The government promises that dirt and grime are to be banished from hospitals - now. Lyn Whitfield wonders if a quick fix is really the answer

There can be no mistaking the government's determination to get NHS hospitals sparkling clean in time for the next general election.

When the NHS plan said£30m would be 'allocated immediately' to improve cleaning, ministers meant it.

Eric Morton, former chair of the Healthcare Financial Management Association and finance director of Chesterfield and North Derbyshire Royal Hospital trust, returned from holiday on 1 August to find the trust's share -£100,000 - in its bank account. It is the first time revenue has been allocated to hospitals in this way. But Mr Morton says: 'The cash is really welcome. We have been saying for a long time that cash needs to get out quickly, and this was slick operating.'

Incoming HFMA chair Mark Millar, finance director of Suffolk health authority, says he both understands and applauds the 'political response' to concerns raised by patients.

But he would not like direct allocation to hospitals to become the norm.'It undermines not so much HAs any more, but primary care groups and primary care trusts.

'The direct allocation of cash might raise concerns about how it will be accounted for, if its impact didn't promise to be one of the most scrutinised outcome in NHS history.'

The NHS plan says every trust must nominate a board member to take 'personal responsibility for monitoring hospital cleanliness'.

Every hospital will have an 'unannounced inspection of its cleanliness' within six months, with the results released to local media.

And in the long-term, national standards for cleanliness will become part of the NHS performance assessment framework, checked on by the Commission for Health Improvement.

A sample of hospitals have already been inspected by Department of Health officials and given the first of health secretary Alan Milburn's promised 'traffic light' codings for cleanliness.

Chief executives, however, have not been told the results. Instead, they have been issued with selfassessment forms.

The two will be compared by the new patient environment action teams , whose 100 or so volunteer members have already been briefed by staff from NHS Estates.

Mike Stone, director of the Patients Association, says it was approached to find volunteers for the teams, and president Claire Rayner had been 'passionate' about taking part because 'this is something people calling in are telling us is important'.

'A growing number of calls to our helpline are about patient experience: food, cleanliness, bad signage, little things like people having name badges that are too small to read, ' he says. Other team members have been nominated by professional organisations.

But Helen Smith, chair of the Association of Domestic Management, sounds a note of caution. The ADM is currently trying to clarify a number of issues - not least when information will be released to the press.

'If somebody is given a very bad report you cannot just say, 'This is a very bad report''- you have to say what is behind it because that might be beyond the control of the managers, ' she says.

Nigel Edwards, policy director of the NHS Confederation, says many of the problems are linked to contracting out and demands for annual efficiency savings. Sorting out such long-term issues will take more than an eye-catching clean up.

Ms Smith says the government will also need to temper its demands for a better-quality environment with its inclination to look for efficiency, because 'throwing money' at the clean-up and then demanding 3 per cent year-on-year efficiency savings 'makes a mockery of the whole thing.'

The ADM is also looking for more information about the NHS plan's commitment to giving ward sisters the 'authority' to insist wards are clean, and to make domestic staff 'fully part of the ward team'.

It is not yet clear whether the first would mean a lesser role for managers - who have considerable technical knowledge and time to deal with staff and rotas that nurses might lack - or whether it is just a reminder of a responsibility Ms Smith says ward leaders 'should have anyway'.

And it is not yet clear how the second will impact on contracts and rotas.

Ms Smith also questions whether the plan's promised£150 annual training budget for every NHS staff member will apply to domestic staff - and how this could be extended to contractors.

One acute trust source says improving staff pay and training will be the real keys to improving hospital cleanliness, particularly when it comes to issues such as infection control rather than making the wards look pretty.

'If you pay peanuts you get monkeys,' he says.' If you get untrained staff you get people who clean walls with the same cloths they have wiped up urine with.

'Yes, if Mr Milburn wants a lick of paint we can do it for£50,000.But these long-term contractual issues will take a lot longer to resolve.'