During his recent speech on his vision for prevention focused on reducing demand on the NHS, health and social care secretary Matt Hancock mentioned local authorities once in passing.
The significance of this is not lost on Wigan MBC’s director of public health Kate Ardern.
Dr Ardern, who has been a key figure in developing the principles of the transformative civic collaboration inherent in The Deal between her council and residents to improve population health and wellbeing, told LGC Mr Hancock’s focus on prevention and “social cures” was “fine and dandy”. However, Dr Arden, who is also lead director of public health for Greater Manchester, insists the key to creating a sustainable model of funding health “in its broadest sense” means establishing productive working relationships across the public sector and communities, with local government playing a central role.
“It makes no sense to me saying ‘you want to cut demand at the front door of the NHS’. We all want that; we want to help people be more self-reliant and resilient,” she says. “A vision for prevention is very laudable but at the same time [the government is] cutting the public health grant and cutting the investment in health determinants that enables that prevention vision to happen.”
Coming from a musical family, Dr Ardern agrees with Mr Hancock’s view of the value of the arts in improving health. He recently advocated the value of GPs prescribing cultural activities for people with certain long-term illnesses, but she questions whether the government’s approach to local government finance will enable this to happen.
Dr Ardern says: “You have to invest in the civic infrastructure and civic society in order to have libraries, museums, orchestras, culture and green space. The primary route for that is through local government.
“If councils can only fund essential statutory services then the very things that social prescribing wants to prescribe for people are not going to be there and they are not going to be there in the very places where they would produce the greatest benefit by tackling health inequalities.”
Wigan is set to save a planned £134m by the end of this financial year since 2011, while reportedly dealing with the third largest proportionate reduction in funding though austerity.
Dr Ardern says public health “is in the DNA of The Deal” and key to the whole system approach which feeds into the development of the area’s integrated care system, in the context of health and social care devolution in Greater Manchester.
Utilising community assets, or as she puts it creating “a social movement for change”, has been achieved through altering the nature of conversations between council and NHS staff and citizens while also building an evidence base behind what works.
Dr Ardern says it is important to first find and work with people who are really interested in a new approach to create momentum, citing members of the community and the fire service, as well as pharmacists who look out for signs of domestic abuse, early years champions in dentist surgeries and GPs who help to tackle homelessness and the health problems associated with it.
She says: “It has been very much creating that positive movement rather than a conflict. You persuade and then you negotiate with people. Be pragmatic, start with the areas you know you can get some traction on and show that it works.
“Show you have some outcomes, build people’s confidence and then it starts to take on a life of its own.”
Former Wigan leader Lord Peter Smith (Lab) stepped down in May and was replaced by David Molyneux (Lab), while chief executive Donna Hall has announced she will be retiring next year.
When asked whether Wigan’s approach could be set to shift as a result of leadership changes, Dr Ardern says one of the strengths of The Deal is that it is now fully embedded in the council’s culture and in the wider community.
“There is a distributed leadership of [The Deal] across senior management and the organisation,” she says. “If we tried to row back on The Deal in any way I don’t think the community would let us.”
Dr Ardern is keen to pay tribute to Ms Hall, describing her as the best chief executive she has worked with.
“People in the wider community and frontline staff know Donna personally and that is unusual,” she adds. “On a personal basis, I am very sorry to see her go because she has been a huge support and a great role model. Donna’s huge success is lesson to any leader [in] that she has created something which is the way we think of the borough now and [there is] no better legacy you can leave.
“The best form of leadership is one which gives its power away and influences the way people think.”