How do? CQC's latest staff survey is out. There will be some nuggets in here - I may even get to finding a few.

Unfortunately, I am getting a bit busy with other bits, so for now will have to resort to their leak to Ramdeep Ramesh of The Guardian, (the journalist whose misrepresentation of the iridescent John Appleby we covered here.

Infection issues iterated
Ramesh reports (accurately, we hope), "Of the167 trusts in its survey of hospital infections in 2009, published tomorrow, the CQC found that 42 were not meeting standards ... 36 trusts were not providing areas to decontaminate instruments, in three trusts there was a failure to regularly flush unused water outlets – crucial for the control of legionellal infections – and 13 trusts were criticised for not keeping clinical areas clean".

Ramdesh also reports that four ambulance services received formal warnings, with one being found to have vehicles with blood-spattered walls.

This is really poor performance. It indicates a 'can't be arsed' level of defeated self-esteem among those who work in such services. In addition to cleanliness and hygiene being 'the bleeding obvious' (pardon the pun) category that the CQC were going to be fascistic about inspecting.

When the 1st April comes around (great choice of date), the CQC's inspectors need to go back to some of these places, unannounced, and look to take a scalp. Because the point has quite clearly, flagrantly not got through some very thick skulls that healthcare is a safety industry.

Or it should be.

Reform - fewer hospitals, more competition
Today also saw the release of the latest report from Reform, Fewer hospitals, more competition, whose launch I attended yesterday.

Reform are a curious organisation. Their NHS reports make a few very good points, but are usually accompanied by some howlingly silly ones. They will be bolstered by the arrival as deputy director of Nick Seddon. Nick is a smart guy, whose book Quite like heaven? Options for the NHS in a consumer age is a respectable analysis.

But this comes a little too early for Seddon's input to do more than tidy up around the edges as a co-author with Nick Bosanquet, Andrew Haldenby, Partick Nolan and Thomas Cawston.

It's a shame it is not better, because one of the key points it makes - that services should be delivered in community settings where possible, but that this will mean closing wards and even hospitals - is quite spectacularly obviously right.

So much so that it's even government policy.

Reform's report actually puts a number on to-be-closed beds, suggesting that if every region did as the south of England does regarding acute bed-per-head ratio, there should be "a reduction of 32,000 in the total number of beds, from 160,000 to around 128,000".

It's fine, and it's eye-catching. But it's also a heroic assumption that you can generalise from the particular. Colsures of wards and beds can no longer be ducked, but the actual reasons why hospitals are where they are and admit as they do have variances by region, local custom, population health status.

There should not be a moratorium on change to patterns of NHS provision. But change should be made after a consultation and discussion with local communities, led by local clinicians. The local clinicians are the only ones left with public credibility - and even then, we will sometimes be asking Turkeys to vote for Christmas.

Hospitals are powerful places - they give you media and political reach and clout.