Most trust boards are prioritising finances and government targets over infection control, an HSJ poll has revealed.

The findings come seven months after board members and senior managers at Maidstone and Tunbridge Wells trust were lambasted for focusing on targets during a massive C difficile outbreak in which 90 patients died.

Only 12 per cent of respondents said infection control received more attention from their trust board than finances, government targets, clinical issues and workforce.

National Patient Safety Campaign director Stephen Ramsden said: “Some organisations haven’t understood the extent of harm we cause our patients.”

The poll of 168 NHS professionals, mainly managers, showed large discrepancies in the views of different tiers of management. Chief executives were most likely to downplay trusts’ focus on targets. Just 11.5 per cent said targets got most attention from boards, compared with 37.5 per cent of middle managers and 40 per cent of trust directors.

The exclusive survey coincides with the Patient Safety Congress today and tomorrow, run by HSJ and Nursing Timesin partnership with the National Patient Safety Agency, the Health Foundation, the NHS Institute for Innovation and Improvement and Microsoft.

The survey uncovers concerns over trusts’ ability to prevent infection outbreaks. Asked if their organisation had sufficient resources to tackle healthcare acquired infections, 42.5 per cent of middle managers said no. Among chief executives this dropped to 11.5 per cent.

The survey also revealed that serious incidents are being covered up. A quarter of respondents knew of a patient safety incident at their trust that had not been reported, including a patient falling out of a window, immunisation errors and preventable post-surgical deaths.

Mr Ramsden said many managers and patient safety directors wanted more support from boards to prioritise safety. At Luton and Dunstable Hospital foundation trust, where he is chief executive, safety is the first agenda item at board meetings. “If strategic health authorities, the Department of Health and Monitor are focusing their attention on targets, then leaders in trusts are going to mimic that,” he said. Many staff agreed the DH needed to adjust its priorities.

Health Foundation chief executive Stephen Thornton said there was no excuse for not prioritising safety issues. “It’s pretty straight-forward: patient safety comes first.”

Asked whether conflicting demands meant boards sometimes had no choice but to push safety down their list of priorities, he said “I don’t personally buy that. We shouldn’t be in a position where we are providing a service that falls below acceptable standards.”

Patient Concern co-director Joyce Robins said “political gimmicks” such as the deep clean masked the fact that “the main focus is money”.

NHS chief executive David Nicholson said the DH had made infection prevention a priority and committed£270m per year by 2010-11 to it. “We are on track to halve cases of MRSA,” he said.

Responding to the findings on boards’ priorities, Mr Nicholson said: “The obligation to meet targets cannot be used as an excuse for failing to meet other managerial objectives. NHS managers must always deal with conflicting priorities and plenty of organisations manage this successfully.”

For more analysis and comment, see Patient safety survey: those in peril and Safety demands leaders at the top and power at the bottom

For more from this week’s HSJ Patient Safety Congress, go to

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