The comments by Andy Burnham ( read the story here) are not surprising as he has made them on a number of other occasions, but it is disappointing to see a government minister publicly taking such a short-sighted view.

The comments by Andy Burnham ( read the story here) are not surprising as he has made them on a number of other occasions, but it is disappointing to see a government minister publicly taking such a short-sighted view.

Hospital cleaning has been an outsourced function for 25 years, in most instances with beneficial results for patients in cleaner wards. At least the past three PEAT surveys have shown no noticeable difference between 'contracted out' and 'in-house' services - both have higher quartile scores while the lower end tended to have a majority of 'in-house' providers. This is reflected in other comparisons such as occurrences of MRSA and Clostridium difficile.

If all cleaning services are taken back in-house, the NHS will lose the benefit of the large amount of research and development undertaken by private companies at their own expense to improve efficiency, reduce costs and fight infection. Many NHS hospitals have benefited from the introduction of state-of-the-art equipment and technology developed in the private sector.

The real issue here is objectivity. The minister seems only to have taken soundings from NHS hospital management and not from those private companies engaged in providing cleaning services for some 30 per cent of NHS premises.

Every trust is under severe cost pressures because of the deficit between tariff income and projected known expenditure. Bringing cleaning services in-house will allow trusts to camouflage the real cost of cleaning hospitals to the level agreed between the NHS and the cleaning industry in the 2004 Cleaning Standards.

Cleaning should be considered to be an integral part of the well-being of the patient, yet in almost all contract renewals over the past two years, trusts have requested that contractors do not quote on the basis of these standards as they cannot afford it. Continued tightening of these budgets place the patient at greater risk of hospital-acquired infections.

Trade unions have always wished to take cleaning back in-house. In the past four years only 12 private finance initiative hospital contracts have included soft services. If the government wishes to make a special case for the NHS and to eliminate the private sector from all services connected with hospitals except those relating to the built infrastructure, let them say so but let them consider all the evidence fairly before they do so.

Norman Rose, director-general, BSA

Cutting corners
Hurray! There is light at the end of the tunnel. I have worked in the health service now for more than 16 years but over that time have had my hours cut.

My work partner and I worked well together and took pride in our work, but when the hours are cut, corners are cut. Then I noticed that a cleaning agent was taken off the daily use, even though this cleaning agent was declared to kill all known germs.

In-house cleaners can feel part of the ward, reporting to the ward matron. I truly think that there would be a very quick solution to infection control. I only hope No 10 can see the light as well.
Gerry Budd, MTT co-ordinator, Bristol Royal Infirmary

Bring back the Nightingales
It's about time someone voiced what the patients in hospitals and their visitors have been saying to staff for a number of years. Hospitals used to be clean and have no MRSA! The cleaners that are contracted in have no loyalty to the wards. They go home with a clear conscience that they have done their required job and will get paid at the end of the month.

In-house cleaning crews used to not only clean their wards or areas of work within the organisation but help staff with patients and make friends with the patients. There was a pride in the cleaners for their work areas. They enjoyed coming to work to make patients lives easier and cleaner.

What a brilliant, belated, user friendly, idea to come out of someone's mouth at long last. The old ways of working go back to where Florence Nightingale started with bringing cleanliness into the medical world. Let her memory live on and bring the Nightingales back to do their job.

Jane Scott, Alan Hanna, Dean Bruton, Paul Bunting, Ken Wilson, NHS West Midlandsworkforce deanery

No surprise at all
Patients' hands and fingers are often not washed and faeces under the nails not cleaned away, leading to reinfection and spreading. This was common last year when my mother was in Princess Alexandra Hospital, Harlow, Essex. She had C. difficileand MRSA. I am not at all surprised it has spread the way it has. It appeared to family visiting that not enough proficient staff were always on duty to ensure correct procedures, cleaning, feeding etc.

Marion Martin, Essex primary care forum manager, Essex Primary Care Forum and special projects, North East Essex PCT