The possibility that fines for C difficile infections will have a “destabilising” effect on some hospitals next year is to be investigated by the Healthcare Financial Management Association.

The NHS standard contract for 2012-13 requires commissioners set a limit for the number of hospital acquired C difficile infections each acute trust may be responsible for in a year without attracting penalties. If trusts exceed their limit they are fined a set proportion of their turnover, based on the scale of the breach.

HFMA spokesman Chris Calkin said some acute trust members had raised concerns that the “penalties that could be imposed were very significant, and perhaps disproportionate”.

“For example, in one case quoted, the understanding was that if they applied the penalty it could cost them up to £750,000 for having one case over and above the target,” he said.

He added: “The service is doing well, and needs to do even better, at getting healthcare acquired infections down, but that seemed to us like something that could potentially destabilise a trust disproportionately.”

The potential issue, Mr Calkin said, was the “law of diminishing returns”. As hospitals have reduced their rates of hospital acquired infection their target limits have reduced, meaning each case has a proportionally greater impact on their performance against the target.

The HFMA plans to survey a representative sample of trusts, to establish whether this is a problem across the whole system or related to just a few specific trusts.

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