Arbennek Project – Leadership Without a Job Title 

How relational influence, not hierarchy, shaped outcomes in the Arbennek INT 

When we think of leadership in health and care, we often picture formal roles: clinical directors, programme leads, managers with job titles and board responsibilities. 

But the story of Arbennek’s Integrated Neighbourhood Team (INT) reminds us that some of the most impactful leadership doesn’t come from a job description. It comes from relationships. 

The independent evaluation of Arbennek’s INT, undertaken by Future Care Capital, reveals a striking theme: informal leadership — the kind built on trust, energy, credibility, and connection — shaped the team’s success more than structure or hierarchy. 

A different type of leadership emerged 

From its inception, the Arbennek INT was less a formal structure and more a living network. It was developed bottom-up, drawing in professionals from GP surgeries, community services, local authorities, and the voluntary sector. 

While there was a designated clinical director and administrator supporting the INT, we found that leadership emerged organically. These leaders were praised not just for their coordination skills but for their personality, energy, and ability to bring others with them. 

Their influence didn’t rely on command. It was earned through clarity of vision, persistence, and emotional intelligence. 

Not a single point of failure 

One of the INT’s formal leaders reflected that depending on any one individual would be a mistake: 

“If we have a leader or we have a manager, that’s a single point of failure. The INT should be able to function without a leader.”1 

This wasn’t a denial of leadership. It was a recognition of distributed leadership where facilitation, decision-making, and accountability are shared. In this model, multiple people take turns guiding the group depending on context, rather than defaulting to hierarchy. 

It’s a lesson in resilience. And it’s especially relevant for complex, cross-sector settings like integrated care. 

Cheerleaders, not commanders 

One of the most striking observations in the evaluation was the role of emotional energy in leadership. A VCSE participant described the need for a “cheerleader” — someone to motivate, uplift, and keep people connected to purpose, especially when the day-to-day pressures threatened to grind them down.2 

This is a different kind of leadership capability. It’s not about overseeing performance targets or cascading strategic priorities. It’s about holding the emotional tone of a group. And it was a key ingredient in Arbennek’s momentum. 

As the evaluation notes, participants frequently pointed to the leaders’ “drive”, “links”, and “personality” as what enabled the INT to grow and succeed.3 

Leadership through relational capital 

Another thread throughout the evaluation is how much depended on relationships built over time — not only between the leaders and other participants, but across the whole network. 

Professionals joined and stayed engaged not because they were instructed to, but because they trusted the people running the meetings and felt a sense of purpose. This relational capital became a kind of informal currency that enabled collaboration, made the meetings feel worthwhile, and supported difficult conversations when needed. 

One senior stakeholder observed that the area had previously struggled to build strong relationships and that the INT had made a noticeable difference: 

“People have struggled in the past to get relationships strong in that patch. And I think this has helped them.”4 

This wasn’t leadership-imposed. It was leadership invited. 

Top-down vs bottom-up: a balancing act 

The evaluation is clear: top-down directives did not drive the team’s formation or effectiveness. They were largely absent from the group development stages described in the report.5 

Instead, the INT thrived through bottom-up leadership — a collective willingness to try new approaches, share power, and adapt to local needs. 

That doesn’t mean formal leadership wasn’t needed. The clinical director and administrator played essential roles. But their authority came as much from their relational skills as from their titles. 

What this means for other areas 

If we’re serious about building Integrated Neighbourhood Teams across the country, we need to think differently about what kind of leadership makes them work. 

That includes: 

• Valuing informal influence alongside formal authority 

• Supporting leaders to act as facilitators, not just decision-makers 

• Recognising the emotional labour of leadership — and resourcing it 

• Investing in relationship-building as a strategic asset 

• Avoiding over-structuring bottom-up initiatives in ways that stifle trust 

The Arbennek experience shows that relational leadership is not a soft add-on. It’s a core enabler of collaborative care. 

It also reminds us that leadership isn’t always where you expect it to be. Sometimes it sits at the edge of the table — not commanding but convening. Not managing but motivating. And in the context of local health and care, that might just be what transformation looks like. 

To read the full report and the other blogs in this series visit our project hub 

Footnotes 

1. Report page 20 – direct quote from an INT leader discussing distributed leadership.  
2. Report page 20 – direct quote from a VCSE participant about the need for a “cheerleader.”  
3. Report page 21 – summarised insight from section 4.4.3, referencing participant-coded praise for key leaders (242 coded references to leaders).  
4. Report page 21 – direct quote from a senior NHS stakeholder in section 4.4.3.  
5. Report page 25 – summary finding in section 5.2: “Top-down approaches to Tuckman’s team development stages are sparsely reflected in this data.”