The challenges for local authorities highlighted in Local Authorities and Social Determinants of Health include: the problems in developing effective partnerships between health and social care services (Chapter 4); the cost of care if you do not own your home (Chapter 12); addressing inequalities in the North East of England (Chapter 7); supporting children and families (Chapter 11); and protecting future generations (Chapters 15 and 20).

Locking down populations, to reduce the spread of the virus, has involved difficult decisions by governments, often choosing between protecting the health of people or the economy. The approach using traditional management tools and leadership strategies has been found to be wanting.

Complex or wicked issues may be approached from multiple, sometimes competing, perspectives and may have multiple possible solutions (Conklin et al, 2017). Identifying ‘a social or cultural problem that is difficult or impossible to solve due to; incomplete or contradictory knowledge, the number of people and opinions involved, the large economic burden, and the interconnected nature of these problems with other problems’ (Rittel and Webber, 1977) is a first step in developing leadership in the public, private and third sectors.

Navigating wicked issues within a social determinants of health framework can help in managing responses to the issues. In Chapter 1, Simmons proposes that such navigation is based on the ‘value that is created when the insights from different patterns of social relations are combined in the search for greater clarity about the path ahead’, such that ‘the impossible becomes possible when you can see it from a different point of view’. This chapter explores the nature of public services leadership using the COVID-19 crisis as a reference. Crises are true wicked issues; they are complex and defy routine, technical solutions. The literature reviewed in this chapter highlights the importance of the collective dimensions of leadership, how it involves a social influence process through which improvised (‘clumsy’) coordination and partnership emerge. The novel notion of a relational dividend is defined here as the sum total of benefits (or ‘combined added value’) that accrue from an investment in relational work.