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The below Parliamentary question was asked by Justin Madders on 2016-02-01.

To ask the Secretary of State for Health, how many cases of sepsis there were in each region of England in each of the last five years.

Ben Gummer

Data for finished discharge episodes (FDEs) with a primary or secondary diagnosis of sepsis for patients in each government office region of residence in England, in each year from 2010-11 to 2014-15 are provided below.

These figures relate only to hospital admissions and do not include those patients who were diagnosed in a primary care setting, or those who attended hospital as an Outpatient.

This is not a count of patients as the same patient may have had more than one episode of care within the same year.

Count of FDEs¹ with a primary or secondary diagnosis² of sepsis³ for patients in each government office region of residence for 2010-11 to 2014-15^4. Activity in English National Health Service Hospitals and English NHS commissioned activity in the independent sector

Government office region	2010-11	2011-12	2012-13	2013-14	2014-15
North East	4,798	5,074	5,655	6,275	7,388
North West	13,258	13,109	14,708	17,221	20,922
Yorkshire and The Humber	9,182	9,189	10,146	11,338	12,857
East Midlands	7,316	8,115	9,831	10,863	12,998
West Midlands	7,772	7,915	10,518	12,297	13,812
East of England	10,380	10,432	11,647	13,108	16,029
London	14,894	15,223	15,580	17,860	19,723
South East	13,945	15,344	16,604	19,239	21,378
South West	8,013	8,292	9,805	10,967	12,722
England – Not Otherwise Specified	48	83	75	84	102
Unknown/Non-England	2,275	8,239	9,716	3,570	3,841
Total	91,881	101,015	114,285	122,822	141,772

Source: Hospital Episode Statistics (HES), Health and Social Care Information Centre

The increasing incidence of sepsis is likely to be due to people living longer and more medical and surgical interventions being performed. People with series co-morbidities are more likely to survive their illness, and for a longer period of time than in previous decades, which leads to much of the hospital-acquired sepsis that now occurs.

Notes:

¹Finished Discharge Episode (FDE) – A discharge episode is the last episode during a hospital stay (a spell), where the patient is discharged from the hospital or transferred to another hospital. Discharges do not represent the number of patients, as a person may have more than one discharge from hospital within the period.

²Number of episodes in which the patient had a primary or secondary diagnosis – The number of episodes where this diagnosis was recorded in any of the 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) primary and secondary diagnosis fields in a Hospital Episode Statistics (HES) record. Each episode is only counted once, even if the diagnosis is recorded in more than one diagnosis field of the record.

³ICD-10 codes for Sepsis – A02.1 Salmonella sepsis, A20.7 Septicaemic plague, A21.7 Generalized tularaemia, A22.7 Anthrax sepsis, A26.7 Erysipelothrix sepsis, A28.0 Pasteurellosis, A28.2 Extraintestinal yersiniosis, A32.7 Listerial sepsis, A39.2 Acute meningococcaemia, A39.3 Chronic meningococcaemia, A39.4 Meningococcaemia, unspecified, A40.- Streptococcal sepsis, A41.- Other sepsis, A42.7 Actinomycotic sepsis, B37.7 Candidal sepsis, O85.X Puerperal sepsis, P36.- Bacterial sepsis of newborn
The following pair of codes is a dagger/asterisk code pair (D and A) which must be present together:
A39.1 Waterhouse-Friderichsen syndrome; E35.1 Disorders of adrenal glands in diseases classified elsewhere

⁴Assessing growth through time (Admitted patient care) – HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer include in admitted patient HES data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information.

Note that HES include activity ending in the year in question and run from April to March, e.g. 2012-13 includes activity ending between 1st April 2012 and 31st March 2013.

The below Parliamentary question was asked by Justin Madders on 2016-02-01.

To ask the Secretary of State for Health, what the implications for his policies are of the findings of the 2015 report from the National Confidential Enquiry into Patient Outcome and Death, Sepsis: Just Say Sepsis on delayed diagnosis.

Ben Gummer

In January 2015, we announced a package of measures to focus attention on sepsis and raise the awareness of this potentially devastating condition amongst professionals and the public. These included new incentives to encourage hospitals to recognise sepsis in adults and children, and to provide timely treatment with intravenous antibiotics within 60 minutes of a diagnosis of severe sepsis.

The National Confidential Enquiry into Patient Outcome and Death report outlined many important findings about awareness and treatment of sepsis both in primary care and hospital settings, and many of these findings are being addressed through the work of the NHS England Cross-system Sepsis Programme Board. The Board published its report, Improving Outcome for Patients with Sepsis, A Cross-System Action Plan, in December 2015.

This sets out the actions being be taken forward to (a) Prevent avoidable cases of sepsis; (b) Increase awareness of sepsis amongst professionals and the public; (c) Improve the identification and treatment of sepsis across the whole patient pathway; (d) Improve consistency of standards and reporting; and (e) Underpin all actions with the principles of appropriate antibiotic use and antimicrobial stewardship.

A copy of the report can found at:

https://www.england.nhs.uk/ourwork/part-rel/sepsis/

“

The below Parliamentary question was asked by Justin Madders on 2016-02-01.

To ask the Secretary of State for Health, what his Department plans to do to ensure that healthcare staff and GPs are adequately trained to recognise the symptoms of sepsis.

Ben Gummer

NHS England is undertaking a number of steps to improve diagnosis and treatment of sepsis, which have been coordinated through a cross-system programme board run by NHS England.

In April 2015 NHS England introduced a new national Commissioning for Quality and Innovation measure (financial incentive) to incentivise hospitals accepting emergency admissions to screen eligible patients for sepsis when they arrive, and to administer intravenous antibiotics within one hour for patients with severe sepsis or septic shock.

Additionally NHS England has made available a voluntary audit tool for general practitioners (GPs) enabling them to assess their care of children with a fever under five years old against the National Institute for Health and Care Excellence (NICE) guidelines, which can be a pre-cursor to sepsis. Primary care IT suppliers have provided data entry templates for the tool which prompts GPs to enter the appropriate observations thereby improving the quality of the patient care record, as well as promoting the use of the NICE guidance.

NICE is currently consulting on a new Sepsis Clinical Guideline that will be published this year, which will make recommendations about the assessment, diagnosis and initial management of patients with sepsis.

The Government has mandated Health Education England (HEE) to provide national leadership on education, training and workforce development in the National Health Service in England.

It is the responsibility of the professional regulators to set the standards and outcomes for education and training and approve training curricular to ensure newly qualified healthcare professionals are equipped with the knowledge, skills and attitudes to provide high quality patient care.

HEE will work with bodies that set curricula such as the General Medical Council and the Royal College of General Practitioners (RCGP) to seek to ensure training meets the needs of patients.

HEE is currently developing an awareness video that will target primary care staff on recognising sepsis in children. A separate piece of work involving the RCGP is focusing on an e-learning package on sepsis in primary care, to ensure that the primary care workforce is ably equipped to deal with sepsis in the general population, including children.

HEE is currently undertaking a scoping exercise on training available for health professionals to recognise and manage sepsis in all patient groups. This survey scoped HEE local offices, NHS organisations, Academic Health Science Network, Ambulance Trusts and Royal Colleges on the resources currently available, which are being reviewed, and recommendations will be made in March 2016.

The below Parliamentary question was asked by Justin Madders on 2016-02-01.

To ask the Secretary of State for Health, what steps his Department plans to take to ensure opportunities for diagnosis and intervention in sepsis are detected.

Ben Gummer

NHS England is undertaking a number of steps to improve diagnosis and treatment of sepsis, which have been coordinated through a cross-system programme board run by NHS England.

In April 2015 NHS England introduced a new national Commissioning for Quality and Innovation measure (financial incentive) to incentivise hospitals accepting emergency admissions to screen eligible patients for sepsis when they arrive, and to administer intravenous antibiotics within one hour for patients with severe sepsis or septic shock.

Additionally NHS England has made available a voluntary audit tool for general practitioners (GPs) enabling them to assess their care of children with a fever under five years old against the National Institute for Health and Care Excellence (NICE) guidelines, which can be a pre-cursor to sepsis. Primary care IT suppliers have provided data entry templates for the tool which prompts GPs to enter the appropriate observations thereby improving the quality of the patient care record, as well as promoting the use of the NICE guidance.

NICE is currently consulting on a new Sepsis Clinical Guideline that will be published this year, which will make recommendations about the assessment, diagnosis and initial management of patients with sepsis.

The Government has mandated Health Education England (HEE) to provide national leadership on education, training and workforce development in the National Health Service in England.

It is the responsibility of the professional regulators to set the standards and outcomes for education and training and approve training curricular to ensure newly qualified healthcare professionals are equipped with the knowledge, skills and attitudes to provide high quality patient care.

HEE will work with bodies that set curricula such as the General Medical Council and the Royal College of General Practitioners (RCGP) to seek to ensure training meets the needs of patients.

HEE is currently developing an awareness video that will target primary care staff on recognising sepsis in children. A separate piece of work involving the RCGP is focusing on an e-learning package on sepsis in primary care, to ensure that the primary care workforce is ably equipped to deal with sepsis in the general population, including children.

HEE is currently undertaking a scoping exercise on training available for health professionals to recognise and manage sepsis in all patient groups. This survey scoped HEE local offices, NHS organisations, Academic Health Science Network, Ambulance Trusts and Royal Colleges on the resources currently available, which are being reviewed, and recommendations will be made in March 2016.

The below Parliamentary question was asked by Justin Madders on 2016-02-01.

To ask the Secretary of State for Health, how many cases of sepsis there were in children and infants under five years of age in each of the last five years.

Ben Gummer

The figures provided in the table refer only to hospital admissions and are not a count of patients as a patient may have had more than one episode of care within the same year.

Data for finished discharge episodes with a primary or secondary diagnosis of sepsis for patients aged 0 to 4 years, in each year from 2010-11 to 2014-15.

Information is not held centrally on patients diagnosed in a primary care setting.

	2010-11	2011-12	2012-13	2013-14	2014-15
Finished discharged episodes	18,417	20,080	22,915	23,840	26,725

Source: Hospital Episode Statistics, Health and Social Care Information Centre

Notes:

1. Finished Discharge Episode – A discharge episode is the last episode during a hospital stay (a spell), where the patient is discharged from the hospital or transferred to another hospital. Discharges do not represent the number of patients, as a person may have more than one discharge from hospital within the period.
2. Number of episodes in which the patient had a primary or secondary diagnosis – The number of episodes where this diagnosis was recorded in any of the 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) primary and secondary diagnosis fields in a Hospital Episode Statistics (HES) record. Each episode is only counted once, even if the diagnosis is recorded in more than one diagnosis field of the record.
3. ICD-10 codes for Sepsis – “A02.1 Salmonella sepsis, A20.7 Septicaemic plague, A21.7 Generalized tularaemia, A22.7 Anthrax sepsis, A26.7 Erysipelothrix sepsis, A28.0 Pasteurellosis, A28.2 Extraintestinal yersiniosis, A32.7 Listerial sepsis, A39.2 Acute meningococcaemia, A39.3 Chronic meningococcaemia, A39.4 Meningococcaemia, unspecified, A40.- Streptococcal sepsis, A41.- Other sepsis, A42.7 Actinomycotic sepsis, B37.7 Candidal sepsis, O85.X Puerperal sepsis, P36.- Bacterial sepsis of newborn,
   The following pair of codes is a dagger/asterisk code pair (D and A) which must be present together: A39.1 Waterhouse-Friderichsen syndrome, E35.1 Disorders of adrenal glands in diseases classified elsewhere.