Sarah Newton is the Member of Parliament for Truro and Falmouth and Deputy Chairman of the Conservative Party.
Our healthcare system is facing the dual challenges of rising demand and expectations while operating with constrained resources. Strategies to improve quality of care focus on lives saved or on patients’ returning lost function, underpinned by clinical priorities set out in the NHS Outcomes Framework. Domain 1 of the Framework sets out to reduce avoidable deaths.
When we think of avoidable deaths, we may think of harm arising from delayed diagnosis of cancer, failure to prevent or deliver timely intervention in heart attack or stroke, or poor care leading to healthcare-associated infection. We may consider reducing C.diff or MRSA infection rates as key to the prevention of unnecessary death from infection. However, there is a much bigger issue out there than any of these conditions – and you may not have heard of it.
Sepsis – previously known as septicaemia or blood poisoning – is the body’s overwhelming response to an infection. The immune system goes into overdrive, damaging organs and tissues and, untreated, leading to septic shock and death. From the time of onset of sepsis the clock is ticking. For every hour’s delay in initiating life-saving therapy in a patient with septic shock, the risk of death rises by 8%.
Sepsis is indiscriminate, affecting all ages, and disrespectful of healthy lifestyle choices.
Few people know about Sepsis, and fewer still know that it kills 37,000 people every year and is the third highest cause of mortality in hospitals. But as co-chair of the all-party group on sepsis, I am committed to work alongside my colleagues to keep this issue on the agenda at Westminster.
The group has just launched its first report since it formed last summer, which highlights the importance of a joined-up approach to permit the reliable delivery of basic interventions within hospitals, and at the interface between pre-hospital and hospital-based care. The report examines the current state of sepsis across the NHS, what progress has been made, and what actions need to be made for improved patient outcomes at every Trust across the country.
The government is committed to saving more lives from big killer diseases and bringing mortality rates down to compete with the best performing countries in Europe. We believe that concentrating on sepsis by implementing simple, practical measures can significantly contribute to that vision. This report sets out a series of practical recommendations aimed at decision makers at Westminster and beyond for a much needed turnaround.
There is significant cost associated with sepsis. These patients stay longer in Intensive Care Units than any other patient group, accounting for one half of Intensive Care expenditure. European data suggests that each episode costs €25,000 in treatment and hospital bed days. With over 100,000 cases annually in the UK, this accounts for over £2 billion of NHS expenditure annually. The true fiscal cost is likely to be much higher, since of the 65,000 survivors each year one fifth will have long term complications.
We know what works in sepsis. Senior healthcare professionals from all disciplines, led by registered charity the UK Sepsis Trust, have identified a set of six simple tasks which can be delivered by a junior doctor or nurse. The Sepsis Six not only reduces the risk of dying by one half if delivered within the first hour, it has also been shown to reduce the mean length of hospital stay by 3.4 days including 2 costly Intensive Care days.
Our recommendations focus on simple, timely interventions that can be made easily. As the NHS looks to reduce the number of unnecessary deaths and save money alongside this sepsis is a key area to focus on. We recommend:
- Acute Hospital Trusts and ambulance services need to ensure that pathways for sepsis are both developed and robustly implemented where they are not already.
- NHS England should work with clinical coders, medical examiners and other relevant stakeholders to support the development of a national standard for the coding and recording of cases of severe sepsis and septic shock.
- Clinical Commissioning Groups should in turn hold Trusts to account on the accuracy of their data collection and submissions
We need to do this, in order that patients in England receive sepsis care of the same quality as those in Scotland and Wales. We have the opportunity to become the first country worldwide with a population over 50 million to establish a national mandate on sepsis. Brazil, Germany and Canada will be there soon. We need to do this in order to save lives.