The number of 'red'dirty hospitals has fallen after being named and shamed, but those in trouble still get the headlines, writes Laura Donnelly

A week is a long time in politics.

But four months is no time at all to improve the cleanliness of 40 per cent of England's hospitals - as the government says it has.

The results of its clean hospitals campaign show that '90 per cent of hospitals have an environment that is acceptable or better' - That is yellow or green, in traffic-light speak.

One might be tempted to be cynical about the government's motives. If its hospital clean-up campaign was designed to increase public confidence in the NHS in the run-up to an election, surely the news can only be a good thing?

But dirt sells more than clean ever could. And news that 42 hospitals had been officially graded as 'red' in the war on dirt was always bound to be the attention grabber - even if the autumn figure was a rather more shocking 253.

The number of hospitals accused of red status dropped during the launch day. While the report itself always named 40, early Department of Health briefings used a higher figure of 42.

And when the news first broke, 11 'red' hospitals were declared 'in need of special measures'. When West Sussex Hospitals trust pleaded innocence on the grounds that it was neither red, nor special measures, and in fact scored a perfectly respectable 'yellow', the figure dropped to 10.

Still lies, damned statistics and all that. When it comes to the blunt tool of naming and shaming, one or two innocent victims are bound to end up getting hurt.

It is a bit like capital punishment.

But when HSJ contacted some of the hospitals rated red we found the falsely accused were not the only ones with explanations ready.

Non-acute trusts were quickly on the defensive about their inclusion in the ratings - particularly those in the red chart. After all, pointed out Oxfordshire Mental Healthcare trust - with five sites earmarked yellow, and two red - as a mental health trust, it was not even entitled to a visit from a patient environment access team.

'Our grading was based on a self-assessment in the autumn.

We have had no visit from a PEAT team and We have had no update. We can only assume they've just carried it [the hospitals' autumn rating] through, ' a spokesperson says.

Put on the spot, the DoH doesn't dispute the facts: 'PEAT teams went into all acute hospitals.

'In most of the community and mental health trusts, teams from regional offices went into the principal units of each trust, and discussed the other sites, ' a spokeswoman said.

For some 500 community hospitals and mental health services included in last week's list, one can understand concerns about the methodology of spot-checks which do not necessarily include a visit to the 'environmental surroundings' tarred with the red rating.

Acute trusts might appear to have less of a case to argue.

Dudley Group of Hospitals trust was named as having four red hospitals - all 'in need of special measures'. So what was their excuse? Well, being home to the NHS's most long-running industrial action hadn't helped. And the Dudley ancillary strikers include a hefty chunk of domestic staff.

A spokeswoman says: 'It hasn't been made clear [to media and public] that the red light is from autumn. We haven't been reinspected because of the strike.

We have made some progress and more is planned, but the priority during the strike has been to maintain cleanliness rather than make massive improvements. We do not want to blame it on the strike - but it hasn't made a programme of improvements the easiest thing. '

The strike is rooted in plans to re-provide services, currently in old run-down buildings, through a private finance initiative building scheme.

'We have the age and condition of these hospitals seriously against us. While we can be clean, we can never be beautiful, ' the spokeswoman explains.

Indeed the DoH is the first to admit that the 10 hospitals now declared 'in need of special measures' are not entirely to blame. It is not that they are the dirtiest - rather that they face the 'most difficult struggle to improve'.

For many of them, the solutions lie less in elbow grease and a lick of paint than in capital development and reprovision of services.

Bristol Royal Infirmary is on the special measures list. Part of its buildings date from 1732. Over the next two years the hospital will undergo a complete facelift as part of a 10-year,£100m revamp.

United Bristol Healthcare trust, which includes the infirmary, received£150,000 from hospital cleanliness funds last autumn - with the bulk of the money to be spent on the infirmary, including internal and external cleaning, clearer signs, better lighting and a brighter more welcoming main entrance.

Director of estates Doug Grewcock explains: 'Maintaining such buildings remains a considerable challenge. However, progress is being made. We continue to work with our cleaning contractor to improve standards of cleanliness. The management of facilities such as catering, housekeeping, car parking and security has been brought together under a new general manager post. '

That same issue keeps recurring.

Park Hospital for Children in Oxford was one of two sites rated red for Oxfordshire Mental Healthcare trust.

'Again, really the environment [score] was in terms of functionality. It is more long-term, but We are looking at reprovision. It is being maintained - We have done a lot of painting - but It is an old building. In terms of cleanliness, hygiene and getting rid of graffiti, We are maintaining the internal environment, but we need to move, ' says its spokesperson.

With its high number of hospitals, it is hardly surprising if London region has the most 'red' ratings. But a spokesperson for the region welcomes progress, which saw the number of red hospitals fall from 52 (out of 107) in the region to just 13.

'Considering that five of the 52 red hospitals have gone straight to green, that is pretty good going.

When you consider the age of the building stock and that many hospitals are involved in major rebuilding programmes it is particularly gratifying. We were particularly pleased with the efforts of Lewisham Hospital, which has had to cope with all the problems of being an old site and still managed to turn around from red to green status. '

But Northern and Yorkshire region is the only one with the statistics to justify smugness. It has no hospitals with a red rating, despite having 30 red hospitals four months ago. The regional office is not complacent: 'It is vital that the hard work continues throughout the region to make even more improvements and ensure the new standards are maintained. '

Two of its success stories are in Huddersfield and Gateshead. All three hospitals in Huddersfield trust scored red in the autumn.

Now it has one green and two amber ratings. A trust spokesperson says: 'We had a combination of problems. Some were down to cleanliness, but we did have a major problem with recruiting domestic staff, which has now been resolved. The other issues were just around major painting programmes to make sure that the patient's journey through the hospital is a nice one. '

Half of Gateshead Health trust's four hospitals had an autumn red light. Now three have jumped to green, and one has reached amber. Trust director of estates and risk management Peter Harding says the main problem for the trust was refurbishment rather than dirtiness: 'We received£100,000 and developed an action plan which comprised refurbishing day rooms and entrances. We set up internal PEAT teams which went round to public areas, and spent time removing hand-written signs and making sure equipment was stored away. '