Action required

This paper provides an update for Board on approach to pandemic preparedness across DHSC and NHS England, specifically to:

• note progress on developing a Pandemic Response Plan
• note arrangements for an upcoming cross-government pandemic exercise (Exercise Pegasus) this Autumn.

Pandemic response plan

1. DHSC are leading overall on the Pandemic Preparedness programme, and NHS England (via NHS Resilience, programme teams and National Clinical Directors) are supporting in partnership with UKHSA, Cabinet Office, and other ALBs.

2. Work is underway on developing a Pandemic Response Plan which will set out national roles and responsibilities, and how the health and social care system will respond to a pandemic occurring now for different routes of transmission. The first of these focuses on response to a respiratory/airborne pandemic.   

Exercise Pegasus

3.Exercise Pegasus is a Tier 1 exercise (defined as a national-level exercise involving ministerial participation and Cabinet Office Briefing Rooms [COBR] activation) and will take place between September and November 2025. Its key purpose is to simulate a realistic pandemic scenario, and is the first of its kind in nearly a decade.

4. Led by DHSC and UKHSA, with participation by Government departments and Devolved nations, it will assess the UK’s pandemic response capabilities more broadly across government. NHS England is a key participant, and NHS systems via LRFs will also actively contribute. Further detail on the exercise objectives and structure are set out at Appendix 1.

5. National participation from NHS England will include the partial use of incident management structures, national executive participation, and key staff involvement for those already involved in pandemic preparedness. Focus will be on core activities and agility to integrate with other national level health play.

6. Executive participation is set to include National Director for UEC and Operations, Chief Medical Officer, selected National Clinical Directors, Chief Nursing Officer, and Regional Directors with support from the National Programme Director for Urgent & Emergency Care, and National Director for NHS Resilience. This will take place across three two-day phases in September and October 2025.

7. All 38 Local Resilience Forums (LRFs) are also requested to participate in the exercise through completion of a workbook designed with NHS England’s input.

8. NHS England regional teams will work with LRFs as required and provide system co-ordination functions where play allows. They will provide updates and technical expertise and support to ICBs and are not expected to commission further requirements from NHS providers outside of workbooks for this exercise.

9. Alongside this, it is proposed that ICBs are supported to work in close collaboration with their LRF counterparts to ensure a suitable level of participation (whilst balancing existing capacity) and for providers to support as needed.

Appendix 1 – Exercise Pegasus Core Objectives

The objectives for Exercise Pegasus set specific elements where there is a reasonable prospect of useful learning rather than assessing the totality of pandemic arrangements. The objectives as agreed are:

1. Exercise decision making processes for measures to contain, control or mitigate the impact of a pandemic including how relevant priority lessons from previous civil emergency exercises and outbreaks of disease have been embedded. 
2. Explore the impact of inequalities, and their consideration within pandemic decision making.
3. Investigate likely impacts of HMG decisions on the health and care system, local responders, communities, businesses, civil society and the general public.
4. Examine processes for the scaling up of relevant capabilities that would be needed as part of a central government pandemic response.
5. Investigate the effectiveness of coordination, including the exchange of information, between different tiers in a UK wide response.
6. Test the strategic response to disinformation and misinformation.
7. Enable and support local exercising of selected capabilities and response issues.
8. Identify and report on relevant areas of learning to improve future pandemic preparedness.

While the number of objectives is relatively high, it should be noted that they will not all be addressed at the same stage of the Exercise, with some to be addressed via table-top exercises in between ‘live’ phases or in preparatory exercises prior to the main Exercise.

Publication reference: Public Board paper (BM/25/28(Pu))