LETTERS

The Business Services Association shares the secretary of state's concern at recent figures indicating that a third of hospitals fall short of the Department of Health's quality control standards on cleanliness. We welcomed these standards and approve the rigour with which they are being applied.

But trusts need to make adequate resources available to cover quality services. For too long the NHS has concentrated on lowering maintenance costs in wards, regardless of the detrimental effect on standards and quality. We welcome the additional funds allocated, but these will only scratch the surface. A fundamental change in policy towards allocating sufficient funds is needed to improve standards.

The DoH's reference to private sector contractors was gratuitous. The same problems apply to in-house and external providers. The proposed mechanism will not give an objective assessment of ward cleanliness. In-house services will have to be assessed on the same basis.

A mechanism is required to deal with failure by in-house providers as well as external ones, but it is more difficult to do this. How is an in-house team to be penalised? The service must continue to be provided and wages paid. The ultimate sanction is to outsource the service but, as in best value, steps must be taken to improve service delivery before that ultimate sanction.

The legacy of market testing will not disappear overnight. A new philosophy will only succeed where those charged with its implementation believe it will work and are given adequate resources. The private sector, too, has to approach trusts in a spirit of co-operation rather than confrontation.

In the health service as in local government, what works is paramount - not who provides. This is the bedrock for future service provision, backed by quality control standards.

A flexible approach, using the best of private sector innovation and business expertise alongside NHS staff experience to suit the local situation, is the best way to raise standards. Patients deserve the best, and we will work with government and the health service to ensure this is achieved.

Norman Rose Director general Business Services Association London WC1