One rather misunderstood and worrying fact is that MRSA is now rather endemic in the community, outside of hospital, while many cases of Clostridium difficile also occur outside of hospital. That is not to say hospitals could not manage these problems better, of course they could, however would fining for failures really help improve the situation?
I would argue a very strong 'no'. Take Tunbridge Wells as a case in point, we can conduct a quick thought experiment here; here was a hospital in financial trouble with multiple management problems:
"Many of the buildings, especially at the Kent and Sussex Hospital, were old and in a poor state of repair ... indicated that shortages of nurses contributed to the spread of infection ... The trust’s bed occupancy rates were consistently over 90% in the medical wards ... By definition for these areas there were no funds for dedicated staff, and at least initially they were staffed almost entirely by bank or agency nurses, bringing little continuity of care. Many of these factors increased the risk of transmission of infection."
"The lack of organisational stability, with numerous structural changes over the last three to four years, and a high turnover of senior managers, meant that managers could not settle into roles and focus on the key issues. Many felt there was little delegation. The style of management was described as reactive, with frequent changes of direction."
"... were preoccupied with finances, and had a demanding agenda for reconfiguration and private finance initiative (PFI), all of which consumed much management time and effort."
The factors contributing to this disaster were complex and included outdated buildings and wards, government targets and the excessive movement of patients, the inadequate isolation of patients, high bed occupancy rates, shortages in nursing numbers and a lack of continuity of care, and managerial malaise due to frequent restructuring and a preoccupation with financial issues.
Virtually all of these factors have been contributed too and massively worsened by the government's incessant interference and meddling with the NHS. A chronic underinvestment has left buildings and infrastructure outdated and unable to cope with modern infection control needs. Top down targets have led to the excessive movement of patients and the catalysis of infection spread. Falling acute bed numbers over the last ten years have led to bed occupancy levels rising to too high a level on average, a known factor in increasing hospital acquired infection. Centrally imposed deficits gave led to the financial pressures that result in key front line staff being laid off, while wards are left dangerously short staffed. While endless political interference in the structure of the NHS has resulted in reorganisation after reorganisation, a situation where no one knows their role, and consequently a system of no responsibility and accountability.
The government has let hospital acquired infection multiply out of control in recent years because it has simply not addressed the root causes aggressively enough. These ideas of fining failing trusts are completely misconceived and would make a bad situation worse. In fact several causal factors are still being worsened by direct action from central government, so the idea of central government fining people for things that it is directly contributing towards is nothing short of idiotic, while the fines would only accentuate the problems by worsening the causative financial pressures on the trust concerned. We currently have a situation where there is no accountability or responsibility, and if there was I have a distinct feeling that several of the people being held to account for this mess would be of the political variety. The politicians should be fining themselves.
* It is worth pointing out that, although it is now used as a general catch-all term for hospital acquired infections, MRSA is a specific bacterium: methicillin-resistant Staphylococcus aureus (methicillin is an anti-biotic from the same family as penicillin).—DK