A good hospital infection control programme can reduce hospital acquired infection, which causes considerable morbidity, mortality, and cost. NHS trusts in the West Midlands were surveyed to assess progress in implementing national infection control guidelines. All 25 acute trusts replied but only 13 of 21 trusts for the community or for mental health (MH). Twenty-four acute trusts had access to an infection control nurse (ICN), but ICNs were responsible for an average of 520 acute beds, twice as many as usually recommended. Seven (of 13) community/MH trusts had only informal arrangements for access to an ICN. Six acute trusts had no formal arrangements for covering ICN leave. All 25 acute trusts had access to an infection control doctor, but on-call cover in eight required this individual to be permanently available. All acute trusts had a hospital control of infection committee, but in only 10 did a senior member of management regularly attend. Twenty-four acute trusts had an outbreak control plan but only 13 had been updated as recommended. The NHS performance management structure needs to be utilised to ensure that these deficiencies are rectified. It would be wise to investigate implementation of national guidance in NHS trusts in other regions.