A letter leaked to HSJ has revealed the strained relationship between the government and the Healthcare Commission following the Maidstone and Tunbridge Wells infection outbreak.

In a terse letter to health secretary Alan Johnson, dated 19 December 2007, Healthcare Commission chair Sir Ian Kennedy firmly rebuffed criticism that the commission failed to brief the Department of Health over the C difficile outbreak, in which at least 90 people died.

Sir Ian was fulfilling a request by Mr Johnson 'to reflect on any lessons which would be learnt both for the Healthcare Commission and the Department of health'.

He said that an effective strategic relationship between the commission and the DH had been historically "difficult to achieve".

Attempts to set up meetings with senior DH staff to "enable appropriate co-operation, including our raising warnings, have not been particularly successful", the letter revealed.

In future, the commission needed regular contact with ministers and David Nicholson's "top team", rather than with their delegated representatives.

There was tension between the DH and the Healthcare Commission following publication of the commission's report on the outbreak in October last year, as Mr Johnson was facing growing pressure to reveal when he first knew about the Maidstone and Tunbridge Wells outbreak.

According to the letter, Mr Johnson told Sir Ian he "did not feel well briefed about the situation".

The letter refers to a memorandum of understanding that identifies the DH's investigation and inquiries unit as the key point of contact for the commission. "The memorandum explicitly says that it is the investigation and inquiries unit's job to keep other interested parties within the DH informed, including ministers and senior management."

Sir Ian said: "Questions have also been raised as to whether the Healthcare Commission should have acted more quickly on behalf of patients."

The commission wrote to Maidstone and Tunbridge Wells trust five times between December 2006 and April 2007, raising concerns about practices at the trust and calling for immediate action, he said.

Copies of the correspondence were sent to NHS South East Coast "where appropriate" and "there was no question of standing by and doing nothing".

Sir Ian said: "We strongly believe that the Healthcare Commission's role is to provide an independent assessment of performance at NHS trusts while the management of trusts' performance should be the role of others, including [strategic health authorites]."

The letter also defended the commission's decision not to ask former health secretary Patricia Hewitt to place the trust in special measures. It says the trust had grasped the seriousness of the matter and was taking steps to improve infection control.

Neither the Healthcare Commission nor the DH would comment.

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