‘Pathology will be exported to Belgium, mental health will now fall under the council’s community support officers and treated with ASBOs.’

Highly Confidential

To: Don Wise, chief executive

From: Paul Servant, operations

Re: Rebuilding the hospital

Dear Don

I am concerned that there may have been some double, triple and perhaps quadruple counting in David Nicholson’s prediction about 60 acute reconfigurations.

Since the announcement, we have received proposals from at least five PCTs to relocate our services within primary care and two more who say they would have made plans to do so if they weren’t being abolished themselves.

Currently, the evisceration of our trust’s activity seems to be fuelling the recovery plans of most organisations in the local health economy. We will loose A&E, maternity, paediatrics and max fax to the University Hospital. Dermatology, endocrinology and audiology go to Polish GPs who are told what their special interest is on arrival at Heathrow. Orthopaedics transfers to the independent sector treatment bungalow behind Morrisons, after the community physios have whittled down the referrals to anyone they can’t maim themselves, and sexual health goes to Boots.

Pathology will be exported to Belgium, mental health will now fall under the council’s community support officers and treated with ASBOs. Angio transfers will go to a private caravan near the bingo hall. That leaves us with the mortuary.

We could become the first foundation trust not to provide any healthcare, but instead be hugely profitable by imaginative management of our estate - which will now be vacant. We are putting together a joint estates/mortuary business plan which will convert the estate into a graveyard - handy for the increased number of corpses primary care will be sending us.

Lastly, I was surprised by a significant omission in the recent HSJ50 list of the most influential people in the NHS.

Surely the leaders of deficit trusts have had the most profound influence of all, leading to Sir Nige going off to explain referral management to Kenyans and the Anschluss of PCTs by SHAs?