Executive summary and action required
Ensuring robust winter preparedness is a key priority for the NHS England Transformation Executive. This paper sets out our approach to planning for winter this year.
ICBs and Trusts were asked in the UEC Delivery Plan for 25/26 to develop system winter plans over the summer, which would be ‘stress-tested’ at regional exercises in September. Individual ICB and Trust Boards will be accountable for providing the assurance on their plans ahead of winter, ensuring they mitigate against key delivery challenges and risks, and include robust plans under three demand levels: baseline, moderate and extreme.
The Board is asked to endorse this approach.
Background
1. System trajectories for Urgent and Emergency Care headline ambitions on 4 and 12 hour waits in A&E and on Category 2 ambulance response times all meet the Planning Guidance ambitions, however are contingent on the ability of the NHS to manage demand pressures during winter.
2. Ensuring robust winter preparedness is therefore one of the 12 priorities in the Transformation Executive’s 100 Day Plan. It is also central to the UEC Delivery Plan for 25/26.
Planning for winter
3. The UEC Delivery Plan asks all organisations to ensure that robust preparations are made for winter. These plans should include actions to prepare for winter (including vaccinations for the public and staff), and actions to be taken during winter (outlined in Annex A).
4. ICBs, as strategic commissioners, will lead the development of ‘system’ plans for their populations and complete preparatory actions throughout the summer. NHS Trusts (Acute, Community, Mental Health and Ambulance) will develop their own organisational winter plans considering response to the three demand scenarios. Trusts should work closely with social care colleagues – commissioners and key providers – including also developing clear actions for intermediate care and social care in the three scenarios (building on Better Care Fund plans).
Ensuring Board accountability for plans and stress-testing through regional exercises
5. This year, we want to ensure that all organisations across the NHS are clear on the actions they will take as pressures build, and – crucially – how decisions are made locally to trigger an effective response. This will need to include who plays what role, and how and where risk is held to avoid transferring it to patients.
6. ICBs and Trusts will not be required to return winter plans to NHS England or to follow any templated approach. Instead, individual Boards are expected to formally sign off their own winter plans assuring themselves, and the public they serve, that the requirements set out in the UEC Delivery Plan have been addressed and provide that onward assurance to NHS England via a Board Assurance Statement.
7. To support that process, NHS England will run seven regionally-led exercises (Exercise Aegis) to enable ICBs and Trusts to stress test whether their plans are sufficient and robust to mitigate winter pressures from baseline, moderate and extreme levels of respiratory illness / flu surge. Senior representatives from ICBs and Trusts will be expected to attend these exercises, along with colleagues from social care commissioning. These exercises will take place in September.
8. Nationally, we will provide the winter exercise content, and the modelling data to support planning for different levels of surge. We are asking regional teams to lead on hosting the events (logistics, venues, facilitation, etc).
Key timeline
NHS Winter Planning Timeline 2025
July 2025
- ICBs and Trusts develop winter plans
- Trusts in current Tier 1 receive additional support, and check and challenge if required
August 2025
- ICB and Trust winter plans are signed off in draft at Board level
- ICBs and Trusts to confirm a named Executive Winter Director in each locality/organisation
September 2025
- all ICBs and Trusts (at executive and operational level) participate in NHS England winter exercise to test plans
- lessons learned from winter exercise captured
- final winter plan signed off at Board level, and Board Assurance Statement submitted to NHS England
October 2025
- ICBs and all NHS Trusts ensure that surveillance mechanisms are in place to alert providers early to surging winter pressures as far in advance as possible in order that contingency plans can be mobilised
Recommendations for the Board
9. The Board is asked to:
9.1 Endorse the proposed approach to testing winter plans through regionally-led exercises in September.
9.2 Endorse the proposed roles and responsibilities of ICBs in planning for and overseeing winter operations.
Annex A – What system winter plans should include (taken from the Board Assurance Statement)
Publication reference: Public Board paper (BM/25/28(Pu))