Defibrillators

Lord Aberdare Excerpts

Tuesday 24th June 2014 Grand Committee

[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.