Winter is the NHS’s perennial test, but 2025/26 is different. This year, NHS England has redefined system accountability, placing the onus of winter preparedness directly on Integrated Care Boards (ICBs) and Trust Boards. In parallel, NHSE is rolling out Exercise Aegis, a nationwide stress-testing programme designed to challenge and validate the resilience of winter plans across all regions.

 

This blog explores the purpose and structure of Exercise Aegis, the key lessons for system leaders, and practical steps ICSs and Trusts can take to ensure their plans are not just compliant, but truly resilient.

 

What is Exercise Aegis?

Exercise Aegis is NHSE’s formal response to the need for robust winter planning:

• A series of seven regionally-led tabletop exercises, scheduled for September 2025.
• Designed to test each ICS and Trust’s response to escalating winter scenarios, including:
  • Surge in respiratory illnesses (e.g., flu, COVID-19 variants).
  • Increased urgent and emergency care demand.
  • System-wide pressures including workforce shortages and social care constraints.

Core Objectives of Aegis

• Evaluate the effectiveness of escalation protocols.
• Assess multi-agency coordination, particularly between health and social care.
• Identify gaps in surge capacity, workforce flexibility, and patient flow management.
• Strengthen governance structures for rapid decision-making.

Strategic Takeaway: Exercise Aegis is a simulated stress test with real-world consequences. It will expose the fault lines in system readiness before winter hits.

 

What ICSs and Trusts Should Learn from Aegis

1. Clarity of Command and Control

• Who makes decisions when systems escalate to critical pressures?
• Are governance lines between ICBs, providers, and social care partners clear and functional?

2. Escalation Triggers and Thresholds

• Are escalation points defined, measurable, and responsive to changing dynamics?
• Is there a shared understanding of when and how to activate surge capacity?

3. Workforce Contingency Planning

• With headcount cuts and demand for service spiking, are workforce plans in place?
• Is there a coordinated approach across ICS partners to fill critical staffing gaps?

4. Discharge and Flow Coordination

• Are there established pathways to maintain hospital flow, prevent admission delays, and expedite discharge?
• Is intermediate care capacity mapped and ready to absorb increased demand?

5. Real-Time Data and Intelligence

• Can systems access real-time data on occupancy, demand, and capacity across the ICS?
• Is data shared effectively between acute, community, primary care, and social care?

Strategic Takeaway: Preparedness is not just a plan; it is the tested capacity to act swiftly and cohesively under pressure.

 

Strengthening Winter Plans: Practical Actions for Leaders

1. Conduct Internal Pre-Aegis Reviews

• Pre-emptively test your winter plans internally before Exercise Aegis.
• Use internal simulations to identify weak points in escalation, workforce, and patient flow.

2. Designate an Executive Winter Director

• Ensure a senior leader is accountable for winter readiness, empowered to lead cross-system coordination.

3. Formalise Agreements with Social Care

• Strengthen discharge arrangements with local authorities and care providers.
• Establish joint protocols for delayed transfers of care.

4. Build Data Dashboards for Winter Surveillance

• Implement real-time dashboards to monitor key metrics: bed occupancy, workforce availability, ED waits, and discharge delays.

5. Stress-Test Governance and Decision-Making

• Ensure Boards are briefed and simulation-trained to make rapid, risk-informed decisions.
• Review Board Assurance Frameworks to include winter-specific risks.

 

Final Word from Altin Biba, MBA, AMBA Chief Executive of ProMedical

Exercise Aegis is not a compliance tick-box, it is a litmus test for system integrity. The true value of this simulation is not in passing the test, but in revealing the weaknesses leaders must confront before winter reveals them for real.

Winter 2025/26 will not reward plans on paper. It will reward systems that have stress-tested not only their protocols but their leadership agility, data intelligence, and workforce resilience.

At ProMedical, we don’t just prepare you for winter, we help you prepare for what comes after: the reputational, operational, and clinical demands of a system that must endure beyond seasonal surges.

For leaders asking whether their system is ready, the better question is: how do we make it unbreakable?

 

References

1. NHS England Winter Planning and Preparedness Paper, 2025
2. NHS England Board Meeting Minutes, July 2025
3. NHSE Integrated Operational Performance Report, July 2025
4. Department of Health & Social Care publications
5. The King’s Fund – Winter Pressures Analysis
6. Nuffield Trust – System Resilience Commentary