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House of Lords Hansard
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22 January 2020
Volume 801

Question

Asked by

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To ask Her Majesty’s Government, further to the University of Washington’s Global Burden of Disease Report, published on 16 January, what steps they are taking to address incidents of sepsis in the United Kingdom which is ranked 132 out of 195 countries for deaths caused by sepsis.

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My Lords, over recent years the NHS has become much better at spotting and treating sepsis quickly. This means that more people are being identified as at risk of sepsis and mortality rates are falling. While we welcome this report’s attempt to advance knowledge of worldwide deaths from infection and sepsis, we are confident in our own data, which puts UK deaths from sepsis as significantly lower than reported in the study.

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I thank my noble friend for that Answer. The House will not need reminding that some 50,000 people a year die in this country from sepsis, far too many of them unnecessarily. I declare my interest as an unpaid adviser to the UK Sepsis Trust, which has done remarkable work to improve awareness. Members of the trust, including clinicians and so on, have had many meetings at different levels within the department, begging for a registry of all sepsis cases in the UK. We have had a very sympathetic hearing but it is a bit like dealing with the laundry— nothing ever comes back. Can the Government make a commitment to introduce a registry which will help greatly to improve the targeting of the right antibiotics for the right cases?

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I thank my noble friend for this Question and I pay tribute to his work on it, and the work of the UK Sepsis Trust. I am aware of the calls for a national sepsis registry for patients. It is important that we understand the data; we are confident that it provides an accurate indication. We think that UK data is as good as it can be at the moment but that there is a clear need for better data on sepsis. The problem with the registry as proposed is that it would use retrospective data collection. We want to go beyond this with the UK’s five-year national action plan for AMR, which includes a commitment to develop the real-time patient-level data of individual patients for infection, treatment and resistance history. Work is already under way by NHS England and NHS Improvement. I hope that is the kind of answer my noble friend was looking for.

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My Lords, as a country our record for the number of deaths due to sepsis is pretty abysmal, as stated already. Most of that is due to late diagnosis of sepsis. One-third of patients die and for every hour that a diagnosis is delayed, the death rate rises by 8%. Last year, on a visit to a biotechnical company in Northern Ireland, the Secretary of State commended the development of a quick diagnostic test, which will give a result within two hours so as to start appropriate antibiotics. Will the Government make a commitment that when this molecular test is available, which is likely to be soon, it will be immediately available to the whole of the NHS?

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The noble Lord, as always, speaks with great expertise in this area. I emphasise the work that has been ongoing to improve the picture on sepsis. Since 2015, screening for sepsis in emergency departments has improved from 52% to 89% and timely treatment for sepsis from 49% to 76%, but the noble Lord is absolutely right that we need to improve the outcomes. Early and accurate diagnosis is at the heart of this. I shall keep an eye on innovations in diagnostics. The noble Lord knows that innovation in this area is right at the heart of what I do, and I think that his proposal is very sensible.

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My Lords, the Government seem to be complacent about this. I know that the Minister has given us lots of facts and statistics, but the number of deaths from sepsis in the UK is five times higher than in the country in the European Union that has the best performance. Only two EU countries have a higher number of deaths, so it is a very serious problem. Why are only 70% of acute trusts in England using the national early warning score system? Why are they not all using it?

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I am not quite sure which data the noble Baroness was referring to. The study stated that the number of UK deaths was at 48,000. This was a modelled estimate; it was inaccurate. Our data, published by the Office for National Statistics, states that the figure is 22,341 and puts the UK’s performance at a better rate. We are not complacent in any way. This is why there has been concerted action through a number of routes not only to improve the performance in sepsis diagnosis and screening but to make sure that we raise public awareness and provide training for NHS staff. The early warning system has been introduced as the revised national early warning score. As the noble Baroness said, it is intended to improve and standardise the process of recording, identifying and responding to patients at risk. It was introduced as a CQUIN incentive and included in the 2020-21 scheme which was published yesterday. This means that it will be in every hospital across the country.

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My Lords, it can be difficult to diagnose sepsis in people with learning disabilities and difficult for them to realise that they may have it. The NHS has a very good little video prepared by and for people with learning disabilities and their carers. Is there anything the Minister can do to make sure that that helpful video is disseminated more widely?

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That is an extremely helpful and constructive proposal. If the noble Baroness would like to raise it with me outside the Chamber, I will take it up as a matter of priority.

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My Lords, does my noble friend accept that public education has an important role to play here, so that people are aware of the symptoms—following the question asked by the noble Lord, Lord Patel? Can we congratulate the BBC, those of us who are fans of “The Archers”, on the work it has done in this respect?

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I am very happy to congratulate the BBC. I do not know that I heard “The Archers” storyline in question, but I shall make sure that I update my education in this respect. I want also to congratulate Public Health England on its national Start4Life information service for parents. It has worked with Mumsnet to make sure that awareness is spread to those most likely to need it, because those most at risk are the young, the elderly and those who have underlying conditions. Targeting the messaging at those who need it most is very important.

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My Lords, the noble Lord, Lord Grade, raises a very important point. Can the Minister tell us what percentage of patients with sepsis have the DNA profile of the bacteria recorded?

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The noble Lord, Lord Winston, always raises very specific questions requiring statistical answers which are not necessarily at my fingertips. I shall write to him on that point.