Direct access rectal bleed clinics! Could anything be nicer? Stockport Acute Services trust doesn't seem to think so, announcing plans to carry out fast-track buttock checks. The logistics of such schemes make interesting reckoning, says Monitor, but in the interests of taste and decency perhaps the matter is best kept under wraps. Lazy gags about a 'bottom-up' approach to health management will similarly be eschewed.

But over at the BMJ , the po-faced pointy-heads probe further, with research flagging up the benefits of 'open access' bowel disease checks.

Now this is all very well, but is it British? 'Buttocks were born to be clenched, ' as Corporal Monitor used to say. Compare that to the view of our Eurofriend Bertold Brecht, who pondered: 'What happens to the hole when the cheese is gone?'

And while on unsavoury topics, what to think of a Westminster gym's plans to shame MPs into foregoing boozy meals for lunch-time aerobics and the joys of 'stepping' - a form of gymnastic activity quite distinct from 'stepping out'? Jubilee Hall Club's Westminster branch is to confront diners leaving their fave watering holes with leaflets asking why they aren't at the gym. The publicity drive has already caused indigestion among gout-happy politicians. Of 12 posters submitted to the House's committee for health, safety and welfare, eight were rejected as 'politically unsuitable'. Four, spelling out the advantages of 'skipping' (debates) and 'spinning', should be littering the streets of Westminster soon.

And finally, if you can't laugh at yourself you can't be the Institute of Healthcare Management. The loons' latest plot to undermine public confidence in health service management comes hot on the heels of selling hostess trolleys (you read it here first). The only cost?

Credibility - something the IHM has learned to live without. It transpires that Bosco the clown will be appearing at IHM training sessions to teach delegates how to juggle, tightrope walk and 'master the art of custard pie throwing'. 'I know it sounds like a waste of money, but it isn't, ' offers seminar organiser and former NHS manager Andrew Corbett-Nolan. For once, my friends, Monitor is speechless.