NHS Long Term Plan to reduce toll of ‘hidden killer’ sepsis

Hospital staff must alert senior doctors if patients with suspected sepsis do not respond to treatment within an hour, as part of the NHS Long Term Plan to save thousands more lives.

Every trust must take action to spot and treat the killer blood condition, which costs 37,000 lives a year, under guidance that is being mandated by NHS England.

The guidance, drawn up with the Royal College of Physicians, The Royal College of GPs, NICE and the UK Sepsis Trust, states that staff should look for sepsis at an early stage in patients coming to A&Es and those who are already on wards.

Medics must ask consultants for help if patients with suspected sepsis do not respond to treatment within an hour.

And hospital teams should also take sufficient note of non-specific symptoms and concerns expressed by relatives and carers such as acute changes in behaviour.

Hospitals will be contractually obliged to ensure they fully comply with the guidance coming in from April.

The initiative comes as the NHS prepares to pilot new clinical standards aimed at providing swifter diagnosis and treatment for patients arriving at A&E with suspected sepsis.

The new focus on fast treatment for sepsis in emergency departments – along with other major killers such as heart attack, stroke and severe asthma attacks – is part of a raft of improvements to NHS waiting time standards which will be trialled over the coming months.

Celia Ingham Clark, medical director for clinical effectiveness at NHS England, said: “We’ve come a long way in the NHS in improving how we identify and tackle sepsis, with more people having the problem spotted and treated than ever before.

“The NHS Long Term Plan is a blueprint for transforming NHS care, and after the success we’ve had ramping up earlier sepsis diagnosis in many parts of the country, all hospitals will now be required to deliver the best possible practices for identifying and treating sepsis.”

Sepsis is caused when the body responds poorly to a bacterial infection and attacks its own tissues and organs, and while early treatment is effective, the condition is hard to spot because there isn’t a simple definitive test or obvious symptom for it which means that too often, treatment starts too late.

However, over the past few years the NHS has significantly improved spotting the hidden killer, with screening rates in emergency departments up from 78% to 91% between 2015 and 2018, and eight in ten patients being given the right medication, at the right time.

From 1 April a change to the NHS standard contract will require all NHS trusts in England to comply with guidance on sepsis, written alongside the Royal College of Physicians, the Royal College of GPs, NICE, Health Education England, the UK Sepsis Trust and Patient Safety Collaboratives.

Dr Tim Nutbeam, Clinical Advisor for the UK Sepsis Trust, said: “The UKST welcomes this initiative; if delivered correctly it will ensure rapid and effective treatment for the patients who need it most, whilst ensuring that senior clinical decision-makers are supported in making informed, balanced decisions in relation to the prescribing of antibiotics.

“We have been working with NHS England for the past three years to improve the recognition and management of sepsis in hospitals. This next step will ensure that every patient receives the attention they require within existing resource.”

At the request of the Prime Minister, the NHS has been undertaking a clinically-led review of how current measures – including the four hour A&E standard, introduced 15 years ago – could be improved to ensure they measure what matters most to patients, reflect significant advances in clinical practice, including the detection and treatment of sepsis, and support NHS staff to deliver the best quality care possible, particularly for those patients with the most critical health needs.

The review, being conducted by top doctors, nurses and hospital bosses, will shortly present its full recommendations for new measures to be trialled over the next few months.

As set out in the NHS Long Term Plan, this will include a new measure for patients with the most serious illnesses and injuries, like sepsis, to ensure that they receive the best possible care in the shortest possible timeframe.

Alongside this stronger accountability for NHS hospitals, the NHS is also successfully working with partners to roll out National Early Warning Scores (NEWS2) in acute and ambulance trusts. NEWS2 is a tool developed by the Royal College of Physicians which identifies acutely ill adult patients and can be used to prompt a senior clinical review to judge whether the patient’s illness is due to sepsis.

NHS England is also working with the Royal College of Paediatrics and Child Health and others to develop a national Paediatric Early Warning System to match the existing adult NEWS2 tool.

Professor Bryan Williams, chair of the NEWS Development Group and Royal College of Physicians clinical lead for NEWS, said: “It is vital that patients with suspected sepsis are seen as quickly as possible, and this new initiative from NHS England is very important in ensuring we get the best opportunity to act quickly and save lives of people with suspected sepsis.

“NEWS2 is a simple but incredibly useful tool to help identify patients at risk of clinical deterioration due to sepsis and is helping transform the speed and effectiveness of treatment for these patients across the NHS. We welcome plans to roll NEWS2 out to acute and ambulance trusts to help identify sepsis at the earliest possible stage and save lives.”

Last year a Suspicion of Sepsis Dashboard, produced in partnership with Imperial College Health Partners through NHS England and NHS Improvement’s Patient Safety Collaboratives and with NHS Improvement, was launched to help the NHS to accurately measure the number of patients admitted to hospital who are at risk of sepsis.

It also allows the NHS to track improvement, such as rates of survival and length of hospital stays through measuring the number of patients coming into hospital as an emergency with a severe bacterial infection categorized as ‘suspicion of sepsis’.

Screening for sepsis in those patients already in hospital for other reasons, and whose condition gets unexpectedly worse, has risen from 69% to 86% since 2016, and prompt antibiotic treatment has improved from 69% to 83%.

The implementation guidance, originally published in Autumn 2017 to help the NHS implement NICE sepsis guidance, reminds healthcare professionals to suspect sepsis at an early stage.

The guidance being mandated in the contract was created by clinicians representing the Royal College of Physicians, the Royal College of GPs, NICE, Health Education England, the UK Sepsis Trust, Patient Safety Collaboratives and NHS England.