Catherine Wilton
When pressure rises, so does the need for courageous, connected and collective leadership. In today’s volatile, fast-moving world, health and care leaders are facing unrelenting pressure, from workforce shortages and soaring demand to chronic underfunding and deepening inequalities. These challenges aren’t short-term, they’re systemic, complex and often unpredictable. Leading in this environment demands more than resilience. It demands a shift in how we lead, together.
Traditional, hierarchical leadership models struggle to survive under pressure. In high-stakes, high-complexity situations, no single person or organisation can hold all the answers. I believe the single most important skill of leaders is to bring people together across boundaries – between roles, organisations, professions, and between people who manage public services and those who draw on them – to make sense of challenges, co-create solutions, and lead change collectively. Collaborative leadership isn’t just helpful, it’s essential. It’s about leading with others, not doing things ‘for’ or ‘to’ them or making decisions over or without them.
Under pressure, we face what are known as adaptive challenges – problems that can’t be solved by technical expertise or quick fixes alone. They require us to work across silos, listen deeply to different perspectives, and be willing to experiment, learn, and adapt. Collaborative leadership creates space for this kind of work, replacing certainty with curiosity, control with connection, and blame with shared responsibility. And when it’s done well, it doesn’t just help organisations cope with pressure, it can create transformational change and sustainable solutions.
All this requires a paradigm shift in how we work and think. It means moving away from the idea of the heroic individual leader and towards leadership as a shared, social process. It calls for humility, empathy, and the ability to cope with uncertainty. And it means recognising that those closest to the issues – frontline staff, people who use services, and communities – often hold the insights and energy needed to spark real change.
This reimagining of leadership is not just a dream, it’s already taking shape in places where people are brave enough to experiment. Mark McKergow’s concept of ‘Host’ Leadership offers a new metaphor: not the leader as commander, but as a convener, a facilitator, a space-holder. In this model, authority is exercised with care, not control, through invitation rather than instruction. Host leaders understand that leadership is not a performance, but a practice of making others feel seen, heard, and empowered.
Collaborative leaders work with complexity rather than against it because they understand that systems don’t yield to force or control, they shift through relationships, shared understanding, and emergence, giving space and time for new ideas and solutions to grow. They understand that while their role can require some direction-setting from the top, their main role is to create the conditions for collaboration and to remove the barriers to it at all levels, to ensure everyone focuses on the greater good and to allow innovative and creative practices to emerge, even under pressure.
There’s no instruction manual for this kind of leadership. It’s not something that can be distilled into a checklist or rolled out via policy. It’s relational, contextual, and deeply human. It requires courage not just to act, but to slow down, to listen, to learn. And perhaps most importantly, it requires us to let go of ego, certainty and of the illusion that we can fix everything alone.
As pressure continues to mount, we might be tempted to seek stronger leaders, but what we really need are stronger connections between people, across systems, and with local communities . The future of leadership in health and care won’t be found in the lone figure at the front, but in the collective strength we build when we lead side by side.
Catherine Wilton is an executive coach and leadership development specialist. She is also Director of the Leadership for Personalised Care Programme, which began life 13 years ago as a partnership initiative on behalf of the Association of Directors of Adult Social Services, Skills for Care, the Local Government Association, Think Local Act Personal and the NHS Leadership Academy. It is now hosted by the charity In Control Partnerships.