NHS Cyber Security: How TTX and CISO-as-a-Service Strengthen Cyber Assurance

Cyber Security within NHS organisations is no longer viewed solely as a technical responsibility. Increasingly, NHS Cyber Security is recognised as a governance, leadership and assurance issue that requires clear ownership and ongoing oversight.

While technology remains essential, experience across NHS organisations shows that cyber security incidents are often shaped by poor decision-making, lack of escalation and accountability - not the absence of tools.

This is where NHS tabletop exercises and CISO-as-a-Service (CISOaaS) together play a critical role in strengthening cyber security assurance.

The role of tabletop exercises in NHS Cyber Security

Tabletop exercises are a core component of NHS cyber security preparedness, but their purpose is often misunderstood.

An NHS cyber security tabletop exercise does not test firewalls, monitoring tools or detection systems. Instead, it examines how an organisation would manage a cyber security incident in practice, focusing on:

• Decision-making under pressure
• Ownership of cyber security risk
• Escalation routes across teams
• Coordination between digital, IG, clinical and executive leadership

By simulating realistic scenarios, tabletop exercises help NHS organisations understand how their cyber security governance operates when time is constrained and information is incomplete.

This insight is difficult to achieve through policies, risk registers or compliance evidence alone.

What NHS organisations learn from tabletop exercises

Well-designed tabletop exercises consistently highlight themes that are central to NHS cyber security assurance, including:

• Unclear or assumed ownership of cyber security risk
• Escalation paths that exist on paper but not in practice
• Delays caused by uncertainty around decision authority
• Gaps between cyber security, IG and operational teams

Findings from such exercises provide clarity and for many NHS organisations, tabletop exercises are the most effective way to identify governance gaps. An essential step to highlight before a real cyber security incident forces those gaps into the open.

Why tabletop exercises alone are not enough

While tabletop exercises provide valuable insight, they represent a point-in-time view of cyber security preparedness.

A common challenge across NHS organisations is ensuring that actions identified during tabletop exercises are:

• Prioritised
• Owned
• Tracked
• Embedded into ongoing governance

Without sustained senior oversight, improvements can stall and assurance becomes fragmented. This is where many NHS organisations look beyond one-off exercises and towards continuous cyber security leadership.

CISOaaS for NHS organisations

CISOaaS provides NHS organisations with access to experienced cyber security leadership without the need for a full-time Chief Information Security Officer.

In the context of NHS Cyber Security, CISOaaS supports:

• Clear ownership of cyber security risk
• Alignment with DSPT, CAF and wider NHS frameworks
• Translation of technical risk into board-level insight
• Continuity between tabletop exercises, audits and incidents
• Consistent assurance reporting to senior leadership

Rather than focusing on individual activities, CISOaaS provides ongoing governance and accountability across the cyber security landscape.

How tabletop exercises and CISOaaS work together

NHS tabletop exercises and CISOaaS are most effective when used together. Tabletop exercises help NHS organisations understand how cyber security risk would be managed in reality whilst CISOaaS ensures that this understanding leads to sustained action and continuous assurance.

When utilised together, they enable NHS organisations to move from periodic testing towards a more mature, governed approach to Cyber Security - one that reflects operational reality rather than theoretical compliance.

Strengthening NHS cyber security assurance through clarity and ownership

Cyber security assurance within the NHS is built on clarity of roles, of escalation, and of accountability. Therefore, combining structured testing through tabletop exercises with ongoing cyber security leadership through CISOaaS, NHS organisations can strengthen cyber security governance, improve confidence at executive level, and reduce uncertainty long before an incident occurs. Supporting compliance aligned with NHS cyber security frameworks, and meaningful assurance that cyber security risk is actively managed and understood across the organisation.

Ultimately, effective NHS cyber security assurance is not achieved through isolated activities, but through clear ownership, informed leadership and sustained governance long before an incident occurs.

To explore how our CISOaaS service can support your organisation download our

CISOaaS Information Pack HERE

Or download our 

Table Top Exercises Information Pack HERE

Alternatively, you can contact our team for a confidential discussion HERE.