Tejal Somvanshi
The NHS is implementing a series of “stress tests” throughout September to strengthen winter preparations across England’s healthcare system. These exercises simulate challenging scenarios such as staff shortages, sudden demand increases, and multiple virus outbreaks to identify potential weaknesses before winter pressures intensify.
This year’s approach gives local NHS leaders more autonomy to develop plans tailored to their communities, moving away from centrally-managed templates. Each region must name an Executive Winter Director by August and participate in seven regionally-led exercises called “Exercise Aegis,” testing their responses across baseline, moderate, and extreme surge scenarios.
“The NHS has done more preparation to be ready for the winter months than ever before,” said NHS Chief Executive Sir Jim Mackey. “Despite record demand this year, NHS teams have worked hard to improve waiting times, with last month’s Category 2 ambulance response times the fastest for four years – but we know the coming colder months will be much more challenging.”
Last winter’s performance data shows why these preparations matter. Only 73% of A&E patients were seen within the four-hour target (against a 95% standard), and about 11% of patients experienced 12-hour waits. The system also handled approximately 315,000 flu-related bed days, with occupancy consistently exceeding the 85% safety threshold.
The winter strategy includes several key operational improvements: Half of all ambulance services now have access to shared care records, allowing paramedics to view patients’ medical histories while on the move. This integration aims to improve handovers and reduce delays.
The NHS is expanding virtual wards and Urgent Community Response teams to provide more care outside hospitals. These services can help prevent unnecessary admissions and free up beds for those who truly need them.
Backed by nearly £450 million overall, including over £370 million in capital funding to deliver around 40 Same Day Emergency Care centres and Urgent Treatment Centres, as part of the Urgent and Emergency Care plan published in June. Mental health trusts are identifying frequent A&E attenders to develop crisis plans before winter, with new assessment centres to reduce pressure on emergency departments.
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However, some healthcare leaders remain concerned about the effectiveness of these measures. Dr. Nick Murch, president of the Society for Acute Medicine, questioned whether the planned interventions are sufficient:
“While NHS England reports it is ramping up preparations, it is concerning the only solutions on the table are ‘stress tests’ for a system that is already unable to cope, and the usual annual vaccination programme,” he said. “I am unsure the public will be reassured the NHS can be winter-proof when it is clearly not even summer-proof.”
Dr. Murch noted that over 35,000 patients waited 12 hours or more in emergency departments in August – a 26% increase from the same period last year. Public health campaigns will play a crucial role in the winter strategy. New vaccination drives will begin on September 22, initially targeting pregnant women for flu, RSV, and whooping cough vaccines. These will expand in October to reach people with long-term health conditions.
The NHS also aims to increase flu vaccine uptake among frontline staff by at least five percentage points, offering on-site walk-in and bookable appointments to make vaccination more accessible.
Health and Social Care Secretary Wes Streeting emphasized that while the government is strengthening preparations, public participation remains essential: “The single best way you can protect yourself, your family, and the NHS is by getting vaccinated. It takes pressure off hardworking staff and helps ensure care is there for patients when they need it most.”
