The Department of Health considered imposing financial penalties on trusts which fail to meet MRSA targets, the leaked memo reveals.

The document suggests that such fines could be included in the NHS model contract between acute and primary care trusts, in the same way that they were introduced for trusts moving too slowly on the 18-week target when the contract was published in December.

It states: 'Discussion is ongoing at an official level about whether to include the target in the model contract, eg as part of a mandatory section on clinical safety and effectiveness. There is a separate question as to whether this should be accompanied by some form of financial consequence for MRSA bacteraemias.'

The document lists three forms the penalty could take:

  • non-payment for any patient who develops an MRSA bacteraemia (possibly limited to cases diagnosed more than 48 hours after admittance to rule out those patients already infected on arrival) and/or;
  • a fixed financial deduction could be levied against trusts that are failing to meet their target trajectory, or;
  • a deduction for every case above the trajectory.

The paper, sent to health minister Andy Burnham as well as health secretary Patricia Hewitt, set out the case against penalties: that they could 'over-complicate the contract; impose an additional administrative burden; waste time in unhelpful disputes over who had caused the bacteraemia; increase the risk of under-reporting and potentially alienate clinicians who up until now have been supportive of the target.'

No mention of a penalty for MRSA failures was included in last month's model contract. Bonuses for meeting the target were also suggested in the document but rejected as a general approach to the model contract.

The government appears to have already acted on two suggestions from the document, written on 20 October: to ensure that the Healthcare Commission's new powers to crack down on MRSA are 'exploited to the maximum', and to include information about MRSA performance in local patient choice booklets.