Star-ratings are to replace the traffic-light system of assessing hospital cleanliness from next April in order to 'align performance in relation to the patient environment with other aspects of trust performance'.

The most recent round of Patient Environment Action Team inspections, using the old system, found significant improvement, with no trusts in the red category, 447 yellow and 389 green. In March this year 42 were red or poor, 367 yellow and 280 green.

While accepting that 'no hospital can be perfectly clean and tidy at every moment of the day and night', the Department of Health has insisted that further improvements can be made - even among those rated green.

To help sustain developments, health secretary Alan Milburn announced that matrons will be mandatory members of hospital cleanliness and inspection teams, and the Women's Royal Voluntary Service will also be invited to join the teams.

Speaking at St Mary's trust which has gone from red to green this year, Mr Milburn said the cleaning campaign was working 'thanks to cleaners, porters, caretakers and ward staff, led by matrons'.

But his remarks were attacked by NHS Confederation policy director Nigel Edwards as 'a vast simplification' and 'an insult to all the other people involved'.

St Mary's does not have any matrons and has appointed a new director of estates and facilities, retendered its cleaning contract and set up a system of zone management. Mr Edwards also said the health secretary's specification of membership of inspection teams was the antithesis of the purported aims of Shifting the Balance of Power, and 'completely at odds with the idea of decentralising'.