DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented - Ongoing. NHS England provided guidance and support to Clinical Commissioning Groups (CCGs) on CCG mergers and on the preparations for Integrated Care Board (ICB) establishment and facilitated learning and spread of best practice from previous organisational changes. Similarly, for ICB establishment, a comprehensive suite of guidance and additional support was provided by NHS England to help CCGs prepare for ICBs to be legally established. 'Readiness to operate statements' were signed off jointly by designate ICB CEOs and NHS England Regional Directors in June 2022, to provide assurance of robust arrangements for organisational transition. The readiness to operate statements were based on a comprehensive 'ROS' assessment checklist. The ROS assessment included use of extensive staff and property due diligence checklists, signed off by CCG Accountable Officers. The due diligence checklists were designed to ensure that there was no loss of corporate memory at the point of transition, and that key information, for example, staff records and information on quality, safety, finance and any other risks, was safely transferred to the new ICBs. The quality and safety information assets covered open incidents and complaints and learning from previous incidents and complaints. For the calendar year prior to transition, there was significant dialogue between NHS England regional teams and ICBs, ensuring that the ROS checklist and due diligence checklists were not treated as a 'tick box' exercise, but were completed on the basis of a deep and shared understanding of the necessary elements to ensure safe and effective organisational transitions. All statutory transactions are reportable, regardless of their size. Once reported, NHS England will consider whether the proposed transaction is the right solution to the issues it is attempting to address and that the intended benefits will be delivered. NHS England will look at the proposal in detail, using a risk framework to determine its risk rating based on four domains: strategy, transaction execution, quality and finance. The Health and Care Act 2022 granted the requirement for the Secretary of State for Health and Social Care to approve all transactions. NHS England will only grant an application for a merger, acquisition, dissolution or separation where they are satisfied that NHS providers have taken the necessary steps to prepare for the transaction, and where the grant is approved by the Secretary of State.

Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.