CLEANER HOSPITALS programme a “clear success”, trumpeted the headline on the Department of Health press release. The Health Secretary appeared at the Royal Free Hospital in London to announce “A large amount of progress has been made in cleaning up the country’s hospitals” but that “there is to be no let-up in our drive to raise standards”.

That was Alan Milburn speaking in April 2001. Ministerial pontificating, however, does not clean bedpans or remove blood stains. This week a report from the Healthcare Commission indicated that two thirds of hospitals failed to meet the highest standards of cleanliness. The Royal Free was one of them. It did not even make it into the second tier, where a hospital is judged to have room for improvement but is not “seriously dirty”.

Instead, the Hampstead hospital is consigned to Band 3, where “The lack of cleanliness is widespread and standards are unsatisfactory for an environment in which clinical care is being provided”. The report goes on to detail what patients might find if they were to enter the hospital that, ironically, claims the best mortality rates in the country. It notes dusty surfaces, signs of spillages, dirty commodes and chewing gum on the floor of a consulting room. “In short, ” sums up the commission, “a standard that many people would find unacceptable in their own homes” let alone in a medical establishment with nominally regal aspirations.

Alan Milburn has long abandoned responsibility for the NHS. Perhaps his sudden desire to spend more time with his family was encouraged by a realisation of the true scale of the problems the Health Service faces. He certainly seemed to throw himself energetically back into the political scene once he had extricated himself from the battle of trying to reform the NHS. Since he had not only to fight against the entrenched ideas of doctors but also those of Gordon Brown, withdrawing to hearth and home would have been an attractive proposition.

But even though his successor, John Reid, continued to acknowledge the need to improve cleanliness in hospitals — impossible to ignore given the march of MRSA, the “superbug” of scary headlines — the dirt appears to have continued accumulating. It was unlikely to disappear as a result of Dr Reid’s prescription. “Our new approach is to empower patients with more knowledge and encourage them to demand the highest standards of hygiene,” he wrote in 2004 when launching yet another wordy tome on the subject. He might have realised that when people are really ill, they do not want to have to lecture staff to clean up the place; they simply want to be made better in surroundings conducive to recovery.

Ministerial initiatives do not reach the places that a lazy cleaner fails to reach. It may not be fun to wash floors and scour bedpans but it should not be beyond the teams of people who are employed to do just that. The knee-jerk reaction from some quarters has been to blame the use of outside contractors for the failure to scrub up hospitals to a reasonable standard. But the Healthcare Commission survey covered establishments where the cleaners were in-house as well as those that used outside contractors, and noticed no discernible difference.

It did extend its snapshot survey to some private sector hospitals and they did fare better than the NHS, although a few, all mental health hospitals, slipped into Band 3. The six hospitals consigned to the appalling designation of Band 4 in the survey were also all NHS mental health hospitals.

Could it be that these institutions are as depressed as some of their inmates? One of the signs of deep depression can be a loss of interest in appearance. Might it be that the failure to achieve sparkling cleanliness is a sign of low morale? That stems not from the cleaners but from the managers, whose responsibility it must be to ensure that proper standards are kept. Whether they recruit outside contractors to do the job or use their own teams, they should not settle for anything but the best results. If they are doing so, as is clearly the case in many hospitals, then it probably reflects that they are only as committed to their role as Mr Milburn was to his.

The Department of Health has masked the true squalor of our hospitals by adopting a peculiar system of inspection that has involved NHS panel members descending at an appointed time, thus allowing for a hasty makeover to be put in place. The result has been a series of announcements about improving levels of cleanliness. The Healthcare Commission wryly reports that it noted a significant difference in what it heard from patients and the positive news pouring out of the NHS. Hence its decision to send in its own, unannounced, inspectors with the grim results that have just been published.

No doubt the latest Health Secretary, Patricia Hewitt, will don her rubber gloves and soon be announcing another initiative to invest more millions in putting matters right. But it will make little difference. The NHS has proved adept at spending vast amounts of money without securing commensurate results. Of the extra billions that Gordon Brown has poured in, only 35 per cent has reached the frontline services. Currently £6 billion is being ploughed into a computerisation project that is already running way behind schedule and seems destined to be one of the most expensive in a long run of IT disasters.

A depressing thought and one that is probably further depressing morale within hospitals. It may be hard to summon up the energy to demand spotless walls when managers see billions thrown down the drain.