The memo considers - and rightly rejects - the case for primary care trusts to fine acute trusts for MRSA rates

Infection control in hospitals is in crisis and the Department of Health believes that the existing target to halve MRSA cases by next April will not be hit and indeed may be impossible. That is the unambiguous message of an internal memo to ministers seen by HSJ. See news story here

The memo also admits frankly that Clostridium difficileis 'endemic' in the NHS. Managers at the highest level have already privately acknowledged that the operating framework's priority to act firmly on C. difficilewill be challenging, particularly as measures tailored to tackle MRSA are less effective. The scale of the problem detailed in the leaked memo will leave no-one in any doubt.

The memo considers - and rightly rejects - the case for primary care trusts to fine acute trusts for MRSA rates. Although superficially attractive, it would be of little practical use and lead to pointless arguments about blame: hospitals are not going to transform their infection rates because they got an invoice in the post. The measures that were adopted are much more sensible, focusing on regulatory levers 'exploited to the maximum' and more widespread information for patients. The latter will be the real key to change in a range of performance issues over the next few years - the evidence shows that customers switching, rather than fines, changes behaviour.

The memo acknowledges that missing the MRSA target will be greeted with dismay by the public, even though the DoH believes strongly that having the target has driven significant improvement. The fact that it claims the NHS is 'light years ahead of where we were two years ago' only underlines just how poor the situation has been allowed to get.