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 determined campaign to want to continue to review the evidence. And, actually, if 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.

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. 

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.

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. 

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.

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. 

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.