Hospital bug fine plan 'unfair'

Most deaths from C difficile occur in the over 65s

The government's plan to fine hospitals for not hitting Clostridium difficile targets is unfair, experts say.

An Oxford University and Medical Research Council-led team looked at the new system of fines starting next year.

It said most NHS trusts in England would end up paying out because of the random nature of the hospital bug, the British Medical Journal reported.

The statisticians said there should be more leeway, but the government said NHS bosses could use discretion.

C difficile rates are falling, although there are still over 8,000 cases among the over 65s in hospital every three months.

The system of fines is unfair and means most trusts will probably end up having to pay out at some point

Sarah Walker, lead researcher

Ministers have set hospitals a target of reducing infection rates by 30% over the next three years.

Those which fail to hit the target can face a sliding-scale of fines depending on how far they miss it by.

But the team said because C difficile was still relatively rare - there are only two or three cases per 1,000 patient-days in hospital - it was quite easy for a hospital to see a blip in cases even if they had good practices in place.

Using a computer simulation, the team worked out that each hospital had a 50% chance of getting fined in a year or a 95% chance over the three years that the target was being measured.

'Unfair'

The statisticians recommended a 15% window be allowed either side of the target to allow trusts some wriggle room.

Lead researcher Sarah Walker said: "The system of fines is unfair and means most trusts will probably end up having to pay out at some point.

"This could lead to trusts holding money back in reserve and that means less money for services."

But a Department of Health spokesman said there was already scope in the system to take random rises into account.

"This contract is clear that the NHS does not have to use the power. It is a local decision which allows the NHS to take into account the full range of circumstances at the time.”