Leadership in public policy making is challenging. There is tension in gaining commitment from competing stakeholder groups, in sustaining public engagement in technically complex areas and securing broad-based support. Our paper illuminates these challenges through a case study of health policy development in the UK. We go beyond individual roles and leader–follower exchange relationships to develop the concept of distributed leadership using a sociomaterial approach to reveal how and why leadership is distributed across sociomaterial practices which together (re)configure policy coalitions and context. In so doing we also show how legitimacy and trust are sociomaterially enacted and shape leadership in public policy.