Sepsis and the NHS – Annual Review by the All-Party Parliamentary Group on Sepsis 2015/16 ALL-PARTY PARLIAMENTARY GROUP ON SEPSIS This is not an official publication of the House of Commons or the House of Lords. It has not been approved by either House or its committees. All-Party Parliamentary Groups are informal groups of Members of both Houses with a common interest in particular issues. The views expressed in this Report are those of the group. Sepsis and the NHS – Annual Review by the All-Party Parliamentary Group on Sepsis Acknowledgements All-Party Parliamentary Group on Sepsis Rt Hon Cheryl Gillan MP, Mark Durkan MP, Baroness Greengross OBE, Jess Phillips MP, Ben Howlett MP, Bob Blackman MP, Rt Hon Dr Liam Fox MP, Nigel Mills MP, Jim Cunningham MP, Mary Glindon MP, Lord Hunt of Kings Heath, Baroness Browning, Lord Selborne, Kelvin Hopkins MP, Roger Godsiff MP, Lord Colwyn, Wes Streeting MP, Christopher Pincher MP, Rob Marris MP, Tom Blenkinsop MP, David Warburton MP, David Jones MP, Andrew Stephenson MP, Virendra Sharma MP, Michael Fabricant MP, David Davies MP, Mike Freer MP, John Howell MP, Andrew Jones MP, Jeremy Lefroy MP, Graham Jones MP, Oliver Heald MP, George Howarth MP The APPG would like to thank the following people for their input into this report: Clinical Advisor: Dr Ron Daniels, Chief Executive of the UK Sepsis Trust and Chair of the Clinical Advisory Board Industry: Becton Dickinson (BD), Cerner, Thermo Fisher Scientific Others: Richard Royal, Melissa Barnett, Paul Bristow, Adam Gilbert, Sandra Smits, PB Political Consulting Page 2 ALL-PARTY PARLIAMENTARY GROUP ON SEPSIS Contents 4 Preface - Rt Hon Cheryl Gillan MP 5 Executive Summary 7 Key Recommendations 8 Introduction 9 Methodology 10 Sepsis Training 13 Resources for Combating Sepsis 17 Recording of Sepsis 20 Appendix: Trust Level Data 28 References Page 3 ALL-PARTY Sepsis and the NHS – PARLIAMENTARY GROUP Annual Review by the All-Party Parliamentary Group on Sepsis ON SEPSIS Preface By Rt Hon Cheryl Gillan MP I am proud to have been elected as Chair of the All-Party Parliamentary Group for Sepsis in June 2015, an organisation which has been campaigning on and bringing the cause of sepsis sufferers to the attention of Parliamentarians and a wider audience over the last two years. Sepsis is a hugely unacknowledged condition of which I have personal experience. Despite many people never having heard of the condition, it is the most common reason for Intensive Care admissions in England and accounts for one in seven deaths in hospitals, making it the third highest cause of mortality in a hospital setting. Despite this, there are concerns that the condition is severely under-diagnosed, under-recorded and under-reported. Last year’s APPG report reinforced this concern by revealing that in some cases NHS Trusts were under-recording incidents of severe sepsis by a factor of 17 or more, prompting the Government to encourage greater awareness and introduce a national commissioning lever. This second Annual Report considers the progress that has been made since then, and particularly focuses on the levels of investment and training for medical professionals to recognise, manage and report incidents of sepsis. It also makes practical recommendations based on its findings which NHS Trusts nationwide should put in place to improve patient outcomes and health service efficiency. I am committed to working with my Parliamentary colleagues and others to drive down the numbers affected by this debilitating and potentially lethal condition. Rt Hon Cheryl Gillan MP Member of Parliament for Chesham and Amersham Chair of the All-Party Parliamentary Group for Sepsis Page 4 ALL-PARTY PARLIAMENTARY GROUP ON SEPSIS Executive Summary Reported cases According to those that submitted figures this The region with both the lowest total number year, the number of recorded cases of sepsis of recorded cases and the lowest average was totalled 50,708. the West Midlands with 3,102 cases across its ten responses, an average of 310 per Trust. This would equate to an average of 576.23 cases per Trust, which projected over the 159 Trusts Over one fifth of Trusts were unable to provide contacted would total 91,620 cases nationwide. any information on recorded cases of any This is still short of the 120,000 we would variant of sepsis and many stated that it was conservatively expect to see, suggesting a difficult to classify the different types, persistent culture of under-recording. It does particularly Red Flag Sepsis, despite this however suggest a better accuracy of recording having been nationally adopted in an NHS - and greater awareness of sepsis - than last England Safety Alert in 2014. year, when responses indicated less than a third of this number for recorded cases of The proportion of medical and nursing staff septic shock and severe sepsis, at 26,753 from trained in sepsis recognition differed hugely 78 respondents, which projected over the same between Trusts, ranging from 8% to 100% with number of Trusts would total 54,534 cases the mean being 66%. But only just over half of nationwide. This represents a 68% increase in all Trusts could evidence 50% or more of their recorded cases. relevant medical workforce having received sepsis recognition and training. The region with the highest total number of sepsis cases is the North West, with 11,264 The percentage of staff receiving such training recorded cases over 16 Trust respondents, correlated with the size of the Trust to which giving an average of 704 cases per Trust. they belonged. Whilst large Trusts were able to However, the highest average figure was the average 76% of trained staff, medium-sized East Midlands with 809 cases per Trust (4,855 Trusts reported 67% and small Trusts 59%. overall), closely followed by Yorkshire & Humber, with 799 cases per Trust (4,792 overall). Page 5 Sepsis and the NHS – Annual Review by the All-Party Parliamentary Group on Sepsis The lack of recording of sepsis training is a The proportion of those with a sepsis team problem in itself, highlighted by the fact that correlated with the size of Trust, whereby 21% over a third of respondents were unable to of small Trusts confirmed a dedicated team, provide any indication of training levels whilst 26% of medium Trusts and 30% of large Trusts taken together around half were able to provide confirmed this. This is astonishing for a either no records or only partially recorded condition which claims more than bowel, overall staff data. Many Trusts consider that breast and pancreatic cancer combined. sepsis training’s absence from the list of statutory requirements negates the purpose of A striking 88% of Trusts throughout England documenting such information. cannot evidence any planned budget for sepsis over the coming year. Nearly three quarters of Trusts reported that medical staff had one hour or less of sepsis 20 Trusts have budgeted more than £1m for training per year. Only five Trusts could stroke and 18 will invest similar for cancer, demonstrate a day or more of specific sepsis compared to just one Trust budgeting the same training for medical staff, whilst only two of amount for sepsis. the 159 Trusts demonstrated this for nurses. 81% of Trusts stated that they were seeking to Less than half of Trusts are able to quantify the deliver the Sepsis CQuIN in 2015/16 with nine number of relevant staff trained in sepsis Trusts expecting to receive in excess of £1m in recognition and management. CQuIN funding. Just 26% of Trusts reported having a dedicated sepsis team: 42% had a heart attack team and 59% had a stroke team. Page 6 ALL-PARTY PARLIAMENTARY GROUP ON SEPSIS Key Recommendations Recording of the number of staff trained and duration of training received 1 in sepsis to be made a statutory requirement Training in recognition and management of sepsis to be mandatory for all hospital medical and nursing staff, in addition to any induction/educational courses. This should 2 be considered competitively in terms of priority against other elements of mandatory training, and consist of at least one hour repeated annually, to a national standard In collaboration with ambulance services and other prehospital providers, 3 training should focus on early recognition and the rapid delivery of collaborative care bundles such as the sepsis six All NHS Trusts to have one nominated Clinical Director with direct responsibility for 4 sepsis and to develop a dedicated team with specific hours dedicated to its management To ensure development with the Health and Social Care Information Centre of a 5 nationwide standard in the coding and reporting of cases of sepsis to incorporate coding for Red Flag sepsis To encourage Trusts to develop specific budgets for sepsis, distinct from overall 6 healthcare budgets, similar to those considered for conditions such as stroke and cancer. To encourage the NEWSDIG group (hosted by the Royal College of Physicians) to improve 7 the national early warning score to include prompts to screen for sepsis Ensure Trusts are prepared to follow the NICE guideline, soon to be finalised, 8 and deliver care according to the UK Sepsis Trust’s Clinical Toolkits To ensure that Trusts recognise the challenges in achieving CQUIN payments, and 9 embrace the need to invest. Such investment may include clinical personal, electronic observation and decision aids or a combination of these 10 Encourage all Trusts to aim to receive full CQuIN payments Page 7 Sepsis and the NHS – Annual Review by the All-Party Parliamentary Group on Sepsis Introduction Sepsis is a condition caused by the body’s immune builds on a similar report published by the APPG last response to a bacterial or fungal infection which, if not year.