“We both know that the only way Monitor will pass us is if we treat a lot fewer patients, with even fewer staff and minimal kit”

To: Don Wise

From: Paul Servant

Re: Heroic failure

Dear Don,

This pipeline business is getting a little bit annoying. We’ve now been asked for our absolute drop-dead date for FT application. This will be our 27th line in the sand which we threaten our staff, patients and communities with, telling them it’s curtains for the trust if we don’t do it by then.

They have shrewdly worked out over the last 10 years and seven management teams that it is curtains for us execs when we fail, and that doesn’t seem to trouble them too much.

We both know that the only way Monitor will pass us is if we treat a lot fewer patients, with even fewer staff and minimal kit. This is the QIPP (Quite Improbable Progressive Programme) as tick-boxed with all our stakeholders to keep them happy.

This is our catch 22. The plan is mad, but if it wasn’t it wouldn’t be an approved plan. If we please the authorities and deliver QIPP we’ll be strung up outside the town hall, and if we don’t deliver it our managerial careers will be consigned to oblivion.

There is only one answer. We need to be heroic failures, such that the public overwhelmingly make it politically impossible for us to achieve our objectives and the DH forgives us for having been exposed to such an impossible situation. It’s the political equivalent of earning your spurs by losing an unwinnable seat with a safe one promised at the next election.

So we need a staff and public engagement and consultation campaign − sorry, programme.

To gain the right reaction, we need to choose our vocabulary carefully. The following are essential elements: tough decision, brave choices, it’s not a downgrade, improved mortality, better outcomes, amazing what you can do with technology these days, revolutionary approach, efficient, it’s not about money and nurse-led.

All very corporate and completely terrifying.