Crisis simulation exercises for ICBs and Trusts: Why they work

In today’s NHS environment, reputational resilience is just as critical as clinical excellence. Integrated Care Boards (ICBs) and Trusts operate under intense public scrutiny, where one misjudged communication or delayed response can spiral into a full-scale crisis within hours. Over the years, I’ve seen that the most reputationally robust organisations aren’t necessarily the ones that avoid crises, but those that prepare for them through crisis simulation exercises.

These exercises, sometimes called “war games,” “tabletop simulations,” or “crisis drills”, are not box-ticking exercises. They are an essential part of building operational and reputational resilience, ensuring that when a crisis hits, your team knows what to do, who to contact, and how to communicate calmly and consistently.

In this blog, I’ll explore why crisis simulations work, what makes them effective for NHS ICBs and Trusts, and how to make them part of your annual communications and governance strategy.

Why crisis simulations matter for NHS organisations

The NHS is a complex ecosystem of stakeholders - patients, clinicians, media, regulators, local authorities, and community partners. When something goes wrong, whether it’s a clinical incident, data breach, or workforce issue, it rarely stays internal for long.

A crisis simulation allows an ICB or Trust to experience the stress and unpredictability of a real-world event in a controlled environment. It helps reveal weaknesses in communication processes, command structures, and media handling, before those weaknesses are exposed publicly.

Unlike classroom training, simulation exercises test how teams respond under pressure. They uncover not just what people know, but how they behave when the stakes feel real. For communications and PR teams, they provide the opportunity to practice coordination with operational leads, executive directors, and clinicians — ensuring that messaging remains accurate, transparent, and timely.

The strategic benefits of crisis simulations

1. Building confidence and muscle memory

When a real crisis occurs, adrenaline takes over. People revert to what they’ve practiced. By running regular crisis communications simulations, you give teams the chance to rehearse responses in a realistic setting. This builds confidence and muscle memory, so that when the real thing happens, everyone knows their role instinctively.

2. Identifying gaps in systems and processes

No crisis plan is perfect. Simulations reveal the blind spots, missing contact details, unclear sign-off chains, or outdated statements. It’s better to find those gaps in a training room than under the glare of national media.

3. Strengthening Relationships Between Teams

Crises cut across silos. Communications, governance, HR, and clinical leadership all play a role. A well-run simulation brings those functions together, helping everyone understand each other’s pressures and priorities. The result is a stronger, more unified response when it matters most.

4. Improving decision-making under pressure

Good crisis management depends on timely and proportionate decisions. Simulations train leaders to assess risk, prioritise information, and make calls quickly, without waiting for perfect data. It’s a valuable rehearsal for the kind of ambiguity that defines real crises.

5. Protecting reputation and public trust

Every NHS organisation is built on trust. A poor response to a crisis, even one handled clinically well, can damage that trust for years. By running crisis simulations, Trusts and ICBs demonstrate to stakeholders, regulators, and the public that they take accountability and transparency seriously.

What a Good Crisis Simulation Looks Like

A good simulation is part art, part science. It should be realistic enough to create urgency, but structured enough to allow reflection and learning.

Here’s how I typically structure a crisis communications simulation for healthcare clients:

1. Scenario Design

The scenario must feel real, based on genuine organisational risks such as data breaches, safeguarding incidents, clinical errors, or reputational issues linked to media stories. The best exercises use evolving storylines with emails, mock tweets, or fake media calls to simulate the pace of a real event.

2. Defined roles and objectives

Participants should play their actual roles - Communications Leads, Executives, Governance, HR, Clinical Directors - with clear objectives. Who authorises a statement? Who contacts NHS England or the ICB? Who fronts media interviews? This helps test real decision-making processes.

3. Time pressure and realistic inputs

Injecting time constraints is crucial. In reality, crises don’t wait for your next team meeting. Simulations should include a fast flow of new information, stakeholder reactions, and mock journalist queries to mirror the chaos of real life.

4. Media and Digital Components

A key part of crisis response today is digital reputation. Include simulated social media activity, fake headlines, or broadcast clips. Practising how to monitor sentiment and respond calmly under digital fire can make the difference between containment and escalation.

5. Debrief and learning

The real value of a simulation lies in the debrief. After the exercise, teams review what went well, what didn’t, and what needs to change. This stage often leads to updated playbooks, clarified responsibilities, and renewed investment in training or media coaching.

Common Mistakes I See in NHS Crisis Simulations

While many organisations understand the importance of simulations, not all get them right.

Here are some common pitfalls:

• Too theoretical: Some exercises stay at a discussion level rather than simulating real decisions. It’s vital that participants feel the heat.

• No follow-up: Running a simulation is pointless without a clear action plan afterwards.

• Limited attendance: Crises don’t just affect comms teams. Senior executives, clinicians, and even estates or IT should be involved.

• No digital component: Ignoring social media and online news is a major oversight.

• Too predictable: Rehearsing the same scenario every year breeds complacency. Keep it fresh and surprising.

Making crisis simulations a core part of governance

For ICBs and Trusts, crisis management isn’t just a communications issue, it’s a governance and assurance priority. Regulators, media, and the public expect organisations to show preparedness. Integrating simulation exercises into board-level risk and reputation management processes demonstrates proactive leadership.

The Care Quality Commission (CQC) increasingly assesses how well organisations learn from incidents and maintain communication with patients and stakeholders. Regular simulations feed directly into that culture of learning and transparency.

It’s also worth linking simulations to strategic OKRs or KPIs. For example, “Improve organisational readiness for reputational incidents by conducting two multi-agency crisis exercises annually.” Doing so embeds crisis readiness into the DNA of the organisation.

The role of PR and communications consultancies

Partnering with an external PR consultancy like Grey Sergeant brings objectivity and realism. As a consultant, I often design and facilitate simulations that mirror real-world media dynamics, from breaking-news tweets to journalist requests for comment. Because we’re not part of the internal hierarchy, we can challenge assumptions, push for realism, and create that necessary discomfort that drives growth.

We also help clients translate lessons from simulations into practical communications frameworks, refining escalation routes, preparing reactive statements, and training spokespeople. In other words, the exercise becomes a living system of improvement, not a one-off event.

Why crisis simulations should be an annual priority

For ICBs and Trusts navigating a challenging media and political environment, annual crisis simulations are not optional, they’re essential. They align with the NHS’s broader shift toward system-wide resilience, inter-organisational collaboration, and transparency.

By running these exercises regularly, leadership teams can:

• Strengthen their communications governance

• Build trust across the ICS and local communities

• Demonstrate accountability and readiness

• Protect reputation during challenging moments

In short, crisis simulations aren’t about fear, they’re about empowerment. They allow teams to respond confidently, communicate clearly, and recover faster when the unexpected happens.

Final Thought

The NHS is one of the most trusted brands in the UK, but trust can be fragile. Crisis simulations remind us that good reputations aren’t maintained by luck, they’re maintained by preparation, teamwork, and honesty. Whether you’re part of an ICB, Trust, or GP Federation, now is the time to invest in the one exercise that can make all the difference when it really counts.

About the author

Michael O’Connor is a partner at Grey Sergeant, specialising in PR, communications, and engagement across the healthcare and non-profit sectors. Through his consultancy Grey Sergeant, he helps primary care networks, GP surgeries, and healthcare organisations define their brand, strengthen their reputation, and communicate with clarity. For more information, contact michael.oconnor@greysergeant.com