'Numbers do not impart wisdom in themselves, you have to learn how to select and use them'

In the recent past regulation and inspection seemed like the only game in town - but for the last year the whole area has gone relatively quiet.

Now the heat on regulation is increasing again.

As we report this week, the Foundation Trust Network has heavily criticised the 'centralist' stance taken by the Healthcare Commission's developmental standards. It claims local accountability will be squeezed out. The network has shown it is growing in confidence and taking up the baton from foundation regulator Monitor.

Meanwhile, the commission has turned its focus to the tricky question of how best to measure value for money. Its paper on efficiency expresses alarm that an approach built on Department of Health productivity indicators published last month will result in 'micro-management' and is at odds with wider NHS reforms. This will be a crucial area over the next year or two - it is still far from resolved what should be measured in terms of productivity and how, let alone by whom.

Anyone involved in workforce planning will know that numbers do not impart wisdom in themselves, you have to learn how to select and use them if you are going to benchmark efficiency properly. And across the board getting it wrong will do major damage not just to individuals and organisations but to the reputation of the NHS itself.

Should trusts be worried about these fierce arguments? If the Foundation Trust Network is right and the developmental standards are a return to 'the old world of the NHS', many managers will be rightly concerned.

But they should not be worried about conflict per se. There is no inspection without dissent ? it comes with the territory. These two related rows serve to show that the rightly contentious debate on regulation is very clearly back on the boil.