Follow-up visits to 50 'dirty hospital' trusts which failed inspection standards last autumn have revealed that 41 of them have moved from 'red' to 'amber' status.

As HSJ revealed earlier this month, inspections by patient environment action teams graded 250 hospitals 'red' - failing to meet core standards for cleanliness. Some of the worst offenders have had a special team of managers from 'green' hospitals to advise them where they are going wrong. The Department of Health said all hospitals will have received an unannounced visit by March of this year.

The results of the most recent tranche of visits were announced alongside an investment of£30m by April on top of£31m already allocated.

Health secretary Alan Milburn also outlined new plans which, from April, will give ward sisters the authority to agree with managers to withhold payments from contracted cleaning companies if standards are not reached. As a last resort, ward sisters could request that other cleaning arrangements should be made.

But the Association of Domestic Service Managers has reacted with concern, with national chair Helen Smith arguing that 'nurses do not have time to do that'.

'And although they have a certain amount of training, it is not sufficient. There would have to be a role for a professional who is technically competent to decide whether an area is clean or not.

'My understanding is that she will have responsibility for ensuring cleanliness, but she would delegate that to the domestic department.'

The association also argues that the additional money, though welcome, should be spent on recruitment.

'From the point of view of longterm benefits, it will not really help because it is non-recurring money. It will help with redecoration and replacing floor coverings, but it will not help the main problem, which is staffing, ' said Ms Smith.