To: Don Wise, chief executive

From: Paul Servant, assistant chief executive

RE: No-payment?

Dear Don

All this fuss about co-payments is very irritating. It demonstrates a complete lack of imagination, guile and cunning being deployed for the benefit of patients by a few of our humourless colleagues. And what pious nonsense when the NHS is allowed to, nay, has to, charge for parking, better dental care, glasses, residential care, IVF, amenity rooms, etc...

This is not something which costs us anything, so why on earth anyone would seek permission from a PCT to accept a co-payment is beyond me. Now everyone's suddenly interested, FOI requests are flying through the air and lots of jobsworths are hyperventilating.

If the cap fits

This all comes on top of the ludicrous campaign to make the little private patient cap fit large FT heads. Opponents of private income complain trusts are not following the spirit of the law but looking for technical ways round it. However, the proponents of the cap don't actually believe in limiting private NHS activity. They want to abolish it. So the spirit of the cap is the abolition of private patients - a bit like pro-lifers wanting to reduce the abortion threshold when in fact they want to abolish abortions.

So in the spirit of saying one thing and doing another, we do not allow co-payments. However, we do have three gratitude schemes on offer for patients wanting to support their hospital. Firstly you can be an ordinary member of the FT, or a platinum member, who makes monthly donations. Or you can become a legacy member, quite popular with the cohort of patients most affected. Last, you can be a credit supporter and acquire one of the hospital credit cards (interest free for the first nine months) where you pre- (rather than co-) pay.

For each of these schemes, you will get one-to-one time with the nurse or doctor of your choice to discuss how your gracious contribution will benefit the NHS and community. And while chatting, they are free to help the patient with anything that comes to mind - in the spirit of patient-clinician co-operation.