Published: 14/04/2005, Volume II5, No. 5951 Page 3

The Conservative Party should put up or shut up over MRSA. Shadow health spokesman Andrew Lansley says he does not want to name the trusts where managers have supposedly refused to close infected wards 'because it would not be fair to turn them into a cause célÞbre' (news, page 8). It is a reassurance that will sound very hollow to North Cheshire Hospitals trust, where Margaret Dixon's shoulder blasted managers into the political spotlight.

Mr Lansley knows that by making generalised comments he can damn all NHS managers without having to produce specific evidence. He also makes it easier for newspapers to use a handful of examples in which trusts have allegedly made bad decisions to suggest that the improved performance in A&E is endangering patient safety (Media Watch, page 10).

High-profile targets can cause some unwanted outcomes to emerge alongside more positive results; it is difficult to have one without the other.

There is a conflict between infection control and reducing waiting lists - every manager knows it and many manage that tension very well. But the National Audit Office report on infection control from which Mr Lansley likes to quote sets out four main areas of concern; the issue of managing in a target-led environment is a sub-set of one of them.

Mr Lansley recognises the complexity of the issue. He should make sure he reflects it rather than relying on a simplistic and misleading vision of managers denying the wishes of clinicians.