The NHS was and always has been a trusted anchor in a time of national uncertainty, but it wasn't without its failings when the pandemic eventually hit.
As lockdown measures came into force, the NHS was ill-prepared in a number of different areas, contending with widespread staff vacancies, outdated facilities and a shortage of personal protective equipment to name but a few.
Even as the NHS continues to recover from Covid, there have been repeated warnings from the World Health Organisation (WHO) that a future global pandemic is a question of when, not if, and has cautioned against complacency.
In response to this threat, NHS England and the Department for Health and Social Care (DHSC) have been proactive in laying the foundations to strengthen the NHS's resolve in the face of a future Covid style pandemic.
Exercise Pegasus, the biggest national pandemic exercise in UK history, took place this autumn to provide an assessment of government's preparedness, capabilities and response arrangements in the context of a pandemic arising from a novel infectious disease.
At healthcare provider level, Emergency Preparedness, Resilience and Response (EPRR) boards and committees too have been proactive in creating pandemic plans to outline local resilience forum protocols and the like.
While preparing for a future pandemic is absolutely crucial, government is also encouraging and supporting the health service to bolster its resilience to a range of different threats in-line with a programme of work being led by the Cabinet Office.
The UK Government Resilience Action Plan, published earlier this year, lays out government's strategic approach to preparing for and mitigating the impacts of future anticipated and unanticipated threats, from cyber security attacks and adverse weather events to power cuts and terrorism.
At the heart of this agenda is developing a ‘whole of society approach' to resilience that seeks to eradicate the single points of failure in the systems and environments that are fundamental to our daily lives. The thinking behind this is that by embedding resilience in all facets of society, it will enable UK as a whole to adapt and respond when disruptions and threats arise.
Few things are more fundamental to our daily lives than the NHS of course. And yet, despite this, a variety of incidents in recent times highlight persistent vulnerabilities in day-to-day operations across primary and secondary care.
Last year a cyberattack on a pathology lab in London delayed over 10,000 outpatient visits and 1,700 elective procedures. A recent global IT outage disrupted systems including EMIS Web for primary care and Lorenzo patient records across multiple trusts. Just a few months ago, there were shortages of vital healthcare equipment across England following the collapse of a major supplier.
Under the Civil Contingencies Act 2004 and the Health and Care Act 2022, NHS organisations have a statutory obligation to put in place emergency preparedness, resilience and response plans and resources. However, it seems they are increasingly under strain, considering the findings of the most recent NHS England EPRR report, which found that 217 EPRR incidents were declared in 2024/25, up from 131 the previous year.
Emergency preparedness has always been a key priority for the NHS, but it seems the risks and threats healthcare providers face are becoming increasingly complex. The report highlights how disruptive incidents are becoming more frequent and are often impacting multiple services and systems simultaneously. That being so, it is recommended that EPRR plans receive a dry run first, as it's one thing to meet EPRR core standards in theory, it's another to put them into practice.
Scenario-based assessments can be a good way of testing healthcare providers' EPRR plans, giving the chance to test, learn and adapt before the next disruption hits, and building resilience where it matters most. However, NHS England's annual EPRR report does raise concerns about persistent challenges in evaluating plans, with resource limitations and operational pressures reducing organisations' capacity to deliver EPRR training and exercises.
As winter pressures intensify and disruptions to services become increasingly likely, the findings of the Covid Inquiry underscore the critical importance of emergency preparedness in an increasingly complex and uncertain world.
Of course, emergency plans alone cannot cover every eventuality, investing in adaptive capacity at a system level and regularly assessing how prepared teams are, does offer a way of strengthening operational resilience over time.
