When someone describes a toilet as being like the one in the film Trainspotting you know It is bad - but it is especially shocking to find that the toilet is in a hospital.

Simon Williams, assistant director of the Patients Association, has spent the last few months carrying out inspections at 30 hospital sites as part of the patient environment action team programme.

The Trainspotting loo - and if you haven't seen the clip from the film, you probably do not want to - was the worst thing he saw in the inspections, but he says he was surprised by the variability in standards. Many hospitals were excellent, but others were extremely bad, and there wasn't the enormous bulge one would expect in the middle.

'Some of the things I saw were disgusting, ' he says. 'We found disabled toilets down steps. A number of toilets were locked - in one place we asked at reception and were told they were locked because patients kept using them.

'We saw a huge investment in Blu-Tack and Sellotape for temporary signs. I always asked for a map at reception and in a couple of hospitals the maps were 10 years out of date. In one place half the site was now a housing estate.'

The teams made a point of asking patients for their views - one revealed that the cleaner had been round that morning, never having been sighted in the ward before.

But there were also lots of examples of good practice: Mr Williams saw hospitals which had good relations with the local community, well-maintained gardens and even a midweek 'cinema' showing. And some of the loos were clean.