Health: Sepsis

Lord O'Shaughnessy Excerpts

Thursday 14th September 2017 Lords Chamber

[Lord Grade of Yarmouth]

To ask Her Majesty’s Government what new efforts they will be making in the coming year to improve public awareness, and clinical management, of sepsis.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)]

My Lords, yesterday was World Sepsis Day, a timely reminder that patients rightly expect the NHS to recognise and treat this devastating condition. To continue making progress in tackling sepsis, NHS England yesterday published its Second Sepsis Action Plan. At the same time, NICE published a new quality standard for sepsis, building on the guidance it published in July 2016.

[Lord Grade of Yarmouth (Con)]

I thank my noble friend for that constructive response. The House may or may not know that sepsis kills 44,000 in the UK every year. It can develop from a simple scratch on the skin, but it is easily cured with antibiotics. The problem is ignorance of the symptoms on the part of both patients and clinicians. Will the department undertake to explore, with the UK Sepsis Trust, an urgent and impactful awareness campaign that will save both lives and money?

[Lord O’Shaughnessy]

I am grateful to my noble friend for raising this important issue and I should like to pay tribute both to the UK Sepsis Trust and to the campaigner, the parent Melissa Mead. I do not know if noble Lords saw the moving “Panorama” programme broadcast earlier this week about the work that she has done to raise awareness of this issue. She is truly inspiring given that she lost her child.

A major campaign was launched at the end of last year to raise public awareness. It was fronted by the Secretary of State, and, indeed, Public Health England is building messages about sepsis into its Start4Life campaign. I believe that the particular proposal is that there should be a campaign of advertising on the sides of ambulances. The Secretary of State is sympathetic to the idea and is raising the issue with the chief executives of ambulance trusts to see whether this is something that we can take forward.

[Baroness Ludford (LD)]

My Lords, I am grateful to the noble Lord, Lord Grade, for raising this extremely important topic, which coincides appropriately with World Sepsis Day this week. My husband is a fortunate survivor of sepsis, albeit at the cost of an amputated leg. He is not one of the 44,000 annual fatalities only because of the speed and skill of the medical professionals at the Whittington Health NHS Trust. I should declare an interest in that he is the chairman of the trust, which I believe has the best record on treating sepsis in London. Clinical awareness is rising in the NHS but it is patchy, so more must be done. Public awareness is very low, and I am grateful to the Minister for announcing those plans. However, they must be reinforced so that friends and family and members of the public know how to spot the possible symptoms.

[Lord O’Shaughnessy]

I am sorry to hear that sepsis has affected the noble Baroness’s husband in that way and I am glad to learn that he is not one of the more than 40,000 people who die from the condition every year. Public awareness is critical and, as I say, we are looking at new ideas for how to get the message across using a range of routes. The point about clinical awareness is also very important. Until a couple of years ago, there was no widespread clinical awareness of the symptoms of sepsis and how to assess and then treat people, but we have seen quite a big improvement. I can give one example. For those presenting with symptoms in emergency departments, previously only around half were assessed for sepsis; the figure is now up to nearly 90%. I see that as good progress, but clearly there is much more to do.

[Lord Turnberg (Lab)]

My Lords, one of the major difficulties with sepsis is the fact that it is so speedy. It can kill within a few hours. Awareness of this speed is vital—for the public and for practitioners.

[Lord O'Shaughnessy]

That is absolutely right but I draw the attention of the noble Lord to a couple of things. First, in the NICE quality standard published yesterday there are some very clear statements about the speed with which people suspected of these symptoms should be treated. Those are quite robust in terms of getting intravenous antibiotics to people within an hour, being reassessed by a senior clinician if they then fail to improve within an hour and so on. That is very clear and there is implementation guidance going through. Another thing announced yesterday is quite important. It is a slightly odd phrase but “safety netting” is where someone has been assessed on whether they have sepsis, does not have it but is sent away with materials that show what the symptoms might be and how to report back if their condition deteriorates.

[Baroness Masham of Ilton (CB)]

My Lords, as has been said, sepsis can be a big killer if the correct antibiotics are not given. Should it not be conditional to report sepsis so that more research can be done? Should there not be a very quick test for it?

[Lord O'Shaughnessy]

The noble Baroness is quite right. Trusts are now incentivised to report incidences of sepsis and their performance against these quality standards. That is happening. Unfortunately there is still variation within the system. That is why the documents that came out yesterday are so important. For the first time, we have an operational definition of adult sepsis. Clearly, that is critical to making sure that it is spotted in time.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the action plan is very welcome. It seems apparent that when patients come through, particularly from A&E, they are not recognised as having sepsis. Clearly, there is an issue about health service staff not recognising the symptoms or understanding the scale of the problem with sepsis. The Minister will be aware of a 2015 report by the national confidential inquiry which criticised the way coding is designed so that, in fact, sepsis does not appear as the prime responsibility for a death. The Government have been asked to look at coding. If it is not in the action plan, will the Minister look at this?

[Lord O'Shaughnessy]

That is absolutely right: there was an issue with coding. The noble Lord will be pleased to hear that from April this year NHS Digital published new guidance on coding for sepsis to deliver exactly the kind of improved reporting he wants.

[Baroness Pitkeathley (Lab)]

My Lords, as a survivor of total-body sepsis, I very much endorse what my noble friend Lord Turnberg said about the speed and danger of this illness. What was so difficult for both my family and the professionals who treated me to understand was that it could lead to a total failure of all the body’s organs—as it did in my case—within, literally, hours. The urgency of this must be emphasised in any public awareness campaign.

[Lord O'Shaughnessy]

I am very sorry to hear that the noble Baroness suffered that but am obviously delighted that she is still here. Just to re-emphasise the point about speed, I encourage noble Lords to look at the quality standard because it is very stringent about the speed at which treatment must be administered. Of course, the critical thing is making sure that there is proper triage and assessment ahead of that. That is where we still need to make some progress.