Bottom up working for effective place-based leadership | Kate Ardern

Kate Arden

Letting go of power for stronger leadership is recommended by Kate Ardern, director of public health for Wigan Council. In the first of two blogs, Kate reflects on place-based working and the qualities NHS leaders need to consider as they develop the Neighbourhood, Place and System vision for ICS working described by the NHS Long Term Plan. 

The first point for me is that our work in Wigan is not just about the NHS and local government working together to improve the health of our community. Ours is a whole public service approach, that encompasses how we work together in everything from the NHS to the police, fire service and schools, to support local communities to live better, more hopeful and more engaged lives. As director of public health, I am also chief officer of leisure services, which is, if you think about it, entirely appropriate.

Sense of ‘place’

Within our borough, the sense of ‘place’ is important. Really important. We have to go with the geography that people identify with. The NHS might have identified Surrey and Greater Manchester as places, but do their local communities care about or identify with Surrey and Greater Manchester? In Wigan, for example, we still recognise the rivalry between Wigan and Leigh that has been around since at least the English Civil War! If you want to engage communities, to motivate them, to take them with you, then you cannot disrespect or ignore identity and history. These nuances of geography are important because civic pride is critical as a way of channelling energy, passion and ownership of personal and social goals. In a top down system, with aims and priorities set centrally, you don’t get to use this asset, and it’s tapping into this that’s making our borough different.

We are currently engaging on our own ten-year deal for 2030 for the development of services and community life in Wigan. The feedback we have heard from our residents has been amazing and building bottom up means that we can genuinely develop proposals that are owned by citizens. We’re getting amazing engagement from younger people at the moment and many of their good ideas on health and wellbeing are going to our Population Health Strategy Board for consideration and further development, and because these ideas are genuinely bottom up, they land much more effectively.

Understanding expertise

I worked in the NHS for many years and reflecting back I’d say that the NHS struggles with bottom up working and letting go of control. The NHS is often very professionally led - by this I mean that the NHS values experts really highly - and often the more expert someone is, the more we value them and pay them.

In local government, one of the most important lessons I can reflect on is that that professional expertise is taken for granted. In local government, there is a basic assumption of professional expertise, but actually that’s just the starting point for being an effective and skilled system leader.

In local government, really good system leaders gain respect for their interaction with local democratic structures and the way they work with and lead diverse teams of people with a wide variety of skills. Local leaders gain respect from how well they foster and nurture good relationships with a wide variety of partners and stakeholders.

Real place-based leadership then is more than just professional expertise, it’s about bringing together small communities and big personalities and working hard at forging a sense of shared ownership where we can celebrate all of our successes and learn from all of our mistakes.

This way of working requires a different set of management styles than we sometimes are used to in the NHS, and the difference in management culture is one that NHS place-based leaders really need to understand and embrace. In local government, the officer code of conduct helps to set some ways of working and standards of behaviour for our leaders and the Wigan Deal takes these guidelines for public service even further.

The Wigan Deal

The Wigan Deal, with our communities and our whole philosophy for working, is integrated into everything that we do. It drives the way that we recruit, develop and retain our staff.

New staff are recruited to core characteristics of being positive, courageous and accountable. New staff get ‘Deal training’ using  anthropology and ethnology to embed our principles and behaviours.

For more longer serving staff, we have needed to understand better how the culture of organisations can discourage innovation and staff using their own judgement. This means that sometimes we have to help colleagues unlearn some work behaviours and in many cases, staff feel empowered and know they have permission to act. We encourage staff to learn new approaches, to hold asset-based conversations wherever they go, and to use their own judgement to make quick decisions in line with agreed guidelines. There are many fantastic examples of the difference this has made to citizens’ health and wellbeing and the morale and motivation of staff… Rediscovering their vocation is a common theme.

Bottom up vs top down management

In Wigan, we believe that we don’t learn without acting, and we don’t learn without making mistakes. We are constantly reflecting on what we do and supporting an environment of continuous improvement.

NHS structures could reflect about the way that they performance manage, with system assurance frameworks and top down management reporting and accountability being the traditional way in which to consider ‘Quality’. It’s interesting to reflect on how assurance might be provided by a trust, a CCG and the CQC in an NHS environment. Compare that to our bottom up, empowered approach where we prefer continuous improvement and a culture where staff are monitored less and encouraged to challenge themselves to improve the way that they work It’s a very different approach and one we feel is working for people in Wigan.

At the heart of the Wigan Deal, in every part of the way we work, is the idea of letting go of power. As leaders, we empower staff. As organisations working in Wigan, we seek to nuture citizens’ experience and talents celebrating their good ideas and helping make good things happen. We are happy to ‘lose control’, and that philosophy, for NHS leaders, is an important one to reflect on.

Kate Ardern is director of public health at Wigan Council. Follow on her on Twitter @Katealvanley

Wigan Council runs regular Deal Days to share their learning.

Why Register?

Great reasons to register with NHS Confederation

  • Access exclusive resources¬†
    Access member-only resources and tailor member benefits and services
  • Personalise your website
    Select topics of interest for recommended content
  • Comment and recommend
    Rate and share content with colleagues
  • Never miss a thing
    Register now to keep your finger on the pulse of the NHS Confederation

Log In