The Department of Health has rejected calls to make the penalties for breaching C difficile targets more proportionate but promised to keep the situation under review, HSJ has learned.

The Foundation Trust Network claims the penalties - which can be up to 2 per cent of turnover under the NHS standard contract - are “potentially financially destabilising” and unfair on strongly performing trusts that are trying to reduce incidents of C difficile against already low baselines.

Four trusts have a target of zero cases while 22 have a target of fewer than 10 cases in 2012-13, according to the FTN.

Its chief executive Sue Slipman said the situation was being “exacerbated” by the pressure being put on primary care trusts to implement all penalties in the contract without discretion. The FTN has been lobbying for a contract variation to make the penalties more proportionate and suggested replacing the measure of incidences with a rate of cases per bed days.

However, DH director of performance Alan Hall rejected the network’s proposals. In a letter to Ms Slipman he said it was “important” the “zero tolerance” approach to healthcare acquired infections continued.

However, Mr Hall said the DH would keep the situation under review and consider a contract variation later this year if evidence of disproportionality emerged. He said sanctions should not be imposed in a “mechanistic” way.