Flood risk emerges from the interaction of hazard and vulnerability. Over recent decades the notion of risk being the basis for flood management decisions has become widely accepted and operationalised through the use of models and quantified risk analysis providing the evidence for risk-informed decision making. However, it is now abundantly apparent that changes in time, at a range of scales, of pertinent variables that determine risk are not a second order consideration but, instead, fundamentally challenge the conventional approach to flood risk management. The nature of some of these changes, particularly those that operate on extended timescales, are highly uncertain, yet decisions that may have implications for several decades still have to be taken. In this paper we explore how flood risk management may be adapted to address processes of uncertain future change. We identify a range of levels at which change may be incorporated in decision making: in the representation of uncertain non-stationary quantities; in the rules that are used to identify preferred options; in the variety of options that may be contemplated for flood risk management; in the scope of problem definition, which increasingly extends to address multiple hazards and multiple functions of river basins; and in the social and organizational characteristics that promote adaptive capacity. Integrated responses to changing flood risk need to attend to each of these levels of decision making, from the technicalities of non-stationarity, to the promotion of resilient societies.