Sepsis (Preventable Deaths)

Jim Cunningham Excerpts

Tuesday 14th October 2014 Westminster Hall

[Sarah Newton (Truro and Falmouth) (Con)]

It is a great pleasure to serve under your chairmanship, Sir Edward, and it is a great honour to raise such an important issue with one of the Ministers with some responsibility for sepsis.

Before I outline the detail of my argument, I will share the scale of the challenge caused by sepsis. It is no exaggeration to say that sepsis is a hidden killer that claims more than 37,000 lives across the UK annually. Sepsis accounts for a third of the UK’s critical care expenditure, and it is the leading cause of death from infection here in the UK and across the world, but it can be stopped. An average constituency in the UK will have 140 cases of severe sepsis each year, resulting in more than 50 deaths. Simple interventions could cut those deaths by more than 50%. Timely interventions across the NHS could save 12,500 lives and £170 million each year with minimal budgetary requirements. Scotland and Wales have adopted the “sepsis six” and have better outcomes for patients than England.

So what is sepsis? Sepsis is a time-critical condition that can lead to organ damage, multi-organ failure, septic shock and, eventually, death. Sepsis is caused by the body’s immune response to a bacterial or fungal infection. It commonly originates in the lungs, bowels, skin, soft tissues or urinary tract. Rarer sources include the lining of the brain, liver or indwelling devices such as catheters. In a patient with sepsis, changes in circulation reduce the blood supply to major organs such as the kidneys, liver, lungs and brain, causing them to begin failing. Although most dangerous in those with impaired immune systems, sepsis can cause death in young and otherwise healthy people.

In my role as co-chair of the all-party group on sepsis, I have had the great pleasure of working with the UK Sepsis Trust, which is a registered charity comprising ex-patients and people bereaved by sepsis. In addition to raising awareness and providing support to members of the public affected by sepsis, the trust supports the actions and campaigns of its associated voluntary professional body, the UK Sepsis Group. Health professionals led by Dr Ron Daniels of the UK Sepsis Trust have identified simple, timely interventions and procedures, labelled the “sepsis six,” as a standard of care for sepsis patients when delivered within one hour. Early sepsis treatment is cost-effective, reducing hospital and expensive critical-care bed days for patients, and will save thousands of lives.

[Mr Jim Cunningham (Coventry South) (Lab)]

I am finding this information illuminating. I did not realise that 12,500 people a year are dying of sepsis. Will the hon. Lady indicate whether that figure is increasing or decreasing?

[Sarah Newton]

I thank the hon. Gentleman for his helpful intervention. The figures are, of course, estimates, but they are well founded estimates from clinical leads. As I will say later, the problem is that sepsis is poorly recorded, especially within acute trusts. We do not currently have a full picture of the number of people who are dying of sepsis. Often, the cause of death is registered as a result of sepsis, rather than from sepsis itself. Without the collection, mapping and use of accurate data, it is difficult to target interventions where they are most needed. The information I have been given is based on good, up-to-date evidence from clinical experts.

The hon. Gentleman is right to say that the scale of the challenge that we face is shocking. That is why I decided to work with the UK Sepsis Trust to set up the all-party group on sepsis in November 2013, following a successful reception for world sepsis day, and many parliamentarians on both sides of the House have been involved. At the same time, the Parliamentary and Health Service Ombudsman published her first report on the treatment of a particular condition. The ombudsman felt so strongly that we were not addressing sepsis in hospitals that she undertook research and published a report. That report, “Time to act. Severe sepsis: rapid diagnosis and treatment saves lives”, was truly groundbreaking, and it highlighted the number of preventable sepsis deaths and advocated swifter sepsis diagnosis and treatment across the NHS to reduce the numbers.

In June 2014, the all-party group launched a report, “The state of sepsis in the NHS”, which addressed the reliable collection of data on sepsis deaths in England and the wide variation in the adoption of the ombudsman’s recommendations across the country The report, however, noted progress, which we further discussed one month ago at our reception on world sepsis day. We noted that the National Institute for Health and Care Excellence will produce a bespoke clinical guideline on sepsis by 2016. NHS England is engaged and has launched a level 2 alert for sepsis, and it is discussing the possibility of a national commissioning lever. The Public Administration Committee recently held a one-off inquiry on sepsis, and it pushed the Government to act more holistically and make more rapid progress on implementing the ombudsman’s recommendations. Like me, the Committee was frustrated with the amount of time it has taken NICE to develop its guideline.

Some parts of the NHS have taken a pioneering approach to sepsis. I am proud to speak up for nurse Susan Bracefield, who has done excellent work in establishing an integrated sepsis pathway for children in the south-west, which I am sure will save lives through early detection and rapid treatment.

[Mr Cunningham]

It was remiss of me not to congratulate the hon. Lady on securing this debate. Is there any specific reason for the variation across the country? Can she identify what those reasons are?

[Sarah Newton]

I thank the hon. Gentleman for his kind words. I encourage him to visit the all-party group’s website, where he will find our report, which addresses each region of the NHS. I made a freedom of information request to every trust across the UK asking a series of questions about the identification, recording and treatment of sepsis in their area. The report shows stark regional variations in England. As in all matters, it is a question of leadership. Good leaders who identify and recognise that sepsis is a problem galvanise their colleagues into taking action. I have seen that in the south-west, particularly in the work led by Susan Bracefield on a paediatric pathway. Sadly, otherwise fit and healthy young children can quickly succumb to sepsis, with tragic consequences that none of us wants to see.

The all-party group’s report highlights the variations across the UK. Clearly more needs to be done, and this debate is about what more we can do about sepsis. It is important that we have education programmes for everyone involved in the health care environment. Sepsis is not only the responsibility of the acute trusts. We need early diagnosis by general practitioners, carers and ambulance staff. Everyone who comes into contact with people in the caring environment must be able rapidly to diagnose the early symptoms of sepsis and ensure that people get the appropriate treatment. That first hour is absolutely critical.

We need some sort of national commissioning lever to get things going. The commissioning for quality and innovation payment framework could be a good approach, and I am interested to hear what the Minister will say about that point. Public Health England also needs to develop a robust public awareness campaign. Terrific success has been achieved on stroke, through the work done to help people identify the early symptoms of stroke so they get to hospital or to their doctor quickly; health outcomes for stroke victims have improved in the UK. We should take a similar approach to sepsis, informing and educating the public about its symptoms, so that they seek medical help urgently.

Health Education England has a key role to play in disseminating education to health care professionals. Ron Daniels and the UK Sepsis Trust have done a huge amount of work with the royal colleges to consider training modules for people throughout the health service, and they need support to disseminate them widely. We also need a national registry of sepsis deaths and survivors to understand the longer-term impact. That will require resources, and exemplar sites will need to be developed and accredited to highlight best practice across the UK. Some parts of the country, such as Nottingham, are doing excellent work, and other parts of the NHS can learn from what their colleagues are implementing elsewhere in the country.

The Government could take a more joined-up approach to the issue. Three or four Ministers have some responsibility for sepsis in their portfolio. We need an approach that brings things together and a lead Minister to co-ordinate the work of their colleagues, and we need to sign up to the world sepsis declaration to reduce sepsis deaths by 2020. We need to make it a UK effort, but it is also a global effort; sepsis is a huge hidden killer around the world. Finally, we must consider how we can use commissioning within the NHS to drive forward the improvements that we all want.

Sepsis deaths can be reduced further. There are proven things that can be done, including implementing the sepsis six, that would have a huge effect on reducing avoidable deaths in the UK and would save the NHS considerable money. Sepsis is not only heart-breaking for families who have to watch otherwise healthy and fit young people, or people of any age, succumb rapidly to undiagnosed cases; it is traumatic for NHS staff who, due to a lack of education, sometimes feel powerless to give their patients the care they need or prevent those avoidable deaths.

We have made progress in the past 12 months. As one of the co-chairs of the all-party parliamentary group, I have been heartened by the extent to which the NHS has engaged with us on the issue. We must not lose that momentum. We must ensure that the issue continues to get the urgent attention that it needs.

Often, in debates on sepsis, we link in the issue of antibiotic resistance. Some very mixed messages can be sent out, particularly to people in general practice: they must prescribe fewer antibiotics to prevent antibiotic resistance, but they must prescribe antibiotics to prevent sepsis. However, I do not think that the issue is contradictory at all. As we deal with antibiotic resistance, we must understand that it and sepsis are intricately related. The two messages are actually aligned, as both campaigns encourage better and more appropriate antibiotic use.

I hope that in responding to this debate, the Minister will be able to address the specific challenges that I have set out and reassure me and all the parliamentarians with whom I am working that the issue remains of great importance to the Government and that the work of the ombudsman, the UK Sepsis Trust and parliamentarians through the all-party parliamentary group will be built on with great urgency in the months ahead.