Your Humble Servant on the annual health check ratings

To: Don Wise, chief executive

From: Paul Servant, assistant chief executive

Re: All the rotten eggs in our basket

Dear Don

We are all terribly proud of the huge improvement we have achieved in the annual health check under your leadership. The fair and fair rating shows just how far we have come in five years. Surely the next stop is foundation trust status?

We all really appreciate how you took on this role here when no-one else would do it and have carried on in that style ever since. I think it is a demonstration of the heights you have reached that there is still no-one else interested in doing your job.

It must be frustrating when you look around at the incompetents responsible for creating our botched trust all those years ago, now in positions of greater authority and power and freely committing the same mistakes all over again on a larger scale.

Still, we could all be proved wrong when we see 'world class' commissioning emanating as colonic vapour up and down the land. How the rest of the world must be itching to learn from our example.

On a more encouraging note we think we've cracked next year's annual health check already. The detail is always in the small print. We keep getting hammered on bad figures for infections, waiting times, cancellations, staff and patient attitude. Only if there are exceptional extenuating circumstances will these be ignored.

Therefore we must concentrate all our activity on being a centre of excellence for extenuating circumstances.

We will become the MRSA, Clostridium difficile, 18-week-breach, grumpy staff and miserable patient NHS trust of choice. We will only treat patients if they have C difficile or MRSA and if they are about to go over 18 weeks.

We offer all the surrounding acute and primary care trusts a deal to dump their disease-ridden breaches with us, and to offload their grumpiest staff as well. They'll clear the decks, and we'll be one big walking extenuating circumstance of a trust that will not count as having failed.

Everyone happy, nasal swabs all round.