‘We concluded that we would need Stalin’s ruthlessness, Patton’s brilliance, Machiavelli’s cunning and Robert Maxwell’s sophistry’

To: Don Wise, chief executive

From: Paul Servant, assistant chief executive

Re: Wool over eyes

Dear Don

We had a useful training exercise last week with the managers on the “Stuff the Theory It’s All About the Targets” module of their continuing professional development course. They were asked to imagine a hypothetical, mentioning-no-names scenario where they deliberately set out to fool everyone into thinking everything was fine. What qualities would they need? How would the enforcing, scrutinising, regulating and commanding hierarchy act? And who would need to be hoodwinked?

We concluded that we would need Stalin’s ruthlessness, Patton’s brilliance, Machiavelli’s cunning and Robert Maxwell’s sophistry. These qualities would be needed to cope with Goliath’s clumsiness, Nelson’s bad eye, Chamberlain’s credulity and the Bank of England’s regulatory competence.

And then, somehow, we would have to survive supervision, oversight, engagement, consultation, inspection, inquests, self-assessment, external assessment, internal audit, external audit, complaints, ranking, rating (and ranting), briefing, revalidation, appraisal and, of course, World Class Commissioning! We would have to cross-check all those forms we fill in to ensure they consistently supported our story. We would have to hope that patients - while alive - and their next of kin at the grave side didn’t think anything odd was going on. We would have to suborn staff to go along with us while ignoring their professional duties and hope that not one of the following batted an eye lid: the trust board - especially the non-execs; councillors; overview and scrutiny; the local authority; politicians; LINKs; the coroner; PCTs; the royal colleges and unions; district audit; the SHA’s performance management unit, its briefing unit and its “and what do you do?” unit; their consultants; the Healthcare Commission; NICE; the NPSA; the university; Monitor; the Department of Health; patients’ lawyers; and the media.

It couldn’t be done, could it?