Pre-election guidance for NHS organisations Spring 2023

When and where are elections happening?

Elections are scheduled to take place in England on Thursday 4 May 2023.

These are:

  • District council elections
  • Unitary council elections
  • Metropolitan district elections
  • Local and Combined Authority Mayoral elections

A complete list of all elections and where they are held is published by the Electoral Commission.

We are therefore reissuing the standard election guidance as follows:

What is the pre-election period?

The pre-election period, previously referred to as ‘purdah’ and sometimes known as the ‘period of sensitivity’, is the period of time immediately before elections or referendums. During this time, specific restrictions are placed on the use of public resources and the communication activities of public bodies, civil servants and local government officials.

The pre-election period is designed to avoid the actions of public bodies distracting from or having influence on election campaigns.

The pre-election period has implications for all NHS organisations, although it is worth remembering that the NHS should remain politically impartial at all times.

When does it start?

The exact start of the pre-election period in your area is determined by when the local authority in question formally declares it. Typically, this will be six weeks before the election. The latest the pre-election period could begin in local areas where there are local elections (ie the latest date at which an election can be declared) is Monday 27 March 2023.

The convention observed by national organisations is different to those observed locally. For national organisations the pre-election period begins three weeks before the scheduled local elections. Therefore, restrictions on NHS England and other arm’s length bodies (ALBs) will begin on Thursday 13 April 2023.

Key considerations

You will want to ensure your organisation is acting and being seen to act impartially towards all candidates and political parties, and not seen to be influencing the election and its outcomes, even inadvertently.

Remember, not publishing information can be just as influential as publishing it.

The Cabinet Office has issued guidance ‘May 2023 Elections: guidance on conduct for civil servants‘, which will also apply to NHS England and other ALBs.

The guidance does not formally apply directly to local NHS organisations, but you are strongly encouraged to abide by its principles.

Local organisations should adhere to processes and restrictions in place due to the national Emergency preparedness, resilience and response (EPRR) incident level.

During the pre-election period, there should be:

  • no new announcements of policy or strategy
  • no announcements on large and/or contentious procurement contracts
  • no participation by NHS representatives in debates and events that may be politically controversial, whether at national or local level.

These restrictions apply in all cases other than where postponement would be detrimental to the effective running of the local NHS, or wasteful of public money.

Communications activities necessary for operational delivery purposes should continue as normal.

NHS organisations and staff should continue to adhere to any Government restrictions and/or public health advice implemented to control COVID-19 or other infectious diseases.

You should consider:

  • Requests for information: These should always be handled in an impartial manner so that information is made available to all candidates. Information should be factual, and candidates should be responded to in a timely manner.
  • Briefing MPs and ministers: These should be handled as per the usual process, ensuring any information shared is factual.
  • Consultations: No consultations should be launched during the pre-election period unless they are considered essential. Ongoing consultations should continue but should not be promoted. Consultation periods can be extended if it is expected that the pre-election period will impact negatively on the quality of the consultation. Consultation responses should not be published until after the pre-election period comes to an end.
  • Media handling: Avoid proactive media work on issues that may be contentious. Reactive lines should be factual and where possible, in line with previous lines.
  • Events: Avoid attending events where you may be asked to respond to questions about policy or on matters of public controversy. This may mean withdrawing from previously agreed engagements.
  • Visits from politicians: The decision to host visits is at your discretion. The same approach must be applied to all visit requests from candidates/parties to avoid any question of bias. Any visits should not interfere with the day to day running of your service and you should be mindful of patient privacy and dignity.
  • Social media and web: Nothing contentious should be posted on your website or social media accounts. Updates/posts, including blogs, should only convey essential factual information.
  • Campaigns: Do not undertake major publicity campaigns unless time critical (ie a public health emergency).
  • Board meetings: Board meetings should be confined to discussing matters that need a board decision or require board oversight. Public board discussions on matters of future strategy should be deferred.
  • Appointments of board members and non-executive directors: Appointments can continue as per the usual process unless you are concerned appointments may flare up local political sensitivities, in which case, you may wish to postpone until after the elections. Exercise sensitivity over the timing of any announcements.
  • Foundation trust governor elections: There is nothing to prevent foundation trust governor elections taking place. As above, exercise caution if there are concerns these may become political. Again, any announcements should be carefully considered during this period.
  • Marketing: Printed materials, such as posters and leaflets, promoting contentious policy or proposed policy should not be given fresh circulation, but can be retained and issued in small numbers on request. Films and other media produced by the NHS, including the NHS logo, should not be made available for use by candidates/parties.
  • Staff activism: NHS employees are free to undertake political activism in a personal capacity but should not involve their organisation or create the impression of their organisation’s involvement or endorsement.

Contact details

Please contact the NHS England External Affairs team on for further advice, with the subject “Pre-election period guidance” at the start of the subject line