Back in November, I spent two days at the Telford International Centre with 900 healthcare procurement and supply chain professionals for the HCSA Annual Conference & Exhibition. Since then, I’ve been travelling and working in the USA and South Africa, which has given me time to reflect on what was a truly great conference and some genuinely inspiring conversations about leadership.

The theme, ‘Collaborate to Innovate’, couldn’t have been more relevant to the challenges facing NHS procurement teams today.

Legitimate Leadership have been partnering with the HCSA for the last couple of years as part of their learning and development programme. This year, as part of our contribution to this wonderful annual conference, I offered to run complimentary coaching sessions for attendees.

The reason is simple: leadership is difficult. If someone can spend 45 minutes or an hour with me and take away a few useful pieces of information, get some stuff off their chest, or share a problem, then that feels like a valuable use of time, both mine and theirs. If they can come out of one of these sessions feeling a little bit more motivated, a little bit more clued in as to how to solve their problem or just experiencing that ‘a problem shared is a problem halved’ feeling, then I reckon that’s been worthwhile.

It was flat out over the two days, which was brilliant. I met loads of new people and made new connections. What continues to surprise me is how close-knit the procurement community and network are in the healthcare sector in this country. They do meaningful work in a very challenging environment, and it’s great to see them all come together.

The Backdrop: Change, Scrutiny, and Doing More With Less

If there was a common thread running through the conference halls, it was this: procurement and supply chain leaders are being asked to deliver more with considerably less. Budget scrutiny. Smaller teams. Rising complexity. The pressure is real, and it’s relentless.

Most of the people here have some form of leadership responsibility, whether to the people they lead in their teams, suppliers, customers, or laterally across the organisation. And these responsibilities are hard to meet on a day-to-day basis when there’s lots of external pressure on you. These people work in an extremely fast-moving, demanding environment. Literally life and death.

Add to that the rapid emergence of AI, with all its opportunities and pitfalls, and you have leaders trying to navigate genuine transformation while keeping the day-to-day operation running smoothly. From panel discussions on the future of ICS procurement to practical explorations of AI in procurement, they all circled back to this fundamental challenge: how do we do better work with fewer resources?

Why Coaching Matters in This Environment

When you’re in the trenches, metaphorically speaking, with bullets flying, it’s extremely difficult to get perspective and clarity on a deep and taxing subject: leading people. It’s very, very hard to put your head above the parapet sometimes or have those balcony moments, as some people call them, where you can look down at everything.

So, what do people get from these sessions? They get clarity, perspective, and hopefully some tools as well. They’re able to discuss some tricky people issues, and we may find a way forward. We try to solve it. I’m calling these coaching sessions, but I’m mentoring quite often. I’ve been there and done this; maybe try this. So, they come out of it with, I think, some theory on why the situation exists that they might or might not be in, and also some application so they can at least go back to their job armed with something.

Rebekah Bradshaw, who attended one of the sessions, put it well: ‘I think that you take a bit of a moment away, you take a step back and you’re able to put it all out on a table with someone that’s completely external from where you sit, who has their own experience in how to be a leader and deliver training somewhere else and you explain your situation and you get an honest, objective sort of response back. I think the importance is that you need to take care of yourself and be the best that you can be to be the best for other people.’

What I do is give people the principles, and when they are in the right frame of mind, they’re able to analyse their own context and behaviours against those principles. I give them time to think.

Why Collaboration Matters Now More Than Ever

The answer that emerged time and again at the conference was collaboration. Not just as a buzzword, but as a practical necessity.

The conference made clear that collaboration isn’t just about working together nicely; it’s about survival and effectiveness. Teams need to collaborate internally to work smarter, eliminate duplication, and share best practices. But they also need to collaborate across departments, across trusts, and across the wider NHS system to achieve the scale and efficiency that individual organisations simply can’t deliver alone.

As Pia Larsen, Chief Procurement Officer at Guy’s and St Thomas’ NHS Foundation Trust, and one of my clients, explained during her session: ‘The 10-Year Plan really is about how we make transformation within clinical care and within our organisations. What that is about is procurement moving away from a transactional mindset. We’ve got to get into the zone of thinking that we’re completely integral and strategically aligned with our organisations and fundamentally supporting that transformation internally, not just within the procurement department. How are we supporting the organisation to fundamentally shift what we do, how we transform the clinical services, and how we transform what is a really, enormously big business?’

This is where leadership becomes critical.

The Care and Growth Challenge

Obviously, everyone’s different, and there’s context around all the conversations you have, but thematically, you pick out things like a high-care, low-growth environment. Because care is easier than growth, leaders are sometimes quite happy to build strong relationships with their people, but then putting those relationships at risk to hold the line on standards and performance is much harder. That comes up quite frequently.

Most of the time, people are quite comfortable with the concept of caring for their staff, caring for their people. That’s quite an easy one to get your head around. But the growth side of things, holding the line on standards of behaviour and performance, what do you do with people who are being a little bit difficult, what do you do with conflict? Those are the harder things for leaders to deal with, and that’s typically where we end up.

Interestingly, you can’t deal with those things until you have proved yourself to be a caring leader in the first place. So, we see those themes coming up consistently.

One thing I’ve noticed when working with the NHS is that there are people in high-tenured positions. They’ve been in the same departments or jobs for a long time, so they’re slightly resistant to change. And it’s very typical in some areas where there’s a bit of resistance to change. Maybe that comes from change fatigue; there’s been too much. Sometimes it comes from people being in the same job for a long time, and they’re just a little bit resistant to things being different from what they’ve built, what they know, which is fully understandable.

I don’t necessarily see it as a problem to be in the same role or organisation for a long time, as long as you’re still growing. I think it’s a problem when you start to get stuck, frustrated, and maybe a little bored, and there’s no growth there anymore. So, I prefer a pot that’s simmering. I want things to come to the top, maybe go out and come back later, maybe move laterally, maybe move to different areas. That’s the job of leaders: to move the chess pieces around the chessboard, to make sure we’ve got people in jobs that constantly stretch them just enough, but not enough to drown.

From Taking to Giving: The Leadership Shift That Matters

According to Gallup’s 2025 Global Workplace Report, employee engagement is declining, and middle managers are a significant factor.

These are the leaders caught between senior leadership setting strategy and frontline teams delivering the work. They’re under pressure from above to deliver results while simultaneously supporting teams facing unprecedented challenges.

At the heart of Legitimate Leadership is a fundamental shift: moving from taking from your team to giving to your team. But it’s not just about being nice or caring, though those things matter enormously. It’s also about growing together as a team, even when budgets are tight, and change is constant.

When resources are constrained and standards remain high, which is certainly the case in healthcare, leaders must create environments where teams can hold each other accountable. Where expectations are clear. Where people know what’s required and feel empowered to deliver it together.

This balance between care and challenge is what enables real collaboration. It’s what allows teams to do genuinely difficult things together, rather than just talking about collaboration while everyone continues to work in silos.

When Do You Know Leadership Isn’t Working?

I think the fundamentals are that, as I’ve experienced, you stop doing the leadership work. You start getting dragged into other people’s priorities, or you find yourself firefighting constantly. Or worst case, you’re wasting time. You really need to be in Eisenhower’s world, box two.

You should be in leadership work, which means one-to-ones and team meetings. Meetings that progress the people, progress the team, not progress the work. You should be watching the game. Pep Guardiola (Manchester City Football Club Manager) is always watching the game. He never misses a game. He’s always at training. Are you missing the game?

And you should be planning and doing root cause analysis? We all have days when we struggle, but if you’re not routinely doing those activities, you’re not leading people.

The other signs? Disaffected workforce, disengaged people, unhappiness, low standards, silos, poor performance, low retention, high absence, high grievance, high disciplinary. I always say the world’s speaking to you. The noise always means something.

Leaders have got to be able to read the environment around them. And then quite often people go missing in that environment, and it’s left to a few hardy souls to carry on the fight, and the pressure on those people tends to be quite immense, and it can be buckling. And helping those individuals is the reason I get out of bed in the morning.

Working With Leaders Who Take This Seriously

One of the clients that I’ve been working with for the last couple of years is Pia Larsen at Guy’s and St Thomas’ Hospital. We clicked early on because she’s someone who’s extremely passionate about leadership and culture, and she takes her responsibilities as a senior leader, not just in her department and area, but as a senior leader in the trust. She takes those people’s responsibilities seriously.

She’s been on a bit of a journey with her department over the last couple of years, and I’ve been lucky enough to help her with it. It’s just been extremely gratifying to see someone at the top of the tree driving change and the impact it’s had on people and ultimately on performance. It’s great to see. It’s good to see her on stage, sharing her expertise with others and linking the technical and people aspects, which is incredibly important for people in her role.

It was also great to bump into David Downey, who attended one of our workshops. As he put it: ‘Something that I wasn’t expecting was to learn so much about myself as a leader, but also how to lead a team so that they would benefit from better advice and someone that really sort of understood their needs in addition to the organisation’s needs. So yeah, it was twofold really in the sense that I learned a lot about myself personally, but also how to support the organisation in a better way.’

The Energy of 900+ People Committed to Better

What struck me most about the HCSA conference was the energy in the room. From the main plenary sessions to the bustling exhibition floor to the conversations over dinner at the gala evening, you could feel the commitment of this community. These are people facing genuine challenges, but they’re not resigned to simply managing decline. They’re actively seeking better ways forward.

The gala dinner and awards ceremony were a particular highlight. Watching teams celebrate genuine achievements and recognise excellent work across the profession, there was a real sense of solidarity and shared purpose. You can really feel it, especially at the gala dinner where great teams and great work is celebrated. You really get the energy of the whole HCSA community and its friends.

Over two days, I heard from NHS leaders, suppliers, legal experts, and international speakers. I heard honest discussions about the challenges of implementing new legislation and technology. And I had countless conversations about what effective leadership looks like in this moment.

As always, this event’s been fantastic. I’m sure they have their disagreements, as we all do, but it’s great to see everyone here. I enjoy coming every year, and I hope to come back next year.

What I’m Taking Away

For me, the conference reinforced something I already knew but is always worth stating clearly: the quality of leadership will determine whether NHS procurement and supply chain functions can meet the enormous challenges ahead.

Technology will help. Better processes will help. Collaboration across organisations will help. But none of these things happen without leaders who can give their teams what they need: clarity, support, and the confidence to hold each other accountable to high standards.

The conversations I had during those one-to-one coaching sessions reflected this reality. Leaders at various stages of their journey, all wrestling with how to do more with less, how to build culture in challenging circumstances, and how to apply servant leadership practically in their context.

It was tiring, early starts, late finishes, but it was very much worth it. If people come out of these sessions feeling a little more motivated, a little more clued in about how to solve their problems, or just having had the chance to share their problems, then I feel like that’s been a valuable use of time.