An Cathaoirleach
I welcome everyone to the meeting. I remind members of the constitutional requirement that members must be physically present within the confines of the place where Parliament has chosen to sit, namely, Leinster House, in order to participate in public meetings. I will not permit members to participate where they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting.
We have some petitions for consideration this morning, but we will hear first from our witnesses. On behalf of the committee, I extend a warm welcome to Ms Sinéad O’Reilly, patient advocate, and Professor Steve Kerrigan, deputy head of the school of research and professor of precision therapeutics at the Royal College of Surgeons in Ireland. Ms O’Reilly and Professor Kerrigan will make their opening statements and we will then have questions and answers.
Ms Sinéad O’Reilly
I am here to tell the committee about my sister-in-law, Sarah. Sarah was 34 years of age. She worked as a vigilance specialist for Baxter Healthcare and was excellent at her job. She enjoyed baking, arts and crafts and professional photography. However, she excelled at languages. She was originally from Germany, with German being her native tongue, and she was fluent in French and English and was also mastering the Irish language since her move to Ireland.
Sarah came to live in Ireland 13 years ago from Germany after she met my brother, Patrick, following three years of a long-distance relationship. They married 11 years ago, and they were over the moon when they managed to buy their first home together. However, Sarah’s greatest wish in life was to start a family and become a mother. Unfortunately, this was not a straightforward journey for Patrick and Sarah, as Sarah endured arduous infertility treatments and IVF prior to becoming pregnant with their precious twins, Lilly and PJ, who we all called little miracles.
Eleven weeks after the birth of the twins, I received a call from Sarah one Saturday morning in August. She informed me that she had been vomiting during the night and had a terrible pain in her right side. At this time, I was working as a tissue viability clinical nurse specialist in Cavan General Hospital. I suspected from Sarah’s symptoms that she may have gallstones and would require surgical review with further investigations, so I advised her to attend the emergency department in Cavan General Hospital. This was during the Covid restrictions when family members could not accompany their loved ones to the hospital. Sarah presented to the emergency department that Saturday morning. I was in contact with her regularly during the day and she informed me, in her own words, “They don’t know what’s wrong with me”. I became concerned when I spoke to Sarah that evening as she did not sound like herself on the phone. I rang the hospital and informed staff members that I was concerned about Sara as she did not sound like herself. I inquired about what the plan of care was following review. They informed me that Sarah had pancreatitis and that she was doing okay, just in a bit of pain, and was now getting some strong painkillers. I was told not to worry, which I was very relieved to hear. I trusted that Sarah was being safely and appropriately cared for in the hospital that I worked in.
Later that night, at 3.30 a.m., I got a call from the ward to say that Sarah had been transferred to the intensive care unit, ICU, but was stable. As a nurse, I was aware of the implications of an ICU transfer and how serious pancreatitis can be, so I asked whether I should attend the hospital. I was again reassured that there was no need to attend, and that Sarah was stable. I attended the ICU the next morning and was shocked to be informed that Sarah had been diagnosed with sepsis, among other medical issues, and was in multi-organ failure. I had never thought to ask if it could be sepsis.
As Sarah’s organs were failing, she now required urgent transfer to Beaumont hospital. This was now 28 hours after her initial presentation. On that first night, when Sarah arrived at Beaumont, there are no words to describe the shock and devastation that we experienced when we were informed by a member of the medical team that Sarah’s kidneys had taken “too much of a hit” and they were failing. We were then told it was only a matter of time for our beloved Sarah. Sarah spent 11 weeks intubated in ICU in Beaumont fighting the greatest battle of her life. She got the best of care there, and the staff went above and beyond to keep Sarah’s babies at the forefront of her recovery. It was so obvious that Sarah was fighting to stay alive for Lilly and PJ and to continue to be the mother she had always dreamed of being.
Tragically, Sarah passed away 11 weeks following admission to Beaumont hospital at the tender age of 34, leaving my brother Patrick a widower and Lilly and PJ without their mammy at the age of five months, eight months after moving into their forever home. We were informed shortly after Sarah’s death that Cavan General Hospital had commissioned an external review into Sarah’s time there. During her time in Cavan General Hospital, Sarah had been reviewed by emergency, surgical and nursing staff. The review identified an abundance of failures by my colleagues in relation to Sarah’s care, but fundamental to the review was the failure of the team to activate the sepsis protocol and the failure to recognise a deteriorating patient. The reviewers concluded that a different plan of care would have resulted in “a more favourable outcome” for Sarah. One of the key recommendations of the review was for senior management to ensure all staff are educated in regard to the deteriorating patient and the sepsis protocol going forward.
This particular recommendation resonated very profoundly with me as a nurse. I was aware that all staff working in the hospital had to complete mandatory training for sepsis, so this recommendation was not new or novel but a repetition of what was supposed to be happening already, yet had clearly not been effective in this situation.
Never in a million years did we think that when Sarah was wheeled into the ambulance from Cavan General Hospital to make the journey to Dublin, it would be the last time that we would ever hear her speak. All we have are photos and videos for her babies to remember her by. How are we going to explain this to Lilly and PJ when they are old enough to understand? I do not understand. Death from sepsis is widely recognised as largely preventable, with early recognition and timely treatment. The HSE’s own policy highlights the importance of diagnosis and treatment within the first hour. It has even been termed “the golden hour” in HSE literature.
Sarah died in 2022 and we have been anxiously awaiting the national sepsis five-year strategy, which was due to be published in 2024. It is now 2026. I am well aware of the HSE’s national clinical programme for sepsis. While it sounds like it ought to be effective, I have to question whether these measures are being implemented effectively, given the number of people who are still dying. Sarah died in October 2022 and Aoife Johnston died in December 2022. That is name but a few. These deaths were avoidable and therefore should have been avoided. Sepsis does not discriminate; it could be anyone here or one of their loved ones. I ask the committee to please help us make sure this does not happen and not to let Sarah’s death to have been in vain. I ask that it support the changes and actions that Professor Kerrigan will outline, in Sarah’s honour, not only for the sake of her beautiful twins but for all the other Sarahs out there.
Professor Steve Kerrigan
I thank the Chair and members of the committee. What Sinéad has just shared is devastating. Sarah’s death was sudden, traumatic and it changed her family forever. It is also, and this is the hardest truth, not unusual. The reason we are here today is that stories like Sarah’s are happening repeatedly in hospitals across Ireland, and they are happening in a system that is not yet designed to recognise sepsis early, respond to it consistently or support families afterwards. Sarah was a person, she was loved and she mattered, but her death also represents something larger. It is a pattern we are seeing in Ireland, across Europe and globally, where sepsis cases are rising while our ability to treat severe infection is being eroded by antibiotic resistance.
My role today is not to revisit Sarah’s story, but to explain why it is part of a growing public health threat and why Ireland has a real opportunity, right now, to lead rather than react. The uncomfortable truth is that we are facing more sepsis, in sicker and older populations, with fewer effective drugs to treat it. Antibiotics, the cornerstone of sepsis treatment, are increasingly failing due to resistance. This is no longer a future threat; it is already shaping outcomes.
Doctors are increasingly faced with infections that do not respond to first-line or even second-line treatments. That means longer hospital stays, higher costs, more complications and more deaths in our health system. Sepsis sits at the intersection of all of this: ageing populations, chronic disease, antimicrobial resistance and overstretched health systems. Despite this, Ireland currently has no dedicated, fully resourced national sepsis strategy or five-year plan that addresses prevention, early recognition, public awareness, professional education, post-sepsis cares or even long-term outcomes for survivors. That absence is what brings us here today.
Sepsis is not just an acute medical emergency; it is a life-altering event. Survivors often live with cognitive impairment, physical disability, post-traumatic stress disorder, PTSD, anxiety or depression, and an inability to return to work. Families are changed forever, careers end and lives shrink. Yet, post-sepsis care is patchy or non-existent, leaving many people to navigate recovery alone. This is not just a health issue; it is a social, economic and workforce issue.
This is where Ireland has a unique and time-limited opportunity. From July until December 2026, Ireland will hold the rotating Presidency of the Council of the European Union. This means Ireland gets to set agendas, chair meetings, shape priorities and represent the Council in negotiations. This is not symbolic; this is influence. We are asking a simple but powerful question. Could Ireland place sepsis on the EU health agenda during its Presidency? Doing so would position Ireland as a leader in patient safety and public health; align with EU concerns on antimicrobial resistance; support cross-border learning on early recognition and outcomes; and show that Ireland is prepared to lead on issues that are complex, costly and urgent. This is not about blaming the system. It is about anticipating what is coming and acting before the cost becomes even higher.
We are not asking for instant legislation or unrealistic commitments. We are asking for three achievable steps. First is that Ireland commit to developing a national, time-bound sepsis strategy, aligned with international best practice and scaled to our health system. Second is that sepsis is formally considered as part of Ireland’s EU Presidency health priorities, particularly in the context of antimicrobial resistance, hospital safety and ageing populations, all of which are key remits for the EU Presidency. Third is that this committee support further engagement by referring this issue to the relevant Ministers, Departments and Oireachtas committees.
Sepsis does not wait for reform cycles, capacity reviews or the right time. Every single delay costs a life, quietly and often invisibly. Ireland has an opportunity, not just to respond but to lead and to show that we take patient safety seriously, that we understand the future pressures on our health system and that when Ireland has the chance to shape Europe’s agenda, we choose to lead on issues that matter. I thank members for their time. We are happy to take some of their questions.
An Cathaoirleach
I thank the witnesses, particularly Ms O’Reilly. Sarah sounded like she was a lovely sister-in-law and I thank her for sharing her story with us today. Deputy Smith will contribute first. As Ms O’Reilly and Professor Kerrigan will know, Deputy Smith has raised this issue several times at the committee, and it is one I know that he has a personal commitment to.
Deputy Brendan Smith
I welcome our guests, who have just given us two powerful statements. There was a lot in both statements for us to consider. I compliment Ms O’Reilly in particular. It has to be extremely difficult to go to a public forum and outline what happened to her lovely sister-in-law, who was such a young lady. I have heard Ms O’Reilly before in this House. I have listened to her on our local radio stations and read interviews with her and read about her advocacy work in the local media in Cavan-Monaghan and nationally. I compliment her and her colleagues on what they have done to bring a greater awareness to this particularly difficult issue.
It is not that many years ago that laypeople like us would not have heard of the word “sepsis”. I know the witnesses, as healthcare professionals, are in a different league to us in understanding sepsis. Ms O’Reilly was so balanced in what she said about her sister-in-law coming to live in Ireland, moving into a new home and starting a young family. It has to be extremely difficult. She is doing a great public service and public good in being able, with such dignity and clarity, to outline what happened and what could have been avoided. I pass on my compliments to Ms O’Reilly’s colleagues who have done so much good work nationally, not just at local level, in creating awareness.
I thank Professor Kerrigan for outlining the serious challenges and difficulties facing us. He did that in very clear terms for those of use who do not have the medical or nursing knowledge. He used the phrase “the uncomfortable truth”. There are many uncomfortable truths here. I refer to the fact that people are not responding to treatment even though they are being administered the drugs that are available. That is frightening. In the context of what drug companies internationally are doing, has there been anything like the effort that was made during Covid to develop vaccines or medication as a matter of urgency? When we were going through the Covid pandemic, governments worldwide and drug companies worked together and invested in order to get vaccines. Is anything of similar scale happening to try to address the scourge of this very serious illness?
With the permission of the Cathaoirleach, I propose that we send the opening contributions, in their totality, to the Minister for Health and to the health committee and that we formally support the request that the Government put this issue on its EU work agenda for our Presidency. We have a very important forum available to us as a small member state of the European Union that only comes around every 13.5 years. The Presidency is an opportunity. We all know that, unfortunately, in public administration, a lot does not happen over a few months. If we get this on the agenda, however, and get focus on it, that will be an important starting point. If we were able to convince the Minister for Health, the Government and those responsible for deciding the EU work agenda for our country, we would bring newer work, the awareness that Ms O’Reilly and Professor Kerrigan are creating and the importance they have attached to this matter to a new level. The latter will be needed if we are to deal with this very serious illness, and not just from a national point of view. As the witnessed pointed out, this is not just a problem for our country; it is a problem for the rest of Europe and the world.
I offer sincere thanks to the witnesses for the great work they do. I am sure that the committee and the Members of the Dáil and Seanad will be glad to continue to support the witnesses in what they outlined in a very cogent and clear manner as regards trying to address this issue in a realistic way .
An Cathaoirleach
Will Professor Kerrigan address the question on the availability of drugs?
Professor Steve Kerrigan
Sure. This is part of the problem we have right now. It is worth pointing out that sepsis is curable. It is not the big killer; it is only a killer if treatment is delayed. If sepsis is caught in time, it can absolutely be treated and we can prevent subsequent organ failure and death that are associated with it. Part of the problem is getting that treatment. We are in an awkward situation right now whereby the antibiotics or the antimicrobials we use to treat sepsis are failing all across the world. Drug companies are not developing new antibiotics. Part of the reason for this is because the micro-organisms that are being treated with these antibiotics and antimicrobials have learned how to overcome them. As a result, many of the large pharmaceutical companies are not developing new antibiotics because the micro-organisms become resistant too quickly, which means that the companies would not see a return on their investment. Unfortunately, there is an antimicrobial void in the world right now because we are not mass producing them. In addition, there is not enough money going into research to find new ways to treat sepsis. There are other opportunities that exist in terms of not relying solely on antimicrobials because they are failing. Alternative opportunities are being looked at and are being progressed. We are in an unfortunate state right now in that we could end up living in a time similar to the pre-penicillin era, when infection was a big problem for us.
Deputy Brendan Smith
So there is a danger of going backward instead of going forward, even with all the technology, know-how and so-called sophistication we have today. Is there any area in which there is an antimicrobial void? Is sepsis the main illness in respect of which that particular void is having an impact?
Professor Steve Kerrigan
The biggest concern we have right now is sepsis. That is because sepsis strikes so quickly. A person who has an uncontrolled septic response can die in a period as short as 12 to 24 hours if they do not receive treatment. In terms of other infections that can be contained in the body, it might be different. Sepsis is where the whole body is infected. The infection spreads all over the body. It is different from, say, a lung infection whereby the infection is contained in the lungs. In sepsis, it travels all over the body. All the major organs become infected and begin to fail at the same time. The concern we have is sepsis. It would be the most serious of all the infections one can get.
Deputy Brendan Smith
We used to hear in the past about MRSA. There was another infection that superseded MRSA. We do not hear much about that particular infection nowadays, do we?
Professor Steve Kerrigan
MRSA, or methicillin-resistant Staphylococcus aureus, is still absolutely a problem. Staphylococcus aureus is the bacteria. Part of the reason people may not be hearing about MRSA as much any more is because there are so many other bacteria that are now resistant to antibiotics. When people heard about MRSA ten, 15 or 20 years ago, it was because it was the major threat. It is not any more. It is still a threat, but there are so many other threats right now because so many other species of bacteria have become resistant to the only drugs we have left to treat them.
Deputy Brendan Smith
This is probably an unfair question. Are antibiotics being administered too freely for lesser illnesses?
Professor Steve Kerrigan
That is a complex question because there are a lot of reasons why we would see antibiotic resistance. It is not just that they are being used too much; there are numerous reasons why we are in this position with antibiotics.
Deputy Brendan Smith
I sincerely thank Ms O’Reilly and Professor Kerrigan for their outstanding contributions and the great work they are doing.
Deputy Pat Buckley
I thank the witnesses for coming in. I know it is not easy for Ms O’Reilly, but at least with this committee, which I always call the lastchance.com committee, people who have concerns have the opportunity to come in here and raise those concerns.
I am going to flip back to 2023 or 2024 when we had Lil’ Red’s Legacy Sepsis Awareness Campaign in here. Around the same time, I met a gentleman named Ciarán Staunton from America who lost his son Rory and who founded END SEPSIS, the Legacy of Rory Staunton. The authorities in New York introduced a state law to make testing for sepsis mandatory. It threw up a red flag for me, pardon the pun, back in 2023 when I went to the Library and Research Service and asked if we could mirror that in legislation here. We were told that it would be too complicated and would not work. In fairness, however, the service produced a policy document that went to the family involved. The family then took it to the HSE. That was supposed to be rolled out in 2024. It was going to be the instruction book or tool kit which dictated that when we are not 100% sure what is wrong with an individual, they should be tested for sepsis. Obviously, that is not happening. That is why the witnesses are here.
I am angry, to be polite. I am well aware that over 11 million people a year across the world die of sepsis.
It does not make sense. I could hear in Ms O’Reilly’s voice the hurt and pain that losing someone causes for families and those who are left behind. What makes it worse is that in certain situations, whether you want to or not, you have to accept death. I refer to circumstances where people know that a death was totally preventable. Ms O’Reilly was not blaming the system or anybody else. We do not have a proper protocol in place even though we do have a policy document that has been agreed with the HSE. I was not aware that the protocol is not in operation. I am extremely disappointed about that. I lost a cousin not too long ago – she was only 37 – to sepsis. It is an absolutely horrible death.
I echo what Deputy Smith said about supporting this. It is like cancer or suicide; it is only when it knocks on your own door and affects that you realise how many people it impacts on. I am stuck for words. The witnesses spoke about diagnosing sepsis and the treatments we have for it. We are skipping way too far ahead here. We need to come back to the start and ask what the basic protocol is. When you go to your GP, present at an accident and emergency department or are admitted to hospital, if they cannot diagnose what is wrong, surely the first protocol would be to identify what is not wrong. That involves carrying out a quick blood test to check for sepsis or whatever. I am both taken aback and disappointed. When the previous iteration of this committee dealt with this in 2022, 2023 and 2024, we thought we had done the right thing. Now I am listening to the witnesses saying that nothing has changed and that more people have died because we still do not have either a policy or a common-sense protocol.
As Ms O’Reilly said, you cannot blame the people within the system. If you do not have the tools, you have nothing to work with. I understand where she is coming from. I also understand the frustration relating to this matter. The committee will certainly do whatever it can to try to assist. Let us try to prevent more people from going through the pain.
I am absolutely speechless. This is 2026. I cannot even remember what the numbers are in Ireland, but I know that about 11 million worldwide die from sepsis each year. I refer to what I think are called Rory’s Regulations in New York. If they work, why can we not pick the good bits out of them, put them together and see if we can replicate what was done in New York? That is where my frustration comes in, particularly as I was told that we cannot do it. I asked if we could do it and was told “No”. It seems to be working there. These regulations are now being introduced in other parts of the US. The position there is really complicated because each state has its own separate regulations as to how everything should work. If they can do it, I cannot understand why we cannot do it. This is not to benefit the two witnesses; it is to benefit everyone in the European Union and across the world. We have a unique opportunity here. Whatever way we can drive this forward, I appeal to the Chair to support it.
I do not really have any questions. I am just so disappointed that we are talking about this now, particularly when much of what has happened could have been avoided. We thought we did something right three years ago. I thank the witnesses.
An Cathaoirleach
I thank Deputy Buckley. We recognise the work done internationally by Ciarán and Orlaith Staunton. The committee has written to the Departments of the Taoiseach, foreign affairs and Health. They are aware. The witnesses will have seen the responses. It would be remiss of me not to mention that there is some work going on. Perhaps we will get a chance, by means of further questions, to detail exactly how that work is progressing and how it is having an impact. I am informed that approximately 3,000 people lose their lives to sepsis every year. This condition is very preventable. The committee’s job is to interrogate the evidence the witnesses are providing and look at how we can make a real and appreciable difference. Senator Brady is next.
Senator Paraic Brady
Professor Kerrigan and Ms O’Reilly are welcome. It is harrowing to sit here and listen to what they have told everyone and to their concerns. I have a confession to make. I have a sister who works in the health service in Cavan. I wanted to put that on the record.
I know exactly how the witnesses feel regarding the trauma it brings and how it wrecks families. It is worrying to hear that we have reached to a stage in our healthcare system where first-stage antibiotics and, sometimes, second-stage antibiotics do not work. This tells me that the immune system is breaking down somewhere along the line. I can only bring it back to – this is very basic – the training nurses and doctors receive. A spike in temperature is the first symptom. Every doctor would know that. What I really want to know is, do we start with a mild antibiotic at the outset or do we attack it with the strongest antibiotic we have? I am a farmer, so, unfortunately, I can only relate this to cattle. I know that when you call a vet to an animal that is sick, he will give you the mildest antibiotic you can get in the first instance. If it persists, you get stronger and stronger antibiotics. Two calls later, you have got the strongest antibiotic out there. They are afraid the immune system might not be fit to take the strong one at the start.
What phase are we at within our health service? It was stated that the first and second lines do not work. After the second treatment, you are getting into critical care. That is what is frightening. Is there no scientific evidence out there to say that if a patient displays certain symptoms, it is definitely sepsis they have and that a particular treatment has to be administered straight away?
Professor Steve Kerrigan
This is the complicated part of sepsis. The signs and symptoms of sepsis are non-specific. They often mimic flu and can often be missed. The problem with the treatment coming with the antibiotics is that it is not the antibiotics themselves; the problem is the speed and the process involved in getting those antibiotics. I appreciate that the national clinical programme for sepsis does have guidance on this. It is a matter of having a process in hospitals whereby the escalation pathway comes with the diagnosis and it then goes to senior review and to treatment. The problem that exists in Ireland – it is not just in Ireland, it happens across the world – is that it is not consistent between hospitals. The speed at which there is a senior review versus the treatment initiation is not the same everywhere. That is where the problems exist. Not having a national strategy where there is an agreed process that every hospital in Ireland must stick to and that outlines the speed at which things happen is the reason people are dying. If we had uniform process across the country, that would save lives because we could agree that you must have a senior review at a specific time and that treatment must be given by that time.
To put this in context, for every 60 minutes or one hour that there is a delay in treatment, there is a 7.8% increase in mortality. In a one-hour period, you almost have a 10% chance dying. That is for every hour missed.
As a result, what we are essentially asking for is that the national strategy be pushed forward quickly and that we agree to have the same process at all hospital sites, regardless of whether they are in Cavan, Dublin, Waterford or Limerick. It should be dealt with at the same speed in every hospital.
That brings us back to why we are asking about the European side. This does not only happen in Ireland; it happens all across Europe. For example, France and Switzerland have national strategies. Sweden has more of a quality measure, and all other countries, including Ireland, have guidelines and protocols. There is a massive opportunity with the EU Presidency to say that we will not only do this in Ireland; we will do it across Europe because none of the other countries have it either. We have the opportunity to agree at European level what the speed is in international best practice, what is the escalation process and to go after it from there. As I said in my opening statement, that will show Europe that we are not afraid of complex decisions. They can be led from Ireland in exactly the same way as Ciarán and Orlaith Staunton did in America. If a single Irish couple in America can completely change how sepsis is viewed in the United States, there is no reason why we cannot do it on a smaller continent like Europe. Ireland should be the one to lead on it. We have the opportunity to do so.
Senator Paraic Brady
Let us come back home before we look at leading Europe. Certainly, we will discuss it with Ministers, including the Minister for agriculture, Deputy Martin Heydon, in the context of our taking over the Presidency. Does something need to be done in the short term that would improve the system? It means getting all hospitals on the same page at the same time in order that when it comes to a certain point, patients will receive this treatment. Is that what Professor Kerrigan is telling us in medical terms?
Professor Steve Kerrigan
We need a national strategy on this that outlines what the process is from when a patient enters hospital with suspected sepsis to treatment.
Senator Paraic Brady
Has Professor Kerrigan engaged with the Minister for Health on this? I am not aware that this has gone to her. It may have, but I am not aware of that happening. The national clinical programme for sepsis has told us that a national strategy is being developed right now. That is the strategy for the period 2025 to 2030. It is February 2026 and the strategy has still not emerged. There probably is a strategy but it has not been released yet. That is the urgent aspect.
An Cathaoirleach
It is noted that the strategy has not yet been published. Professor Kerrigan is right that it is for the period 2025 to 2030. We will move on to Deputy Maxwell.
Deputy David Maxwell
I thank the witnesses for attending. Perhaps they can enlighten me. Is it me or was sepsis not really talked about ten to 15 years ago? Am I correct in saying that? People would hear that someone passed away from sepsis and it seemed to be a new thing. Going back to what Professor Kerrigan said, is that because things have become immune to the antibiotics? Were the antibiotics ten or 15 years ago stopping it more often before it got to a particular point of severity? As Senator Brady said, we get the mild antibiotics, and then it moves and sepsis takes hold. Is that what is happening? Has sepsis become rife because antibiotics have lost their effectiveness? Is that a correct assumption to make?
Professor Steve Kerrigan
There is no doubt that antibiotics have weakened in the past ten years. More and more pathogens that cause sepsis are becoming resistant. However, the reason we are hearing more about sepsis is probably due to increased awareness. There is definitely increased awareness in hospitals. It is also there among the public, although it is still not where it should be. I have no doubt that 2020 could have been the year of sepsis. It would have been a massive year for the world to sit up and hear about sepsis, but, unfortunately, the pandemic took over. The reason I say that is because the first global study on sepsis numbers was carried out in 2019, and we got the numbers entirely wrong across the world. That was the first indication that there were approximately 50 million cases of sepsis each year across the world and approximately 11 million deaths. That was in 2020. It is projected to have grown by approximately 10% per year since 2020. It is now 2026, so those numbers are much higher.
I will put a different slant on it. In the years since Covid hit in 2020, there were approximately 8.5 million deaths. That is a pandemic. In the same period, there were at least 55 million deaths from sepsis and it is not considered a pandemic. We are probably living through a pandemic right now. The Covid-19 pandemic was a test to see how we would cope with the next one. If we do not do something in the immediate future, whether that means getting the national strategy to speed up treatment for patients, we will have another pandemic. That is probably why sepsis is more known about now than it was five or ten years ago. There are many facets to it.
Senator Chris Andrews
I apologise for being late. I missed the presentation. From listening to the questions, it is obvious that it was helpful and informative. I will read the transcript later. Following on from what Deputy Brendan Smith said – and perhaps it was proposed – it would be worth the witnesses making a presentation to the Committee on European Union Affairs because—–
An Cathaoirleach
That can certainly be done. We have exchanged correspondence with the Departments of Health, Foreign Affairs and Trade and the Taoiseach, but it is a good suggestion.
Senator Chris Andrews
I am just wondering about Rory’s Regulations. It transformed the situation. When Professor Kerrigan presents that to people in government, how do they respond? Do they just say the protocols are being worked on? Is that it?
Professor Steve Kerrigan
Yes, it took a lot for Ciarán and Orlaith Staunton to get Rory’s Regulations acknowledged in New York, but when they did, it had an effect on improving treatment and recognition of and training on sepsis. The rest of the states are starting to set up. I have no doubt they will pass similar regulations and that this will transform sepsis care in the US.
Senator Chris Andrews
It can be done. It just needs commitment.
Professor Steve Kerrigan
It can absolutely be done.
Deputy Eoin Hayes
I thank the witnesses for attending. A lot of what they have told us was harrowing. I offer my condolences to Ms O’Reilly and to everyone in her family on the loss of Sarah. It is a difficult thing to go through. I thank her for sharing her story and continuing the advocacy. That is important. I had a friend who passed away from sepsis very suddenly a year or two ago.
One of the things I noted from Ms O’Reilly’s testimony – I apologise I was a bit late but I was listening in my office – is that it never entered my head that sepsis could possibly be the root cause of illness or death.
That really resonated with me. I was totally shocked by it. My friend was in his 30s and was relatively healthy but he got a cold and then pneumonia and within a week he was dead.
One of the things I am reacting to most from the witnesses’ testimonies more generally is this question of a 20% mortality rate. From what I can gather, that is nearly eight times the number of fatalities we had from Covid in the same time period. It is a mortality rate higher than that of SARS, typhoid, yellow fever, cholera or the Spanish flu – the terrible things we think of as being from the 19th or 18th centuries, or whatever. There are 680,000 deaths per year in the EU. There was an article in the medical journal The Lancet calling for a European plan on sepsis in October 2024. If there has been 10% growth in the numbers, as the witnesses are telling us, that is terrifying.
I am really glad other people asked about the progress on a national strategy, but I would like to get a insight from Ms O’Reilly as a qualified nurse into the training, how people talk about sepsis and the awareness within the medical community and among people in hospitals giving this care. What are the gaps within the capacity of the current health service so that we can ensure people are getting the proper training and awareness?
I have a question for Professor Kerrigan on an EU strategy for antibiotic development. I am really concerned about antibiotic resistance but also the pharmaceutical companies’ role in developing medicines. As everyone probably knows, most research and development in medicine is privatised and that means there need to be profit margins and all that kind of stuff when it comes to bringing drugs to the market. There is a question about what we should be doing at EU level to bring about the development of medicines and antibiotics that would help address sepsis in particular, but any kind of disease that is presenting such a risk.
Ms Sinéad O’Reilly
The area I was working in, tissue viability, was quite specialised so I was not in the ED assessing patients, but the HSE has mandatory training on everything. I do not know how much you take from it, however, because you are doing a lot of mandatory training on all of it. Sepsis is time-sensitive, so we should treat it like a time-sensitive illness. That might make a change. If someone presents with signs of a heart attack, even the public know that is time-sensitive and you have to get to the hospital and get treatment to lessen the effects of it. It is the same with the FAST campaign. People know the signs of stroke. You have to get to the hospital and get your treatment. It is about getting people to hospital in time and getting it recognised in time to start the treatment. If staff were supported with a protocol for that, it would be a game-changer. It would support the patients and prevent the staff having to try to figure it out, because the signs and symptoms are a bit ambiguous, especially as it is so time-sensitive. Minutes are everything.
Deputy Eoin Hayes
Yes, there was the figure of 7% for every hour. That was the thing with my friend in that he had been at home for several days battling a flu and by the time he got in there, it was too late.
Ms Sinéad O’Reilly
A lot of people I have spoken to have said they came in, were told they had the flu and were sent home, and then came back in ambulance. There is a lack of recognition of the signs and symptoms, and then initiating the treatment. That is where the gap is.
Deputy Eoin Hayes
Will Professor Kerrigan address antibiotic resistance and its role in this?
Professor Steve Kerrigan
Just before I answer that, Deputy Maxwell brought up the fact this is something we are only starting to hear about in the last five years, and prior to that we did not. Three people in this room have said they knew someone who passed away from sepsis. Everybody is going to know someone who has died from sepsis if we do not deal with this, so that puts another start warning on this.
Antibiotic resistance is being taken seriously across the world. It is a major concern all across the world. We do not have answers for it, because these pathogens have learned too quickly how these drugs are working. We can come out of that. There are other ways to treat an infection without specifically targeting the pathogen. Unfortunately, funding for research and development in those areas is not where it should be. This is a life crisis. It would be great if we could get this on the European-wide agenda, but we need to start pushing for more research and development funding for universities and spin-out companies to develop the next generation of drugs. That funding is not there right now for sepsis specifically. The Deputy’s point is well made that in comparison with any other infection or disease, this one is probably more pressing than any other. Again, to put this in context, about 8.5 million people will die of cardiovascular disease in a year. That goes up to about 11 million for sepsis. Cancer is currently probably somewhere in the middle, at 9 million or 9.5 million. According to the figures we are using at the moment, which are from six years ago, there is 11 million deaths from sepsis. Sepsis is the biggest killer in the world, so research funding for it needs to be prioritised at a European level.
Deputy Eoin Hayes
That is genuinely shocking and terrifying. I thank the witnesses so much for bringing this to us. I hope we can get the appropriate prioritisation from the Departments of the Taoiseach and Health.
Senator Aubrey McCarthy
I thank the witnesses for being here. I agree with Deputy Hayes regarding Ms O’Reilly. It is harrowing and horrific even to read about Sarah’s passing. I extend my condolences to Ms O’Reilly’s family. I know it is not easy to be here and share the story but it is very beneficial to us as a committee. Both she and Professor Kerrigan spoke about the failure to recognise sepsis early and the loss of the critical first hour of treatment. Mandatory sepsis training already exists in Ireland but the review found there were fundamental issues with recognising that a patient is deteriorating. In Ms O’Reilly’s is the fix here? What has gone wrong and what would have prevented Sarah’s death?
Ms Sinéad O’Reilly
That is probably the million-dollar question. The protocols are there so I could not say, in my opinion, what might have prevented it. We will have to leave that up to the HSE to decide. Recognition of the symptoms and timely treatment are probably the biggest thing.
Senator Aubrey McCarthy
A lot of it, therefore, could be down to human error as well, even though we have policies or sepsis training, etc., in place.
Ms Sinéad O’Reilly
I would not be qualified to make that assumption.
Senator Aubrey McCarthy
Professor Kerrigan mentioned in response to Deputy Hayes that we need a nationwide process for each hospital for sepsis and stated that for every hour that is missed, the chances of dying increase by 10%. When one contracts sepsis, how does it progress and how does one avoid the 20% mortality rate?
Professor Steve Kerrigan
This is the next complex question because you can get sepsis from a simple cut on your hand that you do not wash. The infection gets into your bloodstream and once there, the bloodstream innervates or profuses all the major organs in your body. Once the infection is in your bloodstream, it is carried to all the organs, so you can go into organ failure within as little as 12 hours.
Senator Aubrey McCarthy
Does that depend on the person’s immune system?
Professor Steve Kerrigan
No. There may be an aspect of that, but not in every case.
Other primary causes of sepsis, and the ones that we worry about, are pneumonia, urinary tract infections and abdominal infections. That is because the lungs have a lot of blood vessels around them and, therefore, if an infection comes out of the lungs or breaks down the lungs and gets into the bloodstream, you can develop sepsis really quickly. Up to 75% of patients who present at the emergency room with either pneumonia or a urinary tract infection will be admitted. They are admitted because they are at a high risk of sepsis rather than because we cannot contain the infection to the lungs or urinary tract.
Senator Aubrey McCarthy
How can medics determine whether there is a high risk of sepsis? Is it based on the pneumonia aspect or on the individual?
Professor Steve Kerrigan
Yes, there is a scoring system that is used in hospitals. Essentially, it is a sequential failure assessment. A person has to satisfy the symptoms of sepsis in the first place, such as fever, confusion, disorientation, a high temperature and feeling sick. All of those symptoms that I have just noted are non-specific. If the Senator had the flu right now and went to his GP, he could have the flu, so he could go home. There is no doubt that sepsis is tricky to diagnose. There is no biomedical marker for us to look at. We cannot take a blood test and run it through a machine and say a certain marker is up and that, therefore, the person has sepsis. We do not have that yet because sepsis is such a complex disease that involves every organ in the body. Medical staff rely on the scoring system to decide whether to escalate the case to a senior staff member, and then we rely on that staff member to get to that patient quickly, inside one hour, and then decide whether to give the treatment at that point. All of that has to be done in one hour.
Senator Aubrey McCarthy
No cases of sepsis are the same, therefore.
Professor Steve Kerrigan
No.
Senator Aubrey McCarthy
Is there the possibility of a vaccine?
Professor Steve Kerrigan
Not at the moment, no. The primary treatment option is antibiotics. We keep using antibiotics and one of them will hopefully work. Outside of that, there have been no major breakthroughs anywhere in sepsis. There are definitely green shoots for new drugs. To return to the question posed by Deputy Hayes, part of the problem is funding. Not enough research is being carried out on, potentially, the biggest threat to mankind currently because if the antibiotics stop working, we do not have anything else. We need to get Europe and the rest of the world to start putting money into research and development to identify sepsis, learn more about sepsis, try to find a new biomarker or something that tells us that a person has sepsis, and then start developing new ways of treating the infection without having to rely only on antibiotics.
Senator Aubrey McCarthy
Professor Kerrigan highlighted that Ireland lacks a fully resourced national sepsis strategy. How do we compare with our European counterparts? The professor also mentioned that there is no outlier doing really well here. What is the best outlier?
Professor Steve Kerrigan
Switzerland and France have national strategies, and they work.
Senator Aubrey McCarthy
Are their mortality rates as high?
Professor Steve Kerrigan
I do not know what their mortality rates are right now and whether their national strategies have kept sepsis at bay. Sweden has more quality measures. Outside of that, no other country in Europe has a perfect national strategy. European countries are all in the same boat. We are all struggling with this guideline or protocol. It is the best we have right now. It is keeping things at bay but is not perfect. There is enough expertise in Europe to be able to come up with that one European-wide strategy. If that is not possible, then we need to investigate that, through the EU Presidency, to see if it is not possible to do that. Rather than just say we are not putting it on the agenda, we need to investigate whether there is something we can do, as a collective in Europe, to bring down sepsis before it becomes a bigger problem. Again, and we keep repeating this, sepsis is absolutely treatable if caught early. You do not have to die from sepsis. We often see people dying from sepsis but that is because they did not get the treatment quick enough.
Senator Aubrey McCarthy
As there is no biomedical market for sepsis, if I go to my GP with flu symptoms or whatever, I could have sepsis but my GP will not know. What can fix that situation?
Professor Steve Kerrigan
Greater awareness. We need a better scoring system. As for what that looks like, I do not know.
Senator Aubrey McCarthy
Is there a lobbying group? It was noted that this has not gone before the Minister. Does the RCSI have a group that is pushing this issue?
Professor Steve Kerrigan
No. Several groups within Ireland are pushing this but it is not just Ireland. This is across Europe. Every country has its own lobby groups to drive this issue forward. Again, for some reason, the message has been slow to get across, and that is why so many lobby groups are coming forward to say the same thing.
Senator Aubrey McCarthy
I am flummoxed by the numbers.
Ms Sinéad O’Reilly
The sense of emergency is being missed.
Professor Steve Kerrigan
Yes.
Ms Sinéad O’Reilly
There are the European Sepsis Alliance and the Global Sepsis Alliance organisations, to which Ciaran Staunton belongs. People are working on this but they need the backing to do their work.
Senator Aubrey McCarthy
We need joined-up thinking.
Ms Sinéad O’Reilly
There is a call to action, a plan and buy-in but that is where things have stopped.
Senator Aubrey McCarthy
I am flummoxed by the mortality rates across Europe. I know Ms O’Reilly is a nurse but did she have any knowledge of sepsis before Sarah got ill?
Ms Sinéad O’Reilly
Yes, because I underwent mandatory training and I had often heard of people dying from sepsis. That is why I pointed out that, while I am a healthcare professional and had received training about sepsis, the possibility of sepsis was not the first thing I thought of and it did not even enter my head until the medical staff told us Sarah might have sepsis. That leads me to ask why sepsis was not one of the first things that was suspected. I suppose we were worried, it was a personal connection and I probably was not thinking straight, but we cannot depend on members of the public to be thinking of sepsis. Members of the public can suspect sepsis and get to the hospital, but the staff too need to be thinking of sepsis. We need more joined-up thing for this to work.
Senator Aubrey McCarthy
Awareness is huge.
Ms Sinéad O’Reilly
Awareness is huge but, again, for everybody.
An Cathaoirleach
I note that we are a member of the Global Sepsis Alliance. As can be seen, we all represent different parties and political groupings here, as well as Independents, and we have a consensus that action on this is needed. Where there is no political resistance, we have to ask what is causing the issue.
I will now ask a couple of questions. I note we could do more to update the figures. Are the figures generally in the ballpark of what the witnesses think are a true representation of the facts, or are there more people with flu-like systems dying at home who are not being picked up? I suspect there are not. Where are people dying? Are they typically dying in hospital or at home?
Professor Steve Kerrigan
It is in hospitals, for sure. When sepsis takes hold, people become very sick. For people with sepsis, a common trigger is that they say they have never felt so sick.
Ms Sinéad O’Reilly
People feel like they are going to die.
Professor Steve Kerrigan
If people are that sick, they will go to hospital.
An Cathaoirleach
Yes, a relative described sepsis to me as feeling as though they had been hit by a bus. We were very lucky in that sepsis was mentioned to the healthcare professionals at the time and there was a small bit of insistence, if I can put it that way, by the family that a test for sepsis would be done, and we were right. It should not take that level of persuasion where there is any inkling that a person is suffering from sepsis.
I note that World Sepsis Day is 13 September, which will happen while Ireland has the Presidency of the European Union. It would be a good thing for this committee to highlight that day to the Department of the Taoiseach. I am not suggesting it is not aware of it, but we will make sure it is aware it is approaching.
Professor Steve Kerrigan
Yes.
An Cathaoirleach
I do not know whether the Department is aware of the day but we will ensure that the Department is aware of the date.
I am conscious of Ms O’Reilly’s personal experience. If there are any further questions, I will take them now. Before we bring proceedings to a conclusion, we sometimes rush at the end to get things finished. On behalf of the committee, and I know I speak for all of us, we are very grateful. We are sorry that Ms O’Reilly has a very sad story to share with us. Our thoughts are with her family. We thank her. Hard and all as it is, it is very important that we heard not just about her family, but specifically about Sarah and her life. It is not an easy thing to do, and that is not lost on us. We are very grateful.
Ms Sinéad O’Reilly
If you knew Sarah, you would understand. We often said that if it was the other way round, and if it was Patrick who got sepsis, Sarah would be here, and this would be her. I am reluctant, but we all know she would have had her charity organised, she would be on the warpath and she would have been making change. I am motivated because her story needs to be the catalyst for change. I want help to be able to explain to Lilly and PJ that she did not die in vain. I want to be able to say, “Look what your mammy did.” I implore the committee members to keep Sarah in their minds. Lilly and PJ will be four in May. Only the other day, Lilly asked my mother, “Nana, are you my mammy?” Her poor nana said, “No, I am your daddy’s mammy.” She then pointed up and said, “There is my mammy.” It is awfully hard. I ask members to keep that in their minds and use that. That is what motivates all of us. When these children are 18, they need to be able to know what their mammy did. If we keep that in mind and make it the catalyst for change, we can do it.
An Cathaoirleach
Absolutely. Indeed, they can also look at what their auntie has done for Lilly and PJ. In time to come, they will get a chance to look back on this. I am sure they and the rest of Ms O’Reilly’s family will be very proud of what she has done in such tragic and awful circumstances.
Deputy Brendan Smith
I wholeheartedly endorse the Cathaoirleach’s concluding remarks. Ms O’Reilly has been a powerful advocate on this very important topic. She is honouring extremely well the memory of her sister-in-law, and putting the interests of other people first, which is a great credit to her and her family.
I have a question for Professor Kerrigan. What lead is the World Health Organization taking on this? The last time I read some documentation or report, the WHO talked about the next pandemic being loneliness. As well as that, a Commissioner in Europe has some responsibility for health. It is a national competence, understandably. Is that directorate in Europe pulling anything together? Is it driving forward the need for a strategy that would be suitable for every country?
The Royal College of Surgeons in Ireland is doing exceptionally good research on this. Is Professor Kerrigan doing work with counterparts in other countries, such as Northern Ireland, Britain, any of the member states of the European Union, the United States or otherwise? I assume that at the research and clinical level, and in the whole area of healthcare, there is research collaboration and that research is being shared. Is nobody driving this globally?
Professor Steve Kerrigan
There is. From my own research in RCSI, I am connected with the US, many countries in Europe, Australia and Asia. A lot of countries are working together on this. There is a real recognition that it is not going to be one person or one country that solves this. It will have to be cross-country development. The problem is funding. Research funding is so difficult to get, no matter what region you are in. America is very difficult right now. Europe has funding, but not specifically for sepsis. In trying to do that research, there is definitely an appetite for everyone to work together. The sepsis area is actually quite small, and everybody knows everybody. We are all backed by the research we do with the Global Sepsis Alliance and the World Health Organization. They are all aware of this.
The World Health Organization, for example, does not have money, so it cannot give money for research. However, it can advocate on behalf of researchers to say that we are going to run into trouble here if we run out of antibiotics, so people need to fund this area. At the same time, it can only put so much pressure on government organisations to provide money for that kind of research.
Deputy Brendan Smith
There is also the position of the pharma companies. As I mentioned, during Covid, there was investment by governments and the pharma companies to get vaccines. Presumably, pharma companies are putting resources into antibiotics and antimicrobial research, although not to the extent that is needed, or not with the urgency that is needed. Is that accurate?
Professor Steve Kerrigan
It has long been known that sepsis research drug development is a graveyard. There has never, ever been a drug approved for sepsis. We use antibiotics to control the infection, but there has never been a drug to treat sepsis because it is too complicated. I personally do not buy that. I think we know an awful lot more now about sepsis. I definitely see that there are targets worth chasing.
Large pharma companies have been bitten too many times in trying to develop drugs for sepsis that did not work, so they have stepped back from it now. They are expecting academic institutions to identify a drug, take it through a preclinical trial and almost get into human clinical trials before they would get involved, because they have been bitten so badly by it. That is not the way they should be working. A third level institution does not have the money to take a drug into a human clinical trial. We are talking about hundreds of millions. That is where pressure has to come on the likes of the EU, America or elsewhere to provide the money for interesting new targets that are coming out that may work. They need to understand that it is not all about antibiotics and antimicrobials. The host – the body – reacts in a way it should not, so if we can find a way to calm the body down, the infection should be able to look after itself.
Deputy Brendan Smith
To its credit, in the past, the European Union provided funding. I am not as familiar with this as I could be. I served as Minister for agriculture from 2008 to 2011. At that time, we would draw down very substantial funding from the Horizon programme for research and development across the whole food and marine area. The European Union had a very strong research programme at that time, and it would have been available for health-related projects as well. I am not up-to-date with that, and I do not know if it is as strong as it used to be. I sincerely hope it is, and I presume it is.
To Professor Kerrigan’s knowledge, are those in the directorate for health in the European Commission providing any leadership on this?
Professor Steve Kerrigan
They definitely are. The European Commissioner attends the European Sepsis Alliance. They give a talk, and they recognise the problem, the struggle and where this could lead to. They try their best to influence health spending and increase research funding from that angle. That leads back into Horizon. Horizon is still going and is still strong. We have lobbied for a specific sepsis call, not just for antimicrobial resistance, infection-related or host therapies. We have lobbied for a specific sepsis call, and it did not make the cut. We are not the only ones who have done that. It just does not seem to get past the powers that would approve the specific Horizon call for sepsis.
The European Innovation Council has calls every now and again around that but it can be non-specific in the call for vaccine candidates, which gets mixed up in it. That is not what we need to do here. We need to have a very specific call for new targets for sepsis.
Deputy Brendan Smith
I extend my sincere thanks to Ms O’Reilly and Professor Kerrigan for their outstanding contribution today in creating awareness among us. Hopefully this committee will advocate as strongly as we can for what needs to be done, having had it outlined to us today.
An Cathaoirleach
We absolutely will. I know this is not the first time this issue has come across our desks but Deputy Smith has outlined the course of action we intend to take.
Ms O’Reilly and Professor Kerrigan’s attendance this morning and the evidence they gave us form a very important part of keeping sepsis on the agenda. I have very good reason to be very happy the topic was on the agenda. I know the more we talk about it, the more likely it is that we will get better outcomes for people. I was very struck by what they said about the pandemic. It does seem like the pandemic is here and perhaps we are just not talking out it. The fact Ms O’Reilly and Professor Kerrigan are here today means that we are talking about it, and this meeting is also broadcast. Their contributions will inform the work of the committee going forward.
On behalf of the committee, I thank both Professor Kerrigan and Ms O’Reilly for being here and for sharing this very important information with us. I ask Ms O’Reilly to take back to her family, particularly Patrick, Lilly and PJ, the sincere thanks of the committee and our good wishes.
