Andreas Whittam Smith: The truth behind the missed MRSA targets

This Government has form in listening only to those experts who tell it what it wants to hear

A leaked Department of Health memo says as much about the way the Government works as it does about health care. It revealed that the target for reducing MRSA bloodstream infections in hospitals is unlikely to be reached. When the commitment was made, John Reid was the health secretary. He went to the Chief Nursing Officer's conference in November 2004 and told the delegates that "I expect MRSA bloodstream infection rates to be halved in our hospitals by 2008. NHS acute trusts will be tasked with achieving a year on year reduction up to and beyond March 2008".

Mr Reid was responding to public disquiet about the risks of picking up an infection in hospital as magnified in numerous media stories. The chief executive of the National Health Service could have made the announcement, but politicians like to give an impression of action, calculating no doubt that if things go well they can take the credit and if things go badly they can, if they choose, do just what the same Mr Reid is now doing at the Home Office - blame officials. But a further question arises: was the initiative really Mr Reid's or did the order come from 10 Downing Street? The leaked memo provides ample evidence that the Prime Minister was involved.

In discussing what to do, the author, Liz Woodeson, the director of Health Protection at the Department of Health, says that maintaining the target as it is and driving hard to meet it is the policy favoured by the No 10 Delivery Unit. As for dropping the target altogether "this would be hard to get past No 10". The Prime Minister's Delivery Unit, to give it its full title, was set up to enable the Prime Minister greatly to increase his control of what Whitehall does even though Secretaries of State carry full legal responsibility for their departments derived from their status as ministers of the Crown. What seems to have happened in this case is that the Secretary of State made the announcement in order to preserve the established form, but Downing Street gave the orders.

But was the commitment to halve infection rates sensible at the time it was made? Again the memo is revealing. Written last October, it states that "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". The memo went on: "The opinion of infection experts is that we will succeed in reducing MRSA bloodstream infections by a third rather than half - and that, even if we had a longer period of time, it may not be possible to get it down to half."

This makes one wonder whether infection experts were properly consulted in preparation for Mr Reid's pledge to the public? If they did fully support the commitment at the time, then there is no more to be said. We can conclude that they did so in good faith but that subsequent scientific research has shown that the target was in fact much too ambitious.

Stuff happens. But this government has form in listening only to those experts who tell it what it wants to hear. Moreover, rightly or wrongly, Downing Street has a low view of Department of Health officials. It views them as resistant to change. In the absence of information to the contrary, the suspicion will linger that there was insufficient consideration of the setting of the target.

However, there is a second aspect to the question whether the pledge to halve infection rates should have been given. Did the National Health Service have the capacity in terms of management skills to achieve the objective? I cannot fault the way the Department of Health went about the task. Eleven days after Mr Reid's speech, the Department had sent hospital trusts a summary of best practice in screening for MRSA colonisation. Seven months later it circulated a comprehensive delivery programme to reduce infections. This included essential steps to safe, clean care and to key clinical procedures. It listed self-assessment tools and learning resources and it gave a description of high impact interventions . Chief executives were urged to sign up for the programme. I am surprised that all this had to be spelt out to hospitals. How can you run a hospital and not know what are the essential steps to safe, clean care or not understand key clinical procedures or not grasp what interventions might have the highest impact?

Even more astonishing is what the Department of Health decided was the best way to encourage hospitals.

In May last year, when it was already apparent that progress was disappointing, Andy Burnham, the Minister of State for "Delivery and Quality", gave a speech in which he said this: "I want to explain the benefits of reducing the numbers of healthcare related infections. Today we are publishing a new guidance containing a productivity calculator which shows that, if these improvements are implemented and sustained across the NHS, millions of pounds can be saved by Trusts that reduce rates of infections." In effect he was saying to hospital trusts, "if you won't do the right thing for the sake of patients, at least do it for the sake of your bottom line".

What then is the true story of the missed target for reducing superbug infections in hospitals? Downing Street kept up the pressure and the Department of Health responded well. Either the target was wrongly set or the hospital trusts were recalcitrant - or, most likely, both.