I checked every envelope and couldn't find David Nicholson's personal Christmas card to you. But I did find the operating framework for the NHS in England 2008-09 in your e-mail.

To: Don Wise, chief executive

From: Paul Servant, assistant chief executive

Re: Mind how you go

Dear Don

I checked every envelope and couldn't find David Nicholson's personal Christmas card to you. But I did find the operating framework for the NHS in England 2008-09 in your e-mail.

"Don't look up, look out," says David Nicholson and what good advice that is. Every manager should be looking out for the latest piece of emancipation to come out of the Department of Health. In fact, I would do both - look out by looking up for the next "raft of indicators, or vital signs".

And remember, these "vital signs" are not targets, though "the work on how we measure them and how they are regulated is still ongoing". Sounds like more things to look out and up for to me.

Accompanying the measurement and regulation will be a "narrative", which we had also better look up and out for. There is a lot of clarity in the document. Many things to be clear about as well. The vital signs are not top-down targets, in fact they are "completely the opposite. They are a decisive move towards greater local autonomy".

Furthermore, we're not going local because "it's fashionable"! Hmm. I don't think anyone has ever accused Mr Nicholson of that before.

It was, of course, reassuring to read that this is all about "reform with a purpose" as opposed to previous Crispian reforms which have just tickled us and made us laugh in the past. Looking up for one last time, I also notice that the clearout of the Crispites from the DH's top team is now almost complete.

In their place is a whole new team of director generals, forming what presumably must be a high command under marshall Nicholson?

With all these generals floating around, no wonder people are contemplating a constitution for the NHS, though generals, constitutions and local emancipation don't exactly have a brilliant track record these days.

Happy new year and keep looking up while you mind how you go.