What is the incident or experience that’s had the most impact on you in your career, and why?
When I was a junior doctor back in 1988, at 2am one day I saw my tenth heart attack victim of the day. He was 38, with two young children. What struck me was that not that I had saved his life, but that he shouldn’t have been there in the first place. It was a failure of prevention. I thought we as a society should be doing better than this – I should be doing better than this. It’s what made me think of public health as my future.
What should the relationship be like between public services and the citizens they serve?
We always need to remember the importance of geography, history, culture and people’s emotional connection with the place they live. You can’t describe that through performance statistics. A lot of the conversations we’re seeing across Britain at the moment are based on people’s sense of identity and ‘place’. We have really proud traditions in our borough – some of our townships go back so far they’re even mentioned in the Domesday book!
Local government is rooted in that narrative, whereas the NHS is less so. We have to get away from patient engagement and move to citizen empowerment and leadership. We have to get away from ‘public consultation’, usually on a pre-determined set of proposals, to actually co-creating services with the public. What we’ve been doing locally on active ageing, care homes and dementia-friendly citizens have very much harnessed the energy and passion of local people.
The Wigan Deal has been highlighted in recent years as a successful new way of delivering local services. Do you feel it could be repeated elsewhere?
That is the mistake that lots of people make, including policy-makers. There is no one-size-fits-all model. You can learn from lots of places but you can’t replicate it – you are on your own journey. You need to really understand (and invest in) your community, really understand the relationships and the history. And you have to turn it into your own local language. So while we are magpies and learn from the best international and national practice, including from North Karelia in Finland for our public health prevention programme, we always ‘Wiganise’ it and make it rooted in our own asset.
In what ways have you seen it impact on local people?
Female healthy life expectancy in Wigan has now reached the England average for the first time ever, while male healthy life expectancy has also closed the gap on the national average. We’re a working-class, former mining borough but we’ve also made big improvements on smoking prevalence.
And I’ve seen frontline staff freed up in the work we do. We’ve given them their vocation back – and let them get back to why they wanted to do the job in the first place.
You worked in the NHS for 27 years and now in local government for 11 years. What are the main differences in managerial style between NHS managers and the leaders you work with now?
There’s a top-down, command-and-control culture in the NHS. Things are set nationally, without a lot of room for pragmatism or to say “that’s great, but it won’t fit here, so I need to work around it”. The best local NHS managers try to do that, but it’s difficult when being so rigidly performance managed. There’s much less room for managers taking a risk.
In local government, if you have a permissive managerial and political culture (as we do), risk and innovation is encouraged. We wouldn’t put people in danger, but we aren’t afraid to bend the rules a bit if it gets the right result and frees people up. You can’t command and control health and wellbeing, but you can inspire, empower and enable it.
What is the biggest change you’d like to see within health and social care in the UK?
A move to place-based budgeting, so local areas having both the money and the decision-making power to invest that money across all its services. We see a lot of investment going into the NHS, even if that’s not always how it feels. But that money always tends to prop up doing more of the same or the odd grand scheme, which won’t significantly reduce demand or address the real challenges ahead with an ageing population. We need to think more about how to invest the whole public sector pound, especially on health determinants like housing. We must start to see wellbeing as an economic good.
How would you fund social care?
That’s above my pay grade, but – however we decide as a nation to do it – there’s clearly a need to put social care on a level-playing field with health funding. As with public health, when we think of social care in its full breadth and potential, it is absolutely critical to improving the nation’s health. A lot of it comes down to how social care is seen. It’s not just for old people and it’s not just providing care. It is about positively enabling people throughout their life course to live the best life they can.
What would you have done if you hadn’t gone on to have the career you have?
I’d have aimed for a career in classical music or acting. I’m a rather unusual doctor as I didn’t do any science A-levels, and actually was trained classically in singing – I first started singing in public at the age of nine. Even now I don’t produce traditional annual reports. I instead often channel my inner Judi Dench and much prefer to make public health movies and creative endeavours that involve local citizens and tell the story of the place.
Kate Ardern is Director of Public Health at Wigan Council.