NHS Confederation -
The North East and Yorkshire region has developed a distinctive approach to system leadership based on the regional director working closely with chief executives of the four integrated care boards in the region, known as the 4+1 arrangement. This report describes the approach and demonstrates how how all parts of the health system are changing – NHS England, integrated care systems, places, and providers. It also aims to show that a focus on purpose, governance, structure, and incentives needs to be backed by an equal focus on effective relationships.