Defibrillators
(10 years, 5 months ago)
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Lord Storey
To ask Her Majesty’s Government what action they will take to ensure that all schools, sports clubs and public service buildings have defibrillators as part of their first-aid kit provision.
Lord Storey (LD)
My Lords, today we debate a topic that is close to many of our hearts. I note that defibrillation has been raised in your Lordships’ House 57 times in some form or another since 1995, but today I hope that we will see some movement on this issue. Much like the conditions that trigger the need for a defibrillator, this issue will refuse to go away until we fully grasp it. Of course, I am talking about defibrillator provision and what the Government plan to do to ensure that all schools, all sports clubs and all public service buildings include AEDs as part of their first-aid kit provision.
My concern and my involvement in this area stem from the tragic death of a young Liverpudlian boy, Oliver King, in March 2011. He suffered a cardiac arrest during a swimming race at his school, King David High School, in Childwall. Sadly, he passed away as a result of SADS, or sudden arrhythmic death syndrome. His father, who has campaigned tirelessly for the past three years, is here today. I pay tribute to him and the foundation that he and his friends set up in Oliver’s memory, campaigning to get SADS provision in every Merseyside school and for their life-saving work in Merseyside and across the nation. They do tremendous, largely unsung work. I thank them and encourage the Government to pay heed to their suggestions.
In advance of today’s debate, I have received several briefings, notably from the London Ambulance Service, which sent me its Shockingly Easy campaign booklet. That title sums up this issue perfectly. St John Ambulance, the British Red Cross and the British Heart Foundation also sent me notes, as of course did Mr King. I thank them for their assistance and their efforts.
All present will know that a defibrillator is a machine that delivers an electric shock to the heart when someone is having a cardiac arrest. Used in conjunction with cardiopulmonary resuscitation, defibrillation massively increases one’s chances of survival during heart failure. Every second counts, as they say, and I echo calls for defibrillators to be made available within easy reach of anyone who needs such life-saving treatment.
Much like the provision of fire extinguishers and first-aid kits, defibrillators save lives. However, unlike the case with the regulations that mandate fire-extinguisher facilities and first-aid kits, currently no legal safeguards require provision of defibrillators. This is a disgrace, especially when we think that there are 60,000 out-of-hospital cardiac arrests every year in the UK. Survival rates, which have barely improved over the years, range from 2% to 12%. In London, one’s chances of survival shoot from 28% to 80% in cases where a trained person uses an AED.
I shall not labour the facts any further, but they beg the question why, if we think it important to place first-aid kits and fire extinguishers in our schools, old people’s homes and sports clubs, we are holding back defibrillators. More to the point, why is it that we have 16, soon to be 17, defibrillators on the Parliamentary Estate? If it is good enough for your Lordships’ House, surely it is good enough for everybody.
I shall return to the wider question and the topic of this debate. I suggest that the first step towards making our communities more resilient to the devastating effects of cardiac arrest must be to place AEDs in areas that see the highest number of cardiac arrests. To me this sounds like a no-brainer, and it is. I welcome the move by David Laws and the Department for Education to encourage schools to install machines, although I regret that, in this Parliament, we are not yet any further forward in making them mandatory.
As well as the installation of defibrillators in places of high footfall such as schools and public buildings, we should not forget the other side of the coin, which is education. People, young and old, must be educated in how to use a defibrillator, whether in a school, a young offender institution or at work. Fortunately, here in Parliament we are offered training. For the record, the next training session will be at 10 o’clock on 16 November in 7 Millbank, although perhaps that is a long time to wait. In order to make any investment in defibrillators worth while, young people must have access to and be able to engage in first-aid and life-saving education. Only 7% of the population have the skills and confidence to carry out basic first aid in an emergency, which is an appallingly low figure that must increase. What plans do the Government have to ensure a more comprehensive approach to first-aid education?
I know that it is not the done thing to use visual aids, and my noble friend will be pleased to learn that I do not intend to do so, but a defibrillator is very easy to use. You do not actually need any training. Although Mr King has brought one with him, I do not suggest that he should show it to us, but even I could use it without ever having had any training. You just follow the simple instructions. However, it is still important that first-aid training for all should be linked to that.
I think that we agree on the need for and importance of defibrillators, but it is worth stating that they must be installed in areas where there are high numbers of cardiac arrests. According to St John Ambulance, 74% of people think that it should be compulsory to have AEDs in care homes, and I agree. Indeed, I suggest that we should examine the case for having them in all care-home settings, both public and private, because this is a topic that should cut through the distinction between public and private provision. Quite simply, it is too important not to mandate the use of AEDs across the board, whether that be in football clubs, cinemas, schools, train stations or churches. Indeed, I know of some churches that have defibrillators because they save lives.
I am determined that we should do more. My noble friend Lord Nash, who supports efforts in this area, informed me on 3 February that,
“it is a matter for individual schools to decide whether to have defibrillators and to arrange individual training”.—[Official Report, 3/2/14; col. 7.]
Even though the governing bodies of maintained schools must now make arrangements to support pupils with medical conditions—we should remember from the Children and Families Act the importance of the duty of care in terms of medical conditions—perhaps we should extend that duty of care to those pupils who might suffer cardiac arrest.
I want to raise one other issue, on which I have already written to my noble friend the Minister. It concerns a universal logo. If you want to find a fire extinguisher quickly, you know the logo. Similarly, you know the logo for a first-aid kit. However, there is as yet no universal logo for defibrillators, although the Minister did mention that NHS England is considering all avenues to increase the uptake of bystander resuscitation, including the location and use of AEDs. I suggest that a universal logo, combined with their inclusion in first-aid kits and a comprehensive approach to training and education, might be the way forward. Would the Minister consider taking a lead on this issue, particularly with the NHS, by suggesting that we should look at adopting some form of universal logo?
Finally, a word from Mr King, who says that use of defibrillators is often,
“the difference between life and death”.
This fact has been recognised by the national clinical director for heart disease, Professor Huon Gray, who I met with Mr King, as well as the Secretary of State, last year. Let the message go out from this short debate that lives can and will be saved by immediate access to defibrillators.
Baroness Grey-Thompson (CB)
I congratulate the noble Lord, Lord Storey, on tabling the debate this afternoon. I felt compelled to speak after a chance encounter with a young girl and her family who I met at the Paralympics in 2012. Ruby is a wheelchair user because she had a heart attack in school at the age of five. She is now 10. Luckily, and amazingly for Ruby, her teacher had been on a course—I think just a week before—and knew what she had to do to save Ruby's live. She was starved of oxygen for 40 minutes and left with many severe impairments and a heart condition. Apart from one or two isolated cases that I had heard in the news, this was the first time that I had met a child who had had a heart attack, and it had a big impact on me. Her parents are amazing and they give her an incredible and fulfilling life, but it led me to wonder whether, if there had been a defibrillator in the school, her life might now be very different.
In researching for this debate I was contacted by a number of people. One or two raised some legitimate questions about the potential cost of having this equipment in every school and sports club versus the number of heart attacks that occur. In the end, all members of the public who got in touch were in support of equipment in every school. I have seen figures suggesting that up to 12 young people a week are affected by this and perhaps the Minister would clarify the scale of the problem. Obviously the cost per unit versus the cost of medical treatment constitutes a significant saving, but this is not about money. It is about saving young people’s lives—and other people’s lives. I was contacted by a teacher who said that they had a defibrillator in their school; a teacher had had a heart attack and survived.
I was also contacted by a lady from a local community group who said that a person had had a heart attack at their centre and died. However, there was a lot of reluctance to have equipment in the centre because people were not sure about how to use it or about the safety. Most of the time when we think about defibrillators, we think about something from a movie or TV when everybody stands back and it is all very dramatic, rather than the modern technology which, I have been assured, is fool-proof. Someone puts the pads on and the machine takes the decisions. No one has to make the decision about whether it is a heart attack or not, the machine does that.
We also tend to think of this occurring when somebody takes exercise. There was a report in the Hampshire Chronicle on 29 March 2014 about a Mountbatten School pupil in Winchester, Sam Mangoro. He nearly died when he had a heart attack in a PE lesson. He was just 16. Again, he was really lucky. His life was saved by trained members of staff who had access to a defibrillator. As a result of this, the parent-teacher association of another school in the area, the Westgate School, purchased one. However, these are really hard decisions for head teachers to take. Put “defibrillator” and “schools” into a search engine and there is a list of companies willing to sell this equipment. How does a head teacher, a parent or somebody raising money know what is the right equipment to buy?
I was therefore delighted with the Department for Education announcement that the Government are working to identify suppliers. They will look at competitive price, because that is important, but also at the statutory guidelines and advice for schools on supporting pupils with medical conditions. It is important that the Department for Education and the Department of Health take a lead on this, to guide PTAs and schools and make sure that they buy the appropriate equipment.
This should also be on the school curriculum. My husband, who is a triathlon coach, recently went on a first-aid course and learnt how to do heart massage. It reminded me that the last time I did anything like this was when I was a Brownie a very long time ago. Until my husband mentioned it, I thought that I knew what I was doing. I remembered that the numbers five and two were involved, but I could not remember whether it was how many times I was meant to breathe or how many times I was meant to press somebody hard. It made me realise that if I saw somebody have a heart attack, I would be extremely reluctant to get involved, because I would be more worried about causing any more damage than doing something that could help. My daughter helpfully joined the conversation. She is 12 and in school she was taught what to do, using the song “Nellie the Elephant”, which is a brilliant way of doing it, and she would be able to step in and help.
Since I saw this debate tabled, I have noticed signs in many more shopping centres and elsewhere showing where defibrillators are. It made me realise that I am not sure where they are in the Palace of Westminster. I suppose that we are lucky to have a number of eminent doctors or professors here, so we are in a pretty good place if anything should happen to us.
Most sports clubs are very small. They are run by volunteers and do not have a lot of money, so the cost of installing such equipment would be prohibitive even though I think that a lot of them would want it. If there were to be a scheme for schools, it would be an excellent idea to extend it to local sports voluntary clubs so that they would be able to access the right equipment. It is also important that we carry on pushing training courses. I know that they are provided in many sports, but for a lot of voluntary sports clubs it raises issues around training, insurance and the worry about what would happen.
I did not realise until I saw this debate tabled that you can get a free app for your phone which enables you to find the location of your nearest defibrillator. It also has an emergency 999 button already on the screen so that you do not have to press all the buttons. I have not tried it yet, and hope that I will not have to, but things like that should be publicised. It is in that moment of panic, when you see something happening, that you need all the help and guidance that you can get.
We should take this matter very seriously. I want to see defibrillators installed in schools and sports clubs and generally more awareness about what can be done to help people if they suffer a heart attack.
The Lord Bishop of St Albans
My Lords, I am grateful to the noble Lord, Lord Storey, for raising this important issue and for keeping it to the forefront. When I was training to be ordained, I became used to some people going off for a little doze while I was preaching. What I did not know was that, during my very first sermon, somebody—a very nice lady—would have a heart attack. Fortunately, she did not die and I got to know her and her family very well during her convalescence. I saw something of the impact of such events on families; indeed, my sympathy goes out to those who know something of this in their own family.
Each year in the UK, some 60,000 people suffer a sudden cardiac arrest. Ambulance services are able to attend on average only 25,000 of those and the corresponding survival rate is depressingly low. Sudden cardiac arrest is therefore a key issue for us.
Time is of the essence in such instances. Survival is often dependent on quick access being gained to medical assistance in the form of CPR, defibrillation and then excellent follow-up care. I am told that, for every minute that elapses following a cardiac arrest, the victim’s chances of survival decrease by 23%. If CPR alone is available, the survival rate remains alarmingly low—at around 5%—but if defibrillation is conducted within five minutes of the arrest, the survival rate soars to some 50%. Given the stretched resources of our ambulance services and the large and often complex geographical areas that they serve, it is not always easy for professional medical assistance to be with the victim in that very short timeframe. Even the current eight-minute general response target is reached in only two-thirds of incidents. It is obvious, therefore, that for assistance to reach the victim before time runs out, we need some more help to be available locally.
The technology of defibrillation, as many of your Lordships will know far better than me—I am not a medic—has advanced in spectacular ways in recent years. The development of automated external defibrillators—AEDs—represents a huge step in the right direction. AEDs allow ordinary people like me to administer defibrillation to victims of SCAs. They are fully automated and include audio and sometimes visual instructions so that defibrillation can be carried out safely and effectively.
In recent years, thanks to the hard work of charities such as the British Heart Foundation and the Community HeartBeat Trust, many AED schemes have been initiated, which have served communities to good effect. For example, the villages of Wooburn Green and Bourne End in Buckinghamshire recently set up their own AEDs to provide the communities with the ability to treat those who suffer from SCAs in the area. In my own diocese, Buntingford Cougars Youth Football Club, which provides football training in East Hertfordshire for over 200 people, recently acquired a defibrillator for its ground thanks to money given to it by the local council. Thanks to the British Heart Foundation and the Football Association, 11 Hertfordshire football clubs recently acquired their own AED units. These things are happening; it is just a question of whether we can encourage them to happen even more often. These examples show just how much awareness has increased and how the chance of survival for those who suffer SCAs has likewise increased. The tragic case of Oliver King and the almost miraculous incident involving the former Premier League footballer Fabrice Muamba just go to show how increased awareness of cardiac arrests and the need to administer defibrillation is making a difference.
That awareness, as has been pointed out, has extended far beyond sports clubs and into schools, which are providing both defibrillators and the training that has been referred to. I will give two other examples from my diocese that I know of: Bishop’s Stortford College and the Robert Bloomfield Academy in Shefford both have AED units and are able to administer defibrillation if required. Those local examples show that things are moving. Why are we not thinking about what we can do in our churches and church halls? I want to think more about that; indeed, this debate has made me think more about it. On a typical Sunday in my diocese, we have about 30,000 people in our churches and, over a week, it is probably double that number. With the church halls, many of which have lots of events, we are certainly talking in excess of 100,000 people. These sorts of debates make a number of us ask hard questions about what we can do ourselves rather than just looking to government to do things. Sometimes we just need local communities to get on with it.
I commend the work of community first responders—volunteers trained to administer basic medical assistance, including defibrillation. They carry AEDs with them and are often able to treat the victim before the emergency services have arrived. In the east of England alone there are over 2,000 community first responders, who are able to reach those who have suffered SCAs. They are, however, only able to reach about 20% of them, which is where the work of groups such as the Community HeartBeat Trust comes in. They help to fund the installation of community AED units and provide education and training so that people are able to spot the signs of an SCA and are able to use the AED units effectively. For example, the Community HeartBeat Trust has worked with the authorities in Central Bedfordshire—part of my area of responsibility—to develop plans to install units in a number of towns and villages.
For all of this work to have maximum effect, it is essential that there are good levels of communication between the emergency services, the community first responders and AED volunteers. In many cases, the emergency services alert the community first responders in the event of an SCA, who are able to respond and treat the victim if possible. That is a great example of bringing help to patients promptly, which maximises their chances of survival, rather than simply relying on bringing them to hospital. The Community HeartBeat Trust also works in collaboration with ambulance services to ensure that all parties are aware of where AEDs are located and that those AEDs are properly maintained and ready for use.
I am convinced that the growing use of AEDs should be seen as a great and positive development in tackling the relatively poor survival rate of SCAs. However, AEDs certainly should not be a replacement for the emergency services, nor are they an alternative to improving access for all to emergency medicine. They are not suitable for all types of SCA, so it is critical that calling 999 is still the first action taken upon witnessing an SCA or coming across a victim who has recently suffered one. None the less, as part of our integrated emergency care system, in the hands of trained volunteers, community-based AEDs have the potential to save many thousands of lives each year and their deployment in schools and sports clubs as well as in public places—and, yes, I hope in churches and church halls as well—ought to be encouraged and supported. I hope that we can move that forward.
Lord Aberdare (CB)
My Lords, I warmly congratulate the noble Lord, Lord Storey, on tabling this debate. It is a subject that is not only close to my heart, if your Lordships will forgive a feeble pun, but quite literally a matter of life and death for a significant number of our fellow citizens in the UK. Having listened to the three excellent speeches so far, I could probably cut my own contribution to little more than the words, “Hear, hear!”, but I hope that I will be allowed to reinforce some of the arguments and will be forgiven for inevitably covering a considerable amount of the same ground. No doubt that is due in part to my having received the same helpful briefings from the bodies mentioned by the noble Lord, Lord Storey, and indeed from the House of Lords Library. I have to say that my heart sank as one after another of my points was made by the previous speakers. I do not think that my heart has actually stopped yet but, if it does, there is a defibrillator in the Peers’ Lobby.
As we have heard, some 60,000 out-of-hospital cardiac arrests occur each year in the UK. Somewhere between 20% and 40% of them are estimated to occur in public places, with nearly half of them being witnessed by bystanders. The remainder take place at home. Any assistance that is provided at the scene by those bystanders before the emergency services arrive can help to save life. In such cases, every minute that passes without intervention reduces the chances of survival by around 10%. So what are the chances of survival from shockable cardiac arrest? In Oregon, they are as high as 56%, while in Norway they are 52%. In the UK, the average comparable survival rate is only 20%. What accounts for the difference is, quite simply, the number of people who have been trained in first aid. In Germany and the Scandinavian countries, where first aid training in schools is mandatory, the proportion of people with first aid skills is estimated to be as high as 80%. It seems to me a matter of national embarrassment, to put it mildly, that only one in 13 people in the UK feels confident that they could carry out emergency first aid.
Automatic external defibrillators can and do save lives. They are a key part of the so-called chain of survival as defined by the British Heart Foundation and the Resuscitation Council (UK). That includes four elements: early recognition of a cardiac arrest, cardiopulmonary resuscitation, early defibrillation and post-resuscitation care. In order to improve survival rates, that whole chain needs to be in place. AEDs themselves will be effective only, first, if there are enough of them; secondly, if they are in appropriate and visible places; thirdly, if they are accessible and not locked away with the key nowhere to be found, about which I have heard stories from time to time; and, finally, if people know how to use them and are willing to do so. I therefore welcome the policy of encouraging the wider installation of AEDs. Research by St John Ambulance indicates that the majority of people, some 79%, think that it should be compulsory to have AEDs in places such as NHS buildings, 74% that they should be in care homes, as the noble Lord told us, 73% that they should be in large event venues such as concert halls, 67% that they should be in sports centres and gyms, 55% that they should be in workplaces, 53% that they should be in hotels and 50% that they should be in supermarkets.
As important as having defibrillators in place is, of course, knowing where that place is. I was going to suggest that this would be a perfect opportunity for an app, only to hear from the noble Baroness that the app already exists. That is another good point gone. Moreover, as the noble Lord, Lord Storey, mentioned, there are 16 defibrillators on the Parliamentary Estate and a significant number of trained first-aiders who know where they are and how to use them, including, I believe, most or all of the House of Lords attendants. Some noble Lords may not be aware that the best number to call on the Parliamentary Estate in the event of my having an emergency during my speech is not 999 but extension 3333. That is the first point that I alone have made.
All the AEDs that have been or are about to be installed, however numerous, well located and easily accessible, will be effective only if people know how to use them and are willing to do so. Current research shows that only one person in 10 knows what an AED is and, of those who do, just half know how to use it. Again, training is needed. The only way to increase, over time, the proportion of the population who have basic emergency life-saving and first aid skills is to teach those skills in schools, not just to teachers but to students as well. In that way, we can ultimately create a nation of lifesavers, to quote a phrase whose source I have mislaid.
Many voluntary organisations, such as St John Ambulance, the British Red Cross, the British Heart Foundation, the Resuscitation Council (UK) and SADS—Sudden Arrhythmic Death Syndrome—UK, do a good job of providing both information and training. I declare an interest as a trustee of St John Cymru Wales. I have now been trained in first aid three times: by St John Cymru Wales, by St John Ambulance under the auspices of the All-Party Parliamentary Group on First Aid, of which I am a vice-chair, and by the parliamentary Safety, Health and Wellbeing Service, which also covered the use of defibrillators. At least 14 parliamentarians have completed the training offered via the first aid all-party group.
The Government have committed to enabling schools to acquire defibrillators at discounted prices, which I welcome. However, they also believe that schools should decide for themselves whether to include first aid training in their curriculum. That is just not working. The combined efforts of all the groups that I have mentioned reach only a relatively small proportion of students in schools—I believe about one in seven, or 14%. This is nowhere near enough to address what should surely be a significant national priority. Leaders of all five of these bodies signed a letter to the Times last month, expressing their disappointment that, at the same time as encouraging schools to buy defibrillators,
“the government did not go further and insist on first aid education for all pupils and staff”.
I apologise if I am overrunning. I am very much encouraged by the fact that I seem to have spoken for no time at all, but that is presumably not the case.
At the very least, government should surely look at providing much more in the way of incentives and encouragement to schools. Subsidised AEDs, at least for schools in England, are a welcome start, but what about subsidised training in how to use them? What about awards and recognition for schools that achieve the best results in numbers of students trained or in levels of proficiency attained? Incidentally, I welcome the Social Action, Responsibility and Heroism Bill, which should help to overcome any concerns that people may have about the possibility of being sued after trying to resuscitate someone.
Children aged 10 and above can learn the full range of emergency life support skills, including CPR. From the age of 14 they can be, and are, trained in using defibrillators. A significant number have had to use the skills that they have learnt to save the life of a family member or fellow student. Of the children on a British Heart Foundation Heartstart programme in Northern Ireland, 98% enjoyed the training and 67% shared what they learnt with family and friends. Separate BHF research found that 86% of teachers thought that emergency life support should be part of the national curriculum, 78% of children wanted to be taught how to save someone’s life in an emergency and 70% of parents thought that children should be taught emergency life support at school.
First aid and defibrillator training is straightforward; it is quick, requiring as little as two to three hours; it is cheap; it promotes self-esteem and citizenship; it is fun; and it can save lives. Without it, the Government’s laudable initiative to enable more schools to acquire defibrillators may not—will not—be as effective as it could be. So why on earth should such training not be made mandatory in all schools? I look forward to the Minister’s response to that question.
Lord Hunt of Kings Heath (Lab)
My Lords, I thank the noble Lord, Lord Storey, for starting this debate; I very much agree with his central points. I also pay tribute to the Oliver King Foundation and Oliver’s father, whom I have had the pleasure of meeting on a number of occasions. Indeed, I think that the noble Earl would agree with me that the Liverpool primary schools’ defibrillator programme is a remarkable effort on the part of the foundation, which embraces all primary schools in the city. As part of the project, 12 staff in each school were able to receive training. It is a model for what ought to happen in the rest of the country.
Noble Lords have given us a lot of information about what is happening and raised some of the concerns. I will refer to the research undertaken in Hampshire which was published earlier in the year, the authors of which included the South Central Ambulance Service NHS Foundation Trust and the University of Southampton. They reviewed all calls to the ambulance service between September 2011 and August 2012 following a heart attack. For all emergency calls made from locations other than a person’s home, the call handler specifically asked whether the caller could access a defibrillator. If so, instructions were given on how to use it. During the course of this study over a number of months, the service received just over 1,000 calls about confirmed cardiac arrests away from hospital, which was the equivalent of one for every 600 members of the public each year. For 44 of those incidents in 34 different locations, the caller was able to access an external defibrillator—that is 4.25%—and it was successfully retrieved and used in less than half the cases, 18 cases, before the arrival of the ambulance.
This gave an overall use rate of just 1.74% of all cardiac arrests recorded, which the authors understandably felt was disappointingly low and was apparently similar to previous figures from the London Ambulance Service. Looking at the Hampshire picture, 673 defibrillators that could be accessed by the public were located in 278 places, including 146 devices in large shopping centres. The research also showed that only just over one in 10 nursing homes, around one in 20 railway stations and a similar number of community centres and village halls had defibrillators. The suspicion is that figures in Hampshire are probably similar to many other parts of the country. This shows the scale of the challenge before us, for which we hope for a government response.
Noble Lords mentioned St John Ambulance, to which I am grateful for the briefing I received. The survey work which it undertook shows that a majority of the public think defibrillators should be compulsory in NHS buildings, care homes, concert halls, sports centres and gyms, workplaces, hotels and supermarkets. This seems persuasive evidence that the public would welcome a more decisive response by the Government.
In relation to schools, where I would have thought there was an overwhelming argument for having a defibrillator and trained staff—and indeed trained students—we are relying on the response which the Government have given. This is simply to say that it is up to each school, then relying on changes to the Children and Families Act in relation to the duties of governing bodies and the common-law duty on staff to act in loco parentis while children are at school. We could expect a little more action now from the Government. Particularly in relation to schools, I want to hear that the Department for Education will reconsider its disappointing response so far.
The noble Baroness, Lady Grey-Thompson, made a good point about the need to help people to use defibrillators and for education programmes. I also take her point about the need to help sports clubs. Does the noble Earl not think it would be good for health and well-being boards to take this on? Because of the potential collaboration between local government, the health service, third-sector and many other organisations within a locality, might they not spearhead an approach to getting many more defibrillators fitted and people trained to use them?
Finally, Public Health England is a wholly owned subsidiary of the Department of Health. Could the noble Earl be tempted to give an instruction to Public Health England to treat this as a priority for the future? The Department of Health has a really positive role to play if, through Public Health England and health and well-being boards, this was seen to be important and I am sure we could make much further progress.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I thank my noble friend Lord Storey for giving us the opportunity to debate what is undoubtedly an important issue. I know that many people feel that better provision of defibrillators could help save more lives of people who have a cardiac arrest outside a hospital setting—known as out-of-hospital cardiac arrest. I acknowledge in particular the work of the Oliver King Foundation in this area.
First, I emphasise that responsibility for the provision of defibrillators rests with ambulance trusts, which are undoubtedly best placed to know what is needed in their local area. Notwithstanding that, last year’s Cardiovascular Disease Outcomes Strategy set out some recommendations around defibrillators. NHS England is implementing the strategy’s recommendations, which includes working with stakeholders to promote the site-mapping and registration of defibrillators and to look at ways of increasing the numbers trained in using defibrillators. The strategy also acknowledged that, although defibrillators are important, more lives could be saved if more people had life-saving skills. As I shall indicate shortly, NHS England is also working with stakeholders to help achieve just that.
Schools are of course at the centre of their communities and are often used for other purposes outside school hours. They are also frequently the location for sports events and other types of physical activity. There have been tragic incidents in which young children have had a sudden cardiac arrest and were not subsequently able to be resuscitated. The number of such incidents is thankfully very low, but of course every child who dies in this way is one child too many. The use of a defibrillator may have made a difference in these cases, which is why we are encouraging schools to acquire defibrillators in a broader package of measures designed to ensure that the medical needs of children in our schools are supported. It might be helpful if I explain a little more about these measures, particularly in answer to my noble friend’s questions.
We have introduced a new duty on school governing bodies which requires them to make arrangements to support pupils with medical conditions and to have regard to new guidance on Supporting Pupils at School with Medical Conditions, which will come into force from this September. We will also inform schools via the “need to know” e-mail and the “myths and facts” documents, which are sent out to schools each term. I absolutely agree with the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Aberdare, that emergency life-saving skills are very important. Those skills can be taught as part of personal, social, health and economic—PSHE—education. However, it is also right that teachers should be free to exercise their professional judgment in designing curricula that meet the needs of their pupils. Giving teachers greater flexibility and freedom than ever before will help to raise standards and expectations for all pupils. However, one must put that in the context of the role of governors of schools, who undoubtedly have an influence. The Government do not believe that the teaching of emergency life-saving skills should be a statutory requirement, but we encourage schools to teach PSHE, which may well include emergency life-saving skills, and have outlined that expectation in the introduction to the new national curriculum.
On defibrillators, we believe that head teachers are best-placed to make decisions about installing them in schools. They may, for example, wish to have multiple AEDs, or to share a machine between two schools located on the same site. By strengthening guidance and working to secure the devices at a reduced price, we are encouraging schools to install defibrillators.
The noble Baroness, Lady Grey-Thompson, asked me to give some statistics in so far as I have them about the scale of the issue in schools. The Office for National Statistics says that the total number of cardiac deaths of patients of school age—that is aged five to 19—is 88, although we do not know how many of those deaths occur in schools. However, I have some very interesting statistics from the London Ambulance Service. In London, between 1 April 2012 and 31 March 2013, there were 3,848 patients with a presumed cardiac origin to their arrest and in whom resuscitation was attempted. The breakdown of location for these shows that 79.2% were in the home or in a care home. Of the 800 cases which happened in public, 1.1% were in a sports centre and 0.3% were in a school. I shall make a further comment about that in a moment.
The Department for Education intends to produce a protocol on the use and purchase of AEDs in schools. The guidance to which I referred asks schools to consider purchasing a defibrillator as part of their first-aid equipment and, if they do so, encourages them to promote knowledge of cardiopulmonary techniques more widely in the school, among both teachers and pupils alike; I have already referred to that point. To help schools, we will be working with the Department for Education to identify a supplier that will provide suitable defibrillators to schools at a competitive price. We will provide schools with additional advice on the installation and use of these potentially life-saving devices so that staff will feel confident in using them should the need arise.
Safety in all sports is a matter for the national governing bodies—NGBs—as the designated authorities with responsibility to regulate their sport. The Football Association is working alongside the British Heart Foundation to oversee a £1.2 million investment towards state-of-the-art automated external defibrillators at football clubs in England. This initiative, which started in 2013, will see almost 1,300 defibrillators distributed to those clubs in which they will have the greatest potential use. Through bulk purchase, the FA has secured the defibrillators at a reduced cost and eligible clubs may apply for a defibrillator at a further reduced cost. The FA’s partnership with the BHF has ensured that this investment in defibrillators has the greatest possible impact. In addition, all FA-licensed coaches are required to undertake a first aid course and should be able to administer CPR while awaiting the arrival of emergency medical services.
In answer to the noble Baroness, Lady Grey-Thompson, on who is responsible for the safety of people participating in sports in local venues, the national governing body for the particular sport is responsible for the safety of athletes and/or their training. In practical terms, the responsibility would fall to the coaches and/or any other support staff at the facility. We would expect the owner or manager of the building to be subject to any other relevant health and safety regulation or legislation, such as that on fire safety.
There is frequent discussion about screening for the causes of sudden cardiac death. Screening may have the potential to save lives but it is not a fool-proof process. For example, I understand that the footballer mentioned by the right reverend Prelate, Fabrice Muamba, who suffered a cardiac arrest during a match, had received several screening tests. However, it is important that we keep the issue of screening under review. That is why the UK National Screening Committee, which advises Ministers about all aspects of screening, is reviewing the evidence for screening for causes of sudden cardiac death in people between the ages of 12 and 39. The review is looking at the most up-to-date international evidence, including evidence from Italy, where all competitive athletes are offered screening. There will be a public consultation on the review this autumn.
Noble Lords raised with me separately the need to make sure that, when a person dies of sudden cardiac death, potentially affected family members are identified and are offered counselling and testing to see whether they are also at risk. We know that this does not always happen. That is why in last year’s CVD strategy we said that work would begin to improve the necessary processes. I can tell the Committee today that, since the strategy was published, NHS England has met the chief coroner to discuss what can be done. At the beginning of the year, the chief coroner wrote to local coroners asking them to make the families of those who had died of the condition aware that it may be inherited and encouraging them to contact either the British Heart Foundation, Cardiac Risk in the Young, or their GP.
On the general question asked by my noble friend Lord Storey about why the Government should not be providing more funding for defibrillators, I am sure he will agree that we must direct NHS resources responsibly, particularly now. As I indicated earlier, the statistics show that most out-of-hospital cardiac arrests occur in the home, which means that in our view more lives could be saved if more people had life-saving skills. NHS England is continuing to work with the British Heart Foundation, the Resuscitation Council (UK) and other organisations on how best to increase the number of people trained in basic life-saving techniques. The BHF and the Resuscitation Council (UK) have both produced a variety of free publications to help members of the public understand the importance of basic life-saving techniques, as well as offering training through the Heartstart scheme in various mediums that enable more individuals to learn the basics of helping to save someone’s life in the event of an emergency.
But I come back to the point I made earlier: since February 2007, ambulance trusts have been responsible for sustaining the legacy of the National Defibrillator Programme. To address a question asked by the noble Lord, Lord Hunt, we undoubtedly expect the commissioners of urgent and emergency care who take part in discussions at health and well-being boards to engage with ambulance trusts in an appropriate way and, if necessary, to feed in their views to the priority-setting process that the boards engage in.
The noble Lord, Lord Aberdare, asked whether I have numbers for the people who are trained in life-saving skills. I understand that 3.5 million people have received emergency life support training through the Heartstart scheme. The right reverend Prelate the Bishop of St Albans correctly referred to the important role played by community first responders. I have with me an extensive note which unfortunately I do not have time to read out, but suffice it to say that CFRs carry automated external defibrillators and are trained and equipped to provide oxygen therapy. Finally, my noble friend Lord Storey asked me about a universal logo. I am very happy to take that point away and ask Huon Gray in NHS England to consider the matter. I will then feed back to my noble friend as appropriate.
In closing, I would like briefly to take this opportunity to pay tribute to charities such as the British Heart Foundation and the Oliver King Foundation for their tireless work in placing defibrillators locally and raising awareness of sudden cardiac death. I would also like to take a moment to acknowledge and thank the wide range of stakeholders we have collaborated with to develop the new statutory guidance for schools that I mentioned earlier. I know that they include my noble friend, with the Health Conditions in Schools Alliance, along with a range of other cardiac organisations such as the Oliver King Foundation and the British Heart Foundation. Their advice played an instrumental part in shaping the arrangements that we are now introducing.