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NHS England has issued an updated (publication 11 October 2022) suite of Complex Change guidance about how it will assure and support proposals for complex change that are reportable to it. New and (where it is still in force) existing Complex Change guidance are as follows:

• Statutory transactions - for new guidance and for appendices which apply to intra-NHS mergers, acquisitions, dissolutions, separations and transfers
• Certain significant service contracts - click for new guidance which applies to material contracts that could expose the NHS to significant risk
• Commercial transfers - click for new guidance which applies to material sale, purchase and novation agreements
• Financing arrangements that are novel, contentious or repercussive - click for new guidance which applies to financing arrangements that are novel, contentious or repercussive
• Forming or changing a subsidiary – click for existing guidance which applies to all NHS trusts and foundation trusts considering transactions involving the creation of subsidiaries or material changes to existing subsidiaries
• Planning, assuring and delivering service change for patients - click for existing guidance which applies to substantial service change.

If proposals for complex change are reportable, NHSE will assess the level of risk to determine the extent of any assurance work required.

Some transactions and projects fall outside Complex Change guidance but are instead subject to other NHS England guidance. For example:

• Provider collaboration and place-based partnerships - click  for statutory guidance about arrangements for delegation and joint exercise of statutory functions
• Capital investments or property transactions – click for guidance
• Trust special administration – click for NHS trusts guidance and click for foundation trusts guidance
• Independent sector providers of NHS services – click for guidance.

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