Defibrillators

Earl Howe Excerpts

Tuesday 24th June 2014 Grand Committee

[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.