World Sepsis Day

Rachael Maskell Excerpts

Wednesday 13th September 2023 Westminster Hall

[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.

--- Later in debate ---

[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.