Defibrillators

Wednesday 20th March 2024 Westminster Hall

14:30

[Jonathan Gullis (Stoke-on-Trent North) (Con)]

I beg to move,

That this House has considered public access to defibrillators.

It is a pleasure to serve with you in the Chair, Dame Maria.

Every year, 160,000 deaths—nearly a quarter of all deaths in the United Kingdom—occur as a result of heart and circulatory diseases. Of that figure, an estimated 100,000 people die each year from sudden cardiac arrest. Shockingly, the survival rate for out-of-hospital cardiac arrest has been persistently low, at around 8.5%. There is an urgent need for parliamentarians and the Government to improve the survival rate and radically change the way we approach cardiac arrest.

As chair of the all-party parliamentary group on defibrillators, I have heard some deeply moving stories that have led me to conclude that public access to defibrillators should be one of the Government’s foremost priorities. The APPG has undertaken a detailed inquiry into public access to defibrillators, which was published today. Its primary aim is to understand the impact of out-of-hospital sudden cardiac arrest and the need for improved public access to defibrillators. The plain reality is brutal: without defibrillation or cardiopulmonary resuscitation, someone’s chances of surviving cardiac arrest drop by 10% every minute. If a sudden cardiac arrest victim does not receive CPR or defibrillation within 10 minutes, they are unlikely to survive.

The quicker a defibrillator can be accessed, the more likely someone is to survive cardiac arrest. However, the APPG found that there are considerable regional disparities in access to defibrillators. The National Institute for Health and Care Research found that deprived areas had far more limited access: while 45% of the most affluent areas had at least one device, the figure was only 27% for the most deprived areas. Further, according to the journal Heart, people in England and Scotland’s most deprived areas are between 99 metres and 317 metres further away from their nearest 24/7 defibrillator than those in more affluent areas. Rural areas are also at a significant disadvantage: while 64% of urban areas have at least one device, the same can be said for only 36% of rural areas. Ambulance response times in rural areas are also considerably slower than in urban areas, heightening the risk of death by cardiac arrest. That should make access to defibrillators an imperative in those areas, but, much though I would like it to be, that is not currently the case.

Given the sad truth that socioeconomic factors, education, diet and stress can increase or decrease someone’s chances of cardiac arrest, that all goes to show that we need to improve public access to defibrillators significantly, especially in disadvantaged communities.

[Sir Gavin Williamson (South Staffordshire) (Con)]

I congratulate my hon. Friend on securing the debate. I know that he has done so much on this issue. In Stone in Staffordshire, we have the amazing charity AEDdonate, which does so much on installing defibrillators. One of the key points that it always hammers home is the importance of having defibrillators registered so the emergency services know where to direct people. Does my hon. Friend think that is critical to ensure that we get the best use out of them?

[Jonathan Gullis]

I could not agree more with my right hon. Friend about the need, which I will come to later, to ensure that devices are registered. Having visited AEDdonate myself, I can say that it is made up of fantastic custodians working incredibly hard, not just in rural Staffordshire and Stoke-on-Trent but across the country, to make sure there is access. I know that my right hon. Friend is a doughty champion for its cause, as well as for the community he serves in ensuring access to these lifesaving devices.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Stoke-on-Trent North (Jonathan Gullis) for bringing this subject forward. Many in the House, and others, will be aware that I brought the Automated External Defibrillators (Public Access) Bill to the House in 2020. The Government at the time accepted the necessity of having defibrillators in schools, and that was a fantastic milestone in this campaign, which the hon. Gentleman has taken further. Does he agree that it is one thing to have defibrillators installed, but that more must be done to educate people in schools, such as teachers, and teachers’ associations, to use defibrillators properly and make the most out of them, thereby saving more lives?

[Jonathan Gullis]

I thank my hon. Friend for that intervention. He is a great champion for the people of Strangford and it was an honour to visit his local community with him and see the fantastic work that he is doing there. That Bill still has my full support. I will come to the importance of improving education, so that it is not just a one-off. It needs to be repeated year in and year out, so that children in particular are immune to seeing what will be a distressing scene but, most importantly, have the muscle memory and are able to put that lifesaving support into action. The Minister himself is regularly saving lives, not just in his constituency but across his wider region, with the work that he does, so I am sure that he will understand the importance of persistent and regular education and training.

In September last year, I was pleased to see the Department introduce the community automated external defibrillator fund. This £1 million investment will help to increase access to these lifesaving devices and put an extra 2,000 defibrillators on the streets. That is an important step forward by the Department, but I urge the Minister to do far more to address the clear imbalances that I outlined.

The APPG on defibrillators and I have concluded that there is no co-ordinated national strategy to ensure that defibrillators are placed in areas with the highest need. With previous research illustrating that cardiac arrest is more likely in deprived areas, the Government must ensure that those areas have better or at least equal access to lifesaving equipment to more affluent areas. At this moment in time, that is simply not the case.

With over 30,000 out-of-hospital cardiac arrests in the UK each year and a survival rate of just one in 10, it is crucial that bystanders and emergency responders can locate and access the closest defibrillator immediately. The British Heart Foundation, NHS England, St John Ambulance and Resuscitation Council UK provide the NHS with vital information about the location of defibrillators. The Circuit is a nationwide, data-led map of defibrillators in the United Kingdom. Currently, over 86,000 have been registered, but it is estimated that tens of thousands are still unaccounted for.

[Alan Mak (Havant) (Con)]

I thank my hon. Friend for securing the debate and for giving such an excellent speech. Hayling Island Community Responders is a voluntary emergency response group in the Havant constituency. The responders carry defibrillators and train volunteers to use them. They are often the first people on the scene in a medical emergency. Will my hon. Friend and my right hon. Friend the Minister join me in supporting community responders, encouraging more defibrillator training and encouraging more volunteers to join community medical response groups across the country?

[Jonathan Gullis]

I thank my hon. Friend for the undoubted effort that he puts in regularly in his constituency to raise the profile of that fantastic community group of dedicated volunteers. That relates to the point made earlier by my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson). These groups, who go in day and day out, do not expect much money at all, but try to do everything that they can at cost, in their own time, to literally save lives. I wholeheartedly congratulate the organisation that my hon. Friend the Member for Havant (Alan Mak) referred to, and I congratulate him on using this opportunity to mention its name and ensure that it is in Hansard for all the right reasons. Ultimately, those people are lifesavers, quite literally, and without them our community would be poorer. I am grateful to him for giving me an opportunity to praise them.

It is vital that “defibrillator guardians” register their device on The Circuit, so that ambulance services can access their data. The national view provided by The Circuit means that if 999 is called in the west midlands but the call handlers of the West Midlands Ambulance Service are all busy, the call can be diverted to call handlers elsewhere, who can locate the nearest defibrillator if it has been registered.

By creating a comprehensive AED map, The Circuit provides data identifying where defibrillators are needed. The “Complete The Circuit” campaign by the Express led to a further 16,000 defibrillators being registered, but we need to ensure that every lifesaving device is registered. I hope the Minister will be able to clarify whether the Government will pursue that.

Since becoming the chair of the APPG in January 2023, I have made a conscious effort to monitor public access to defibrillators in my constituency of Stoke-on-Trent North, Kidsgrove and Talke. I have visited several local organisations and groups over the past year to see what access they have to a defibrillator. For example, in October 2023, I was delighted to visit Linley and Kidsgrove rugby club, which had written to me earlier last year about getting a defibrillator on site. It was an honour and a privilege to present the club with a CellAED, which will ensure the wellbeing and safety of players, spectators and the wider community. The device is portable, meaning that it can be taken to away games, too, which could prove vital.

It was also fantastic to visit the Jolly Carter pub in Middleport, which installed a defibrillator late last year after a charity drive to raise funding for one. When I met the landlady, Nicola Fisher, I was surprised to hear that the defibrillator had already saved the life of a man involved in a car crash. The Ford Green pub, which I visited in May, also got its own defibrillator last year, thanks to the hard fundraising efforts of Jayne Bushell and her team. The pub is at the heart of a very busy local community, and the defibrillator could help save lives. And a defibrillator that I personally donated towards—thanks to Mr Rob Matthews bringing the campaign for it to my attention—is now located on Chell Heath Road in the Bradeley and Chell Heath ward. Slowly but surely, public access to defibrillators is improving, but it is essential that we do everything we can to rapidly speed up the process to better protect the public.

The APPG’s report suggested mandating that every emergency vehicle must have a defibrillator. At an APPG session in May last year we heard the tragic story of Naomi Issitt, who tragically lost her 18-year-old son Jamie because a defibrillator was not available when he collapsed at two in the morning. Shamefully, ambulances did not arrive within the required response time, and the police car was not equipped with a defibrillator despite the force believing it had one. The sad reality is simple: had the police car been equipped with a defibrillator, Jamie might still be with us today.

The APPG also found that only one in 11 police cars have access to a defibrillator. We sent freedom of information requests to all the police forces in the UK, and we found that many forces have defibrillators in less than 1.5% of vehicles. We met a representative of Lancashire police who told us that the majority of specialist police vehicles—roads and armed-response vehicles—already carry defibrillators, but most standard police vehicles do not.

Putting a defibrillator in every emergency vehicle and ensuring that all emergency workers know how to use them could help save lives. If only ambulances and specialist police vehicles have these lifesaving devices then there is a high possibility that a police officer could get to the scene of a cardiac arrest and be unable to help in the way that they would wish. Jamie’s death should be a wake-up call. I urge the Minister to consider urging emergency services to better protect the public and ensure that all vehicles are equipped with these lifesaving devices.

Alongside improving access to defibrillators, we need to ensure that people know how to use them. As a former teacher, I know just how important education is in developing people’s understanding of key issues like this. The APPG made it clear that integrating comprehensive first aid training with a strong focus on CPR and defibrillator use can play a pivotal role in equipping younger generations with lifesaving skills. I am pleased that every state school is now mandated to have a defibrillator through the Government’s Defibs4Schools programme. That is an important step forward in widening access to defibrillators, and saving lives as a result.

However, there is a concern that legislation fails to mandate that schools must store their defibrillators on the outside of buildings. I sadly need to revisit the tragic story of Naomi Issitt. She told me in an evidence session that, as well as the issues surrounding the emergency services’ lacklustre critical response time, Jamie had collapsed near a school that had a defibrillator equipped, but because the defibrillator was located inside the school premises, it was inaccessible. The APPG and I agree that it is essential that defibrillators in schools and other public places are accessible 24/7 to heighten the chances of survival through quick access to a defibrillator.

Alongside having physical access to a defibrillator, it is vital that the public are aware how to use them. The fact that the survival rate is depressingly low is due in part to the lack of skills and confidence in performing lifesaving CPR among the UK population. With survival dependent on rapid support, it is the responsibility of policymakers and politicians to campaign to ensure that as many people as possible have those lifesaving skills.

According to a survey of over 4,000 adults conducted by YouGov, over a third have never learned CPR. Nearly half cited a lack of awareness about where to learn, and a quarter of respondents said they lacked the confidence to learn. Those figures are striking. We need to find radical solutions to better equip the public with the skills needed to save lives.

The APPG and I heard from Dr Thomas Keeble, a consultant cardiologist and associate professor at Anglia Ruskin University, who revealed that defibrillators are used in only one in 10 cardiac arrests where lifesaving defibrillators are available. His research revealed that not only are people inadequately equipped with lifesaving CPR skills, but they lack the confidence to use a defibrillator when it is available.

The APPG and I have met some incredibly inspiring individuals and groups over the past 12 months, including Mark King from the Oliver King Foundation. The foundation was established in 2012 following the tragic death of 12-year-old Oliver at a school in Liverpool. Oliver died from sudden arrhythmic death syndrome, a hidden heart condition that kills 12 young people every week. The foundation, set up by Oliver’s father, Mark, provides training in defibrillator awareness and first aid, and has placed 5,900 lifesaving devices in schools and organisations across the United Kingdom. At an APPG session, the foundation emphasised the importance of education, telling me that confidence is key when using a defibrillator, and that removing the fear factor is vital when teaching children how to use it.

The Defibs4Schools programme is a welcome step, but I urge the Minister to consider rolling out CPR training in primary schools. In addition, it is essential that we extend the regulations to ensure that defibrillators should be part of first aid sessions too. These are simple yet effective ways to bridge the gap and empower individuals to become first responders from a young age.

Alongside bettering young people’s understanding and confidence with defibrillators in schools, the APPG has heard that many European countries require people to undertake first aid training to complete a driving test. That is another way in which we can help to develop public awareness and, ultimately, save lives. In Switzerland, applicants must demonstrate that they have undertaken 10 hours of first aid instruction from a Government-approved company to complete their theory test. Germany also requires seven hours of first aid training—nine lessons of 45 minutes each—for all categories of driving licence. Similar models are used in the Czech Republic, Austria, Slovenia, Hungary and the Baltic states. In the UK, around two thirds of young people aged between 21 and 29 have a driving licence. That presents us with a remarkable opportunity to empower a significant portion of the population with life-saving capabilities.

Let me turn to VAT on defibrillators. Defibrillators vary in cost, but the average unit is around £1,250. That is a considerable expense for many groups, charities and sports clubs, especially considering that a sizeable portion of that is the 20% VAT. On average, small businesses, community groups, charities and private users must pay added tax on top of all defibrillator purchases, bringing costs up by £200 to £500 per defibrillator.

I know that my hon. Friend the Member for Colchester (Will Quince) regularly raised this when he was a Minister in the Department. Sadly, he could not make it to this debate, but he wanted to reiterate his support for the Government to re-evaluate this. Some charities are exempt from paying VAT on defibrillators: not-for-profit hospitals; charitable institutions that provide care or medical or surgical treatment for disabled people; and rescue or first aid services. However, most sports clubs and community groups do not qualify.

Last summer, I visited AED Donate, as my right hon. Friend the Member for South Staffordshire has mentioned. It obviously supports the placement and use of automated external defibrillators in local communities. It told me that the removal of VAT would have allowed them to install another 223 additional defibrillators in communities in 2023—they could not do that because of VAT. I look forward to hearing the Minister’s response to that.

Improving survival rates for sudden cardiac arrest rests on increasing public access to defibrillators. It is of paramount importance that we tackle the clear barriers that are preventing lives from being saved by improving public access in disadvantaged areas and through better education. I hope that this debate, which I thank all my hon. and right hon. Friends for engaging with, will raise awareness and that the Minister will take some of my suggestions on board.

16:17

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Dame Maria. I start by congratulating my hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) on securing this important debate. I know that he is a passionate and vocal supporter of increasing access to life-saving public defibrillators and first aid training. I pay tribute to the work of the all-party parliamentary group on defibrillators and look forward to reading its report in due course. I also pay tribute to the hon. Member for Strangford (Jim Shannon), my hon. Friends the Member for Havant (Alan Mak), and my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson) for their contributions to this short debate.

Public defibrillators can really be the difference between life and death for people who suffer what are known as out-of-hospital cardiac arrests. According to the British Heart Foundation, automated external defibrillators, AEDs, are used by bystanders in around only 10% of these types of incidents, but early defibrillation—within three to five minutes of collapse—can increase survival rates by as much as 50% to 70%. That is why we are working hard to increase the number of community defibrillators, increase public awareness and tackle the wider causes of heart attacks. I am proud that we have introduced the community automated external defibrillators fund. The £1 million match fund allows communities across England to bid for AEDs in places with high footfall, in more remote areas that have longer waiting times for emergency medical responses, in areas with high numbers of vulnerable people, and in areas that host activities that mean they are more likely to be needed.

[Sir Gavin Williamson]

I congratulate the Department of Health and Social Care on that fund. My hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) and I referred to the charity AED Donate. There is a lot of charitable work going on in this sector. I wondered whether it would be possible for the Minister to arrange for the charity to meet up with suitable officials, so that it can best understand how it can deliver the Department’s aims and so that the Department has an understanding of what it is delivering in communities across the country.

[Andrew Stephenson]

My right hon. Friend makes a very important point. I join him in paying tribute to that organisation. I would be happy to arrange a meeting with relevant officials in the Department.

Our partners on the programme of rolling out defibrillators are Smarter Society and the London Hearts charity. They have been assessing applications for delivering additional AEDs, working with a wide and diverse range of groups. The first hundred devices that Smarter Society distributed were fully funded, and our partners at the University of Warwick helped us to prioritise the areas of greater deprivation without an AED in situ.

I am delighted to update hon. Members and tell them that, as of 12 March, Smarter Society and London Hearts have now delivered 1,590 AEDs and are working to deliver more. I would also like to pay tribute to the work of my hon. Friends in the Department for Education, who are ensuring that every state school has access to a defibrillator. I am told more than 20,000 devices have been delivered to almost 18,000 schools. That will drastically increase the chances of surviving cardiac arrest for pupils and school staff across England.

The Department for Education has supported schools in making the defibrillators available to the community, having offered external heated defibrillator cabinets to primary, special and alternative provision schools in areas of deprivation, where access to defibrillators is typically lower. It has also provided internal cabinets to secondary schools with two or more defibrillators, so one device can be placed at a sports facility where cardiac arrest is more likely to happen.

All state-funded schools are required to teach first aid as part of the mandatory relationship, sex and health education curriculum—another positive change made by the Conservatives since 2010—since we have been in government. That involves children over 12 being taught CPR and the use of a defibrillator. The Department for Education has also provided awareness videos showing how simple the defibrillators are to use, and it is encouraging schools to share the videos in staff meetings and assemblies. That will ensure that as many people as possible are able to respond in an emergency.

I know that making defibrillators as affordable as possible is important to my hon. Friend the Member for Stoke-on-Trent North, as he set out in his speech. The Government and I agree, although we have to keep these matters under review. He will appreciate that matters relating to VAT are for my right hon. Friend the Chancellor of the Exchequer.

Although having access to defibrillators is important, just as important is knowing where they are, so that they can be used in a time of crisis. That is why the NHS is working in partnership with the British Heart Foundation, the Resuscitation Council UK and the Association of Ambulance Chief Executives to set up The Circuit, which my hon. Friend talked about. The Circuit is a national database that will make it easier for ambulance services quickly to identify the nearest defibrillator when assisting someone who is having an out of hospital cardiac arrest.

As of 1 March, there were 86,337 defibrillators in the UK—68,509 in England— registered on The Circuit. We encourage everyone with an AED to register it. I can assure the House that all defibrillators granted by the community automated external defibrillator fund must be registered on The Circuit. The registration is completed by what is known as a defibrillator guardian—someone nominated by the organisation hosting the device. That role involves registering it on The Circuit, regularly checking the defibrillator to ensure that it can be used, and keeping the record updated. As I hope my hon. Friend appreciates, that is both an effective and a pragmatic approach to ensuring that defibrillators are where we think they should be, and that they continue to be ready for use in times of crisis.

I reinforce the fact that defibrillators are designed for ease of use. If there is one message I want to land in today’s debate, it is that these simple devices are easy to use, yet life-saving. Anyone can use them without formal training. That said, training is actively helpful in increasing the confident use of defibrillators in a community setting. For that reason, the NHS has partnered with St John Ambulance to help people gain the skills they need. That includes a national network of community advocates championing the importance of first-aid training, and training up 60,000 people, which will save up to 4,000 lives a year by 2028.

I would like to take the opportunity to pay tribute to those organisations and others that work tirelessly to improve defibrillator access and first aid training in communities across the country. Their contributions are crucial in getting help for people in some of the toughest moments of their lives and I cannot thank them enough.

My hon. Friend the Member for Stoke-on-Trent North has raised the idea of requiring defibrillator training as part of driving tests. My hon. Friend the Member for Colchester (Will Quince) was a strong supporter of that as my immediate predecessor in this role. While this is primarily a matter for the Department for Transport, I know that my hon. Friend the Member for Stoke-on-Trent North will continue to make representations in this area. I assure him that the Government are always happy to engage in those discussions.

I am also aware of my hon. Friend’s interest in ensuring that all emergency vehicles carry AEDs as a matter of course. While the Government fully recognise that the equipment carried by emergency vehicles is an operational matter, I encourage all services to consider the benefits of carrying AEDs as a matter of routine.

On a personal note, I would like to pay tribute to David Brown, the incredible team leader of the Pendle, Padiham and Burnley community first responder team, of which I am part. I was backed up by David on the first ever cardiac arrest I attended as a community first responder almost 10 years ago. He does incredible work delivering CPR training across Pendle, as well as putting in thousands of hours as a volunteer with the North West Ambulance Service.

I would also like to pay tribute to my late constituent, Ruth Sutton. In 2016, Ruth saw a photo of me in the local newspaper unveiling a new community defibrillator in the Pendleside village of Blacko. She contacted me to see how we could get even more defibrillators across Pendle. Over the following months, she worked with me and the North West Ambulance Service, investigating possible locations to install new defibrillator cabinets. By 2018, Pendle had the best coverage for public access defibrillators in Lancashire, with 20 cabinets installed: a real, lasting legacy of a remarkable lady.

I hope that our prevention and treatment work, including the forthcoming major conditions strategy, which my Department is in the final stages of drawing up, will act as a guiding light for a faster, simpler and fairer NHS. In combination with our efforts to increase defibrillators and increase first aid training across the country, we will improve our ability to intervene in an emergency situation and to save lives.

I once again thank my hon. Friend the Member for Stoke-on-Trent North for securing this incredibly important debate. I look forward to working with him long into the future to make progress on this vital issue.

Question put and agreed to.