About Softwired
What I believe
“The most ambitious thing that humans have ever attempted is not the technology we build, but the systems we create to work together.” – Atul Gwande
Creating effective and integrated health and care systems is one of the biggest challenges we face in the 21st century. In every corner of our planet, the world of health and care is staggeringly complex involving a diverse range of different actors, organisations and competing interests. As people, families and communities we find ourselves trying to navigate this complexity - and often whilst we are at our most vulnerable.
We hope that somehow, someday, somebody, somewhere will come up with an ultimate solution for health and care – a plan, a structure or a mechanism that will make health and care systems work so that everyone gets the help that they need, when they need it and to slow the spiralling costs involved.
And yet, over the last century whilst we have seen breath-taking advances in our ability to prevent, diagnose and treat ill-health - we have continued to struggle to make our health and care systems work as they should. This is despite countless attempts to fix health and care by re-engineering the way that systems are ‘hardwired’ – through restructuring, redirecting flow, changing contractual relationships or introducing new processes and procedures. We have spent too long looking for solutions in the wrong place.
I believe that the real challenge that we face is to achieve collective coordination, shared purpose, and the relational fabric that allows our increasingly complex health and care systems to function.
“Life is what happens to you while you’re busy making other plans.” — John Lennon
Real integration and transformation will not emerge from formal plans, structures or strategies alone. It unfolds in the lived moments — the conversations, relationships, shared values and human connections that shape how people actually work together. In the same way that life’s meaning is found in what happens between the plans, system change happens between the structures: in trust built over time, in belonging created through shared purpose, and in the informal but powerful connections that allow people and organisations to collaborate effectively.
Genuine transformation in health and care will never just be the product of a plan for how the system is ‘hardwired’ - it will be the product of the people and how they are ‘softwired’.
Seeing 'softwiring' in action
I have seen the importance of how health and care systems are ‘softwired’ played out time and again in different places around the world. For example, the exceptional outcomes achieved for people living with severe mental health problems in Trieste underpinned by the strong sense of shared purpose and values shared by those leading local mental health services.
In Sri Lanka comprehensive transformation of community mental health services was achieved through the bravery and commitment of local leaders who believed that something better could be possible and continued to collaborate to make change happen over the two decades following the Indian Ocean tsunami.
Both in the UK and abroad, in trying to understand why in one place health and care ‘worked’ but in another place it didn’t – I would find myself with colleagues not describing the local processes and procedures but instead the people and how the place ‘felt’.
Learning from Suffolk and North East Essex ICS
From the outset I found the concept of Integrated Care Systems inspiring and from 2016-2026 I had the privilege to be part of the leadership team striving to make our local health and care system work. For myself and my colleagues the experience was nothing less than profound. By the end of that journey the Suffolk and North East Essex Integrated Care System (ICS) was been recognised for its collaborative, values‑driven system working with a highly rated NHS Integrated Care Board (the only ICB in England rated NOF Segment 1 ‘outstanding’ in 2025).
National changes to ICS boundaries meant that the ICS concluded in March 2026. Leading up to this partners reflected collectively on what had been achieved, what head been learned, and what they felt should be carried forward into the new Norfolk and Suffolk and Essex health and care systems. This learning was captured in a report ‘Our Journey Together’ which included internal reflections from a large number of local stakeholders and input from a range of external organisations including the University of York, Hult International Business School, The King’s Fund, Imperial College Business School, Future of Health and the NHS Confederation.
The report concluded that what stood out about the Suffolk and North East Essex ICS was the progress made by the system was not just because of how the system had been ‘hardwired’ for integration but how it had been ‘softwired’ - highlighting seven lessons about the importance of trust, purpose and shared leadership - for transformation in future systems:
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Build the system on shared values, principles and relationships.
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Start with purpose (‘Start with Why?’) before designing structures.
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Create inclusive spaces that build belonging, trust and understanding.
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Actively redistribute power, especially to VCFSE partners and communities.
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Focus on leadership culture, not just governance.
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Enable transformation to evolve, not be forced.
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Nurture a healthy system ecosystem where innovation can thrive.
The learning from Suffolk and North East Essex is striking in that it reflects so much emerging contemporary thinking on systems leadership and managing complexity. As such it is an important contribution to current debates in the UK and elsewhere about the future faced by health and care systems around the world of increasing complexity and demand.
