Governance in the English regions has been undermined and weakened by recent structural changes. Although well established during the New Labour era, the regional level of governance in England did not survive the post-2010 process of institutional churn shaped by economic austerity and central government’s aversion to the regional level. This has subsequently led to rescaling to the sub-regional level and the rise of devolution ‘deals’ involving new combined authorities with elected mayors. This article looks at the experience of North East England, where regional structures have been broken up and the region disempowered by such changes. It reviews what has happened to governance in the North East over the past 20 years and why the dismantling of regional governance matters. Whilst the region’s external relationships with central government are problematic, it is also argued that governance problems within the region are no less important and need reforming. Longitudinal research indicates that organisations providing public services in the North East have continued to be characterised by inadequate accountability, unrepresentative governance and lack of transparency. The combined effects of the devolutionary consequences of Brexit and the ineffectiveness of small-scale ‘devo-deal’ interventions mean that the ‘Regionalist case’ in England will need to be refashioned and restated. The article concludes by considering the case for reintroducing regional-level governance and points to ways of bolstering the accountability and effectiveness of this level of sub-national governance.