Sepsis (Preventable Deaths)

George Freeman Excerpts

Tuesday 14th October 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is a great pleasure to serve under your chairmanship, Sir Edward. I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate, and I thank her for bringing this issue to the House. I also thank the hon. Member for Coventry South (Mr Cunningham) for his helpful and supportive interventions. This is a chance to discuss an important issue. I know that the lack of colleagues here today is not a sign of disinterest; it is merely because the House is on a one-line Whip. I pay tribute to my hon. Friend for her campaigning work on the issue and her co-chairmanship of the all-party parliamentary group on sepsis, which is doing important work to raise the profile of this urgent condition.

Let me say at the outset that the information and case studies in the reports by the all-party parliamentary group and the parliamentary ombudsman make for sobering reading. I extend my regret and sympathy to the families affected by these preventable deaths, particularly the family of Sam Morrish. Every preventable death is a tragedy from which we must learn. I pay tribute to the important campaigning work of his family and others to improve sepsis care and treatment across the NHS.

We entirely accept that more can and should be done to address sepsis, paying particular attention to the points raised in the reports by the ombudsman and the all-party group. I am grateful to my hon. Friend for sharing the key points of her speech in advance. I will do my best to deal with all of them in the time available, but I hope that she will indulge me. If the clock beats me, I will write to her and deal with them all clearly in writing.

Colleagues should be in no doubt that the Department takes its responsibilities on sepsis very seriously indeed. In fact, sepsis is one of the few issues on which three departmental ministerial colleagues each have a specific responsibility for overseeing action. I take my hon. Friend’s point about the need for co-ordination, and I will pass it on. The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), covers sepsis management in hospitals, and the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has responsibility for sepsis management in the community. In the House of Lords, Lord Howe covers sepsis management in hospitals.

Although I am standing in for my hon. Friend the Member for Central Suffolk and North Ipswich, who is indisposed this morning, coincidentally, only last week, when we went to the US to visit pioneering clinical innovators in the life sciences, one issue that we discussed was the early detection of sepsis through greater use of digital technology in community health care. Early diagnosis in that first hour is crucial. It is one of many areas in which investing in new technology, particularly data technology, provides a much higher chance of early intervention and thus of preventing complex and costly downstream complications. Point-of-care diagnostics are a crucial part of that, and I am mindful of that in my work on innovation.

Hon. Members will appreciate that although the Department is accountable to Parliament for health care, the delivery of that care is the responsibility of NHS England, the executive non-departmental public body responsible for overseeing the running of the NHS; Ministers no longer run the NHS. NHS England works with NHS staff, patients, stakeholders and the public to improve health outcomes for people in England. We hold NHS England to account through the mandate, which sets out its priorities. I am glad to say that sepsis is incorporated in the patient safety and premature mortality provisions of the mandate.

We all agree that we will have the greatest impact by focusing our efforts on improving the clinical management of sepsis by health care providers and ensuring a consistently high standard in sepsis care across the whole system. We are doing so through a range of initiatives, including better education and training in recognising the warning signs of sepsis; ensuring that trends in sepsis are monitored —that is where data become important—raising the profile of sepsis in the community; and ensuring collaborative working across the whole system.

In the period between the publication of the ombudsman’s report in September last year and of the all-party parliamentary group’s report in June this year, we made significant progress. For example, we have mandated that Health Education England must include sepsis in its work to improve the training and education of health care professionals. We have also ensured that sepsis is included as a key patient safety priority in the NHS business plan for 2015-16.

The NHS outcomes framework sets out the indicators that are used to hold the NHS to account for the outcomes that it delivers through commissioning health services. Sepsis is captured in the overarching indicator measuring potential years of life lost from causes considered “amenable to health care”—a clumsy phrase, but it is a statement of the importance attached to the condition. Reducing the number of deaths from sepsis is specifically included in that indicator.

NHS England is considering the range of commissioning levers that it will put in place for 2015-16. The commissioning for quality and innovation payments framework is one option. I cannot comment further at this point as internal discussions are ongoing, but we are conscious of the interest in a specific lever on sepsis.

NHS England has also initiated work to develop a consistent methodology for a robust, retrospective case-note review of deaths in hospital. That is part of further work to develop the NHS outcomes framework, which will offer a way of establishing much more accurately how many deaths are attributed to sepsis, identifying any shortcomings in sepsis care management and feeding any improvements into local practice. That work is expected to be completed by 2016 and rolled out thereafter.

Regarding paediatric care, a children’s sepsis summit is planned for tomorrow—15 October—as I am sure my hon. Friend is aware. It will bring together a range of national experts and key personnel from the south-west, particularly those involved in the review of the tragic case of Sam Morrish, to share learning and to set the direction for further work on the timely recognition and treatment of children with sepsis.

Furthermore, NHS England has developed a webinar series to promote greater awareness among clinicians of the actions to be taken to treat patients who are critically ill. Sepsis clearly features in this “deteriorating patient as a medical emergency” campaign; the first webinar in the series covered sepsis and was held on 17 September.

Regarding the timely recognition of sepsis, we fully endorse the work carried out by NHS England’s surgical services patient safety expert group, its children and young people patient safety expert group and the safety board of the Royal College of Physicians to roll out the “sepsis six” guidelines, to which my hon. Friend referred and which were produced in collaboration with Dr Ron Daniels. That has led to the development of a series of clinical toolkits for health professionals, which were launched by the UK Sepsis Trust.

To support the implementation of existing resources and guidance on sepsis, such as the sepsis six and the paediatric sepsis six, NHS England issued a stage 2 patient safety alert. I am advised that that alert has been cascaded to all trusts, social care providers, community providers and, via area teams, to GPs and public health directors in all local authorities.

Wider work to further the sepsis agenda includes initiatives to combat antimicrobial resistance more generally. While some might argue that there is a tension between limiting the inappropriate use of antibiotics to reduce the incidence of antimicrobial resistance and the provision of early antibiotics in cases of suspected sepsis, we would argue that those activities are complementary and do not cut across each other. The key issue is the appropriate use of antibiotics, which is common to both agendas, as each requires the appropriate use of antibiotics for the right patients at the right time.

It is also important to note that we have strengthened and updated a key resource on the appropriate use of antibiotics. This guidance, called “Start smart—then focus”, was originally published in 2011. We are currently consulting on an update, which is due to be published shortly. The resource has been updated to refer explicitly to sepsis and to draw particular attention to the need to act promptly

“between the onset of sepsis-related hypotension and the administration of appropriate antibiotics”.

Equally importantly, it focuses on the need to initiate effective antibiotic treatment

“within one hour of diagnosis in patients with life-threatening infections”.

It also sets out clear guidelines on the need to review the clinical diagnosis within 48 to 72 hours and to make a clear plan of action when additional information becomes available, such as new microbiological, radiographic or clinical data.

Let me turn to another point raised by my hon. Friend in the all-party group’s report, which is the need to establish robust pathways to deal with sepsis. That is an absolutely key objective, which NHS England has been developing in conjunction with the UK Sepsis Trust. The action includes the development and publication of toolkits for acute medical units and emergency departments. The toolkits, which were published in September, identified organisational standards for the acute management of sepsis in both locations.

I understand that the UK Sepsis Trust is working with NHS England to establish sepsis exemplar sites and to recognise publicly those providers that excel at the processes and behaviours that improve the early detection, diagnosis and delivery of interventions to patients. The sepsis exemplar standard initiative is to be welcomed, as it encourages joined-up thinking between health care units, which will help to strengthen further the provision of seamless care for critically ill patients.

The programme is expected to include three phases. The first phase is the accreditation of excellent emergency departments, which will identify departments with traditionally strong links with primary care, pre-hospital systems, acute admission units and critical care, and which have demonstrated willingness and drive to improve sepsis care and an engagement with sepsis-related audits, changing improvement strategies and improving data collection.

The second phase is the accreditation of further health care units. Following the pilot testing for emergency department standards, and building on lessons learned in creating those standards it will involve the development of accreditation plans for other health care units, such as ambulance trusts, in-hospital critical care outreach or sepsis teams and acute medical units prior to expansion in other areas. The final phase is the assigning of exemplar unit status as part of our commitment to demonstrate best practice.

I turn to the National Institute for Health and Care Excellence, which my hon. Friend mentioned and for which I have ministerial responsibility. Of course, we recognise that we need to support NHS colleagues in addressing sepsis with the provision of comprehensive and up-to-date guidelines, so in April we asked NICE to develop such guidelines to aid the recognition, diagnosis and management of severe sepsis. These guidelines are under development and will be comprehensive and thorough. They are scheduled to be published no later than July 2016, but I very much hope they will be published earlier than that.

[Sarah Newton]

At the Public Administration Committee hearing, frustrations were demonstrated by Committee members, which I certainly share, about the fact that a “90% good” NICE guideline would begin to save lives and that the time that NICE is taking to get this guideline 100% right is allowing preventable deaths to continue. I urge my hon. Friend the Minister to go back to NICE and say that, while it is important that whatever it does is excellent and should be based on the best available evidence, in the meantime the delays in developing guidance are costing lives.

--- Later in debate ---

[George Freeman]

My hon. Friend makes an excellent point, which I will pick up. NICE rightly prides itself on making thorough health assessments, but it is equally important that we get the right guidance out quickly. I will raise her point with NICE.

I will touch on data collection, because we will also fund work by Public Health England to improve the data collection mechanisms in emergency departments. Awareness raising is also important, and there are two key initiatives in that regard. First, the “Sign Up to Safety” campaign was launched by my right hon. Friend the Secretary of State in June. It has a three-year objective to halve avoidable harm in the health care system and to save 6,000 lives. It is for everyone in the NHS, and will include information on sepsis.

The second initiative to publicise sepsis will be part of Public Health England’s work on this year’s European antibiotic awareness day on 18 November. Social media messages will highlight the importance of the appropriate use of antibiotics, to ensure that they are effective for the treatment of infections such as sepsis, and there will be a number of other measures as part of that campaign.

We have also commissioned work to revise the code of practice in the Health and Social Care Act 2008 on infection prevention and control to strengthen provisions on the diagnosis, treatment and management of multi-drug resistant infections and severe sepsis. That code will be used by regulators such as the Care Quality Commission and Monitor as part of their inspection regime.

Finally, I will touch on the world sepsis declaration, which sets a number of targets. We are not in a position to sign up to the declaration, but we support the intention behind it and we are considering supporting it in future.

In conclusion, I thank my hon. Friend for bringing this matter to the attention of the House this morning and for giving us a chance to raise awareness of this important issue. I hope that the measures that I have scuttled through at speed give some indication of the concerted effort given to treating this important condition, not only by the Government but by NHS England, Public Health England, NICE and other agencies, to try to get on top of it. Above all, we owe the families of those patients who have lost their lives as a result of sepsis nothing less than a robust and comprehensive response to the threat that sepsis poses. For their sake, and for all patients who entrust their care to our health care services, we are determined to ensure that lapses in the recognition and treatment of sepsis are minimised, and the provision of safe patient care remains paramount.