The Parliamentary Under-Secretary of State for Health (David Mowat)
The hon. Member for Garston and Halewood (Maria Eagle) started her excellent speech by saying that defibrillators save lives. We accept that; there is no question but that that is the case. Before I respond to the points that she and my hon. Friend the Member for Twickenham (Dr Mathias) made, I want to add my congratulations to the Oliver King Foundation on its work, and to the family on turning a terrible tragedy into something positive. We have heard about what has been achieved in Liverpool, as well as more widely.
One of the asks of the hon. Member for Garston and Halewood was that I meet her and the family to talk about how to take this matter forward. I confirm that I would be very happy to do so. Indeed, the sports Minister, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who is with me on the Front Bench today, also feels passionately about this matter, which was in the sport strategy that was published about a year ago. I am happy to set up such a meeting. I am not in a position to set out tonight the Government’s view if the private Member’s Bill does not go through, but if the hon. Member for Garston and Halewood organises the meeting, I would be happy for it to be more widely attended by interested Members.
Mr George Howarth
I think the hon. Member for Lewes (Maria Caulfield) accepts, as I certainly do, that although a ten-minute rule Bill might have been a good way to raise the issue, it is not a suitable vehicle for taking this forward. The request is that the Minister and the Department look at the Bill as it stands, and that, if it needs to be amended or redrafted, they suggest ways of doing so, or even take it on themselves. The Government should bring a measure forward, rather than leaving this to a legislative vehicle that simply will not work.
David Mowat
As I have said, I am not in a position to say tonight what the Government will do in respect of the Bill. I am willing to say that we will meet and talk about it after this debate. As I will come on to say, there is a question about the extent to which defibrillators should be mandatory, as was raised in relation to schools, versus dealing with this through guidelines and other forms of help. I will try to make some of those points later.
The hon. Member for Garston and Halewood made the point that the survival rate of people who have an out-of-hospital cardiac arrest is in the order of about 10%. It varies a little by ambulance service—it can be between 7% and 12%—and if we could get all ambulance services up to 12%, that in itself would save many lives. There is no question but that if defibrillators were available in time, the figure would be at least doubled and perhaps increased by more than that. We also accept the figure from the British Heart Foundation, which I think she cited, that every minute of delay reduces the probability of success by something like 10%.
We need to achieve two things: we need to create more access to defibrillators; and, as my hon. Friend the Member for Calder Valley (Craig Whittaker), who is not now in the Chamber, said in relation to the incident in his family, we also need to increase training and CPR awareness. I recall doing CPR training and being taken through all this two years ago in a church hall in Warrington. It really did not take very long, and I hope I can still remember how to do it. Using these things must be done in parallel with other training. I understand that some defibrillators work fairly easily without too much training, but experience of and ability in CPR buys time, which is what we need to achieve.
I will talk about what the Government are doing in relation to public places, schools, the workplace more generally and, as I have mentioned, sports. I will also take a few minutes at the end of my speech—I do not think that we will be here until 10 o’clock—to talk about screening, which was mentioned as something we ought to consider.
Since 2007, ambulance trusts have had responsibility for the defibrillators around the country. That is because they are where 999 calls go, and they ought to know where the nearest defibrillator is when they get one. If there is a code or the defibrillator is locked, they are responsible for that. In addition, the British Heart Foundation in England—this is also happening in Scotland—is trying to create a database of the defibrillators that we believe are out there. The BHF thinks that there are something like 14,000 defibrillators. Unfortunately, for historical reasons that have grown up over time, there could be maintenance issues with some of them. We need to bring all that up to date, and the BHF is leading the charge on that.
In the past two years, the Government have allocated £1 million per annum for defibrillators in public places. That money is for England only and has led to some success. We had 700 new defibrillators last year as well as the cabinets that go with them, in addition to a range of CPR training, and we expect the same thing to happen this year. That represents an appreciable increase in the number of defibrillators. As I have said, we are doing that because we believe that defibrillators save lives, as does the training around them.
The Member for Garston and Halewood talked about schools. She rightly said that schools have been issued with guidance saying that we expect them to consider the installation of defibrillators, but it is also true to say that not every school has a defibrillator. The hon. Lady also talked about defibrillators costing in excess of £1,000. The scheme that we have put in place for schools uses NHS Supply Chain, which means that they can source a defibrillator for something like £435, which is clearly better than £1,000. I accept that that still comes out of a school’s budget, but nevertheless a great number of schools are taking that up. Schools can also apply to the British Heart Foundation scheme that we talked about earlier, provided that the defibrillator is publicly accessible, which in many cases it would be. However, I accept that we have not mandated such provision, as the Bill asks us to—I will talk about that a little later.
There are workplace health and safety aspects that every employer must consider. We have put in place a requirement that, from 1 January this year, everybody in a workplace who is first aid-accredited—obviously health and safety regulations require that there are such people—must have defibrillation training and be in a position to use those facilities. That is now happening, and it includes everybody who will have to do a first aid refresher course.
As I mentioned, sport is a priority area. Sports governing bodies will have formal responsibility, and many sports are taking this forward. We know of the incidents that have occurred. I think it was Fabrice Muamba during a Tottenham game who was saved by a combination of a defibrillator and a doctor in the crowd who knew CPR, and rugby league and rugby union are also involved. The Football Association has made available a £1.2 million grant to buy 1,300 defibrillators for use at football grounds up and down the country—and not just at the very large grounds. I am involved at Warrington Town football club, and we will be getting a defibrillator under that scheme as well. All FA-accredited coaches will also have to be CPR trained.
I know from the sports Minister that the sport strategy has made defibrillators in sports a priority. She has nominated Baroness Grey-Thompson to take this forward, in terms of putting a duty of care on the various governing bodies. It is an area of priority.
It is also important to understand more about sudden cardiac arrest and to make progress through research. The Government have provided funds through the National Institute of Health Research particularly to deal with the genetic aspects of the condition, given that it has a generic element. Work on gene discovery is also going on at the Oxford Biomedical Research Centre. I am not saying that we are close to a solution or a clear way forward, but this is a research priority. If we understood the genetics better, it would help us to do screening better, so let me move on to screening.
There is a school of thought that screening for children’s genetic predisposition to heart problems could make a difference. In 2015, the UK’s screening authority, the screening committee, considered screening people between the ages of 12 and 39. It did not support that, however, and I believe that that position is consistent with that of every other country in Europe. We have looked into this, and my understanding is that no other country carries out such screening. A number of reasons have been given: it is difficult to get clarity about the numbers of people who would be affected; there is concern that even if screening were to identify people with a potential weakness, there is no consensus on how that should be managed; and, finally, there is a significant concern about the efficacy of a test, especially regarding the number of false negatives and false positives, which it was felt could do more harm than good. If peer-reviewed evidence came forward, based on the findings of places that had conducted screening work, the matter would be reconsidered, but without that, it will not be looked at again until 2018. That leaves us with the issue of how to make more progress on the number of defibrillators available. Perhaps the difference between the hon. Lady’s remarks and my response is not whether it is a good thing to make progress on defibrillators, but whether the Government should mandate putting defibrillators in every school and sports facility.
Maria Caulfield
I understand the Minister’s concern about whether this should be mandated. However, these days we would never operate a school without a smoke alarm or fire extinguishers, and we would not put children on a school bus without seat belts. For me, defibrillators are as essential a piece of safety equipment as any of those things.
David Mowat
I accept that. As I say, the guidelines are clear: any school can make use of the NHS Supply Chain facility to put in a defibrillator for £400 or so.
Mr George Howarth
The Minister talked about screening, which my hon. Friend the Member for Garston and Halewood (Maria Eagle) also mentioned. Although I understand the conclusions and the advice that has already been given, to ensure that there is no confusion, is it not appropriate that if somebody has already been affected, screening should be available to their family, particularly their siblings?
David Mowat
I accept that. Also, a number of sports governing bodies offer screening for people who participate in their sports, but of course that is not the national screening of all 12 to 39-year-olds, which was the issue that was looked at.
Let me finish by reiterating my willingness to meet the hon. Member for Garston and Halewood, other Members and people from the Oliver King Foundation.
Maria Eagle
I conveyed a request for the Prime Minister to meet the Oliver King Foundation and Oliver’s parents. Could the Minister help me to facilitate that?
David Mowat
I can do many things, but I cannot answer for the Prime Minister. I think I am right in saying that those people met the Secretary of State a couple of years ago. Perhaps when we meet, however, they can start at the bottom end of the food chain before working their way upwards.
When the Government invest in any aspect of health, whether it be cancer drugs or access to GPs, efficacy and cost-effectiveness must be evaluated. The National Institute for Health and Care Excellence uses the criterion “quality-adjusted life years”. Investment in defibrillators must be judged against investment in other necessities, such as cancer drugs, but it is clear from what has been said in a debate that has attracted interest on both sides of the House and the border that defibrillators save money as we start to save lives. The Government accept that, and I want us to make progress in this regard.
Question put and agreed to.