The NHS faces yet another formidable winter, with the risks of seasonal flu, respiratory infections, and surging emergency demand looming large. But this year, NHS England (NHSE) has signalled a fundamental shift in its approach to winter planning: accountability is no longer centrally driven, it is devolved. The responsibility for system readiness now rests squarely on the shoulders of Integrated Care Boards (ICBs) and provider leadership.

 

As we approach the critical winter of 2025/26, this blog examines the NHSE’s new accountability model, the implications of Exercise Aegis, and the question all system leaders must ask: are we truly prepared?

 

A New Era: Devolving Accountability for Winter Readiness

Historically, winter preparedness in the NHS was guided by centrally prescribed planning templates and oversight. However, NHSE has redefined this approach for 2025/26. The new model:

• Requires ICBs and NHS Trust Boards to formally sign off their winter plans.
• Mandates the appointment of an Executive Winter Director within each organisation by August 2025.
• Dispenses with mandatory centralised plan submissions, replacing them with local Board Assurance Statements.

This shift aligns with broader system reforms: placing autonomy and accountability in the hands of local leaders, while reducing unnecessary bureaucracy.

Strategic Takeaway: System leaders now hold direct responsibility for ensuring that their services, and the wider health and care system, are adequately resourced and resilient against winter pressures.

 

Exercise Aegis: Stress-Testing System Resilience

To support and test this devolved model, NHSE is launching Exercise Aegis, a series of regional tabletop exercises scheduled for September 2025. These exercises aim to:

• Simulate severe winter scenarios, including extreme flu outbreaks and surge demand.
• Evaluate whether local plans are robust, flexible, and scalable.
• Facilitate cross-sector coordination between NHS providers, ICBs, social care, and local authorities.

Key Features of Exercise Aegis:

• All seven NHS regions will host an exercise, ensuring national coverage.
• Senior leadership participation is mandatory, embedding accountability at the highest levels.
• Learnings will be consolidated nationally to inform best practice.

Strategic Takeaway: Participation is not just a tick-box exercise; it is an essential diagnostic to identify gaps and stress points before winter pressures peak.

 

What System Leaders Must Prioritise Now

1. Capacity Planning and Surge Protocols

Leaders must ensure that capacity expansion plans are credible, deliverable, and adaptable to sudden demand shifts. This includes:

• Additional acute and community beds.
• Surge staffing plans, including internal bank and external flexible workforce solutions.
• Strengthened discharge pathways to avoid hospital bottlenecks.

2. Integrated Coordination Across Care Settings

True winter resilience demands seamless coordination between hospitals, community services, social care, and primary care. System leaders must:

• Establish joint escalation protocols.
• Enhance data sharing for real-time situational awareness.
• Engage local authorities in planning and response.

3. Public Health and Prevention Measures

Winter planning must integrate robust prevention strategies, including:

• Flu and COVID-19 vaccination campaigns for staff and the public.
• Public health messaging to reduce avoidable demand on services.

4. Board Assurance and Governance

Boards must not only sign off winter plans but actively monitor their implementation, ensuring:

• Clear risk ownership.
• Regular review of capacity and demand forecasts.
• Activation of contingency measures as thresholds are met.

 

Are We Ready? The Leadership Imperative

The NHSE Board’s message is unequivocal: winter readiness is a leadership responsibility. The absence of centralised checks places the onus on local systems to self-assess, self-correct, and deliver.

Failure to prepare adequately will not only risk service delivery but could lead to reputational damage and eroded public trust. Conversely, systems that demonstrate foresight, adaptability, and robust governance will be better positioned to navigate winter and emerge stronger.

 

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

Winter has always tested the NHS, but this year the terms of engagement have fundamentally shifted. Accountability no longer sits with the centre, it sits with system leaders, Boards, and executives. The question is not whether winter will pressure-test services, but whether leaders are ready to respond with agility, clarity, and control.

 

At ProMedical, we are more than a workforce provider. We are strategic partners in resilience, providing data-driven insights, flexible staffing models, and clinical advisory support tailored to the unique pressures of winter. The cold months will pass, but the legacy of this winter will be defined by leadership readiness, not the weather.

 

For those seeking a partner that understands the stakes, we are ready to support.

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 and Social Care publications
5. The King’s Fund – Winter Pressures Analysis
6. Nuffield Trust – System Resilience Commentary