Assuring and supporting complex change

NHS England has a role in supporting and assuring certain types of complex change, as set out below.  Where proposals for complex change are reportable to us, we will assess the level of risk to determine the extent of any assurance work required.

Where proposals for service change do not meet the thresholds for review, trusts and ICSs may nevertheless wish to use the relevant guidance to support their implementation.

This guidance does not apply to:

Trusts and ICSs considering complex change should use the links below to access detailed guidance.

Commercial transfers

Material sale and purchase agreements or novation agreements, eg where only part of a trust is being divested/acquired

Forming or changing a subsidiary

For all NHS trusts and foundation trusts considering transactions involving the creation of subsidiaries or material changes to existing subsidiaries