Radical Place Leadership: Why Efficiency Isn’t Enough

19 February 2026

Communities Working Together Winter Seminar Series | 19 February 2026 Andrew Laird & Sophie Coles, Mutual Ventures

In February’s Winter Seminar, Andrew Laird and Sophie Coles from Mutual Ventures explored why the conventional response to public service pressure — cutting budgets, raising thresholds, focusing on targets — is not only failing to resolve the underlying challenges, but in many cases compounding them.

The argument will be familiar to many working in and around public services. As councils and health systems become increasingly consumed by crisis response, the space for preventative and relational work — the kind most likely to reduce demand over time — continues to shrink. The Christie Commission set out this dynamic clearly in 2011, and the tension it described between reactive spending and long-term prevention remains largely unresolved.

Meet Brian

The session’s most striking illustration came through the story of Brian — a real person whose entire journey through public services was painstakingly mapped by researchers. Over the course of his life, Brian had 3,382 contacts with health, social care and justice services. His 1,474 health presentations alone cost nearly £920,000, with the total cost to the public purse coming to almost £2 million.

Each of those contacts represented a moment where earlier intervention, better coordination, or a more joined-up response might have changed the trajectory. The point is not to assign blame, but to illustrate what siloed, transactional systems tend to produce at scale — not through any individual failure, but through the logic of how they are structured. As Sophie noted, the cost of Brian’s health contacts alone would have funded a Band 7 nurse for 14 years.

A different way of working

Radical Place Leadership (RPL) is Mutual Ventures’ response — an approach grounded in the understanding that health and wellbeing are shaped by place: by housing, community networks, local economies and relationships, as much as by clinical services. It asks leaders to work across institutional boundaries, to distribute authority closer to communities, and to orient around outcomes that matter to people rather than those that are simply easiest to measure.

This connects directly to themes running through the wider Communities Working Together programme and this seminar series. Dr Helen Wilding and Dr Erica Gadsby’s session on systems thinking explored how the interconnected nature of complex systems means that interventions in one area will always have effects elsewhere — and that dashboards and targets can rarely capture this. Dr Frank Reilly and Prof. Katharine McGowan brought the lens of co-production and social innovation, making the case that meaningful change requires working genuinely with communities rather than designing solutions for them. In March, Neil McInroy will explore community wealth building — asking how local economies can themselves be shaped to support people to live well. Radical Place Leadership sits within this same tradition: different in emphasis and language, but grounded in a shared set of values.

The conversation in Argyll and Bute

The discussion that followed the presentation was honest and energising. Participants reflected on the experience of doing relational, preventative work within systems that are not yet structured to support it, and on the particular kind of leadership required to hold space for a different approach when the pressures towards short-term thinking are so significant. The question of whether Argyll and Bute’s exploration of a single authority model might offer a structural opportunity for deeper change was also raised — with the shared sense that structural reform, while potentially important, will only make a difference if it is accompanied by a genuine shift in culture and practice.

These are not easy questions to answer. But they are precisely the questions that Communities Working Together exists to sit with — building the relationships, shared language and collective capacity across our partnership so that when opportunities for change arise, we are better placed to act on them together.