In the world of public services, some people emerge as catalysts for change, reshaping the landscape with new thinking that challenges conventional wisdom. Prof. Kate Ardern is one of those people. In the field of public health, her visionary leadership has been instrumental in helping communities across Liverpool City Region and the Northwest towards healthier, happier lives.
Kate was a speaker at Capacity’s recent Fundamentally Different conference. It brought together leaders, thinkers and doers ready to do things differently to transform public services. Kate’s journey in public health is characterised by that rare mix of passion, expertise, empathy and a keen focus on getting stuff done.
As Director of Public Health for Wigan, Kate was one of the team in Wigan Council involved in the development of the celebrated Wigan Deal and Greater Manchester’s Lead Director of Public Health for Health Protection and Emergency Planning & Response. She has a deep understanding of both healthcare and the broader socio-economic determinants of health.
Beyond the profound impact Kate has made on public health, we also wanted to hear her vision for public services in the years ahead. This conversation between Emma Lord, Director at Capacity and Kate took place in May 2024.
Kate Ardern and Phil Porter at Fundamentally Different
EL: Kate, there was a real buzz and energy at the recent Fundamentally Different event and we’re thinking about how we build on it. We heard two things. First, we need to move from transactional to relational working and second, there’s good work happening but it can feel tough and isolating. How can Capacity convene and connect people?
You’ve always had an ability to translate vision into action. What do you think needs to change to transform public services generally, but in LCR and Cheshire specifically?
KA: Having worked in Liverpool City Region and Cheshire for many years, I’m a long-term observer and resident. A couple of observations.
What this region has is lots of creativity, innovative ideas, passion and enthusiasm. Where it has been less successful is harnessing, focussing and translating that into coordinated action. There has been a tendency to write far too much strategy and there has, in the past, been a tendency to have far too many projects – “projectitis” – which don’t connect with each other and haven’t necessarily fundamentally changed core business.
What I liked about Fundamentally Different is it brought people together and enabled them to see how they and, vitally, the work they do connects with each other. The change we want to see is about building relationships and, most importantly, trust leading to collaboration and vitally, coordinationed action. This is an important lesson I’ve learnt during my time working in Wigan and Greater Manchester.
Part of your work to transform public services is about building hope and confidence in all parts of the region. Some places do feel like they’ve been left behind and not benefited from the wave of regeneration after the Capital of Culture, so that’s important. Again, a lesson from my time in Wigan is that individuals and communities need to have hope and confidence in their futures … something to live not just exist for and that’s very difficult when you face a challenge to even cover the cost of daily living.
We have to leave behind old school paternalism. Professionals love to fix people. But it’s about working with people and nurturing them. People and organisations, even with the best intentions, have to be persuaded away from being fixers. It’s about the relational working Capacity has been nurturing, the conversation about not ‘doing to’ people. But I’m really encouraged by what I saw and heard at the conference from progressive local authority leaders like Phil Porter (CEO, Sefton Council) and Elizabeth Hartley (Director of Children’s Services, Wirral Council) who are on that transformational reform journey.
EL: We’ve been doing some work with the Combined Authority on the development of OPSI. What lessons can we learn from the Wigan Deal, which is rightly acclaimed as key development in public service reform?
KA: There’s a big opportunity for the Liverpool City Region. But OPSI has to focus on the nuts and bolts of public service reform, not churning out grand vision plans. That means listening to people, which can be challenging. What we found in Wigan is that we quickly had to drop what we think people want and actually listen and work with them. It’s about stepping back and not trying to take charge.
Capacity has an important role to play in place-based leadership, but it requires organisational and personal development across public services. The innovation and transformation we want to see isn’t about tinkering at the edges. It’s about fundamentally rethinking how services are delivered and the outcomes we want to achieve. If we’re not challenging outdated assumptions, breaking down silos, and embracing a culture of experimentation and learning, it’s not going to work.
In the city region, there are progressive organisations, independent in their thinking. The VCSE and NHS in Liverpool City Region are great examples. There are some ‘subversive’ people doing radical work and that’s an advantage for the public service reform you’re championing.
Public services in the future will look different than they are today. There needs to be a big change in thinking and mindset. That was so important in establishing the Wigan Deal. It’s about inclusive, genuine community engagement. But it also needs political and institutional support. That means building a culture of risk-taking and creativity. Not everything will work. But it’s crucial failure isn’t seen as fatal, but as an opportunity to learn and iterate… we learn by doing and from our failures as much as our successes.
Another thing we learnt is that anthropology and ethnography can really break down barriers. These are skills Capacity can leverage to accelerate public service change. It makes you do away with your preconceptions about what people want and the ‘we know best’ philosophy that’s been integral to public service management. Ethnographic training needs to underpin all staff training across public services from new recruits to senior managers.
Capacity can really drive this change to do things differently. You haven’t got the baggage of some of the public sector world – local authorities, NHS et al. You can have a different relationship with the VCSE community, for example. That’s part of the value you can bring to OPSI. My other suggestion would be to work with the region’s universities on developing this approach. They have expertise in anthropology and ethnography and bring academic rigour and evaluation to public service reform. That might help foster a culture of being less risk averse in public authorities and support Capacity’s more ‘progressive’ approach to public service reform.
EL: We’ve been working closely with the university on civic data.
KA: The university has a role, especially on data. But data is only part of the puzzle. Our experience in Wigan and Greater Manchester is there has to be both quantitative and qualitative data. Data has to be contextualised in the “story of place” … history, geography – physical and social and culture really matter. That has to be part of developing a really compelling narrative. If there’s a lesson from the success of the Wigan Deal, it’s having a strong narrative that everyone can get behind. The data only tells you part of the story.
EL: You’ve been involved in producing a recent report “Health is Wealth: A Fast Start for Better Health” that makes some radical recommendations. Tell us more.
It’s actually the second report Lord Filkin and his small team of advisors (I’m one of the public health experts) has produced with input from colleagues from across the UK and international expertise. The first was ‘A Covenant for Health” published in June 2023 which really made the case for government investment in prevention as a societal and economic necessity.
This latest report is about setting out the priority actions for the first 100 days of a new government. It’s very action orientated but it also focuses two out of the five actions on children. We must take action now to break the generational cycle of inequalities. It has been very well-received and has cross-party support and we will be having a series of conversations with local and national stakeholders over the next few months. It’s very much in line with the powerful discussions on the future of English devolution. That’s really important in LCR, Cheshire and in Greater Manchester. Mayor Burnham and Mayor Rotheram’s recent book ‘Head North’ focuses on investment in young people and breaking that cycle of poverty. Our report could be very helpful in the conversations you’re having around OPSI.
The work of Capacity, your thinking, your raison d’etre is very much alive in that report. It’s been written by a very respected group of cross-party politicians and professionals, endorsed by progressive organisations like NESTA, Joseph Rowntree Foundation and the Kings Fund. A lot of the actions are relevant to this region, things everyone can get behind and support. LCR and Cheshire have got the foundations, it’s just sometimes it doesn’t get its act together to actually do it!
EL: Are some of the issues you’ve mentioned sticking more than others?
KA: No, they all are. Interestingly, there’s a real read across with what’s coming out of organisations like the Institute for Government, New Local and Reform think tank now about preventative measures, not just for better health outcomes, but across public services generally.
It’s about the Combined Authority and Capacity being conveners of change – bringing public organisations and wider civil society together. That includes the VCSE community and also business and SMEs who are crucial in place-based collaboration, cooperation and coordination.
EL: We’re working on a follow up to Fundamentally Different in June. It’ll move away from ‘concept’ into action and how we achieve the relational working we believe is at the heart of public services in the future. Any final thoughts?
KA: Get the collaborations and partnerships working and you’re well placed for success. Yes, there has to be political buy-in, but it’s absolutely vital to bring together diverse expertise, different perspectives and to consolidate resources. That’s what makes a difference to tackling complex issues from multiple angles, driving long-term change. Most importantly, local people and communities have to be real partners in change – part of the decision-making process to make sure their voices are heard, their ideas, experience, knowledge, skills and expertise nurtured, supported and prioritised .. people are the solution not the problem.
EL: Thanks Kate!