Command and Control at Scale: Full-Scale BC Exercises for an NHS Mental Health Trust
Sector: Healthcare — NHS Mental Health | Scope: BC plan development, progressive exercise programme, command post exercises | Outcome: Organisation-wide resilience tested at scale across multiple sites
Most business continuity exercises involve a room, a table, and a facilitator working through a scenario with a management team. They are valuable, proportionate, and appropriate for most organisations most of the time.
Some organisations need something more.
Cambridge Risk Solutions worked with an NHS mental health trust over an extended period to develop business continuity plans and then test them through a progressive programme of exercises that culminated in two full-scale command post exercises — among the most demanding and logistically complex exercises Cambridge Risk Solutions has delivered.
Building to Scale
The engagement began with plan development: working with the trust to build BC arrangements that reflected the specific operational realities of a mental health setting, where continuity of care for vulnerable patients sits at the centre of every recovery decision. From that foundation, an exercise programme was developed that built capability progressively — starting with smaller, more contained exercises for individual teams and departments before scaling up to test the full command structure.
The Command Post Exercises
The full-scale exercises brought together 90 to 100 participants across the organisation — bronze-level teams representing each of the trust’s departments and sites, coordinating with a central silver command team. Communications ran across telephone and email, with a dedicated injects cell responsible for feeding new information and complications into the exercise as it developed.
The injects cell deserves particular mention. Trained by Cambridge Risk Solutions ahead of the exercise, they approached the role with an enthusiasm that made the scenarios genuinely dynamic and challenging. The main events log — the detailed script that governed the flow of the exercise — managed the timing and sequencing of injects across multiple teams simultaneously while maintaining the internal coherence of the scenario.
Coordinating an exercise at that scale, across that many participants, in real time, requires a different discipline from a standard tabletop. The logistics of keeping bronze teams working on their own problems while silver command deals with the information coming up from them — and the injects cell introduces new complications at the right moments — is a genuine facilitation challenge. Getting it right produces an experience that is as close to a real incident as most organisations will ever want to get.
The Outcome
The exercises produced substantive findings across all levels of the command structure — actions for individual teams, improvements to the plan, and recommendations for how future exercises should develop the capability further. The trust left with a tested, evidenced understanding of how its command arrangements functioned under pressure, and where the gaps were.
The engagement ended when the trust’s internal lead retired — a familiar marker of long-term consultancy relationships, and a reminder that embedding capability internally, rather than in a single individual, is always worth the investment.