HSJ 's Management Challenge gave contestants a vivid insight into the demands of their jobs - and one vowed to be nice to the city council for the rest of her life.Tash Shifrin was there

It is probably some time between the announcement of a£15m deficit and a psychiatric patient opening up with a handgun in the council offices that the thought of a G&T occurs.

Gin, cuddly toys, in-trays, gin, fresh air, a nine-month-old baby and, er, a bottle of gin were nominated by contestants on HSJ 's Management Challenge as the items they would most like to have brought with them - but didn't.

The one-day simulation, run with Birmingham University's health services management centre and sponsored by pharmaceutical company Pfizer, put 50 teams through the mill, forcing them to come up with strategies for their local health economies under the watchful - some might say vengeful - guidance of their regional offices.

Many teams had come prepared, with some turning up hours before the event to set up shop. Rumours that extra-keen health service managers had spent the night camping out on the pavement proved unfounded, but a distinct air of 'more kit than thou' was noticeable in some quarters.

Attractive logos and slogans of the mildly cliched kind - 'empowering through partnership', 'partnership for the future' - were soon on display, and the enthusiastic rustle of flipcharts filled the Clarendon Suites, Birmingham.

The teams - grouped in clusters of a health authority, an acute trust, a primary care trust, a community mental health trust and a city council - were expected to work in partnership, pushing ahead with a joint strategy in the face of deficits, gunmen, racial harassment allegations, greedy developers and not entirely helpful enquiries from the press. And, of course, there was a teensy bit of tension between the partners, too.

Of course, regional offices are always helpful with such matters, we know.

The challenge's own 'regional officers' doubled as assessors, judging the teams' strategic, partnership, creativity and teamworking skills, by calling them in for regular progress reports.

The odd prime ministerial visit was also thrown in, just to keep the contestants on the hop.

'The only way to survive is communication, being flexible, understanding each other's agendas and working together, ' said assessor Hugh Ross, in real-life chief executive of United Bristol Healthcare trust. He felt teams would gain through sharing 'knowledge across a range of health service - and even local government - issues.'

But his teams had told him they most enjoyed 'being a different person, doing a different job, in a different organisation and thinking outside their boxes', he said.

'I will never, ever ignore the city council again for the rest of my life, ' pledged one exhausted health service manager, profoundly grateful for the end of her day's stint as a local government officer.'Now I know what social services go through, ' added a colleague.

The introduction of the city council role was a new feature of this year's challenge, and 'a really useful move', according to lead assessor Dr Kieran Walshe, a senior fellow at the health services management centre.

Despite this added dimension, teams had shown an improvement on last year in joint working. 'We've been impressed at how quickly they've moved to partnership, ' he said, as the more competent time-managers snatched a lunch-break.

Dr Walshe also praised 'how well they've got to grips with the real issue of strategy', adding: 'They've maintained their own agendas, despite the battering of events.'

But former Bromley health authority chief executive Claire Perry - now seconded as project director to modernise professional self-regulation for nurses - said the event had demonstrated that it was 'very, very easy to be dominated by financial pressures'.

Teams in the cluster she assessed 'had to fight a lot to get some perspective', she added.

One team that got to grips with a new perspective for the day was Birmingham Heartlands and Solihull trust's team B, winners of the outstanding performance award. They had 'prepared extremely carefully', the judges said, and had 'thought themselves into the role' of a city council. They also 'worked well as a team, with an excellent presentation' and 'their communication was excellent'.

And they won plaudits from Northfield primary care group - winners of the award for creativity - who in their own Oscars-style acceptance speech said: 'We couldn't have done it without the 'city council'.'

The two teams had shown the type of collaboration assessors were looking for.

Judges said the Northfield team - playing the role of the community and mental health trust - had 'scored an emotional hit'when they invited the 'city council' to co-present, in the final debriefing by the regional office.

They had also 'followed alternative ideas on how to use resources' and, faced with an uncertain future as a community and mental health trust, 'had managed to reinvent themselves' by applying for PCT status.

The teamworking award was designed to reward a team that worked well and efficiently together, 'not some kind of homogeneous octopus'with all its members turning up together to every meeting with outside bodies.

The winners, who may have surprised themselves, were the team from Birmingham HA, whose members were only confirmed at 4pm on the day before the challenge.

Andrew Moody of Sparkbrook PCG explained that the combination of PCG, HA and community trust managers drawn together at the last moment 'had a mixture of experience that helped us through the problems that came up'.

'We coped with the pressures as they arose, changing in midstream when our original idea was thrown out by the regional office.'

The strain of maintaining standards over a period of time, despite setbacks, had clearly begun to tell on contestants.

The judges spotted 'a marked difference between performance in the morning and performance in the afternoon'. So no resemblance to the real-life NHS there, then.

The group of teams that collectively won the partnership working award had overcome this problem.They won praise for supporting each other through the gruelling event. 'When one fell away, others came forward, ' the assessors found.

Team spirit of a different kind materialised after the official awards ceremony when teams in one cluster presented each other with alternative prizes for 'scary health authority', 'nearly commended' and 'completely ignored'.

As tired contestants took to the dancefloor after a day described by one as 'very quick, very stressful, fun, frustrating, taxing and challenging, a good day and a good learning experience', assessor Mr Ross hit on the item he wou ld have packed for them , but d idn't.'I'd have brought them a substantial waiting-list problem.'

Never mind, there's sure to be one back in the real world.

Those winners in full

Outstanding performance: Birmingham Heartlands and Solihull trust team B

Creativity: Northfield primary care group

Teamwork: Birmingham health authority

Communications and public relations: Winchester and Eastleigh Healthcare trust

Working in partnership: Nottingham Healthcare trust Battersea PCG London Ambulance Service East Sussex, Brighton and Hove health authority Bro Morgannwg trust

Holding the hacks at bay

There's nothing like having the local paper ring up to harass you just when you're dealing with a crisis and the regional office wants you on the other phone right now.

Except, perhaps, having HSJ staff pretending to be your local paper harassing you - and assessing your performance at the same time.

To be in with a chance of winning the communications and public relations award, teams had to make sure they were proactive, clear and succinct, and politically sensitive.

But the judges felt most teams had 'a lot to learn'.They ranged from 'the totally reticent' to the 'relentlessly communicative, papering the town with press releases on vision statements' that had no chance of appearing in print.

And, strangely enough, assessors playing the part of regional officers noted that teams seemed rather reluctant to keep them informed.

The award winners, from Winchester and Eastleigh Healthcare trust, had avoided these pitfalls.Their 'almost flawless' communications were 'very good at getting the language and tone exactly right'.

The judges noted : 'Every answer had practical examples of what it wou ld mean for local people.'