System Leadership in the NHS: Learning from the North East and Yorkshire Region

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 (ICBs) in the region, known as the 4+1 arrangement.

In this arrangement, a team of teams provides leadership across the region and ICBs have adapted this way of working in their systems with many leaders and staff involved.

System leaders across the North East and Yorkshire have been ‘learning by doing’ as we seek to enable improvement and reform of health and care services to deliver better outcomes. The strength of self-improving systems is the ability to undertake a critical and objective appraisal and use this to inform leadership practice. When the Richard Barker announced his retirement as regional director of the North East and Yorkshire region, four ICB Chief Executives, Sam Allen, Chief Executive, North East and North Cumbria Integrated Care Board, Gavin Boyle, Chief Executive, NHS South Yorkshire Integrated Care Board, Stephen Eames, Chief Executive, NHS Humber and North Yorkshire Integrated Care Board and Rob Webster, NHS West Yorkshire Integrated Care Board wanted to capture the learning from their work together over the last eight years. Since capturing this insight, we have a new government and Lord Darzi’s report into the NHS has been published.

Much prominence inevitably has been placed on structure since the establishment of statutory Integrated Care Systems (ICSs) in July 2022. Clarity of structure, roles and purpose is necessary: particularly as ICSs, with their Integrated Care Partnerships and Integrated Care Boards, are novel constructs in the history of the NHS. The key lessons in a new report show how all parts of our systems are changing – NHS England, ICSs, places, and providers – and that a focus on purpose, governance, structure, and incentives needs to be backed by an equal focus on effective relationships. If we get these right and pay constant attention to them then the structures can operate more effectively.

System leaders – wherever they sit – will be tested now and into the future. Recovering performance and maintaining safe, effective services will be tough. Improving outcomes will be even tougher. The Darzi report is clear about all these things.

This new report, researched and written by Sir Chris Ham CBE helps us in the North East and Yorkshire region to increase our chances of success. The four ICB CEOs have worked with the NHS Confederation to share our work more widely as the NHS works to respond to the Darzi report.