‘What’s important is that if you’re crap you own up and if you’re fabulous you live to fail another day’

To: Don Wise, chief executive

From: Paul Servant, assistant chief executive

Re: No see

Triumph! The Care Quality Commission says we’re middling and Dr Foster agrees. Monitor sticks two ticks in the box and we quietly stick two fingers up, behind our backs, and keep our heads down.

It now doesn’t matter how well you do - what’s important is that if you’re crap you own up and if you’re fabulous you live to fail another day. What you must not be caught doing is polishing a turd.

We are, obviously, obscenely grateful to those poor saps - sorry, trust chiefs - for laying down their reputational lives, alongside their patients, while we fumble along in our quiet, unremarkable, unnoticed, middling way.

I sense some reshuffling coming on, with former chief executive comrades who have spent time being rehabilitated in strategic health authorities being spruced up to swap places with aforementioned saps. Whoever said the NHS wasn’t green? We have the best career recycling programme outside politics.

The NHS has been compared with the Soviet Union, and some of its leaders have even been outrageously described as Stalinist. But I think we are looking at the wrong era of Soviet history. As we mark the 20th anniversary of the fall of the Berlin Wall, we need to think of Gorbachev. Glasnost was the introduction of openness alongside Peristroika, which liberalised the economy.

What actually happened was that Russians were finally given the freedom to acknowledge how appalling their lives were and how bankrupt their economy was. In the NHS, we are going through a similar process with the Freedom of Information Act and tariffs.

The real trick will be to avoid what the Russians did next - flog everything off cheaply, reintroduce one party rule and pretend it all looked so rosy all those years ago. Hmmm. We’ve got PFI, the tyranny of targets and the old guard running save our hospitals campaigns.