A little over 10 years ago I worked with Dame Julie Mellor, the then Parliamentary and Health Service Ombudsman (PHSO), on the report ‘A Time to Act’ which highlighted significant failings in the care delivered to patients with suspected sepsis and their families.
This report was a trigger point for a concerted set of actions around improving the recognition and management of patients with suspected sepsis being cared for by the NHS in England.
- Sepsis: the silent killer
- What nurses need to know about sepsis and how to act
- New warning system introduced to prevent avoidable child deaths
The Program Board later developed the CQuIN commissioning framework for excellence in sepsis care which operated for English hospitals from 2016-2019. This incentive yielded significant process improvements: with almost 80% of patients in participating hospitals receiving antimicrobials rapidly by 2019 and with some evidence pointing toward a relative risk reduction for mortality of over 20% – sadly, unlike the widely reported and almost identical data from New York State, NHS England elected not to publish these data. Notwithstanding this, we should acknowledge that there was a degree of professional disquiet around the lack of ability to exercise clinical judgement together with some, unsubstantiated, allegations around fuelling of an increase in antimicrobial use in hospitals.
Further, although a public awareness campaign was welcomed, it would be remiss not to highlight that it was funded at way less than 1% of the public funding afforded to, for example, the FAST campaign for stroke.
Since these halcyon days for sepsis and the clear improvements in the quality of care delivered to our public, we have of course struggled with a global pandemic together with increasing burden on an already under-resourced and understaffed NHS. These have taken their toll, and focus has drifted away from sepsis as one of the leading causes of death in the UK and globally.
Tellingly, the Cross-System Sepsis Programme Board has now been subsumed into the NHS Acute Deterioration Board, and the Sepsis CQuIN criteria have now been absorbed into standard tariff and therefore are subject to less scrutiny. The achievements between 2016 and 2019 have not been sustained.
In the wake of an estimated 480,000 lives lost to sepsis since the publication of ‘A Time to Act’, the stakes have never been higher. While not all these fatalities may have been preventable, the urgency to take action cannot be denied. The time to act is now, not tomorrow, not in a few years – but right at this moment. We need to educate our public and empower and adequately resource our health professionals to act quickly. The numbers stand testament to the dire consequences of inaction. We cannot afford to wait another ten years for a grim reminder of our failure.
Dr Ron Daniels, founder, Sepsis Trust