...paint the walls, ring the Lord Lieutenant, get the police in, involve the unions and call the press? Views of the monarchy may be changing, but the royal visit survives unchallenged. Barbara Millar reports
Almost 100 hospitals in the UK include royal, queen, prince or princess in their title, and dozens of NHS organisations will receive a royal visitor this year, just like any other year. This is at a time when research shows dwindling support for the royal family. A Guardian/ ICM poll published in August last year showed only 52 per cent of respondents thought Britain would be worse off without a royal family, compared with 70 per cent who held this belief in 1994. The poll also showed that 69 per cent considered the royal family out of touch with ordinary people.
And Modernising the Monarchy, a report published by the think tank Demos in September, called on the royal family to move beyond formal visits in order to demonstrate their support for public services. 'They should educate their children in state schools and use NHS hospitals,' it urged. Such action, it argued, would demonstrate 'their commitment to national life in a more powerful and real way than opening hospitals or museums'.
Meanwhile, however, royal visits continue in their traditional form. Such occasions require considerable advance planning by managers. So why bother?
'It's a nightmare to prepare - days and days of work - but worth every moment,' says Ray Rowden, visiting professor at the department of health studies, York University, and a former NHS manager who was involved in visits by the Queen Mother and Princess Margaret.
'Royal visits just give everybody a fantastic lift, and I do mean everybody. I never had any hostility from staff. But it's crucial to involve everyone - unions and porters - very early on. And I never allowed any special work like painting halls or corridors.' He believes many royals belie their formal image. 'Princess Margaret came to a nursing home in Lambeth and was an absolute blast. The visit was due to be 40 minutes and she stayed three hours and was brilliant with everyone, really fun.'
Not everyone shares his particular approach. Edmund McMahon-Turner, press officer for Moorfields Eye Hospital is preparing for a visit by the Queen in June, as part of the hospital's centenary celebrations.
'We will be doing some painting,' he says. But he adds that it is 'all part of routine maintenance'. It is just that the route the Queen will take will benefit from routine maintenance somewhat earlier than it might have done. (There is a story that one royal family member has commented that on almost every visit they make, the most powerful feature is the overwhelming smell of fresh paint.)
The Queen is patron of Moorfields and her visit marks 100 years since her grandfather opened the hospital on its present site. 'We have always had a strong royal link,' says Mr McMahon-Turner.
Royal diaries are planned up to two years in advance - and confirmed at least six months in advance - so the hospital sent in its request for a visit three years ago, sending a 'reminder' last year. The Queen's private office confirmed the arrangement a couple of months ago and told the hospital which date she would visit - 29 June. Buckingham Palace also said how long she would stay - an hour and a half, which is a long time for a royal visit. She will not eat at the hospital - royals rarely stay long enough to have more than a cup of tea - and will leave at 12.30pm.
Official guidance on planning royal visits requires that any request for a visit remains confidential until a formal announcement is made by the royal household, the menu is submitted for approval if a main meal is to be included, and the wording of any plaque is approved. The guidance also advises that the royal party should be as small as possible when touring the establishment.
'We are now putting the programme together,' says Mr McMahon-Turner. 'We will send it to the Palace, they will make suggestions and we will amend it accordingly.' The Palace will also send an official to walk the route two or three months in advance 'to check the timings and see if the programme works', he adds. 'At a later date the police will also be involved and will co-ordinate with the Palace on security arrangements.'
Planning the visit will take up much of Mr McMahon-Turner's time. 'But the Queen is worth it,' he says. 'I did a little survey of staff, asking them what they thought of the ideas I was putting forward to celebrate our centenary. A visit by the Queen attracted 80 per cent support, coming a close second to the suggestion for a staff party. The staff are very keen and the patients like it.'
The Queen is also patron of the Queen Elizabeth Hospital in King's Lynn, just down the road from her Norfolk estate at Sandringham. So, when the King's Lynn and Wisbech Royal Hospitals trust was planning to open a new day surgery centre 'it was felt appropriate' to ask the Queen to attend, says trust chief executive Richard Venning.
The trust approached the Palace 'a long time in advance' and the Palace offered a date that suited the Queen's itinerary - 18 January 1999 (she had scheduled a visit to Campbells Soups in King's Lynn the same day). 'You have to start thinking about such a visit early and be prepared to be flexible about dates,' Mr Venning advises.
The idea of inviting the Queen first surfaced at a trust board meeting. 'A few years ago, the Queen had toured the hospital and there was a feeling that this had been a very nice event,' he says. 'It gets recognition for the staff, it is nice for patients and good for the local community.'
Although a royal visit is clearly not part of a hospital's normal routine, the Palace tries to ensure minimal disruption, says Mr Venning. 'We carried on doing operations in the day surgery centre. We finished the morning list a bit earlier and delayed the start of the afternoon list but the Queen was able to see patients shortly after they had come out of theatre and she met the friends and relatives who were visiting them.'
As many staff, patients and relatives as possible met the Queen. 'In particular, we made sure our staff - not just the consultants but junior doctors, nurses and all the other staff who provide services for our patients - met the royal visitor to explain what they do. The board members and I were on hand but, if there is to be real understanding of the work we do, the royal visitor needs to have direct exposure to those who do it.'
With Balmoral castle a stone's throw away, the Aberdeen Royal Hospitals trust gets its fair share of royal visits - scheduled and unscheduled. Planned visits are normally arranged in the first instance through the office of the Lord Provost (Lord Lieutenant), explains Alan Reid, the trust's director of corporate communications.
'You can ask for a specific member of the royal family, or a relatively new unit attached to the Queen's private office can steer you in the direction of a family member who has a particular interest in a relevant healthcare issue or area. It may also be appropriate for a royal who is going to be in Aberdeen for other reasons around the date you have suggested to attend.' The programme should be co-ordinated through one department, says Mr Reid. 'Of course we talk to many people in setting up the visit, but you can't have too many bosses involved or it will all go wrong.'
These days there are rarely any special requests from the royals. 'Years ago you would have to supply a specific brand of tea, for instance, but all that is less important now,' he says. 'Princess Anne has had a coffee at the trust, Princess Margaret once took lunch here, but providing meals is a rarity.'
There are lots of positive reasons why royal visitors are important, he adds. 'There is a sense of occasion, a break in routine, a boost for morale, of course, and lots of good press coverage. We make sure as many staff as possible know the route the royal visitor will take so that people can take a quick tea break and see them. People like to feel that what they are doing is important enough for a member of the royal family to come and take a look, and the royals are so good at these things - they go on to a ward and shake hands and chat to every single person there. They are real professionals.'
It is important to work closely with the local police, with Special Branch officers locally and with the Royalty Protection Group in London, he adds. 'They all pay a number of visits and walk the route. A search team from the local police checks out the entire route the day before or on the morning of a visit. They work with us. They know we are a working hospital and can't just shut the front door.'
Official line-ups of people to be presented to the royal visitor are kept as short as possible. 'They really want to meet as many patients and staff as possible. But the secret of a successful royal visit is to make sure everyone has an absolutely clear idea of exactly what is expected of them on the day,' he says.
In the past five years the trust has hosted visits by the Queen, Princess Margaret, Princess Anne - twice - the Duchess of Kent and the Prince and late Princess of Wales, together and separately.
So what are the benefits of royal patronage? Many say a visit brings a boost to an institution, and note how well-informed royal visitors are. June Andrews, Scottish secretary of the Royal College of Nursing, says: 'Before I met the Queen at an RCN event I was very sceptical about the value of the royals. But she was lovely. She asked me a lot of challenging questions which really stretched me - it was like a viva. She was interested and aware. People who have had anything to do with them find it hard not to be charmed by them and grateful for the money they can bring in.'
Donald McNeill, secretary of the Scottish Institute of Health Services Management, says: 'I am a bit of a Scottish nationalist myself, but when I was a health service manager we had two royal visits and I have to say the patients loved them and the nursing staff went gaga. And as a manager I was able to prise money from various sources to get corridors painted.'
There was only one royal who could open the Prince Philip Hospital in Llanelli - Prince Philip - and he did so in 1991. But the last royal visitor was the Duke of Gloucester, who spent 30 minutes there in March 1998, during a visit to the town. Sir David Mansel Evans, Lord Lieutenant of Dyfed, a friend of the then chair of Llanelli/Dinefwr trust, asked whether the hospital would like a visit if he could arrange time in the Duke's itinerary, explains Delyth Edwards, the trust's corporate services manager.
The programme sent to the Duke's office included a biography item on everyone he was due to meet. Although his time was short, he managed to take in the MRI scanner and the day unit 'and had clearly read all the background information we had sent to him', Ms Edwards says. He 'whizzed round... I have never seen so many security officers and policemen descend in one fell swoop'.
Ms Edwards adds: 'It certainly produced some positive PR for the hospital and costs were negligible, just a few floral arrangements to brighten up the entrance.'