Nearly one year after the UK Government launched its ambitious 10-Year Health Plan, NHS leaders are under increasing pressure to turn strategy into delivery. Backed by an additional £29bn in annual funding expected by 2028, the plan sets out a bold vision of transforming the NHS from a reactive, hospital-centred service to one centred on prevention, integrated care and digital innovation.
However, the reality facing leaders across NHS England tells a more complex story. Recent reporting has highlighted that around one in ten NHS operations are cancelled at short notice—with nearly 40% considered avoidable—pointing to systemic co-ordination and efficiency challenges across patient pathways. These cancellations are not simply operational failures; they are symptoms of a system under pressure to improve performance while simultaneously redesigning how care is delivered. Addressing these issues requires more than better execution. It demands earlier intervention, stronger co-ordination and new ways of organising care, all while continuing to provide safe and reliable services.
This is not simply a resource challenge. It is fundamentally a leadership challenge. A challenge exacerbated for leaders who are building new teams at pace as part of a substantial restructure in public bodies such as the NHS and local government where the intersection of health and care sits in the NHS 10-Year Plan.
Leaders are expected to transform the system without compromising continuity of care. This involves introducing new technologies, redesigning patient pathways and shifting towards prevention while maintaining today's services under relentless operational pressure. Unsurprisingly, immediate priorities often dominate. Transformation programmes lose momentum, teams become frustrated, and collaboration suffers. What is frequently labelled ‘resistance to change' or a ‘lack of alignment' may instead reflect something far more fundamental: different ways of approaching problems and change itself.
This is where ambidextrous leadership becomes critical. NHS leaders are expected to deliver seemingly contradictory objectives at the same time: reducing waiting times while redesigning care pathways; increasing appointment availability while introducing new technologies; delivering efficiencies while improving patient outcomes; and maintaining today's services while building the NHS of tomorrow. These are not competing priorities to be solved one after another—they must all be delivered simultaneously. Ambidextrous leadership provides a way of understanding and navigating these inevitable tensions.
However, while ambidextrous leadership explains the tensions leaders must navigate, it offers relatively little guidance on how they should build and lead teams capable of managing them. This is where Kirton's Adaption–Innovation (KAI) provides a valuable missing perspective.
KAI recognises people naturally approach problem-solving in different ways. Some instinctively improve existing systems through incremental refinement, while others challenge assumptions and seek fundamentally different solutions. Neither approach is better; both create value.
So what does this mean in practice?
The first step is to diagnose whether the challenge primarily requires exploration, exploitation, or a combination of both before deciding how to solve it. The leadership challenge is recognising which type of thinking a particular task requires and creating teams capable of integrating both perspectives. Not every problem requires the same type of thinking. Consider an NHS trust working to reduce waiting times while simultaneously redesigning its elective care pathway. One challenge focuses on improving the performance of the existing system through greater efficiency and reliability. The other requires questioning established assumptions and developing new models of care. Both are essential, but they demand different ways of approaching the problem. Treating them as though they require the same thinking—or staffing them with identical teams—risks slowing progress on both.
The second step is to understand the cognitive landscape. Most leaders spend considerable time selecting people with the right technical expertise but rarely consider how they think. Mapping cognitive preferences helps leaders anticipate where teams are likely to agree quickly, before productive challenge becomes unproductive conflict.
The third step is to design teams intentionally. Rather than selecting project teams solely according to role or seniority, leaders should consider the cognitive balance required by the task. A pathway redesign initiative, for example, benefits from individuals who question established assumptions alongside those who can translate promising ideas into safe, reliable and implementable solutions. The objective is not diversity for its own sake but deliberately matching the team's cognitive strengths to the demands of the challenge.
Finally, leaders must lead the tension productively. Cognitive diversity inevitably creates disagreement but effective leaders recognise this as constructive challenge rather than resistance. Instead of forcing premature consensus, they create environments where different perspectives are explored before decisions are made, leading to better decisions and more sustainable transformation.
The NHS's 10-Year Health Plan is ultimately not just a test of policy, funding or technology—it is a test of leadership. Success will depend on leaders who can simultaneously improve today's services while building tomorrow's NHS. Ambidextrous leadership provides the framework for navigating that challenge, while cognitive design, through tools such as KAI, supports inclusion and accesses a new level of diversity within the organisation, providing a practical, people-centred way to make it happen.
