COVID-19 exposed critical vulnerabilities across the health and care system, from supply chains to surge capacity, from data visibility to public communication. Five years on, NHS England is taking pandemic preparedness back to first principles.

This autumn, Exercise Pegasus, the UK’s first Tier 1 pandemic simulation since COVID – will pressure-test the system’s capability to respond to a national health emergency. Coupled with a new Pandemic Response Plan in development, NHS leaders face a vital opportunity to ensure lessons have not only been learned but embedded.

This blog critically examines Exercise Pegasus, the NHS’s updated pandemic planning strategy, and what system leaders must prioritise now to ensure a resilient response next time.

Exercise Pegasus: Stress-Testing the System

Led by the Department of Health and Social Care (DHSC) in partnership with NHS England and UKHSA, Exercise Pegasus will:

• Simulate a national respiratory pandemic over three phases between September and November 2025.
• Include participation from all 38 Local Resilience Forums (LRFs) in England.
• Engage national, regional, and local NHS command structures.
• Activate elements of the NHS incident response infrastructure, including Gold-level leadership.

Core Objectives of Pegasus

• Test high-level strategic coordination across government and health systems.
• Examine local and national surge capacity and workforce deployment.
• Evaluate systems for addressing inequalities in response and access.
• Assess inter-agency communication, data flow, and public messaging integrity.
• Identify gaps in logistics and supply chain resilience.

Strategic Takeaway: Pegasus is not just a scenario exercise; it is a real-time examination of readiness, leadership, and inter-agency interoperability.

Pandemic Response Plan: Learning Embedded

In parallel, a refreshed Pandemic Response Plan is being developed with a respiratory pandemic focus. This plan:

• Defines roles and responsibilities across DHSC, NHSE, UKHSA, ICBs, LRFs, and provider trusts.
• Structures incident response tiers, including when and how COBR and national health command structures should activate.
• Embeds learning from COVID-19, Operation Cygnus, and previous pandemic simulations.

A critical lens is being applied to:

• Early-warning systems and surveillance integration.
• Workforce scaling and cross-regional mutual aid.
• Command clarity: who decides what, when, and how.
• Public information management in an age of misinformation and disinformation.

Strategic Takeaway: This plan represents the UK’s blueprint for future pandemics. NHS leaders must understand it, influence it, and be prepared to implement it.

What NHS Leaders Must Plan For Now

1. Local Pandemic Playbooks

Every ICB, provider, and care system should be updating and aligning their internal pandemic response frameworks, ensuring they:

• Match national expectations under the new plan.
• Integrate with LRF emergency protocols.
• Include clear workforce surge modelling and redeployment triggers.

2. Equity in Emergency

COVID-19 magnified health inequalities. Pegasus explicitly tests how future responses will account for vulnerable groups. Leaders must:

• Identify at-risk populations in advance.
• Build equity lenses into triage, communication, and service provision.

3. Workforce Protection and Flexibility

Pandemic response hinges on people. Systems should:

• Revalidate PPE protocols, infection prevention measures, and staff health surveillance.
• Design flexible staffing models and reserve rotas.
• Strengthen internal bank and external flexible workforce capacity and cross-organisational redeployment arrangements, we cannot afford a repeat of the past.

4. Information Flow and Command Clarity

In crisis, clarity saves lives. Boards should:

• Stress-test their command and control escalation protocols.
• Review internal comms procedures to ensure consistent and timely messaging.
• Coordinate communication flows with ICBs, NHSE regions, and UKHSA.

Final Word from Altin Biba, MBA, AMBA

Exercise Pegasus and the new Pandemic Response Plan represent the NHS’s most significant preparedness effort since COVID. But no plan survives first contact with reality, readiness is not written, it is practised, challenged, and refined under pressure.

At ProMedical, we have seen first-hand that when the system is stretched beyond its limits, it is often the flexible, external workforce, the agency healthcare professionals, who keep the wheels turning. The pandemic taught us that resilience is built on partnership, not isolation.

The next emergency will not announce itself in advance. Leaders who wait for certainty will find themselves reacting too late. Our role is to help you prepare, not just with clinical capacity, but with strategic foresight, advisory support, and data-driven workforce solutions.

The question is not if the system will be tested again, it is whether we will be stronger, faster, and smarter when it is.

References

1. NHS England Pandemic Preparedness & Exercise Pegasus Briefing, July 2025
2. NHS England Board Meeting Minutes, July 2025
3. UK Health Security Agency (UKHSA) planning guidance
4. DHSC Pandemic Planning Framework, 2025 (draft)
5. Nuffield Trust – COVID-19 Retrospective Analysis
6. The King’s Fund – Health Inequalities and Emergency Preparedness