The NHS is not on track to hit the April 2008 MRSA target - and the government's own experts believe the goal of halving the incidence of infection from its 2004 rate may never be achieved.

A Department of Health memo, seen by HSJ, gives the stark warning and sets out plans aimed at ducking negative publicity when the news about the infection breaks.

Options discussed include delaying the deadline, which the paper admits would leave the government 'open to the accusation of fiddling', and switching to locally set targets, which 'would be presented by the media as a cop-out'.

In November 2004 then health secretary John Reid pledged that every trust would halve cases of MRSA (methicillin-resistant Staphylococcus aureus) in the blood by 2008.

But the memo, sent to ministers by DoH director of health protection Liz Woodeson on 20 October 2006, reveals that the government has little confidence this will be achieved.

It says: 'We have a three-year target to halve the number of MRSA bloodstream infections (bacteraemias) by April 2008. Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable.'

It continues: 'The opinion of DoH infection experts is that we will succeed in reducing MRSA bloodstream infections by a third, rather than a half - and that, even if we had a longer period of time, it may not be possible to get down to a half.'

And in a section discussing putting the target back by a year, it adds: 'We might still fail to achieve the target in 2009 because a certain level of MRSA is unavoidable and we don't really know what that level is.'

The paper stresses that failure 'is not due to a small number of trusts doing badly but 116 underperforming'. The whole NHS in England is off course by 27 per cent.

Much of the document focuses on the 'handling' of the target. Ms Woodeson says it 'is not a public service agreement target, so there is theoretically scope to change it. But it has been publicly announced by ministers, including to Parliament, on many occasions, so handling would be an issue'.

A DoH spokeswoman said: 'We deplore this leak. This paper confirms that from the prime minister and health secretary downwards, the government is determined that the NHS should get on top of the problem of MRSA and other infections.'

She said progress on the target had been 'slower than anticipated' but that combined with measures to combat the bug it was 'undoubtedly having an impact' with an 11 per cent reduction in MRSA bloodstream infections in hospital in the winter of 2005-06, compared with two years earlier.

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