At the age of 16, Bethan James shared her aspirations with her YouTube audience, expressing her desire to have a fulfilling career, a life partner, and potentially children by 2026.

Bethan James would have turned 27 this year, but tragically, her life was cut short when she passed away at 21 due to complications from sepsis, pneumonia, and Crohn's disease.

The delayed diagnosis of Bethan's sepsis and the subsequent delay in receiving life-saving treatment have prompted her parents to advocate for improved training in recognizing this condition, which is a major cause of death in the UK.

An investigation by the BBC has revealed that sepsis awareness training is not compulsory in most Welsh hospitals, a fact that has led Bethan's parents to worry that other families may suffer a similar tragic loss due to inadequate care.

In response to these concerns, the hospital where Bethan received treatment and the Welsh government have stated that sepsis awareness is a key area of focus and a priority, while the Welsh Ambulance Service claims to have implemented significant changes to address the issue.

In 2020, Jane and Steve James experienced a profound loss with the passing of their eldest child, a death they described as senseless and utterly devastating.

Jane, a resident of Cardiff, remembered her child fondly, noting that she possessed a uniquely compassionate and gentle nature, with a great deal of potential.

Steve James, a former England cricket international, reflected on what could have been, saying that thoughts of his child's untimely death evoke strong emotions, leaving him to wonder about her current circumstances and aspirations.

According to the couple, their daily routine continues, but beneath the surface, they are struggling to cope with the aftermath of their loss, often finding themselves overwhelmed by feelings of despair and darkness.

Sepsis occurs when the body's immune response to an infection becomes excessive, causing it to target its own tissues and organs, leading to a potentially life-threatening condition.

According to the UK Sepsis Trust, sepsis-related illnesses claim approximately 48,000 lives annually in the UK, with a significant portion of these deaths being preventable.

This week marks six years since Bethan's passing, and her parents' advocacy led to an inquest that revealed delays in her care and treatment would have been avoided if proper protocols had been followed, potentially saving her life.

An investigation by the BBC has uncovered that sepsis awareness training in Wales is inconsistent and not mandatory, even at the University Hospital of Wales in Cardiff, the country's largest hospital, where Bethan received her final care.

Jane expressed frustration, stating, "It's astonishing that while sepsis awareness posters are prominently displayed throughout hospitals, frontline staff may still lack the training to identify sepsis symptoms, highlighting a critical gap in care."

In the 10 days leading up to her death, Bethan's condition deteriorated, prompting five separate hospital visits, underscoring the need for improved sepsis recognition and response.

According to Jane, a physiotherapist, medical staff were overly dismissive of the symptoms presented.

The patient's vital signs were a cause for concern, with an elevated heart rate and low blood pressure, yet medical staff were unresponsive to these warning signs.

Following a decline in her condition, Bethan was readmitted to the hospital, where she encountered the same physician who had previously treated her.

Steve, currently a sports writer for The Times, remembered a medic assuring them that Bethan would experience a swift recovery.

Steve recalled that he had been scheduled to travel to Ireland to provide coverage of the Six Nations rugby match between Ireland and Wales.

He recalled the doctor's assurance that she would recover within a fortnight, which influenced his decision to go.

On the Saturday of her passing, Bethan repeatedly mentioned to Jane that a doctor had told her she would be fine.

The decision to travel to Ireland is one he will have to live with for the rest of his life, and it is a choice he deeply regrets, having taken the doctor's words at face value.

The day after Steve departed for Dublin, Bethan's health took a turn for the worse, prompting Jane to call emergency services, and a paramedic was dispatched to their Cardiff residence.

According to Jane, Bethan exhibited a high temperature, a greyish complexion, felt cold, and was experiencing chest pain.

It was later discovered that medical staff were unable to obtain a blood pressure reading from the patient due to its extremely low level. These symptoms collectively raised concerns about the possibility of sepsis.

An evaluation was conducted on Bethan, and she was assigned a National Early Warning Score (NEWS), a metric that takes into account various vital signs, including blood pressure, heart rate, and respiratory rate.

A NEWS score exceeding seven signifies a high risk of sepsis, necessitating immediate escalation of care to facilitate an emergency medical review within an acute care setting.

Bethan's NEWS score was determined to be eight, yet the paramedic on the scene did not identify sepsis as a potential diagnosis.

Although the paramedic requested an ambulance, Bethan's case was not classified as a priority, and advance notification was not provided to the hospital. As a result, when they arrived at approximately 20:00 GMT, a resuscitation bed had not been reserved for her.

According to Jane, the emergency room was in a state of disarray that night, with no one appearing to be in charge of Bethan's care.

Bethan's condition was critical, marked by extremely low blood pressure, blue-tinged lips, a blotchy complexion, and rapid breathing as she struggled to get enough oxygen.

The nurse who initially assessed Bethan should have recognized the signs of sepsis, given her NEWS score of eight, which indicated a high level of concern.

Approximately 45 minutes after admission, Bethan was moved to the resuscitation unit, where diagnostic tests confirmed sepsis and antibiotic treatment was administered, but the delay had already taken its toll.

Jane recounted that a doctor informed Bethan, "we believe you have sepsis," a diagnosis that would ultimately prove to be too late to change the outcome.

The last words she heard were a request for her visitor to depart. Approximately five minutes later, she suffered a cardiac arrest and passed away at 22:00.

Steve rushed back from Dublin but was unable to arrive in time. While en route from Heathrow Airport to south Wales on the M4, he received the news that Bethan had passed away.

The Welsh Ambulance Service acknowledged the mistakes made in Bethan's case and announced that sepsis training is now a requirement. The service also stated that significant reforms have been put in place.

Cardiff and Vale University Health Board, the governing body of the University Hospital of Wales, emphasized that recognizing sepsis early and raising awareness are key priorities. The board added that it regularly assesses its sepsis training programs to enhance their consistency and accessibility.

A Freedom of Information request submitted by the BBC to all health boards in Wales found that, where mandatory training existed, it was often incorporated into broader training modules rather than being a dedicated sepsis training program.

An investigation by the BBC revealed inconsistencies in the auditing of training programs, with some health boards failing to track completion rates altogether.

Dr Ron Daniels, chief medical officer of the UK Sepsis Trust, expressed strong concern over the findings, stating that the situation is utterly alarming.

According to Dr Daniels, sepsis is a major public health threat, highlighting its significant impact on mortality rates.

The lack of regular training for hospital staff is a serious oversight, bordering on negligence, as it can have devastating consequences for patient care.

Dr Daniels emphasized that the failure to provide adequate training not only puts patients' lives at risk but also suggests that the organization is not taking the condition seriously, which can have far-reaching and fatal consequences.

The UK Sepsis Trust is advocating for compulsory sepsis training for all hospital clinical staff, aiming to facilitate early detection of the condition.

According to Dr. Daniels, timely intervention is crucial, as "each hour that passes without administering life-saving treatment reduces a patient's chances of survival."

In cases where the condition progresses rapidly, such as Bethan's, prompt action is even more essential to prevent further deterioration.

An investigation by the BBC found that Aneurin Bevan University health board in south-east Wales has implemented a program allowing staff, patients, families, and caregivers to request a second opinion for inpatients experiencing rapid decline in their condition.

The Call for Concern initiative has been introduced in three additional Welsh health boards on a partial basis, with plans for the remaining three to follow suit; however, this scheme does not currently extend to outpatient areas, including accident and emergency departments.

England has introduced a mechanism for families to request urgent second opinions for patients, including those in emergency departments, following the implementation of Martha's Rule, which was established in memory of 13-year-old Martha Mills, who passed away in 2021 due to untreated sepsis.

The parents of Bethan, along with the UK Sepsis Trust, are advocating for the adoption of Martha's Rule or a similar protocol in Wales, which would also apply to accident and emergency departments.

According to guidelines set by the National Institute for Health and Care Excellence (NICE), ambulance services should administer antibiotics in cases of sepsis when the combined time for transfer and handover to hospital emergency departments exceeds 60 minutes.

In response to a query from the BBC, all UK ambulance trusts were asked if they adhered to these guidelines; only Scotland and the Isle of Wight confirmed full compliance, while South Central, serving southern England, has implemented the guideline partially.

The UK Sepsis Trust is encouraging other ambulance services to adopt the approach taken by Scotland and the Isle of Wight, and to follow the recommendations outlined by NICE.

According to Dr. Daniels, the majority of ambulance services have transit times exceeding one hour, which he believes warrants the administration of pre-hospital antibiotics.

Steve expressed his frustration with the current system, stating that if they resided in the Isle of Wight, Bethan would likely still be alive, highlighting the perceived inequity of the postcode lottery.

Jane reflected on the situation, noting that the most difficult aspect is knowing that Bethan's survival was possible if she had received appropriate medical treatment.

Jane emphasized her desire to prevent other families from experiencing similar tragedy, asserting that Bethan should still be with them.

The family is advocating for changes to be made, with Jane feeling a sense of responsibility to act on Bethan's behalf, as if guided by her presence, to bring about necessary reforms.

The Welsh Ambulance Service has expressed its openness to additional studies on the potential advantages of administering antibiotics prior to hospital admission by paramedic teams.

Steve and Jane are advocating for the Welsh government to implement mandatory, audited training programs focused on sepsis awareness across all health boards in Wales.

According to the Welsh government, addressing sepsis will be a key priority in the upcoming NHS Wales improvement plans for 2026-27, with the goal of achieving uniform, high-quality patient care.

A government spokesperson further stated that efforts are underway to enhance sepsis recognition and response within NHS organizations, including the utilization of National Early Warning Scores, providing patients and families with crucial safety information, and introducing the Call4Concern initiative in all inpatient wards.