. And no thanks to Tim for his
comments and for telling us, you know, about his journey
in a nice shout out there to the staff and Totunger. Yeah,
if you're in the system, look, the care is fantastic.
And I know from being a DHB chief executive and
I love that job. It was great because you could
really see the teams working well and delivering great care.
(39:02):
And sometimes though we would let people down. And you know,
I had the occasions where I sat at my desk
and I put my head in my hands and think,
how do we let this person down? And it wasn't
anyone's fault. You know, no one got up that morning
thought oh I'm going to go to work and create
a bit of a problem. But it's it's how does
how do we make sure the system delivers reliably high
quality care and for those people who can't get access,
(39:25):
what is it we need to do as a country
to think, Okay, what's the funding level, what are the buildings,
what's the what are the digital systems, what's the workforce?
What what are the sort of ongoing and planning requirements
that we need to help us build that system back
to where it needs to be. And it's not going
to happen overnight. Again, it's a bit like you know,
Winston Churchill during during the Second World War. He didn't
(39:49):
say to everybody, it's all right, folks, We've got this.
It's going to be a cakewalk. He said, look, all
I can promise you is blood, sweat, toil and tears.
But guess what that we're in this all together and
there's nothing but victory. That's what we're aiming for. So
I'm not Churchill, but look, if we take a bit
of a and I'm saying about a ten year of
(40:09):
you on this, and we actually get our best minds together,
our good people, and we just say, let's work out
the plan to get our system to where it needs
to be. We know we've got an aging population, we
know that it's hard to fund the system, train the workforce.
Let's take a really thoughtful, systematic approach to this and
hopefully good support for that across a range of part
(40:30):
inns Ashley that it endures.
Speaker 3 (40:32):
Thank you so much for your time. Sorry I have
to jump in. They were really appreciate the time you
spent with us this halfnoon and all the best.
Speaker 1 (40:38):
For more from the Weekend Collective, listen live to news
Talk z BE weekends from three pm, or follow the
podcast on iHeartRadio.
You're listening to the Weekend Collective podcast from News Talk SEDB.
Speaker 2 (00:14):
I don't care if Monday, Tuesday is gray and Wednesdays Thursday.
Speaker 1 (00:21):
I don't care about youriv.
Speaker 3 (00:25):
I'm in Loday. You go for the Tuesday Wednesday break
my Heart.
Speaker 1 (00:34):
Of Thursday.
Speaker 3 (00:37):
Start spy. Yes, and welcome back to the show. I'm
Tim Beverage. This is the Weekend Collective. If you've missed
any of our politics, we were discussing tariffs with Shimmerer
Yakeb and we also had a chat with Chris Bishop
about the increasing size it's going to be permitted for
the granny flats. You can go check that out on
our webcast a web podcast, should I say, just look
(01:00):
for the Weekend Collective on Newstalk SAIDB dot co dot
NZ or iHeartRadio. But now, well, welcome to the Health
Hub and we have a special guest today. A next guest,
by the way, chose the song just as a little
bit of trivia. This is the Cure Friday arm and Love,
because we like to offer our guest just a way
of easing into the with the choice of their song
to ease us into our conversation. So anyway, he didn't
(01:22):
know when he took up the job in twenty eighteen
that he would soon become a household name, and he
was direct to General of Health, leading the country through
the hardest health channel's hardest health challenges New Zealand has
faced in modern history. And today he's a professor at
University of Auckland School of Population Health. His formal title
is doctor Sir Ashley Bloomfield, but I think we can
(01:44):
get away with saying Ashley for today, good afternoon.
Speaker 4 (01:48):
Cure it's him, good afternoon.
Speaker 5 (01:49):
So actually, let's.
Speaker 3 (01:51):
Talk about your new job at School of Population Health.
What is sort of that encompass in terms of its
breadth of study and who's part of you? Your student population.
Speaker 4 (02:02):
Well, population health is a sort of another name for
public health. And the students range from all those students
who are doing their first year medical science is really
trying to get into medical school, many of them, and
I did election to three hundred and fifty of them
just last week and I asked for a show of hands,
most of them trying to get into medical school. So
(02:24):
that's like a first year paper. We also arrange of
courses postgrad students doing masters PhDs, so I do some
lecturing on global health, health leadership, health management as well.
Speaker 3 (02:36):
Do you completely draw from your experience up to date
or how much of your role is with the doing
this course involves you researching and updating yourself on the latest.
Speaker 4 (02:48):
Well, the role at the university now is actually, well,
I'm back to just half a day a week because
I've taken on something else. But I tend to draw
on my deep experience over twenty five thirty years working
in the health system. So I'm not coming to it
as an academic. I'm coming to it, you know, based
on my experience, and clearly a bit of that experience
(03:09):
was the COVID pandemic. But I'd worked for many years
in government out in the district health boards. I'd been
a DHB chief executive, and of course, originally I trained
in medicine and then specialized in public health.
Speaker 3 (03:21):
What actually got you interested in public health?
Speaker 4 (03:24):
You know, it's hard to put a finger on it,
but I was doing I was working as a doctor
in the hospitals, even doing a little bit of general practice,
and a good mate of mine from medical school started
the public health training. He just messaged me, well, actually
this was before messaging. I was chatting to him one
day and he said, you know, you should put your
hat in the ring to join this training program. I
think you'd like it. And so I took a bit
(03:45):
of a I did some research, obviously, took a bit
of a punt, and just found yep, this really did
press my buttons. And then when I joined the public service,
so joined the Ministry of Health originally in nineteen ninety seven,
and I found that sort of that interface between public
health and public policy and the politics was just rare interesting.
So that's where I stayed.
Speaker 3 (04:07):
So let's now that you're no longer in the thick
of it. By the way, just before we carry on,
we'd love you to join our conversation as well. I'm
going to a bit of a chat with Ashley about
his thoughts about the health system. But you can give
us a call on eight hundred eighty ten and eighty
in text nine two nine two. And I guess the
question we can explore is how are we going to
get on top of the health challenges that we face,
(04:28):
because the more we see of the headlines, it all
seems very doom and gloom. But Ashley, now that you're
no longer in the thick of it. Is it like
watching and observing the health system from the outside, do
you do you get a certain sense of clarity now
that you're not sort of tied up in the in
the sort of day to day frenzy that you've been
involved with in the past few years.
Speaker 4 (04:50):
Well, you can see it from a different perspective, and
you know, not being tied up in that immediate response,
particularly to the political process, gives you the opportunity to
read widely, have a look at what's happening and other
health systems, reflect on the issues, support your colleagues who
are still in there, because it's a tough job being
a leader in the health system. And so yeah, I've
(05:13):
developed some thoughts about that, and just over the last
few weeks, I've sort of gone out with this idea
of a ten year plan and we can come back
to that. But one of the things that's predicated on is,
as you say, the headlines tend to be pretty catastrophic.
You know, you look on the front page of the
newspaper every day and I'm one of those probably rare
people that still gets a newspaper delivered every day, and
(05:34):
it's unusual not to see a headline on the front
page that is about the health system. And you know,
the words crisis, failure, broken seem to be words that
come up a lot. And one of the arguments I'm
making is actually very challenging in the system, but I
don't think it's broken, and in fact, the challenges we
face here are neither new nor are they unique to
(05:57):
our country.
Speaker 3 (05:58):
Is that because and look, I'm not going to get
on the whole beating the media up or anything, but
I guess headlines are driven by hyperbole, And is that
a bit of a problem is that, you know, the
stuff that gets the attention is the sort of thing
with the most dramatic headline, where in christ is the
words you used failure? Is that a problem in a
way that we're not getting No, I don't want to
(06:19):
go down that rabbit hole either, but that we're not
getting a balanced reporting of maybe some of the successes
in the system as well.
Speaker 4 (06:27):
Well. You know, I've been around the system for a
while and it's always been hard to get coverage of
good news stories. We can speak a little bit about
what's going well, So that's not a new thing, and
that what's changed now is of course the pace of
the new cycle, and with online news, and with with
(06:48):
emerging events, with sort of coming out on social media.
So the new cycle is just so fast now, and
so to get attention, really the headlines have to be
in a way more and more sort of sort of
stark and eye catching. I think the biggest problem with
(07:08):
it is not so much the headlines, because there's still
some very good journalism. I went pretty closely with a
whole lot of journalists through COVID, and it wasn't always
a comfortable experience. I think I did twenty five interviews
with Mike Costking of a Thursday morning, and you know,
he would give me a run for my money. But
the key thing there was, of course turning up and
(07:29):
face and speaking about and being accountable for what we're doing.
And so in many respects New Zealanders are very well
served by our media. The challenges, of course that just
that need to kind of keep ahead of the news
cycle means there's a bit of catastrophizing and that turns
people off and that's not a good thing.
Speaker 3 (07:46):
I actually do recall that last interview that you had
with Mike, and he said, despite the crossing of swords
that you often had at times that you turned up
every time to answer the questions. And I guess, are
we still seeing that level of transparency from our politic
public health leaders.
Speaker 4 (08:01):
I do think that's still happening. Of course, they're much
less in the media themselves now. It was unusual for
me to be most as a public servant, to be
fronting so much media. That's not typical. When I first
started in the ministry in the late nineties and even
through to the sort of the mid noughties, even as
a technician in the Ministry of Health, I mean I
(08:22):
was a public health advisor, I would often front media issues.
But that's very seldom the case now. The media issues
are very tightly managed through minister's offices, even through the
Prime Minister's office, So it's not unusual now that actually
those health leaders are way less visible in the media.
Speaker 3 (08:42):
What do you think look on the big picture side
of things. By the way, I was just thinking reflecting
in terms of you were talking about normally people wouldn't
you wouldn't have been so accessible. I couldn't tell you
without googling it who the Director General of Health is
right now. And that's I guess the side side of
the times of what we've been through, isn't it?
Speaker 5 (09:01):
It is?
Speaker 4 (09:01):
Yeah, And in fact it's just changed because the d
after me, Dr Diana Safati stood down just maybe a
couple of months ago, and another chief executive, Audrey Sonison,
who was at the Ministry of Transport, has just been appointed.
She's been transferred into that role. So yeah, but most
people would have no idea about that, and that's usual.
(09:23):
I didn't start the role thinking it was going to
be spending quite so much time in the media. You know,
there was a significant event.
Speaker 3 (09:31):
Well what do you think what are the major pressure
points that we need to address with our health system?
Speaker 4 (09:39):
You well, that's a good question, and maybe just a
couple of comments on what's going well if I can
start there. Well, you know, life expectancy in Altero in
New Zealand keeps increasing, and so we're doing something right.
People value living long and particularly long healthy lives. So
even since the nineties we've had a six year increase
in life expectancy. It's pretty stunning really, So that's good.
(10:02):
We've got great staff, we're delivering ag more care to
more people than ever and so we should celebrate that.
When people get the care they need, you.
Speaker 3 (10:12):
Know, when they Once you're in the system.
Speaker 4 (10:14):
Once you're in the system, it's very you know, most
people are really impressed with the care they get. You
will hear that from people who've touched the system. So
that's good. What are the things that really need a
bit of focus. Well, the things that worry me most
are of course waiting times in hospitals, and so people
are waiting too long and often then their health is
(10:36):
deteriorating while they're waiting. One of the key drivers of that, though,
is that we've got a real problem in our general
practice workforce. So if you go back to the year
two thousand, about over thirty five percent thirty six thirty
seven percent of doctors we're working in general practice. That's
now down to twenty four percent now. Of course the
(10:57):
number of doctors has increased a lot over that time,
but increasingly there's an increasing proportion than working in the
hospital setting. And of course a good GP is able
to deal with those everyday common illnesses that come in
and experienced GP will know exactly where someone might need
to go for investigation or further referral or whether they
(11:18):
don't need that. So that's the part of the system
I'm probably most worried about, but usually what we hear
about the doctors and nurses and hospitals. You know, last
week it was Gisbon Hospital. Before that it was Nelson Hospital.
Whereas there's this ongoing real challenge in general practice, primary
care and our care sector as well our aged care
(11:39):
sector and those who are providing home and community support
services for frail older people. So there are a couple
of things. There's still some communities and some groups don't
get the access they need into the system, and that
could be you know, rural gaps in the rural healthcare area.
We know Marty and Pacifica tend to have trouble accessing
(12:01):
the system as well, and if they do access it,
sometimes they don't get as good as outcomes. So these
are things that need a lot of focus. And we've
also seen another thing that really worries me as a
public health doc is drop in immunization child immunization, and
this has happened around the world after through COVID because
all healthcare systems were put on hold a bit. And
(12:23):
of course one area that people will really be concerned
about is mental health as well.
Speaker 3 (12:29):
So just on the GPS did you what do you
think of the changes they're brought in enabling people to
get qualified by I can't remember the details, or people
working within GP practices to make more make it more
easier for people to become qualified from other countries.
Speaker 4 (12:46):
Yeah, well, I think that's an important part of the package.
And the current Minister of Health same and Brown announced
a series of interventions and initiatives just two or three
weeks ago. That was quite a good package, I thought,
and it was well welcomed, certainly by primary care. One
of them is training some more doctors through medical schools,
(13:07):
making it easier for overseas graduates to get into general
practice in particular. So those are all good initiatives, so
saying this will need a sustained and deliberate investment over
some years to turn that around. And one of the
things that you'll hear the College of GPS and other
general practice groups talking about is the aging general practice workforce.
(13:30):
So there's quite a proportion of them who are due
to retire in the next five or ten years and
there's a bit of a gap in that next you know,
the sort of actually the gen X is my age.
It's being filled again, but there was a period of
time when we weren't training enough GP. So it's going
to take a really sustained investment so that people can
(13:50):
get that access to the GP in a timely way
before their illness gets worse and then they end up
in an emergency department and or requiring admission to hospital.
Speaker 3 (13:58):
Is there an age limit on people practicing medicine? Is
it basically up to them.
Speaker 4 (14:04):
It's up to them really. Of course, every year you
have to get to your registration renewed. I'm about to
renew my practicing certificate. I'm still vocationally registered in public
health medicine. And there are really good programs that each
of the medical colleges runs to keep an eye on
people's fitness to practice, and that includes I guess as
(14:25):
people get older, you've got to make sure that whatever
age people are, but particularly as they get older, that
they're kind of their cognitive ability is still is still
up there. And of course there are new things happening
all the time, new advances, and so you've got to
keep up with your continuing medical education and achieve certain
standards every year.
Speaker 3 (14:43):
Just on them. Just before we go to the break,
the talk about workforce and that's mean the headlines a
lot lately. How are we respect to the rest of
the world, Because the gist I get is that we're
not alone. You hear England talking about people leaving to Australia.
Here Australia talking about people leaving to America. Or are
we all suffering? Are all oecd country suffering from a
(15:05):
shortage in the workforce.
Speaker 4 (15:07):
Yes, it's a global phenomenon. And yes, I read a
headline in The Times last year about I think it
was one in four mental health nursing vacancies in mental
health nursing roles was vacant in the UK and the
article said, and guess where they're going. You know, they're
going to Australia and New Zealand and Canada. So there
(15:29):
is that mobility of the workforce. One of the things,
and we might get onto this after the break, is
we needed just a bit more of sophistication around our
discussion around the workforce, because it's not just about numbers.
As I said, you know, we increase the number of
nurses and doctors every year working in health New Zealand
and our hospitals, and in fact, over a five year
(15:49):
period from twenty eighteen there was a twenty three percent
increase in both doctors and nurses and our hospitals around
them or too, but the population only increased six percent.
So it's not just about the numbers, it's about the
system they're working in, the express support they've got, you know,
the digital talks I've got, and of course there's the
bigger gaps in my mind are in the primary care
(16:10):
and community sector.
Speaker 3 (16:12):
All right, hey, look we're back in just a moment
where we're going to welcome some calls to Ashley Broomfield
as well, doctor Sir Ashley Bloomfield. Just to give the
correct title from time to time, I think we should
throw that in there. But the number is eight hundred
and eighty ten eighty. I've got a lot of things
to discuss with Ashley as well on basically just giving
ourselves and maybe a little optimism and what are the
things that are within our control that we can do
(16:33):
as a country to actually improve maybe our sense of
optimism for health outcomes in New Zealand. The number is
the numbers of eight hundred and eighty ten eighty. It's
twenty three past four news talks. The'd be yes, welcome back,
My guest is Sir Ashley Bloomfield, talking about the future
of our health system, and we're going to explore a
few ideas that might make us feel a little bit
more optimistic about the way forward. But let's take some
(16:54):
calls as well from you to join the conversation. Dallas,
good afternoon, Well.
Speaker 6 (16:58):
Good afternoon. Then. I want to thank you Ashley for
those COVID times, all the time you put it and
the effort. And I know that the Podium of Truth
has been criticized, but in those early days especially it
was in terms of New Zealand, it was the podium
of truth because it was the most reliable source of information.
(17:19):
There was so much misinformation flying around, So I have
no problem with calling it the podium of truth.
Speaker 3 (17:25):
Trying to trigger too many people, Dallas, But yeah, actually okay.
Speaker 6 (17:29):
But Ashley, looking forward to the next pandemic and looking
back on the last one, are there any lessons, any
regrets you have, or any lessons we could take forward
to the next pandemic?
Speaker 5 (17:43):
Oh?
Speaker 4 (17:43):
Look, thanks Dallas today and thanks for the feedback. Look,
if we go back five years, it was a pretty
frightening time and we could see what was happening around
the globe, and I guess we had to make some calls.
We chose a pathway and went down. And the thing
I'm most proud of is the way New Zealand is
the way kiwis actually rallied together, looked after each other.
And that's if there's anything that underlies why we did well,
(18:07):
particularly in those first couple of years, it's because of that,
because Kiwi's kind of you know, actually roll their sleeves
up and looked after each other. If we think, if
we look forward, is there a risk of another pandemic, Well, certainly,
and we should be prepared for it. Are we better
prepared than we were? Well, we've had a lot of
experience and we know some things that work, and we've
(18:28):
got some things in place that we didn't have, like
we've got a national contact tracing system. My current main
role at the moment, I'm working out at ESR, which
is the organization that does two interesting things. It does
all the forensics work for the police, but it also
does all the infectious disease surveillance and we're still doing
wastewater testing, we're doing whole genome sequencing and so we've
(18:50):
got these these kind of capabilities that we didn't have
five years ago. So in many respects, we're better off.
To your point about what might we learn, Well, that's
the point of the inquiries that have been done, and
we've had the first stage of the inquiry reported it.
It was a very long report, some excellent recommendations, and
I think, you know, government agencies are picking those up
(19:12):
and getting them underway. So I do often get asked
the question, have I got any regrets? Well, not so
much regrets about what we did at the time, but
I was asked this by well, I think I'm allowed
to mention his name on this on the show that
Patty Gower a couple of weeks ago, and you know,
I said, you know, one of the things we can
never do enough of and even in our daily lives
is listen. And you know, especially as things started to
(19:34):
get fractious and we started to get, you know, that
kind of unity coming apart, maybe if we'd taken a
bit more time just to listen and understand what people's
concerns were and really keep explaining the pros and the
cons and make it and just make them feel a
bit better heard. I think that that's something we could
never do enough.
Speaker 3 (19:53):
Of and to be clear, I guess and where that
one to reliterg at that stuff because as we've seen
Royal Commission reports and things. I mean, you advise you're
not necessarily the decision maker, so I guess you know
it's I don't know what the ROC commiss and said
about that. You know how often politicians could follow advice
because you might have a politician who doesn't care what
you think, what you say. That would be the biggest worry,
I guess, wouldn't it.
Speaker 4 (20:13):
Well, public servants are there to provide advice and support
the government's agendas. It's the politicians who go out to
the electorate every three years that are responsible and accountable
for making the decisions. You're exactly right, I think in
New Zealand, you know, we're fortunate with our politicians, and
certainly through COVID, I can say that they were extremely
open to our advice, our public health advice, and of
(20:34):
course we were all looking at what other countries were
doing and learning from them as well.
Speaker 3 (20:39):
Actually, of course, I mean. The only other point to
make is that I think sometimes I hear and discussions
around assuming that if there was ever another pandemic that
it would be like the one we've just seen, and
of course it could be completely different, you know, different
fatality rates or anything. I mean, so I don't know
how many lessons you can take from one pandemic to another.
If we do have something that's completely different threat, well.
Speaker 5 (21:00):
That's right.
Speaker 4 (21:00):
And one of the things going into this last pandemic
was we had planned for an influence pandemic, but it
was a coronavirus pandemic, and the virus, the virus, you know,
kinda operated differently. We also underestimated the role of that
aerosol spread and so we didn't advise masks. We were
probably overly focused on hand washing and those sorts of
(21:22):
things initially. But there are some basic things and one
of the things we do know is interestingly isolation and quarantine,
which is effectively what lockdowns are and what we did
at the border. They are centuries old ways now that countries, villages,
regions have actually dealt with highly infectious diseases like a pandemic.
(21:44):
So the basic stuff stays the same, but we also
learned a lot about you know, communication, leadership, decision making,
and those are the things that are going to serve
us well. If there is another pandemic When there is another,
one will say yes.
Speaker 3 (21:58):
And hopefully not in our lifetime, but you never know.
Now more, let's get back to focusing on the future.
If I like to sort of specialized sometimes in asking
sort of lay dumb questions. So I'm going to throw
something at you just as a suggestion. We have got
a major problem with obesity in New Zealand. And another
thing we've got a problem with is the poor rate
of childhood vaccinations. And the reason I mentioned those two
(22:20):
things as we can correct me on that if you
like as well, But is the key to better at
health outcomes essentially trying to get New Zealanders to take
better care of themselves. And we're all going to be
humanly fallible and we'll still have problems with alcoholism and
all sorts of things. But how easily I mean, is
that frustrating for you when you look at population health
(22:43):
that we wouldn't have the problems with the health system
that we have if maybe we took better care of ourselves.
Speaker 4 (22:50):
Well, there are a couple of things in here, Tom,
And the first thing is just to be really clear
that the key driver of increased demand on our health
services and increased. You know, kind of use of health
services is actually aging. It's aging population, and of course
this is happening around the globe. Now, let me be clear,
Aging is humankind's greatest achievement. We should be we celebrate it.
(23:12):
You know, we all actually want to learn to live long,
healthy lives. But with aging, because it's the strongest risk
factor for cancers, it's the strongest risk factor for cardiovascular disease,
for diabetes. And these are these what so called noncommunicable
diseases are the ones that put the pressure on our
health system. The are the ones that are responsible for
(23:34):
many of the admissions to hospital and a lot of
the presentations to general practice. Likewise, osteoarthritis, you know, so
people then need hip and knee replacements. These are these
the things that happen when as we age. So we've
just got to keep that in perspective. But as you
pointed out, we also know an awful lot about how
to keep ourselves healthy. You know, physical activity is amazing.
(23:57):
It doesn't matter actually what your weight if you are
physically active. Of course, being a healthy weight is a
good thing. But physical activity, if it was a pharmaceutical
and you could sell it you'd be wealthier than Elon Musk.
It's just amazingly good for your well being. And it
doesn't mean you've got to be exercising or you've got
(24:18):
to be an athlete. It's just things like walking and
gardening and so on and riding your bike. We started
doing a lot more of that during the lockdowns of course,
So physical activity we know, not smoking is it is
just really fundamental. And our adult smoking rate in this
country is now under seven percent. You know, when I
(24:38):
started kind of early in my career in the early
two thousands, our footing and fifteen year olds, the Maori
girls who were forwarding the fifteen were smoking over a
third of them, thirty seven percent were smoking daily. Well
it's now about three and four percent, so huge impact there.
The thing that is important to remember here though, it's
not just people making bad choices. It's not just we
(25:01):
decided in the eighties, oh, let's let's all eat too
much and get overweight about the environment, and that's where
that's what population health is about, and it's about making
it easy for people to make good choices and enable
them to kind of live healthy life.
Speaker 3 (25:14):
So obviously you don't want to distill these things in
an over simplistic fashion. But if you were to look
at one, because you're a strong and advocate for prevention
and prevention focused health system, so looking at all things
like sugar and saturated fats and alcohol and all that
sort of thing, would you put exercise at the top
of the list. If we could improve New Zealanders exercise habits,
(25:36):
we would see a vast improvement in our health outcomes.
Speaker 4 (25:41):
That would be something I would be really really strongly for.
All of them are important. You know, we've made great
in roads around reducing smoking. It's well that is having
a major impact. I'd hate to think what the demand
would be on our system now if we hadn't spent
the last two decades getting our smoking rates down. That
is having a phenomenal impact. Physical activity is really important
(26:03):
because it's just so beneficial for every for pretty much everybody,
whatever your age, whatever your size, whatever your ethnicity or gender.
But it does go hand in hand with a good
healthy diet of course as much as possible. And and alcohol.
You know, if people do drink galkhola, it is just
kind of moderating. It's just you know, not using it
(26:26):
in ways that are harmful to you and others. Don't
flog it, Yeah, don't flog it. It's like everything that's
the old old thing in moderation. And you know the
Greeks had this as well a health and the other
thing is about mental health. You know, it's a healthy
mind and a healthy body, so doing things as well
that help our mental health and well being. And that's
the other thing about physical activity is there's such good
(26:47):
evidence that it's good for our mental well being as well.
Speaker 3 (26:50):
It doesn't sound I mean, it's one of those things
you can recommend which doesn't sound particularly controversial as opposed
to some other topics.
Speaker 5 (26:55):
I guess, you know, I.
Speaker 4 (26:57):
No one really argue with it, and there's no kind
of major multinational industry that's trying to, you know, perhaps
work in the opposite direction. So it is a bit
of a no brainer.
Speaker 3 (27:07):
Just before we go to the break, is there any
country that you look at that's sort of no one's
nailing it? But which country do you think we could
look at as in something we might want to emulate
and maybe in terms of even just their population but
also their health system.
Speaker 4 (27:22):
Well, I mean, one of the things I've been saying,
and you know, over these last few weeks actually for
a week while is actually the building blocks of our
health system are really strong, and we should look to
other countries, but not try and replicate exactly what they've got,
because everybody's health system sits within a historical context, a
(27:43):
cultural context, and economic contexts and sort of the sort
of the values that a country has, Like for us
in New Zealand, fairness is a really important value, whereas
if you go to the US, you know sort of
that individual responsibility and individual freedoms is a much stronger value.
Now we have both in New Zealand, but we've sort
(28:03):
of built the country on a on a value of
fairness and that applies in our health system as well.
So we should look to other countries for ideas about
what we could do better, but we should also find
our own solutions because as I used to say to
my leadership team at the ministry, no one is coming,
you know, and actually we've got this.
Speaker 3 (28:22):
Yeh okay, Look, we'll be back in just a moment.
We're talking with doctor Sir Ashley Bloomfield about, you know,
looking for the way ahead in our health system and
what are the causes for maybe a little bit of
optimism amongst the doom and gloom as well. Well, we'll
be talking to Matthew soon eight one hundred and eighty
ten eight. You can give us a call. It's twenty
one minutes to five News Talks. He'd be yes. Welcome
back to the Health of My guest is Ashley Bloomfield,
(28:44):
former Director General of Health, discussing well, our health in
the future and looking ahead. Let's take some calls Matthew.
Speaker 2 (28:50):
Hello, Oh, good afternoon, gentlemen. Good afternoon, doctor Bloomfield. Thanks
for taking a call. I mean some might say you
got off a bit lightly with Hosking in some ways,
but I wouldn't say that. Thanks for listening though, because
you know, it's I think that we've got to address
(29:11):
what we got wrong during the pandemic before we can
move on from that and move forward. I think that
it's starting to be recognized that some big mistakes were made,
so I mean it's important that we addressed that if
we are to face another pandemic. But look, you said
that you were you were looking. You could see the
(29:33):
global picture as things are unfolding, and I've always sort
of wanted to ask one question around it because I
was looking globally too, And as you know, New Zealanders
didn't receive the vaccine roll out till later on in
the piece, and we could actually see some of the
data coming from other countries, and we could see that
(29:53):
there was clearly a cohort that were perhaps at more
risk from some of the safety signals that were starting
to show from the new mRNA products, the younger cohort.
And I'm wondering why, with the ability to see that
there was a safety signal there, why did you still
(30:14):
recommend that that younger cohort was to take the experimental
mRNA products.
Speaker 3 (30:21):
Okay, I've got a question there from Matthew there, Ashley's
what's your comment there?
Speaker 4 (30:26):
Yeah, well, thanks Matthew. And I mean, clearly you've got
a view on the mRNA vaccines and just some of
the terms you're using there. Can I sense where you're
coming from. And by the way, it didn't feel like
I was getting off lightly when I was talking with
my costing. It was pretty tough at the time.
Speaker 5 (30:46):
Look.
Speaker 4 (30:46):
Actually, New Zealand started its vaccination program worth the Pfizer
mRNA vaccine in mid February twenty twenty one, and the
first countries had only started using this vaccine within maybe
a few weeks, maybe a month six weeks prior to that,
and we were because we were smaller, and we also
(31:08):
didn't have the pressing need that other countries did because
they had rampant kind of infection in their communities and
also were wanting to protect their health workforce. So we
were a little bit after them. As soon as that
signal came out, in particular, I think you're referring to
that signal around you know, that safety issue around mayocarditis
and some younger population groups. We really took notice of
(31:32):
that because we had very active monitoring. We had a
group of specialists of experts that were monitoring all that
watching very closely, and so we immediately put in place
extra information that was being provided to everybody who was
having the vaccine. But one of the reasons we still included,
a key reason we still included, you know, younger people
even under thirty and down to about age eighteen and
(31:55):
then and further down to twelve, was there was still
expert advice both here and globally that the balance of
benefits versus risks in that in the cohort and that grouping,
and that age group was still the benefits outweighed the risks,
and that was that's a really key thing. And the
other thing is, you know, those early vaccines were also
(32:18):
quite effective at preventing people from spreading the disease. Not
so much now, but their effectiveness against the early types
of the virus, you know, the original virus was pretty high.
So always a balance in the advice you give.
Speaker 3 (32:33):
Hey, actually, just looking ahead technology and AI and innovation,
how what are the exciting sort of sparks on the
horizon that we look at which can make a difference
to the healthcare we get.
Speaker 4 (32:45):
I look, technology and really good use of data and
informationist is just fundamental to providing good care now and
it's going to be more so. And of course good
data is also fundamental to having effective AI when you
introduce it. There are two parts of this really and
the part that gets the you know, the the interest
going and you often see the stories is around the
(33:08):
use of AI and kind of very technical or diagnostic
type work, for example reading X rays or other radiology investigations.
But one of the really important uses, and this is
already happening particularly in general practice but elsewhere, is just
using simple AI to for example, transcribe consultations and summarize
(33:34):
them so instead of having instead of the clinician having
to recall at the end of the consultation, ah, what
were the issues? Bang, You know that it can be
summarized and then you can go through and say yep,
and they can even come up with you know, here's
a plan of what to do. If you have that
integrated with the notes, then what you can do is
absolutely reduce the administrative burden on your clinicians, your free
(33:56):
up clinical time. And actually it's a win win. So
those kind of less glamorous uses of AI could really
transform and take out a lot of the administrative burden
out out of our system. And I think that's an
area that is being pursued and that could make a
real transformation. And also you know you're freeing up workforce
capacity quite a lot.
Speaker 3 (34:17):
Does that make a big difference to our macro sort
of health outcomes as well? So as AI progresses and
it's knowledge, it gets exponentially well, we know it gets
just smarter and smarter. Does it mean that for instance,
the ability to en mass analyze breast cancer scans and
breast scans and X rays and things rather than having
(34:40):
I don't mean remove the human element, but be able
to sort of collate and manage that information in a
much faster fashion. Yeah, stule through that, you know what
I mean?
Speaker 4 (34:49):
I know what you mean. Look, it's absolutely complementary to
the human element. And so if you think, say around
in radiology, one of the things is when women have
a mammogram, that mammogram usually is read by two radiologists
and if they agree that's good, they don't agree that
a third person reads them. So you could potentially swap
(35:10):
out one of those initial radiologists with an AI program
that could be doing that reading, because many of them
have been validated and shown to be highly accurate. So
that the role of AI won't replace clinicians and clinical judgment,
but it can really complement it and also potentially do
some of the more complicated things that as humans, you know,
(35:32):
we may maybe struggle with. So real opportunity to improve
the quality, the efficiency and the outcomes of care.
Speaker 3 (35:39):
What about robotics and AI, I mean it sounds fairly
Star Wars sort of Star Trek sort of thing, but
it might not be that far ahead, is it.
Speaker 4 (35:46):
Well, not at all? And in fact of course we're
already using robotics in surgery and being able to get
really precision surgery done by the use of robotics. So
the advantage of AI and the sort of large language
models has just been able for them to be able
to learn and build that that knowledge based on in
(36:07):
sort of complementing the work of robotics. But you know,
just to go back, there's a real opportunity first up
just with that reducing the administrative burden on the system,
and that's that's an area that's that's right for development
right now.
Speaker 3 (36:20):
Right, we're going to take a moment. We'll be back
with you, Ashley Blomfield, and just to tick it is
eleven minutes to five, and we're going to have a
little bit a look ahead in terms of what actually
might do if he was advising the government now and
how we're all face shaping up. And we'll be back
in just to tick. This is news Talks, head b
it's ten to five News talks. He'd b look, well,
I've got a couple more questions to ask Ashley Bloomfield.
To Ashley Bloomfield, who is our guest right now? Will
(36:43):
to squeeze another call? Tim?
Speaker 5 (36:44):
Hello, Yeah, Good afternoon, Tim, Good afternoon, doctor Bloomfield. Uh,
doctor Bluefield, thanks for the advice he gave the government
to get us through COVID. He took a bit of flack.
I think looking back, anyone who did that might realize
(37:05):
they were overly harsh. I don't think anyone could have
done it better anywhere in the world. So yeah, I'll
leave that as a simple thank you. I'd like to
move on to a bit of a plug. To Towering
a hospital. I had occasion to present there on Wednesday
afternoon this week. I thought I'd had a heart attack.
(37:27):
Turned out it was symptoms of vanagina. I was there
until yesterday afternoon. Ultimately I received a heart scan and
an engine gram. What artery was narrowed, it opened up.
I feel like a champion now, just got to catch
(37:47):
up on a bit of sleep, so you know, I mean,
I could not fault the treatment I received, the care
I received at every step of the way in that hospital,
ed Ward three C, cat lab and coronary care, recovery.
(38:11):
Every staff member orderlies, it work beautifully, good stuff, and
I can only put that down to the guidance and
the information they receive from doctor Bluefield. And his staff
and thank you good stuff.
Speaker 3 (38:28):
Hey Tom. I guess actually that time ties into the
fact that once you're in the system, the quality of
the care we can get across New Zealand. Despite the challenges,
we've got the care. The professionals are great.
Speaker 4 (38:40):
Yeah they are. And no thanks to Tim for his
comments and for telling us, you know, about his journey
in a nice shout out there to the staff and Totunger. Yeah,
if you're in the system, look, the care is fantastic.
And I know from being a DHB chief executive and
I love that job. It was great because you could
really see the teams working well and delivering great care.
(39:02):
And sometimes though we would let people down. And you know,
I had the occasions where I sat at my desk
and I put my head in my hands and think,
how do we let this person down? And it wasn't
anyone's fault. You know, no one got up that morning
thought oh I'm going to go to work and create
a bit of a problem. But it's it's how does
how do we make sure the system delivers reliably high
quality care and for those people who can't get access,
(39:25):
what is it we need to do as a country
to think, Okay, what's the funding level, what are the buildings,
what's the what are the digital systems, what's the workforce?
What what are the sort of ongoing and planning requirements
that we need to help us build that system back
to where it needs to be. And it's not going
to happen overnight. Again, it's a bit like you know,
Winston Churchill during during the Second World War. He didn't
(39:49):
say to everybody, it's all right, folks, We've got this.
It's going to be a cakewalk. He said, look, all
I can promise you is blood, sweat, toil and tears.
But guess what that we're in this all together and
there's nothing but victory. That's what we're aiming for. So
I'm not Churchill, but look, if we take a bit
of a and I'm saying about a ten year of
(40:09):
you on this, and we actually get our best minds together,
our good people, and we just say, let's work out
the plan to get our system to where it needs
to be. We know we've got an aging population, we
know that it's hard to fund the system, train the workforce.
Let's take a really thoughtful, systematic approach to this and
hopefully good support for that across a range of part
(40:30):
inns Ashley that it endures.
Speaker 3 (40:32):
Thank you so much for your time. Sorry I have
to jump in. They were really appreciate the time you
spent with us this halfnoon and all the best.
Speaker 1 (40:38):
For more from the Weekend Collective, listen live to news
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