Phil Hammond MD

`The Mid Wives Club', `Flush Gordon' ... Oh no, it's hospital Christmas revue time again, and the first casualty is subtle humour

Of the many moral responsibilities facing film-makers, perhaps the most onerous is to ensure that the title can be easily lavatorialised for a hospital Christmas show. Back Passage to India, Room with a Poo, Beverly Hills Plop, Flush Gordon and On Her Majesty's Secret Cervix are just a few of the many successful bastardisations that have flourished. But this year, they're not playing ball. Of the four Christmas revues I've seen advertised, none has matched former glories. First up, it's 101 Constipations. Constipations? It doesn't even take a plural and it's not even close. Then there's The Mid Wives Club - closer, but feeble. And finally, brace yourselves for the worst double-bill ever: I Shot Andy Arsehole and Finger All the Way.

`What puerile nonsense," I hear you scoff into your Yule log. But before you dismiss the hospital revue, can I point out that of all the indicators of the health of the NHS (job vacancies, waiting lists, staff suicides, the length of the trolley queue in casualty), by far the most important is CSD, or Christmas Show Density. In a happy hospital, porters, nurses, managers, domestics, doctors, receptionists and mortuary technicians join hands on stage (and wash them afterwards) to celebrate their work, personalities and culture. In between the knob gags, you find a steady trickle of satire (in Taunton, they reworked Abba's "Super Trooper" to "Super Dooper (I'm in BUPA)" and it's perhaps the only time of the year when staff from all disciplines function as a team. Every night sells out, the audience is implausibly enthusiastic, at least one consultant exposes himself in the Balloon Dance and all the proceeds go to charity (eg buying pillows for the intensive care unit).

Considering what a morale-booster it is, you'd have thought every hospital would have one but, alas, an exclusive survey commissioned by me has discovered that the NHS's CSD is at its lowest-ever level. As one past director put it: "We're pounds 6m in debt, half the wards are closed, 200 staff are facing the chop and the rest are on sick leave. So where do I get my chorus line from?" Of course, it's tempting to politicise the plight of the hospital revue, but it may just be that they are passe. Today's comedy consumers want stand-up and storytelling, not sketches and skits. Medical revues were once a cornerstone of the Edinburgh fringe and the critics loved them. Now you're lucky to find one that dares to show its face in public.

And that's the problem. To progress and survive, hospital revues need public input. In today's consumerist NHS, you have both a right and a responsibility to be at those script meetings, to weed out the dross and diseasism and replace it with accurately-observed insights into life on the receiving end. We need patients up on stage, in between the doctor and the mortuary technician, and backstage tying knots in the balloons.

Interested? Well, it's not too late. You have to wait for everything in the NHS, so why not have a Christmas show in January? Start by phoning your local trust's public relations officer and asking her if they've already had a show. She'll say "No comment," because she'll presume you're from The Sun and you've been tipped off about the Balloon Dance. Then ask to be put through to the quality monitoring officer for the contracts' facilitator in the Care Services Directorate - for no other reason than if such a person exists, your hospital is very sick indeed and desperately in need of some satire.

Ultimately, you'll be passed back to Maureen on the switchboard, who you should have asked in the first place. Hospital switchboard operators know everything: who's in bed with whom, who's good for knees, who's footing the bill for the chief executive's aromatherapy sessions. Half an hour with Maureen and you'll have enough ideas for 10 shows. Ask her nicely, and she'll even put the posters up for you. If you want anyone to turn up for auditions, it's feeble medical wordplay, I'm afraid. Something along the lines of "The Clot Thickens" or "Struck Off and Die". Auditions, too, have a set format. Everyone has to be able to sing "New York, New York", do a box step, and hold at least two balloons at a time.

Introduce your ideas slowly. The doctors will doubtless want to resurrect songs they sang at medical school, eg (to the tune of "God Rest Ye Merry Gentlemen"):

"Sometimes when I have a poo it cuts nice and clean

So when I check the paper, I can't tell that I've been," etc

Allow the first two verses and the last if you must, but avoid verse three at all costs. To make up for it, offer them "Tie a Yellow Ribbon Round the Old Oak Tree". This is a medical revue classic, skilfully rewritten to "Tie a Duodenum Round the Mesentery":

"From embryology we know/ The kidneys and gonads together grow/ My pairs went and fell in love/ But then were split in twain/ So all my kidneys now can do/ Is sing this sad refrain ..."

Thereafter it's full of incomprehensible medical jargon, but in the penultimate verse there's a blank to fill in the name of the worst surgeon in the hospital, eg:

"Now the only way they'll get together/ As far as I can see/ Is when Hacker Harris plunges in/ With radical surgery"

Now's the time to slip out of the room, phone your GP and ask if your hernia could be repaired by Mr Bates instead. Merry Christmasn