Full debate transcript here: http://record.assembly.wales/Plenary/4976
Janet Finch-Saunders AM20:08:31
Diolch, Llywydd. Again, I'd just like to endorse and pay tribute to Angela for her contribution there that covered so many aspects of sepsis. Daily, we're reading now about how brutal this disease is, and how people are still very much unaware. I would just like to touch on people who are 'hospital at home', who are in an environment where they are reliant on carers coming in, and how quickly things can escalate, such as a urine infection. And then, when they're taken to hospital, even now, I am being informed of cases where it has not been identified. Could it be sepsis when people are there? And, literally, their lives are ebbing away. Sepsis is a horrendous thing. And one thing is that once you've had sepsis, it is a fact that you can never, ever think that you'll—. It leaves its mark on you and it can come back at any time when your C-reactive protein levels are up, any time that your resistance is low. So, this is really an important debate here tonight, and it's one that I wholeheartedly support Angela Burns on. Please make an awareness campaign. Get that education out there in schools, in hospitals, in care homes, in hospitals at home, in people's own homes. And please, Cabinet Secretary; you have the levers, please use them and let's not see such horrendous scenarios that I am only too well aware of myself, but also with friends, colleagues and my own constituents in Aberconwy. Thank you.
Cabinet Secretary for Health and Social Services
Diolch, Llywydd, and thank you to Angela Burns for continuing to raise this very serious issue. I want to start by recognising that sepsis can be a difficult illness to diagnose, particularly in elderly people, but also in children. And that is part of the challenge in dealing with this successfully. Sepsis is estimated by the UK Sepsis Trust to cause the deaths of around 44,000 people every year in the UK, and that would equate to about 2,200 people here in Wales. The figures show that, over the last five years, the number of people who have died annually in a hospital setting in Wales as a result of sepsis decreased from 2,112 to 1,687, so a real reduction but still a real number of people who have continued to die within our hospitals.686
The number of incidents of sepsis in Welsh hospitals in the same period actually increased from 6,950 to 8,313. So, that does show that there is a greater awareness of the illness with more people being diagnosed, but the percentage of deaths is decreasing. Sadly, not all of those deaths will be avoidable, but we can be confident that a number of them are. That is why, since 2013, the Welsh Government has, together with the NHS, made the reduction of the avoidable harm and mortality caused by sepsis a high priority for NHS Wales. I well remember, on World Sepsis Day, when I was a Deputy Minister at the time, Mark Drakeford decided that he would do an event on World Sepsis Day to try and raise awareness, to raise the profile of the condition within the service.687
Now, we do recognise, frankly and honestly, that there is always more that needs to be done to combat what can be a deadly disease, but I do want to recognise some of the progress that we have made to tackle this life-threatening condition. To be fair, Angela Burns has recognised this as well. We should be proud of the fact that we are seen as leading the way in the UK in making sepsis recognition and treatment a top priority. Our fight to combat sepsis continues, and a huge amount of work has been done since 2012, when we were the first country in the world here in Wales to implement the national early warning score system, known as NEWS. That should ensure the early escalation of patients who are seen to be deteriorating. And that simple step should ensure that we're using a common language throughout NHS Wales to communicate about deterioration and sepsis. NEWS and sepsis screening have been introduced in all acute clinical areas, in the Welsh ambulance service trust and in many community and primary settings. We should be proud of the fact that, in Wales, NEWS has been standardised in all of our hospitals since 2013.688
The main vehicle for that change here in Wales has been the active participation of health boards and individuals in the 1000 Lives improvement service rapid response to acute illness learning set, commonly known as RRAILS—and I'm glad they have an acronym at least within the service. But it's clear that there's still lots of work for them to do. They're a huge important part in helping to try and drive system-wide improvement, because we have to continue to try and live up to the recognition that we received in 2016, when the progress NHS Wales had made in improving the treatment of sepsis was recognised by an award from the Global Sepsis Alliance in the 'governments and healthcare authorities' category.689
But, as with all things, we can't assume that progress is obvious, easy and inevitable. We have to constantly review what we are doing to ensure ongoing improvement. There is always more that we are able to do in keeping learning and improving, and peer review is an ideal and important part of that. The RRAILS programme involves peer review of the management of acutely deteriorating patients, and it's been developed to enable each health board and trust to develop a proper plan to approve the acute deterioration services that they have. It is good to hear that this work is already well under way, with a series of visits to health boards already having taken place, and more planned. Both the reviewers and the staff being part of that peer review recognises that it's been an important and helpful conversation for each of them.690
Recently, the public services ombudsman commended the 1000 Lives work around the peer review, and he acknowledged the impact that that work is having on improving services and saving lives. Other issues are under way, including the work on the development of a sepsis registry that Angela Burns referenced. But the results of a trial in the Cwm Taf 'sepsis 6 box' study suggest improvements in patient outcome, associated with the use of that box. That includes reduced mortality and intensive care unit admissions, and a significant reduction in NEWS at 24 hours, which is an important marker of patient recovery. I am seriously looking forward to a further evaluation of the trial results, so that final conclusions can be reached to see if we could and should roll that out across the whole country.691
I want to try and address the difficult question of a public awareness campaign. I say it's 'difficult' because I understand completely the case that is made about wanting to raise broader public awareness in the hope and the expectation that that would save more lives. The practical problem and question for me is whether the money and the resource we'd put into a public awareness-raising campaign would deliver the outcomes we want in having improved outcomes for people.
692
20:15
Would you take an intervention, Minister?693
Yes, happily. 694
You talk about saving lives, and you're absolutely right, that's very important, but, actually, the thing about sepsis is the destruction it causes to the people who do survive it. So, if you can get into a hospital quicker, then you are less likely to lose your limbs, you're less likely to have your brain basically scrambled by the sepsis, you're less likely to be left with debilitating long-term conditions. So, when you talk about the fact that the deaths have gone down, which is great, and when you talk about the fact that you're seeking to improve it, I would say to you that there are still way too many people who present to GPs or to hospitals with symptoms that are not recognised quickly enough. So, even though they go on to live, they live with such catastrophic consequences that their lives are completely changed.695
I really do recognise the case for wanting to raise broader public awareness, but there are times when you have to look people in the eye and say, 'I'm not sure the case is made to do that', and that is an honest reflection on the advice that I receive on the effectiveness of awareness-raising campaigns across a range of conditions. It's the reality of what, in part, my job involves: a fairly regular number of people who want the health service to conduct individual condition awareness-raising campaigns, and on a range of pretty common conditions, actually, with large numbers, like sepsis, and serious conditions as well. I always have to consider not just receiving that advice and then making choices but where is the greatest gain to be made—where is the greatest health gain to be made—and I actually think that part of our challenge is that I think that, at this point, most of the evidence points to—raising awareness amongst our health and care professionals will help to identify symptoms at an earlier stage, with more consistency, and then more consistency not just in the identification, but then in the treatment and support that people receive. I do, though, retain an open mind, and I would not say 'no' and 'never', but what I will say is that, at this point, I don't think there's a case that I could support with the advice that I have about what is the right way to deliver further improvement in outcomes to people in Wales. But I'm more than happy to keep on talking and keep on listening, and I know that there is a—[Inaudible.]—campaign to want to continue to review the evidence. And, actually, the evidence in England is that it is not just the right thing to do from the very obvious passion that people feel around the issue, but it makes a real difference in outcomes. [Interruption.] Then I'll be more than happy to listen and look again.696
The awareness amongst healthcare professionals is something that we do recognise feeds part of the inconsistency of our service responses. That's why the work that we're doing is largely aimed at health and care professionals, not just raising their awareness, but about thinking what they then do at that point in time. There's a pre-hospital sepsis group, which is a sub-group of the RRAILS programme. That's been established, and it draws together a variety of stakeholders to plan for improving practice in the outside hospital environment. A number of projects initiated from that work include collaboration with GP clusters about acute kidney injury and sepsis improvement, how to advise the out-of-hours and 111 groups on adopting NEWS and sepsis screening in a non-hospital setting, introducing sepsis and acute kidney injury tools in district nursing and intermediate care teams, and collaboration with the deanery here in Wales on clinical placements for GP trainees. 697
The standardisation of best practice has led to a similar standardisation in training methods and the curriculum. RRAILS online in a modular e-learning tool developed by Abertawe Bro Morgannwg health board in collaboration with and funded by 1000 Lives Improvement. That is available to ensure that all NHS Wales staff, including medical and healthcare students, will be able to access the same level of training. Data on the uptake and the pass rate for that module to date has already shown 477 passes for one of each of the five modules. There is, of course, always more to do, but there are staff who are accessing it. I see on my regular visits around the hospital sector as well as outside hospitals that there is a raising of awareness amongst our staff about sepsis and an awareness of it and of its consequences. But the information gathered from this will feed into the data gathered as part of the ongoing peer review process.698
I am pleased that we have a very good working relationship with the UK Sepsis Trust, which is a member of the RRAILS steering group. We have a shared ambition to raise awareness and improve the response to sepsis. I was very happy to be invited by Angela Burns, as chair of the new cross-party group, to attend the meeting in March where we had the opportunity to hear first-hand some of the personal stories of those directly affected by sepsis, much like the story that you opened this debate with, and of course your own experience as well. 699
I do know that sepsis does carry a terrible cost, not only in terms of mortality but, as you and others say, the effects that survivors have to carry with them. And it is therefore important to listen to sepsis survivors to hear that often they have to cope with physical and cognitive challenges, which again have been set out within the debate, and that can radically change their life, and to understand their experience as part of what we then need to do to respond to try and make sure that we continue to help that person to live their life to its fullest.700
So, I'm keen to understand those wider needs and what sort of arrangements need to be in place to help meet them. I'll be happy to come to a future meeting of the cross-party group to continue the openness and the conversation that I'm trying to set out and continue. We recognise we can't do this in isolation. It's important we continue to collaborate with all key partners to achieve our shared objectives. That's why I'm pleased that there is a collaborative project between the UK Sepsis Trust, the RRAILS programme, and the 1000 Lives education for patients programme, aimed at offering support to people who have post-sepsis syndrome. 701
I'd like to close in recognising and expressing my own personal admiration for all of those people who have spoken out about their experiences with and of sepsis, people directly affected, people who have survived around them, carers, loved ones, and I recognise the tireless campaign of those people to try and make ensure there is further action, but, ultimately, that should lead to a further improvement, so that more lives are saved and more people who live through sepsis are supported in their recovery journey. That is a vital component of our shared fight against sepsis and to ensure that we build on our learning Wales-wide and we never take for granted the progress that we have made and concentrate on what more we could and should do.