Posted by: Witch Doctor | May 18, 2010

NHS “Letters of Direction”


The Witch Doctor has just had an Ah-Ha moment.

She was contemplating the reports today that civil servants have a formal means of indicating to ministers that they do not agree with what they are being instructed to do. Apparently it is rare for civil servants to use this “last resort” type of protest.

“Mr Baume, leader of the First Division Association, told 5 live’s chief political correspondent John Pienaar: “When a permanent secretary asks for their letter of direction from a minister, it is because they feel that a serious decision is being taken, which they feel is not right.

“It’s not a decision that is taken very often to ask for such a letter of direction, which is why it is regarded something of a nuclear option. So when it happens it tends to be a big spending decision, where the civil service believes this is not the right thing to do.”

The instructions – formally titled “letters of direction” – have been sent to the Treasury, and will be sent on to the cross-party Commons public accounts committee, which evaluates public spending for propriety and value for money.”

It seemed to The Witch Doctor that it might be a good idea for doctors to occasionally use “Letters of Direction” within the context of the NHS.

Then – the Ah-Ha moment!

It suddenly came to The Witch Doctor that over the years on two or three occasions she had used the equivalent of “Letters of Direction” to her “Lord and Masters” within the NHS when she disagreed strongly with something she was being asked to do.

They were not called “Letters of Direction” of course.

They were not called anything at all.

But in essence they had all the attributes of “Letters of Direction”

It is an alternative to saying an outright “No” to employers, although The Witch Doctor has done that too.

Saying “no” to an employer within the NHS nowadays is a high risk strategy which may cost a doctor his or her livelihood so it should never be done by e-mail, in haste or without considering the consequences very carefully.

Letters of Direction should probably not become a habit for any one doctor or they will not be taken seriously enough.

When The Witch Doctor wrote these “Letters of Direction” they were designed to focus minds and force sensible decisions.

A variation that is really helpful is to outline the only possible options in a Letter of Direction and ask which option you as a doctor are required to follow.

And copy to file. (cc file).

Most senior managers know what this means.

Chances are a crazy decision or lack of decision will be changed to the sensible one.

That’s what we found.

Didn’t we, My Black Cat………



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