Bristol is not a city with happy connotations for the NHS. But Monitor feels duty bound to alert you to the joyous celebration that is Gut Week 2001, running from 10-16 September. Our ship-shape city plays its part with the truly fascinating Bristol Scale, Gut Week literature reveals. The useful scale allows easy categorisation of stools - not the three-legged sort - into seven types. The detail is rather unsavoury, but the NHS's pursuit of excellence dictates that Monitor should give some broad performance indicators. Those aiming for green traffic-light stools should bear in mind this advice from Gut Week's Guide to the Gut. 'The ideal stools are type 3: like a sausage but with cracks in the surface, or type 4: like a sausage or snake, smooth in texture.' And remember: the NHS's performance management framework has not been finalised yet. Gut Week encourages good gut health and aims to encourage members of the public not to suffer in silence. The caption to a lovely Gut Week picture asks: 'Could you grin and bear a gut problem for the sake of your career?'

Monitor found the subject's grin rather reminiscent of a smile with which we are all more familiar. Is our health secretary bravely bearing a gut problem? Monitor urges him not to suffer in silence.

Readers will recall Monitor's shock last week that the previously bearded Peter Homa had been shorn. But careful observers have picked up a further transformation in the appearance of the softly spoken Commission for Health Improvement chief executive - trendy new glasses (see right). Monitor Towers is abuzz with rumour. The words 'image consultant' and 'celebrity makeover' have been swiftly rebutted by CHI insiders, but Monitor fears the man who re-engineered Leicester Royal Infirmary has himself been re-engineered.

Monitor realises the dismal findings at Epsom and St Helier trust have made CHI frontpage news. Perhaps tabloid hacks and long-lens paparazzi are even now encamped outside Dr Homa's Moorgate eyrie, hoping for a glimpse of the man himself. Monitor's visit to CHI's 14th floor conference suite had led him to believe that the view out - across the rooftops of London - was somewhat more spectacular than the view in. How wrong he was.

Accidents will happen, Monitor muses regretfully. But perhaps no more! For that august periodical the British Medical Journal has initiated an accident prevention scheme that puts stairgates for toddlers and riverside lifebelts to shame. After all, why prevent minor incidents like being run over by your lawnmower or tomato soup spillages when you could abolish accidents altogether, as the very thorough BMJ has done. 'Most injuries and their precipitating events are predictable and preventable, ' it says sternly, adding that the word 'accident' is henceforth banned. The medics concede that one or two uses of the A-word are sadly 'unavoidable'. But It is not much of a let-off for accident and emergency departments 'which should be renamed'. Perceptively, it adds: 'Mishaps, misadventures, calamities, events and incidents have their own shortcomings.'

Monitor is a keen moderniser and even keener on friendly chumminess, so imagine his delight at a breakthrough by the NHS's very own PALS - the advance guard of the brave new patient and public involvement system. As ministers took their second bite at ridding themselves of those pesky CHCs last week, Monitor's eye was drawn to the triumph described in the charmingly named 'listening document' on patient and public involvement: 'As a result of a patient who contacted the PALS service, a letter for a one-stop clinic has been changed.' Yes! A whole letter changed! Now, as well as patients being informed that 'they might be there all afternoon' in appointment letters, those lucky enough to receive re-arranged appointment letters will get the same happy news! Monitor was unable to contain himself. . . until he recalled the DoH website described in this column just weeks ago, which advised - in worrying detail - on the tricky matter of appointment letter writing. Could it be that this crucial guidance had been ignored before the valiant PALS stepped in? Surely not.