Christine Hancock, general secretary of the Royal College of Nursing, called for a back to basics movement to improve the "environment of care" in hospitals.

Speaking at the RCN's annual congress in Harrogate, she said issues such as patient dignity, confidentiality, cleanliness of wards, services for partners and relatives and hospital nutrition were as important as the government's new clinical indicators.

These were often the areas that patients singled out after a hospital stay, she said, and in many cases, standards were getting worse as a result of the shortage of nurses.

"We've got league tables for death rates - why not have them for the incidence of pressure sores, for pain management, nutritional standards, or the number of patients who say that their discharge home was properly planned?" she asked.

Staff levels

She added that league tables could also measure staffing levels, the skill mix of qualified and unqualified nursing staff and staff turnover.

The RCN expressed concern earlier in the week that experienced nurses were being replaced by cheaper less experienced nurses or healthcare assistants.

Christine Hancock: 'the environment of care is as important as clinical care'

"Would you want to go for an operation in a hospital where you knew there was a low ratio of registered nurses to healthcare assistants on the surgical wards?" she asked.

"Most trusts don't even know how many registered nurses they've got on a ward.

"At the moment we know how many operations are done - but there's no way to find out if the windows are dirty, or how long it takes for a broken toilet to be fixed."

She added that many of Britain's hospitals were "depressing, dirty, demoralising buildings which are long past their 'sell by' date".

Often the sheets had not been changed and the paint was flaking.

Pay

Ms Hancock said there were five key ways to improve the "environment of care": improving clinical governance of nurses, investing in leadership programmes for community staff, improving the "environment of care", working in partnership with patients and raising pay for all nurses.

Nurses at the conference accepted the government's recent pay rise with reservations.

Delegates angrily denounced the way the decision to raise newly qualified nurses' pay by 12% while setting an average rise of 4.7% had led to divisions and tensions on the wards.

The anger is deeper for some nurses who complain they are on the wrong grades.

They are also worried about talk of the government introducing some form of local flexibility over pay which could prove even more divisive.

The RCN is involved in a pilot study in Ealing involving "competence-based pay".

Christine Hancock said this was not the same as performance-related pay as it would be difficult to measure one nurse's contribution to a patient's outcome.

"Nurses provide round the clock care and several nurses may be involved in the treatment of one patient," she said at a press briefing.