The Department of Health has published a revised national tariff for when payment by results (PbR) is rolled out next April.

The new tariff promises to reflect as closely as it can the true cost of service delivery. The Department has also pledged that the changes do not alter the fundamentals of PbR, that being:

• the use of national casemix-adjusted prices with a focus on commissioning on volume and quality (in place of local price negotiation)
• the freedom of providers who operate at below tariff price to use surpluses as they wish (ie, for the benefit of patients)
• a responsibility for all parties to operate within a rules-based and transparent system for the benefit of patients

Major players in the war on hospital acquired infection have met to discuss strategy.

The first national conference for NHS directors of infection met in London and Leeds this week. The directors have recently been given new powers to fight infection at ward and hospital level by:

• challenging hygiene practice and prescribing decisions
• increasing training
• enforcing hand hygiene
• ensuring sterility of invasive equipment

The directors hope to establish a national network for infection control so they can learn from best practice in other areas.

Infection director is a new post announced by Sir Liam Donaldson, chief medical officer, in December. In each hospital they head a team of experts and nurses charged with ensuring hygiene procedures are followed and infections are contained swiftly. Every hospital also has a top team member directly accountable to the chief executive and responsible for cutting healthcare associated infections.

Health Secretary John Reid said: 'Everyone has a role to play in tackling MRSA — cleaners are as important as consultants. This conference is part of an NHS-wide campaign to reduce levels of hospital infections to the lowest possible levels. To achieve this, we need to drive home the fact that prevention is everybody's business, not just the specialists.'

John Reid underlined his strong stance on this matter by announcing that one of the key duties of the new chief nursing officer, Chris Beasley, would be to fight the hospital superbug methicillin resistant staphylococcus aureus (MRSA).

Infection facts

• 5,000 people die each year from hospital acquired infections (HAI), although the National Audit Office believes the real number may be higher
• The UK has one of the highest rates of HAI in Europe.
• MRSA, one of the main causes of HAIs, first appeared in the 1960s and cases have increased six-fold in the last ten years. They will probably double in the next six years
• Some of its strains are resistant to all known antibiotics
• The fight against it costs the NHS £1bn a year

The fight against infection is one of the key duties of the new chief nursing officer Chris Beasley.

On the day of her appointment the DH launched a matron's charter, which sets out the powers nurses have to control hospital hygiene standards. These include:

• Being able to withhold payment for poor cleaning services
• Ensuring that all staff have training for infection control
• Making cleaners feel part of the ward team
• Providing clear, well-publicised cleaning routines

The document follows Florence Nightingale's diktat: 'Let whoever is in charge keep this simple question in her head, not how can I always do this right thing myself, but how can I provide for this right thing to be always done?'

It asks matrons to consider some of the following:

• What could you do to make it easier for cleaning staff to do their job?
• Before you buy a new piece of equipment, do you have a cleaning plan in place for it?
• Are cleaning staff invited to staff parties and do their photos appear alongside others at the entrance to wards?
• Does your trust involve infection control nurses in refurbishment and new build projects?
• Do you pick up odd pieces of litter?
• Do you have a rapid, reliable response to patient comments?

Gail Adams, head of the nursing section of the public services union UNISON, which represents many nurses and hospital cleaners, commented on the matron's charter: 'UNISON will be arguing that taking contracts back in house is the best way to make cleaning staff accountable and feel part of the NHS team, not simply making sure they are invited along to the Christmas party.'

Health Secretary John Reid criticised the last Conservative government's contracting out of hospital cleaning, saying that the people doing the cleaning did not always feel part of the healthcare team. In an interview on the Today programme, BBC Radio 4, he said: 'I am not going to ban contracting out at the moment... but if there is going to be a contract out-of-house, then the nursing staff must be involved in the drawing up of that contract so that there is clear control for clinical nursing staff on the ground.'

Chris Beasley, whose last post was head of the NHS Modernisation Agency, has worked in a variety of hospital and community nursing roles since 1962. The previous chief nurse, Sarah Mullally, left the DH for the Church of England.

The chief nursing officer is head of all nurses, midwives and health visitors in the country. Duties include:

• Advising on nursing, midwifery and health visiting and helping develop policy
• Working with professional statutory bodies, professional and staff associations, NHS managers and the voluntary and independent sectors
• Ensuring an effective UK contribution to nursing and health policy in internationally including with the World Health Organisation, the Commonwealth and Europe
• Contributing to managing the NHS

The independent regulator of NHS foundation trusts (Monitor) has set new target dates for the authorisation of the next two groups of foundation trusts.

The 20 new applicants (see below) have been given an extra two months to assess the impact of the recently published 2005/06 tariff changes under the payment by results system.

Group three deadline: 1 January 2005
Barnsley District Hospital
Burton Hospitals
Chesterfield and North Derbyshire
Gateshead Health
Harrogate Healthcare
Nottingham City Hospital
Southend Hospital
South Tyneside Healthcare
West Suffolk Hospitals

Group four deadline: 1 April 2005
Aintree Hospitals
Birmingham Heartlands and Solihull
Birmingham Women’s Healthcare
East Somerset
Frimley Park Hospital
Lancashire Teaching Hospitals
Liverpool Women’s Hospital
Newcastle-upon-Tyne Hospitals
Royal Bournemouth and Christchurch
Royal National Hospital for Rheumatic Diseases
Wrightington, Wigan and Leigh

One of the first foundation trusts is in financial distress and has been ordered to call in a firm of professional advisers.

Bradford Teaching Hospitals NHS Trust has been ordered by Monitor, the independent regulator of NHS foundation trusts, to use the services of financial advisers Alvarez and Marsal.

The independent regulator has taken this action to correct a departure from the business plan approved in April. This is the first time Monitor has used its powers in this way.

The size of the deficit has not been officially revealed, although The Guardian sets it as £4m.

The Guardian also reports that the chief executive of the trust, David Jackson, has blamed payment by results, an inadequate inflation allowance and the high cost of the new consultant's contract.

Foundation trusts have been rewarded for high standards by a degree of financial independence from the government. They are a new scheme under the Labour government. Foundation trusts that run into financial difficulties are not bailed out by the government as ordinary trusts are.

Wales may go the way of Ireland by banning smoking in the workplace.

Welsh Health Minister Jane Hutt outlined the Assembly's hopes on this issue when the British-Irish Inter-Parliamentary Body met in Wales for the first time since the principality devolved.

She said: 'The introduction of the workplace smoking bans in Ireland and Norway has generated a great deal of interest and debate. We are fortunate to be able to learn from their success at implementing this, in terms of leadership, public support, the timeframe required, the need for public education and issues around enforcement.'

In January 2003 the Assembly called upon the UK government to bring forward a bill giving the Assembly powers to enact such a ban.