Sepsis Guidelines and Medical Negligence: Why are there still so many claims?
During Sepsis Awareness Month, Zoe Donohue, Associate Solicitor in our Manchester medical negligence team, considers the effectiveness of sepsis guidelines, six years after reforms were rolled out.
Posted on 29 September 2025
Sepsis remains one of the most pressing challenges in UK healthcare with 245,000 people affected in the UK each year. According to the UK Sepsis Trust, sepsis is responsible for an estimated 48,000 deaths each year—many of which are preventable.
In 2019, the National Institute for Health and Care Excellence (NICE) updated its guideline to improve early recognition and management of sepsis, and the guidelines were updated again in March 2024. Yet, despite these efforts, medical negligence claims related to sepsis continue to rise, raising questions about the effectiveness of how these guidelines are being implemented and accountability in practice.
What are the NICE sepsis guidelines?
The NICE’s NG51 guideline focuses on integrating the National Early Warning Score (NEWS2) into clinical practice.
NEWS2, endorsed by NHS England, was designed to help identify deteriorating patients. It is a clinical tool used to identify patients at risk of deterioration, including those with suspected sepsis. It standardises the assessment of illness severity based on six observations including respiration rate, oxygen saturation levels, blood pressure, pulse rate, level of consciousness and temperature.
In March 2024, NICE released significant updates to its guideline on the recognition, diagnosis, and early management of suspected sepsis. These changes aimed to improve clinical decision-making, reduce unnecessary antibiotic use, and enhance patient outcomes.
The guideline now includes broader criteria for identifying high-risk individuals, including those with spinal cord injuries, immunosuppression unrelated to cancer, and learning disabilities or autism. It states that high-risk patients should receive broad-spectrum antibiotics within one hour and lower-risk patients may be treated within one to three hours, allowing time for diagnostic clarification and targeted therapy.
The UK Sepsis Trust developed a clinical care bundle to improve outcomes for patients with suspected sepsis and outlines six key interventions which should be delivered in one hour of identifying sepsis.
The Sepsis Six is a treatment protocol widely used in hospitals. Studies have shown that implementing the Sepsis Six can reduce mortality, shorten hospital stays, and improve recovery outcomes.
These steps are designed to stabilise the patient, treat the infection, and prevent organ failure.
The Sepsis Six Interventions:
- Administer oxygen
- Take blood samples
- Give intravenous antibiotics
- Start intravenous fluids
- Check lactate levels
- Measure urine output
Why are there still so many medical negligence claims for sepsis?
Despite these improvements, medical negligence claims involving sepsis have not reduced. In fact, the 2024 NICE evidence review showed that while timely treatment improves survival, less than half of patients (49%) currently receive antibiotics within the recommended one-hour timeframe for high-risk cases.
The review also found that delays in diagnosis and treatment remain common, often due to staff shortages, overcrowded emergency departments, and failure to escalate care.
In August 2022, a report by NHS Resolution identified sepsis cases as one of the three leading bases for medical negligence claims against NHS GPs, alongside cancer and cardiac-related illness. Delays in, or failure to diagnose sepsis were found to have occurred in 81% of the clinical negligence cases examined in the report.
In our experience, medical negligence claims typically arise due to failures to recognise early warning signs, failure to monitor or document vital signs and NEWS2 observations, junior staff failing to escalate concerns to senior clinicians and failure to start the sepsis six protocol within the recommended timeframe. These failures can result in permanent disability, multi-organ failure, or death, leading families to pursue legal action for accountability and compensation.
John’s story: The real life impact of sepsis related negligence
I have recently been instructed to investigate a medical negligence claim by a patient, whose name we have changed to protect his identity. John was undergoing chemotherapy for bladder and rectal cancer. He presented to a specialist hospital after collapsing with clear signs of neutropenic sepsis, including very low blood pressure, elevated heart rate, breathlessness and low urine output. Despite these symptoms, sepsis was not initially suspected, and antibiotics and IV fluids were delayed for over seven hours.
Blood tests were eventually taken five hours after he arrived in hospital and confirmed he was very unwell with an acute kidney injury, anaemia and low platelets caused by infection. Despite this it took a further hour for antibiotics to be started when John’s blood pressure dropped extremely low.
The trust involved has completed its own investigation and acknowledged multiple failures in care, including:
- Failure to recognise and escalate suspected sepsis
- Delay in administering life-saving treatment
- Poor communication and monitoring
John’s condition deteriorated significantly, requiring critical care and prolonged hospitalisation. He later developed neurological complications, mobility issues, and visual impairment, and now requires open heart surgery.
The trust concluded in its report that this was a “failure to rescue”, and that the delay likely prolonged his recovery and contributed to ongoing health complications.
The impact on John’s life has been severe and he was only able to return home a few weeks ago. It has left him unable to work and reliant on his wife for care and support. Whilst nothing can change what happened to him, I’ll be taking his claim forward and asking the trust to repeat the criticisms they have made in their report as a formal admission of negligence.
Conclusion: Guidelines alone aren’t enough
The introduction of clearer protocols has made it easier to establish breaches of duty in negligence cases. With national standards now in place, courts can assess whether clinicians followed the Sepsis Six pathway. If a hospital fails to act on abnormal clinical indicators, it may be deemed to have breached its duty of care.
The 2019 NICE sepsis guidelines marked a significant step forward in standardising care for suspected sepsis. However, implementation gaps, resource constraints, and variability in clinical judgment continue to undermine their impact. Until systemic issues are addressed, many patients and their families will be let down and medical negligence claims related to sepsis are sadly likely to continue as a result.
Zoe Donohue
Zoe is an Associate solicitor working in the medical negligence department in Manchester.
Sepsis claims
Misdiagnosis of sepsis can be devastating for you or a loved one.
Inquest finds Mum died aged 56 of natural causes contributed to by neglect and delay in sepsis diagnosis
An inquest has concluded that there were ‘significant failures’ and missed opportunities when treating mum and grandmother Tracey Farndon, who died hours after admission to the A&E department at a Birmingham hospital.