An apparent increase in sepsis deaths by more than a third in two years has been fuelled in part by staff shortages and overcrowding on wards in English hospitals, a safety expert has said.
According to Sir Brian Jarman, the director of the Dr Foster research unit at Imperial College London, the number of recorded deaths where the primary cause was sepsis was 11,328 in 2014-15. By 2016-17 there were 15,722 deaths in hospital or within 30 days of discharge where sepsis was the leading cause, an increase of 38.8%.
Jarman, whose unit sends real-time alerts to hospitals that fall behind the expected mortality rate, blamed the increase partially on the consequences of real-terms funding cuts.
“The biggest thing that’s important seems to be the number of staff – doctors per bed,” he told BBC Radio 4’s Today programme. “One of the secondary important things is the overcrowding of hospitals. The level of overcrowding shouldn’t be more than 85% [bed occupancy], and it’s been going over 90% in recent years.”
Jarman, a former president of the British Medical Association, said the number of beds available had halved and the number of admissions had roughly doubled over the past 30 years – an “amazing change of provision of healthcare”.
The NHS said it had placed a greater emphasis on screening for sepsis in recent years. It claimed the rise in recorded deaths was due to an increased recognition of the condition, with cases previously recorded as simple infections now being classified as sepsis.
“Over the past three years there has been huge effort across the NHS to increase clinical recognition of, and recording of, sepsis,” an NHS England spokesperson said. “That improved method of recording means some cases previously recorded as simple infections are now classified as sepsis. So these data do not prove an increase in sepsis cases per se.”
Although sepsis is fundamentally caused by the immune system going into overdrive, it is triggered by infection – such as an insect bite or a contaminated wound. If the immune system fails to prevent the spread of the infection, the body can go into septic shock, potentially leading to organ failure and death.
Dr Ron Daniels, the chief executive of the UK Sepsis Trust and an intensive care consultant, said the nature of hospital record-keeping made it almost impossible to keep track of the number of sepsis deaths.
“It’s very common that if someone dies of sepsis that it’s coded or reported as simply being the underlying infection,” Daniels told the BBC. “So they might die of sepsis in an intensive care unit with multiple organ failure – but they’re recorded as a death from pneumonia. We need to fix that problem before we can truly understand the scale of sepsis.”
He added: “The best way for us to do that is to develop a prospective data system like a registry that exists for other conditions, so that we can really get a national picture of what’s going on.”
Prof Bryan Williams, the chair of medicine at University College London, told the Today programme that sepsis death rates were falling and there was simply an increased awareness of the condition.
“In reality what is happening is an increased awareness of sepsis and increased detection of sepsis and an actual reduction in mortality in hospital and in the first 30 days after discharge from sepsis,” he said.
“I would really think it is important for the public to recognise the NHS is taking this incredibly seriously and if you go to any hospital now it is treated as one of the priorities and death rates are falling.”