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Christina Rees (Neath) (Ind)
I beg to move,
That this House has considered World Sepsis Day.
It is always a pleasure to serve under you in the Chair, Ms Fovargue.
Dame Cheryl Gillan stood down as chair of the all-party parliamentary group on sepsis in March 2021, and I felt so humble when she asked me to become chair. I had always admired Dame Cheryl, who became a dear friend and treated me with respect and dignity. It was a tragedy when she died in April 2021 only a month after standing down as chair. I miss her wisdom and guidance, but most of all I miss her friendship.
I have done my very best to lead the APPG and have had enormous help from the UK Sepsis Trust, particularly from Sarah Hamilton-Fairley and Dr Ron Daniels. I could not have carried out my duties as chair without their constant support, advice and good humour. We have become close friends.
Why did Dame Cheryl choose me? Perhaps it was because she knew that I initially became a member of the APPG in 2017 because I am a sepsis survivor. One day we had a cup of tea together because she wanted to know my sepsis story. In summer 2013 I went to New Zealand to visit my daughter Angharad, who was living and working in Te Anau, South Island. On the flight over I started to have what I thought was toothache in my lower right jaw. After a few days in Te Anau, it did not improve, so I went to the emergency dentist, who took X-rays and could not find anything, but gave me antibiotics and painkillers. There was still no improvement after about a week and the right side of my face became swollen, so I went back to the dentist, who thought it might be an abscess and gave me stronger antibiotics and painkillers.
I got on the flight home. During a short stopover at Singapore airport, I started being sick, but I thought it might be travel sickness. I just wanted to sleep. By the time I landed at Heathrow I was in a bit of a mess, but I managed to get to Paddington and get on the train back to Wales. The pain and swelling had increased, but I was so exhausted I just fell asleep.
I got home, took more painkillers and slept. I live alone. When my friend Jen called to see me, she was really concerned, so she drove me to my dentist, who could not find anything. They thought it was an abscess and replaced the filling. I was on the ceiling with the pain, which I felt through the many injections, which also put me into orbit. The dentist gave me more antibiotics and more painkillers. Nothing improved and I continued to be sick. I had not eaten anything in days and became extremely dehydrated.
Jen called to see me again and took me to the local A&E. The emergency doctors rehydrated me, but did not diagnose anything and sent me home. I continued to be sick and Jen took me back to my dentist, who sent me immediately to the dental hospital at the Heath Hospital in Cardiff. I must have lost consciousness on the journey because I do not remember anything more. Jen told me later that they admitted me to A&E and the duty surgeon, Dr John Jones, identified sepsis. He told Jen that if he did not operate immediately I would die. He asked whether it would matter if he had to cut my face to get rid of the poison and Jen told him, “Just make sure she doesn’t die.”
After some time in intensive care and on a ward, I had recovered enough to be discharged, but it took me years to recover my strength physically and mentally. How I caught sepsis remains a mystery. I was fortunate to survive and I owe my life to Dr John Jones, who correctly identified sepsis and acted immediately, to all the wonderful NHS staff who cared for me, and to my friend Jen.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
I pay tribute to my hon. Friend’s courage, the contribution she has made and her tribute to Dame Cheryl, and congratulate her on securing this debate on World Sepsis Day. Through her story, she has shown the importance of raising awareness and recognising symptoms of sepsis early. Will she join me in recognising the vital work of the UK Sepsis Trust, whose support made such a difference to my constituent Kamaldeep Sandhu and her family after her brother Rick, whom she describes as the perfect brother, husband and father, tragically lost his life to sepsis last year, aged 42? The family believe that the hospital spotting the signs too late meant that he died more quickly than he would have done otherwise. I also pay tribute to Kamaldeep’s campaigning to try to ensure that what happened to her family does not happen to anybody else.
Christina Rees
I thank my hon. Friend for her important intervention and I am very sorry to hear of her constituent’s loss. My heart goes out to Rick’s family and friends. I will speak a lot about the UK Sepsis Trust, because it helped me enormously and I want to highlight its work in fighting sepsis.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady on securing this debate and for the very personal story she has conveyed to us all—we are very much moved by it. To reinforce what the hon. Member for Feltham and Heston (Seema Malhotra) said in her intervention, sepsis claims some 11 million lives globally each year, or five lives every hour in the United Kingdom. That is more than the deaths from bowel, breast and prostate cancer combined. To give a Northern Ireland perspective, sepsis affects around 7,000 people yearly in Northern Ireland, of whom 1,240 lost their lives to it in 2021. Does the hon. Member for Neath (Christina Rees) agree—I suspect the answer will be yes—that there must be more awareness of the earliest symptoms, to ensure that death from this dangerous and life-threatening disease is reduced as much as possible across all of the United Kingdom of Great Britain and Northern Ireland?
Christina Rees
I agree with the hon. Gentleman. He must have seen my speech, because he has quoted some of the stats that I am going to come on to later.
What is sepsis? It is a life-threatening condition that arises when the body’s response to infection causes injury to its tissues and organs. It is a global health concern, but today I will focus on its prevalence, the challenges and some potential solutions in the UK. Sepsis is indiscriminate. While it primarily affects very young children and older adults and is more common in people with underlying health conditions, it can readily occur in those who are otherwise fit and healthy.
Sepsis can be triggered by an infection, including chest and urinary tract infections. It is not known why some people develop sepsis in response to those common infections whereas others do not. Sepsis is often referred to as “the silent killer” because of its ability to strike swiftly and unexpectedly. In the UK, sepsis is a significant public health problem. Each year around 240,000 cases are reported, leading to more than 48,000 deaths.
Sepsis is the leading cause of avoidable death in the UK, claiming more lives than breast, bowel and prostate cancer combined. Unlike data for heart attacks, strokes and cancer, sepsis data is imprecise, because it relies on coded administrative data rather than the granular clinical data of patient-level registries. Moreover, this striking deficit means that not only do we find it necessary to estimate the burden of disease, but we are decades away from precision medicine for sepsis. However, therein lies a paradox, as the UK’s unique healthcare infrastructure means that we are well placed to change that for the world.
Around 40% of people who develop sepsis are estimated to suffer physical, cognitive and/or psychological after-effects. For most people, those will only last a few weeks, but others can face a long road to recovery and develop post-sepsis syndrome. One of the biggest challenges in tackling sepsis is early diagnosis. Sepsis can mimic other common illnesses, making it difficult to spot in its early stages. Symptoms such as fever, increased heart rate, rapid breathing, confusion and extreme pain can be attributed to various conditions. This leads to delayed treatment, which significantly worsens the patient’s chance of survival.
To combat sepsis effectively, awareness is the key. The UK and devolved Governments, healthcare professionals, and organisations such as the UK Sepsis Trust have been working tirelessly to educate the public and healthcare providers about the signs and symptoms of sepsis. Public awareness campaigns and training for healthcare workers have been instrumental in improving early detection. Timely intervention is crucial in sepsis management. The UK Sepsis Trust’s “Sepsis 6” care bundle and treatment pathway includes administering antibiotics, providing fluids and monitoring vital signs, and has been implemented in 96% of hospitals across the UK and in 37 other countries worldwide to ensure rapid and effective treatment. Early recognition and swift action can save lives and reduce the severity of sepsis-related complications, but despite such work, there remain many cases of avoidable death every year.
Rachael Maskell (York Central) (Lab/Co-op)
I am grateful to my hon. Friend for securing today’s debate, and for the very powerful speech she is making. My constituent, a teenager, tragically lost his life. Not only did he display so many signs, his parents were screaming for help, but those calls for help—for further investigation and better treatment and management—were just not heeded. Does my hon. Friend agree that it is now crucial that we introduce Martha’s law, so that parents can be granted a second opinion when they ask for one, in order to save lives?
Christina Rees
I am very grateful for my hon. Friend’s intervention. I think she must have been looking over my shoulder, because I am just about to come on to Martha’s law. As always, her timing is impeccable.
Over the past couple of weeks, significant media attention has been given to the tragic case of Martha Mills, who died of sepsis aged 13. Martha’s grieving parents have advocated for the establishment of Martha’s rule, which would empower patients to request an immediate second opinion if they feel that their medical concerns are not being addressed adequately. Other preventable deaths include UK Sepsis Trust ambassador Melissa Mead’s son William. The then Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), apologised to William’s family after a report found that clinicians missed four opportunities to save his life, and to Jason Watkins, who lost his daughter Maude when she was only two and a half years old.
In order to end these preventable deaths, parents need to feel empowered to advocate for their child—to just ask, “Could it be sepsis?”—and clinicians must be given clear guidance on the appropriate care pathway in cases of suspected sepsis. At the moment, there is room for improvement on the clinical side, because of the confusion created by delays in updating the National Institute for Health and Care Excellence clinical sepsis guideline, NICE guideline 51. In addition, research plays a pivotal role in understanding sepsis better and developing more effective treatments. The UK has a rich history of medical research, and ongoing studies are dedicated to improving our understanding of sepsis. Advances in genomics, microbiology and immunology are shedding light on the complexities of sepsis, paving the way for innovative therapies. Technology is also proving to be a game-changer in the fight against sepsis, with AI-powered algorithms being used to interpret patient data and identify sepsis risk factors early on.
The UK Sepsis Trust is a charity founded by an NHS consultant, Dr Ron Daniels BEM, in 2012. It has led the fight against sepsis after Ron witnessed the tragic and preventable death of Jem Abbots, a 37-year-old father of two. The UK Sepsis Trust aims to end preventable deaths from sepsis and improve outcomes for sepsis survivors. It also strives to raise public awareness of sepsis and works to support anyone affected by this devastating condition with its free, nurse-led support service. It raises awareness by educating healthcare professionals and by instigating political change.
The UK Sepsis Trust aims to protect people by enabling the prevention of severe infection and the treatment of sepsis, while helping to ensure that antibiotics are used responsibly. Its clinical tools are used by healthcare professionals across the country and have been formally endorsed by NICE.
The trust contributed to feedback on a draft update to the NICE clinical sepsis guideline—NG51—in March this year. The final version was due to be released in June, following a request by NHS England to update it in the wake of a statement from the Academy of Medical Royal Colleges about the timing of using antibiotics. However, the publication was pulled at the last minute without any obvious reason. The result is that we are left with a NICE guideline from 2016 that conflicts with the position statement from the Academy of Medical Royal Colleges. This has caused confusion among clinicians, which could lead to patient harm.
Sarah Owen (Luton North) (Lab)
I thank my hon. Friend for giving way, and for her powerful and personal speech today. We have heard about the UK death rates from sepsis, but it is really important for us to bear in mind that sepsis is a global killer; one in five deaths globally are attributed to sepsis and one person dies from it every 2.8 seconds somewhere in the world. A lack of access to medical treatment is often a reason for those figures. Because the symptoms of sepsis are often similar to those of other illnesses, as has already been discussed, it is vital that we increase not only public awareness of it but awareness in clinical settings, too. Does she agree?
Christina Rees
I thank my hon. Friend for her very important intervention, and what she says is why World Sepsis Day is so important. Sepsis deaths are a global phenomenon and we need to do our bit in the UK to fight sepsis, as well as working globally.
Sepsis is a critical healthcare challenge in the UK and across the world, but it is one that we can tackle with determination, awareness and innovation. Early detection, rapid intervention, research and support for survivors are the cornerstones of our battle against this silent killer. I urge everyone to take sepsis seriously, to educate themselves and others about its signs and symptoms, and to support the ongoing efforts of the healthcare professionals and organisations working tirelessly to save lives and improve outcomes. Together, we can make a significant impact and reduce the devastating toll that sepsis has on our society.
On World Sepsis Day, we remember those who have lost their lives and those whose lives have been affected by sepsis. We stand by their families and friends, and we try to support them in any way we can. Their stories must be told. I ask the Minister to meet me, Dr Ron Daniels and Sarah Hamilton-Fairley from the UK Sepsis Trust, to discuss the help she can give to set up a national sepsis register.
When will the updated NG51 guideline be published? Can the Minister update us on the recent announcement by the Health Secretary in the main Chamber that he is exploring the introduction of Martha’s rule? He referred to Ryan’s rule, which has been successfully established in Queensland, in Australia, and which has prevented several potential tragedies. Ryan’s rule provides patients and their families with the opportunity to request a clinical assessment from a doctor or nurse when the patient’s health is deteriorating or not showing expected improvements. When will Martha’s rule be implemented?
The Swiss Government have recently announced 10 million Swiss francs of state investment—around £9 million—over a five year period for implementing sepsis improvement across five workstreams. The best possible way to mark World Sepsis Day would be for the Minister and the Government to commit to a similar investment in sepsis improvement work in the UK and, in so doing, prevent the UK from falling rapidly behind the international curve, when it should be leading.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Ms Fovargue. I start by thanking the hon. Member for Neath (Christina Rees) for introducing this important debate, which is taking place on World Sepsis Day; for her work as chair of the all-party parliamentary group; and especially for her tribute to Dame Cheryl Gillan, who did so much work in this space. I am sure that Dame Cheryl would have been delighted by the way the all-party parliamentary group has been taken forward under the leadership of the hon. Lady.
I was touched by how she shared her personal experience of sepsis because I think that will highlight to people listening or watching how difficult it sometimes is to diagnose sepsis and the very many circumstances in which sepsis can present. Sepsis is a devastating condition and, while many people who develop sepsis survive, every death is tragic. Patients rightly expect it to be recognised and treated promptly because very often they are feeling so poorly that they are not necessarily in a position to raise concerns themselves. Even as the hon. Member for Neath pointed out, just becoming unwell with sepsis has long-term consequences and it can take many months to recover from an episode. She put that extremely eloquently.
The many interventions have moved us all. Many of us will know people who have become worryingly ill or have died from sepsis. It is especially heartbreaking when the family of someone who has died from sepsis feel that more could have been done to save them. Those cases are hard to hear, but it is important for us to listen and learn at all levels of Government, from officials through to frontline clinical staff.
As has been mentioned, we have all been moved to hear about Martha Mills who was 13 when she tragically died from sepsis despite concerns being raised by her family about her care. On what would have been Martha’s 16th birthday last week, her mother spoke about her death and the need for patients and families to be listened to when they think that something is wrong. I echo the words of the hon. Member for Neath. We need to encourage more people to ask that question: could it be sepsis?
I am pleased to add my support to the announcement made by the Health Secretary that the NHS will be exploring the introduction of Martha’s rule in the United Kingdom. The Secretary of State is meeting Martha’s family later today and is looking at how this could be implemented. I am sure he will be updating the House and I am happy to update Members on the follow-up from that meeting and the work that is being done to look at this.
We anticipate that Martha’s rule will be similar to a system in Queensland, Australia, known as Ryan’s rule, which is a three-step process allowing patients and families to request a clinical review of a patient’s condition if they are deteriorating. Such a system would build on initiatives already being tested in the UK, including the Call 4 Concern scheme introduced in the Royal Berkshire Hospital. Evidence from the scheme suggests that patients and their families find it useful, and that it can make a real difference in outcomes for patient care.
Rachael Maskell
In the light of the fact that people suffering from sepsis can rapidly deteriorate, will the Minister ensure that a review of a patient could also be undertaken really quickly, without it becoming a bureaucratic process?
Maria Caulfield
Absolutely. That is the point: if families want a review, it needs to be done as quickly as possible. If we are going to look at Martha’s law, those processes will need to be looked at. It must not become bureaucratic to make a request. It must be a really practical process that makes a difference.
Sepsis is not a single disease and it cannot be diagnosed with a single test. It varies in presentation depending on the source of infection and the individual. I pay tribute to the UK Sepsis Trust, which today has reiterated the signs and symptoms for people to look out for, including: fatigue; not passing urine; breathlessness; skin being discoloured, which is particularly important for ethnically diverse communities, because the skin colour may be different in different communities; fits and shakes; confusion; and shivers. All those symptoms are signs of potential sepsis, so it is really important that people understand to look out for them. We will never fully eliminate the risk of sepsis or other forms of acute deterioration, but we must do everything we can to ensure that clinicians and other NHS staff working on the frontline can recognise a very sick patient.
As many Members know, 100% of ambulance trusts and 99% of acute trusts in England screen for sepsis using the national early warning score or NEW score, which is carried out in clinical care. Following recommendations from the Academy of Medical Royal Colleges and the National Institute of Health and Care Excellence, we are working to update national guidance on sepsis. I very much take the point made by the hon. Member for Neath about the importance of ensuring that that information is all in step and aligned with guidance across the board, so that there is one clear narrative about recognition of sepsis and the targeted use of appropriate treatment.
Research is key to improving outcomes the detection of sepsis and finding more effective treatments. We are committed to driving the evidence base to improve our understanding, and the Department is providing funding of over £1 billion a year through the National Institute of Health and Care Research to drive forward research studies in these areas. Since 2017, the national institute has funded 14 research projects on sepsis, with a combined total funding value of £27 million, but further applications will be welcomed, so if there people out there want to undertake research studies, please encourage them to come forward and put in applications.
It is important that I touch on antimicrobial resistance, as the issue is inextricably linked to sepsis. It is critical that we conserve our antibiotics so that if an infection occurs, they remain as effective as possible when they are really needed, including for sepsis. In line with the asks of the declaration, the Government are delivering a five-year national action plan and a 20-year vision to contain and control antimicrobial resistance by 2040.
I am pleased to say that we are working collectively, across the UK, with our counterparts in Northern Ireland, Scotland and Wales on that antimicrobial resistance national action plan. Hon. Members have touched on international collaboration, because no country or Government can tackle this issue alone. A study published last year by the Global Research on Antimicrobial Resistance Project shows that resistance was associated with the deaths of 4.95 million people worldwide, and many of those cases will be because of sepsis related to antimicrobial resistance. By working together with international partners, we can protect ourselves and help to treat sepsis more quickly and easily.
World Sepsis Day is an important reminder that there is more work to be done. In recognition of that and as a reminder of the importance of the issue, the Department is lit up in pink today. Once again, I thank the hon. Member for Neath. I am happy to meet her and anyone she wants to bring with her, because there is still work to be done. We have made great progress, and she is touched on work that is being done, including on Martha’s rule, but I am happy to meet her and the APPG to ensure that, by next World Sepsis Day, we have made further progress with this significant condition.
Question put and agreed to.