Published: 24/03/2005, Volume II5, No. 5947 Page 26 27

Ah, the joys of a general election. Are you ready to cope with the 'lights, camera, action' of smiling MPs and the use of the health service as a political football? HSJ's expert panel is here to help

SIMON STEVENS Former health adviser to the prime minister and health secretary

do not dump on opposition policy and do not undermine government policy. Allow visits and keep local controversy to a minimum, in line with Cabinet Office/Department of Health election guidance.

While comment is unwise, facts are important. Come out fighting if someone claims local services are getting worse when they are improving.

Avoid surveys and pre-recorded interviews (your nuances will end up on the cutting room floor). Beware the tendency of papers such as the Daily Mail and, sadly, The Guardian to twist the reality of your hospital or primary care trust to fit their editorial antagonism to the government.

Act fast. Does your switchboard know how - and when - to contact you and your medical and nursing directors 24/7? You have perhaps an hour to produce a factual media response, not overnight. Keep the DoH in the loop as It is happening.

In some ways It is business as usual, but unpredictable things happen. Take 16 May 2001: Tony Blair launched the manifesto with a row about private treatment centres, Sharron Storer declared University Hospital Birmingham useless and John Prescott punched someone.

NOEL PLUMRIDGE Former NHS trust finance director

The culture of NHS managers sometimes assumes aloofness at election times. While the politicians play their games, we soldier on. But do not be fooled: all around you, people are politically active.

During the 1983 election, productivity in our office stuttered and at one point halted. Most of the younger staff - good, liberal public sector workers - were overtly hostile to Margaret Thatcher's government after four years of factory closures, rioting and the rally-round-the-flag patriotism of the Falklands War.

Every night they were out on the doorstep.

They were exhausted. Concentrate on the budget? They could barely stay awake. And when it was all over and There is No Alternative (TINA to her friends) was safely back in Downing Street, the chief accountant needed leadership skills that are not found in textbooks.

Serious politics happens at board level too, of course. Chairs feel particularly vulnerable, though in the NHS it is rare for them to go with unseemly haste. In local authorities, however, elections are brutal. Key members disappear overnight, and associated senior officers start taking an urgent interest in the job ads.

DR NEIL GOODWIN Chief executive, Greater Manchester strategic health authority

Two aspects of the NHS come to the fore at election time: It is a politically driven system, and healthcare facilities are a manifestation of the reason we pay taxes.

The dilemma for managers is if they pursue high-profile public initiatives such as consultations about major change, they risk influencing the way people vote and, consequently, the election outcome.

That is why managers are asked to maintain a low profile.

Although planning can continue, proposals for change should not be launched publicly until after the election.

In any case, the election outcome may influence the proposal. Changes to the majorities of re-elected politicians or the election of different parties and personalities are likely to require reassessment of plans.

Elections often see 'bureaucratic' NHS management becoming fair game for political parties, but do not take it personally.

Many managers compare elections to firework displays: noisy and flashy, but essentially timelimited events that are best observed from a safe distance in the knowledge that normal life is soon resumed.

NICK SAMUELS Director of communications, Barnet and Chase Farm Hospitals trust

It is like listening out for the doodlebug. You know It is coming; you just pray it flies by and hits someone else.

The parties will not be banking on the abolition of strategic health authorities or the benefits of practice-based commissioning to get elected. They will focus on pain, suffering, waiting and death inflicted or avoided by the marvellous or decrepit NHS.

Debate will revolve around a few misfortunes that come to define the issues. The war of Jennifer's ear in 1992 or Sharron Storer almost a decade later focused the nation's attention. We have already had Margaret Dixon's shoulder and it could happen again.

Your fate is probably already sealed. The parties have been trawling the country for individuals to talk about their dreadful or fantastic experiences. The case histories are already researched, consent obtained, press releases finalised and pictures posed and taken.

The key to survival is invisibility.

For four weeks you do not want people to remember you. Eliminate any uncertainties - no developments, no decisions, no discussions. Get lost in the crowd.

Weaklings and overachievers are always noticed first.

When the doodlebug does crash on you, rapid damage limitation is essential. If something needs owning up to, do it quickly and without qualification. Keep your health economy and SHA closely briefed and ensure there are no further surprises.

EDNA ROBINSON Chair, National Primary Care Networks

Tidy up the waiting rooms, bring in Hello! magazine from home, sweep the fag ends from the entrance and get ready for the MPs.

Scan the manifestos. If you want to know about management costs, look for a section with the heading 'cuts and reductions'.

Put photo opportunities their way: wheel in staff in uniforms and babies in bandages, but make sure There is not a manager in sight.

Be ready to hear about staff that are 'national jewels', but do not dare ask questions about budgets or structures. Be prepared to look inspired and enthusiastic.

Remember, no matter how unlikely it may seem today, they could be your new bosses by May.

Have a team ready to respond to their election teams' request about how many more or how many less you may have achieved or missed.

The questions will be set according to the mischievous plot of the day.

Remember the general message, that all parties want to put clinicians in charge and communities in control and then will spend most of their term of office back-tracking.

In particular, be ready for a visit from the leaders, so get your best suit to the dry cleaners. But remember only the professional executive committee chair will get in the pictures.

And you could always run a book on the next health secretary - you need a good laugh.

KEN JARROLD Chief executive, County Durham and Tees Valley strategic health authority

Elections are useful because they remind NHS managers of three things, and managers who remember them will cope with the campaign.

First, we are public servants.

Ministers are our bosses and they set the agenda. As long as we take the Queen's shilling we are there to implement the policy of the democratically elected government, whatever our personal views.

Second, remember that the purpose of elections is to choose a new government and that oppositions become governments and governments become oppositions. When governments are in power for a long time, some managers get too close to the ministers. It happened in the late 1980s, early '90s and it is happening again now. We are not employed to serve a political party.

Third, remember that you are a citizen with the right to vote, be a councillor and stand for parliament.

Be an active citizen. You do get a say in choosing your boss.

CLARE AUSTIN Communications consultant and former communications director, University Hospital Birmingham foundation trust

Politicians of all shapes and sizes will crawl out of the woodwork wanting to kiss babies and visit hospitals, but how much do you have to accommodate them?

First, you do not have to let politicians in. Will their visit benefit you, your patients and staff? If the answer is no, say no.

If you decide to let them in, remember that you must be fair and allow politicians equal access whether they are Labour, Lib Dems, Conservatives or Yogic Fliers - you can't just accept the chairman's chums.

What do they want from you?

Politicians in power are looking for good news about the health service while the opposition want bad.

They all want publicity and the journalists with them will be looking for controversy. If you're in a marginal seat, you could be in for a rough ride.

You must dictate your terms. Be in charge of where they can go, what they see and who they meet.

Take responsibility for media liaison - you know your own territory, where the pitfalls are and what you do not want journalists to see.