Nye Bevan's famous remark about hearing the crash of every falling bedpan (or bucket of slops, in the original) has reverberated around the NHS this week with health secretary Alan Milburn's endorsement of 'explicit' guidelines on how to clean hospitals.
If proof were needed of the government's centralising tendencies, it would surely have arrived in the endorsement of guidance telling managers not only how often sloppy floors should be mopped, but what cleaning products they should be mopped with.
On the other hand, Mr Milburn's political instincts were - as usual - spot on. His call played well with his nursing audience and the daily papers, who wanted to know why the NHS was wasting money on managers who can't even keep hospitals clean.
Managers know it is not as simple as that. One senior figure admitted privately this week that, as a chief executive, he had ordered reductions in cleaning specifications to meet the relentless drive for 'efficiency' savings.
The result? At least one well-known hospital in this country has two-tone walls - light and relatively dirt-free to just above head height, darker and grubbier higher up because it costs more to employ cleaners who climb ladders.
But perhaps it should be that simple. What is the point of NHS management if hospitals are filthy, and food - the subject of more explicit guidance this week - is inedible? Or to put it another way, what is stopping managers from rising above the legacy of the internal market, cost cutting, contracting out and all the other horrors to get these things sorted out where they need sorting?
Despite the government's huge injection of cash into the NHS and its palpable desire to see standards raised, managers remain curiously disempowered and even dispirited about change.
Ministers putting their name to guidance that tells them to buck up and go and check the cleaning rota is not the way forward. It perpetuates a climate in which people feel they cannot act before a circular tells them what to do - or dare not act for fear of being 'off message'.
What the NHS urgently needs is more managerial leadership. It needs people who are achieving this to stand up and inspire others. It needs a champion who can go to ministers and tell them what can and cannot be done, and what should and should not be done to meet political imperatives and effect far-reaching change.
Politicians are stepping into the vacuum. The suspicion is they will be tempted to continue to fill it. But as Nye Bevan knew very well, those falling slops cannot be caught from Whitehall, however much noise they make.
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