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Sepsis at the Senedd

October 16, 2015

For the past few years since the inception of World Sepsis Day in September 2012, the UK Sepsis Trust has organised reception events at Parliament. These events must be sponsored by an MP and financed by whatever organisation wants to promote their message. This and other work done by the CEO of the UK Sepsis Trust, Dr. Ron Daniels, has helped push the sepsis message into the minds of the politicians and has helped with the creation of the All-Party Parliamentary Group for Sepsis and has pushed NHS England into taking sepsis seriously. I won’t bore you here with details of what sepsis is or how common it – please visit the UK Sepsis Trust website for such details.

Health is a devolved matter, so while it’s all well and good promoting the sepsis message to MPs, in reality discussions with Westminster have little impact on what happens in Scotland, Northern Ireland and Wales. However, sepsis doesn’t miraculously stop at the Severn Bridges or Offa’s Dyke, so it’s as much a priority for NHS Wales and its political masters to take steps to reduce sepsis morbidity and mortality. I can’t tell you what happens in the NHS or governmental structures in the countries of our Celtic cousins, but I can give you a quick update on what goes on in Wales.

NHS Wales has a history of quality improvement, participating between 2004 and 2008 in the Safer Patient Initiative, organised by The Health Foundation. A huge part of this work was the Welsh Critical Care Improvement Programme. This resulted in significant changes in how aspects of patient care were delivered, helping (for example) to reduce the occurrence of ICU-acquired infection. This was followed by the launch of the 1000 Lives Campaign in April 2008, running until May 2010, to be succeeded by the 1000 Lives Plus programme, a national programme to build on what had already been achieved. One major workstream to reduce avoidable harm is the Rapid Response Acute Illness Learning Set (RRAILS). A key feature of this work was the introduction of standardised early warning scores across Wales, using the National Early Warning Score (NEWS), developed by the Royal College of Physicians in 2012. Through the RRAILS programme, Wales became the first country in the world to adopt NEWS as a national standard. The primary aim of the RRAILS programme is to identify patients who are deteriorating early so that therapy can be started as soon as possible, thereby reducing the chances of a poor outcome. Sepsis is a common cause of such deterioration, so it is natural that a great deal of the work of the RRAILS programme is to aid diagnosis and treatment of sepsis. Following on from this, Welsh Government put two targets for sepsis into Tier 1 of the NHS Delivery Framework for 2013/14 as development priorities.

When I first linked up with the UK Sepsis Trust in 2012, I wondered whether it would be a viable proposition to have a reception event, in a similar style to the London event, at the Senedd. The UK Sepsis Trust was supportive of the idea and I found an Assembly Member willing to be the sponsor. However, circumstances meant that I couldn’t progress this idea any further, although it was something that occasionally cropped up in conversations amongst colleagues with a major interest in sepsis care. The idea of a Senedd reception for the UK Sepsis Trust was resurrected by the Executive Director for Wales, Terence Canning. I first met Terence back in 2012 and it’s fair to say that he’s an inspiration and a tireless worker for the charity. Tapping into contacts already made in the past few years and using the expertise of PB Political Consulting, Terence was able to get the event organised for Thursday, 8th October 2015, with the Deputy Health Minister for Wales, Vaughan Gething, being the sponsor. If you’ve not visited the Senedd, you should!

The day was blessed with fine weather and the invited guests gathered – health professionals, health service managers, politicians, civil servants, families bereaved by sepsis and survivors of sepsis. Terence started proceedings, followed by Vaughan Gething and then by Chris Hancock (Programme Director and Manager of RRAILS). Chris spoke about how the work done via 1000 Lives Plus and RRAILS was beginning to show real benefit in reducing sepsis mortality across Wales. Everyone who has been involved in the RRAILS programme should be congratulated on what has been achieved so far.

It was then my turn to speak. This is what I said:-

“Helo, fy enw I ydy Paul Morgan

Hello, my name is Paul Morgan.

I’m a consultant in intensive care medicine and sepsis lead in the Cardiff and Vale University Local Health Board, and I’m Lead Volunteer in Wales for the UK Sepsis Trust.

Firstly, I’d like to thank Vaughn Gething for sponsoring this event and for the UK Sepsis Trust and PB Consulting for organising proceedings.

Sepsis is a major cause of death across the world. In the UK, it is estimated that there are over 100,000 cases of sepsis each year and is responsible for over 37,000 deaths. Yet, despite this, it remains relatively unknown in comparison to other major killers, such as heart disease, stroke and cancer. To give you some perspective of the size of the problem, sepsis kills as many people as die from breast, bowel and prostate cancers – combined. It is the leading direct cause of maternal mortality.

Here we are just a stone’s throw away from the magnificent Wales Millennium Centre and its beautiful Donald Gordon Theatre. Imagine the auditorium full. Every year in Wales, sepsis wipes out an entire audience. Of those who are fortunate to survive sepsis, about 20% are left with long-term physical and psychological problems and yet there’s very little, if any, support for sepsis survivors. Survivors also have an excess rate of hospital readmission in the next 12 months and may not be so fortunate next time.

Treating sepsis costs NHS Wales in excess of £100 million each year, much of it in Intensive Care. It accounts for at least one third of all critical care expenditure.

The saddest part of all this is that sepsis can be treated successfully and cheaply if caught early – and therein lies the major problem. In recent years, we have seen major campaigns leading to improved outcomes from heart attack and stroke, with a huge part of the success being the recognition that early treatment is key – this concept is known as “time is tissue”. We need to emphasise that sepsis is a whole-body attack and that time is tissue just as much in sepsis as it is in a heart attack. By promoting awareness amongst members of the public and among health professionals to think “could this illness be sepsis?” we can reduce both the morbidity and mortality from sepsis.

Today we are here to make you, our politicians and government officials, more aware of sepsis and to seek your help in reducing the morbidity and mortality. We cannot save everyone with sepsis – that would be unrealistic. But we estimate that we can save about one-third of those who currently die. The good news for you is that this can be done relatively cheaply – a really good example of prudent healthcare! Education programmes such as 1000 Lives are helping the early recognition of the acutely unwell patient and has had some success, particularly when combined with critical care outreach services. We also need better data to help us understand what really happens to sepsis patients so that we can deliver better care both during and after sepsis. The establishment of a national sepsis registry would be a massive step to achieving this. We’re making progress, but we cannot rest on our laurels. We need to do more to build on what has been achieved so far. We need your support to ensure that sepsis care gets the attention across NHS Wales at all levels – prevention, recognition, treatment and after-care. Sepsis care needs to be a core feature of the Together For Health NHS Delivery Plan.”

Formal proceeding were wrapped up by Ron Daniels, acknowledging the progress made in Wales and challenging NHS Wales to do even better. Game on!

I came away satisfied that there had been a real opportunity to engage with the Senedd about sepsis and to consider what we need to work on to make further improvements. I was therefore pleased to hear that Vaughan Gething was to make a statement in the Tuesday Plenary Session in the Senedd. I was able to watch this on line as the Senedd has a live feed and also stores an archive of broadcasts. His statement clearly told us that he had listened to what was said at the reception and had digested the information given to him. The short debate that followed was informed and conducted in a mature fashion that makes events in the House of Commons look silly and pathetic by comparison. To cap it all, we were mentioned as part of the discussions!

You can watch proceedings here – watch from about 3:09

I’m delighted to see that Welsh Government is continuing to give sepsis the attention it merits and it means we can work with them to deliver improvements in outcomes. I was recently made Sepsis Lead for the Cardiff and Vale University Local Health Board, demonstrating the commitment of my employers to further improve sepsis care. By working as a team across the acute specialities, I hope – sorry, expect – that we can make further progress.

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