New Monitor rules on C difficile infections could still mean foundation trusts are downgraded by the regulator for relatively small outbreaks, HSJ has been told.

Trusts had previously complained to the regulator that their governance risk ratings could be disproportionately hit by small rises in the infection rate.

Monitor uses red, amber and green governance ratings to track how well a foundation trust is run, assessing organisations’ C difficile performance against a quarterly target.

Monitor’s compliance framework rulebook for 2012-13 claims to address concerns from foundation trusts that providers with very low C difficile targets would breach them too easily.

This year 22 trusts have a target of fewer than 10 C difficile infections and four have a target of zero, according to the Foundation Trust Network.

To help these trusts, Monitor has set a minimum of 12 cases of C difficile before it will consider downgrading any organisation.

The network welcomed the threshold.  But it said the new methodology and the way this had been “translated into contract penalties” could still cause problems for larger trusts, which would almost always have targets above 12 because of their size.

A network spokeswoman said this “could have unintended consequences for large high-performing trusts”.

One foundation trust chief executive told HSJ the new minimum was a “get out of jail free card” for smaller trusts but failed to help larger organisations.

He said: “The rest of us face extremely challenging targets, and whilst many will deliver a lower out-turn this year, that has largely been due to there being no serious flu outbreak and no serious winter [pressure].

“The prospect of holding that position in a bad year would in my view be nigh-on impossible.”

HSJ’s Barometer survey of chief executives saw the same complaints from trust bosses.

The new targets for trusts have been set in order to produce an 18 per cent national reduction in C difficile infections.

A monitor spokesman said downgrading trusts above the C difficile target would not be automatic.