Firefighters: Mental Health Support

Bill Grant Excerpts

Tuesday 18th December 2018 Westminster Hall

[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Sir Roger.

I thank the hon. Member for Kensington (Emma Dent Coad) for raising this very important issue. I do not have a confession, but from the outset I have to declare an interest—that would be the best phrase—as I served for 31 years with Strathclyde Fire and Rescue Service, and it was a proud journey through my working life. In retirement, I became a local councillor who sat on the fire board, so I continue to have a great fondness and a great respect for the firefighters of today, although I am—quite clearly, for those who can see me—a firefighter from yesterday. I joined in 1974 and served until 2005.

Frontline firefighters—whether they are whole-time, retained or volunteer firefighters—who respond to emergencies, and those with specialist roles within the fire service such as fire investigators, frequently encounter seriously injured or even fatally injured persons in their day-to-day work. Preservation of the scene, particularly if it is a potential crime scene, may mean that anyone who is declared medically deceased must remain in situ, with firefighters having to work in close proximity to them.

Some incidents result in multiple fatalities. I will touch on some in the west of Scotland, but there are many others that I could cite between John O’Groats and Land’s End. For example, there was the Chinook disaster on the Mull of Kintyre, in which 29 individuals died. The first responding appliances to that incident were carrying retained personnel; they were not full-time professionals, but men and women who held down everyday jobs. There was the Lockerbie air disaster, in which 270 persons lost their life, 11 of whom were in the town of Lockerbie, particularly but not exclusively in Sherwood Crescent. Again, the first responding appliances to that disaster were carrying retained personnel, and I absolutely applaud the work that retained personnel do. There was the Rosepark care home fire in Uddingston not so very long ago, in which 14 residents died, and that was a modern facility, and there was the Stockline plastics factory explosion in Glasgow, which was attended by whole-time personnel; nine people died in that fire. That is to name but a few incidents, none of which I personally attended. However, having been part of the fire service, I have followed the stories about them with great interest.

There are also incidents that firefighters endure in which our colleagues are injured, or even fatally injured, in fires. It does not happen that often, but when it does, what a sad and dark day it is. We can even go way back to the Cheapside disaster in Glasgow in the late 1960s, in which I think 15 firefighters and four salvage personnel lost their life. That was an exceptionally horrific incident, but we have improved safety a lot since then.

Such repeated experiences without appropriate ongoing support from external counsellors or medical professionals may result in some firefighters and other emergency responders—I do not exclude other emergency responders who suffer similar pressures—succumbing to stress-related illness, leading to absence from work and, in the worst cases, to their being medically retired; indeed, as the hon. Member for Kensington said, they may even lead to firefighters taking their own life, which in itself is an absolute tragedy.

Believe me: firefighters give their all at incidents, both physically and mentally. They have to be constantly alert at an ongoing incident—alert for their own safety; for the safety of their colleagues; and for the safety of the general public. If the outcome of an incident is not what firefighters would wish for, their initial adrenalin rush turns to what I would describe as a devastating disappointment that they have not achieved their goal or what they had hoped for. Their bodies and minds must cope with sudden emotional changes.

There are also occasions when the judicial process exacerbates firefighters’ exposure to potential stressors, in that the police and, in Scotland, the Crown Office and Procurator Fiscal Service may be reluctant for immediate debriefs of crews to take place until they have met with individuals and taken their statements, to ensure that their evidence is not compromised. It is an added stress when firefighters have to speak to people in authority about what has taken place. We have seen on our televisions the grilling of some of the officers at the Grenfell fire. Those individuals did their very best that night, yet they are being grilled through the courts service and various inquiries.

Debriefs have immense value, not simply so that crews can learn lessons in relation to how an incident went—what they could have done better, and so on—but to provide individuals with the opportunity to express their feelings to their peers. They may not wish to burden—or may not be able to burden—their family and friends with those feelings, or confidentiality might prevent them from offloading those concerns on those outwith the service. All of these things may be worse for retained or volunteer firefighters, who live in the very communities that they serve; on many occasions, they may know the victims of an incident.

I will touch on two poignant road traffic crashes that illustrate that. In one incident, a firefighter said hello to four young individuals at a shopping centre in a small town. He knew the four individuals and their parents. An hour after a courteous conversation with the four individuals, his pager was activated and he responded to a road traffic crash in which two of those young individuals had died. As one would expect, he conducted himself professionally, but weeks, if not months, later that incident came back to haunt him. I am pleased to say that he received assistance from Strathclyde Fire and Rescue Service, and he made a full recovery.

There was another incident that had a good outcome. The driver of a retained appliance approached a road traffic crash and spotted his wife’s car; it was his wife who was trapped. As I say, there was a good outcome, as she made a full recovery. I attended that incident and it was quite a tense situation. I give credit again to those who serve their own community.

[John Howell]

What my hon. Friend is saying is very powerful. Does he believe that there is more that the fire service can do—I encourage my own local fire stations to do this—to have public exhibitions of what they do and show how they go about their work, because once the public understand that, there is a tremendous amount of additional support for the fire service and for the actions that they take? It would help if we gave firefighters a lot more encouragement to do that.

[Bill Grant]

I thank my hon. Friend for that intervention. Yes, a lot is already being done to encourage people and to raise awareness. The fire service in Scotland used to have an annual event at the old Strathclyde regional station, with the slogan, “Reckless driving wrecks lives”, where we brought along fifth and sixth-year schoolchildren. All the emergency services took part. We also make home safety visits now and we are very much part of the team that tries to prevent these events before they happen, through accident and fire reduction. Also, let us not forget the introduction of a very simple thing in people’s homes, which is the smoke detector. In Scotland, we fit them free of charge for anyone who approaches us, and they are worth their weight in gold; they are very effective. A lot has been done on the preventive side. It is a failure if the fire engine goes out; we should prevent all the fires and reduce the number of accidents.

Recently, while out driving in my constituency with a staff member, I turned to them and told them that we had just passed the site of a fatal road accident. The accident had happened 30 to 35 years ago, but decades later I could still vividly envisage the two deceased persons in that vehicle. What triggered that, I really do not know. For some people, there will be no trigger; regrettably, an incident will live with them and haunt them for the rest of their lives constantly. I am able to put such an experience back in the box and reflect on it; perhaps I am very fortunate in that way.

It is so important that rescuers themselves do not become later in life the people who have to be rescued from extensive mental trauma. Let us be proactive and protect, to the best of our abilities, our firefighters from mental trauma or mental harm. The Health and Safety Executive defines stress as

“the adverse reaction people have to excessive pressure or other types of demand placed upon them.”

That can apply to a lot of emergency responders, including the police, but it applies to firefighters in particular.

Most people, including most firefighters, can cope with the challenge of work demands, but when other life pressures are added accumulatively—for example, debt problems or marital problems—sometimes it just gets too much to bear and a tipping point is reached. Many workplaces offer stress management courses. In my time in the service, we introduced welfare officers as far back as the 1990s, along with external counselling. I am sure that continues today, probably in an improved way. Many workplaces also have in-house occupational health staff. The hon. Member for Kensington mentioned the fire service benevolent fund, which has been going for more than 100 years and is now called the Fire Fighters Charity. It offers invaluable support through its psychological rehabilitation service for serving and retired firefighters.

While people may be screened and tested for underlying illnesses, susceptibility to stress, as I understand it, may not be immediately apparent and the individual themselves may not know or wish to admit—that is one of the very sad things, and it was a very male-dominated service when I was in it, although I am pleased to report that that was changing for the better when I left—that their illness may be stress-related, given the previous stigma around mental health issues. To some degree that stigma remains.

When we see someone with an injury to their leg or a broken arm, we can see the physical injury, but we cannot see or feel a mental injury. Firefighters may wrongly perceive such an admission as a weakness on their part. It certainly is not. According to the mental health charity Mind, 37% of firefighters think colleagues would treat them differently in a negative way if they conceded or admitted that they had a mental health issue. The black humour and banter of my days—days gone by, fortunately; it is no longer politically correct, and that is quite right—was once a release valve and coping mechanism behind closed doors for firefighters, but they still have the camaraderie and they still work as a team. That is a form of therapy in itself, and it has immense value. When a whole-time firefighter returns to the station, they have that group. It is different for retained and volunteer firefighters. They return to their partners and wives individually, and that gives a different dimension to the situation.

According to Mind, 85% of people in the fire and rescue services—it is an inordinately high number—experiences stress and poor health at work. They are twice as likely as the wider workforce to identify problems at work as the main cause for their stress. Statistics obtained by Members of the Scottish Parliament through a freedom of information request indicated that in 2016, 137 employees of the Scottish Fire and Rescue Service—firefighters, control room staff and support staff—were recorded as taking sick leave due to stress. Regrettably, those figures appear to be on the rise, as the figure for those recording stress as a reason for absence was 77 in 2015 and only 27 employees in 2014. That is despite an apparent fall in the number of fires and incidents. We are doing well on fires, but we have got road accidents, factory accidents and farming accidents—there is a whole range of special services. We need to discover what has changed since 2014. What are the root causes and contributing factors? Most importantly, we need to address them.

An article in a recent Fire Brigades Union magazine, Firefighter—I am an out-of-trade member and I still receive it—highlighted a need for ring-fencing moneys within NHS budgets for mental health. That is a prudent thing to request. The Prime Minister said last year:

“I want to use the power of the government as a force for good to transform the way we deal with mental health problems right across society, and at every stage of life. Tackling the injustice and reducing the stigma associated with mental health conditions is a priority for me, which is why today I set the goal of providing 1 million members of the public with basic mental health awareness and first aid.”

That goal has to be welcomed. I understand that NHS England got a top-up of £50 million over five years, which is most welcome, but I do not know whether that will be enough to address the issues and the incident of Grenfell, the consequences of which will be felt for years to come, sadly.

When we consider how much it costs to train and equip a firefighter, together with the potential costs of their ill-health, such as absence or early retirement—they may even go to the extreme of taking their life—surely it makes economic sense to invest in appropriate support measures. Firefighters are the finest example of an asset to society. They serve it on a daily basis, and they must be properly supported. Should they stretch out their hand for help, we must grasp it and give that help. Better still, let us prevent them from needing to do that in the first place.

--- Later in debate ---

[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate my hon. Friend the Member for Kensington (Emma Dent Coad) on securing the debate. I am pleased that she was successful in applying for it. In view of her expertise, given that the Grenfell disaster happened in her constituency, no Member is better placed to lead the debate.

When I took the shadow fire and emergency services post, I wanted to visit as many fire services as possible to learn at first hand what firefighters’ main concerns are. I expected to hear about problems with funding, staffing, pay and pensions, but I was taken aback by the deep concern about mental health. Firefighters are on the frontline. It is their job to deal with life-threatening situations. I acknowledge that it is highly demanding and stressful work, but it is also invaluable for our communities. Mind, the mental health charity, has done some great work in supporting firefighters through its blue light programme. Its workplace criteria for identifying the potential for mental illness correspond to the risks that are posed to firefighters daily: the repeated exposure to traumatic events, the potential for physical injuries, workload pressures, suffering loss, and worries about money. Invoking those criteria helps to explain why the potential for mental illness in the fire service is extremely high. The distinct lack of direct central Government action and focus, when the evidence is clear, is astonishing.

I acknowledge that the responsibility for ensuring the health and safety of firefighters rests with individual fire and rescue authorities, and the Chief Fire Officers Association supports them in that work through its lead on fire and rescue occupational health matters. I am sure the Government will point to the commitment of £7 million to pay for mental health support through Mind’s blue light programme. That is positive, but in 2017 the number of fire and rescue staff taking long-term sick leave because of mental illness had risen by nearly a third over the previous six years. Mind has found that 85% of fire and rescue personnel have experienced stress and poor mental health at work, and firefighters are twice as likely to identify problems at work as the main cause of their mental health problems. However, that does not only affect the firefighters; there is a big impact on their families.

Fire services work hard to ensure that the support infrastructure is available. I have heard of brilliant examples of that happening, including in the London Fire Brigade and Tyne and Wear Fire and Rescue Service, but the evidence shows that more has to be done to provide support to fire services. I do not doubt that the Government have acted, but any action cannot be separated from their wider attack on the service. Their ideologically-based austerity agenda has put more pressure on emergency services, and firefighters are bearing the burden. I am told time and again by the Minister that the number of fire incidents is decreasing but, as we know, that is not the full story. The overall number of incidents that the fire service responds to has decreased by 12.6% between 2010 and 2018. However, 11,854 firefighters have been cut in the same period, which equates to 20% of frontline staff. Therefore, on average we have fewer staff responding to more incidents, and incidents have risen every year since 2014. Workload pressures have increased over the past eight years, and if the Government want to be effective they must consider a staffing review as part of their policy to address mental health issues.

The effects of sustained cuts have put a considerable amount of pressure on the workforce, but that pressure is also changing. National discussions are being held regarding the expansion of the role of the firefighter to include emergency medical response. That may be a positive step if it is properly funded and if training is made readily available. However, I am not optimistic that central Government will ensure that that happens. I am not opposed on principle to EMR, but it must be properly funded. It will increase firefighters’ exposure to traumatic events and potential of losses of life. If they are not prepared for that change, it could be catastrophic for their mental health.

As a nurse, I saw such events at first hand. I assure Members that if someone is not prepared to deal with such incidents, the consequences for their wellbeing could be devastating. I was a cardiac nurse for 12 years and had an advanced life support qualification. I used to carry a cardiac arrest bleeper, and we used to run across the hospital to arrests. At that time—this is going back five to 10 years—the success rate was about 20% of resuscitations. That was in hospital, so we were getting there quickly. When a firefighter arrives at a cardiac arrest more time will have gone between what we used to call down time and the start of resuscitation, so the chances of success will be lower. At least we were successful a proportion of the time. By virtue of the way their work will happen in the community, the firefighters will see more fatalities; they will have to deal with that regularly, so it is an even more important factor in their mental health.

[Bill Grant]

I thank the hon. Lady for her good work in cardiac services. That was in a controlled, measured environment, but the challenge for firefighters and ambulance personnel is that they operate in a quite unnatural environment, whether they are attending an accident at a farm or factory, or a car accident. They are exposed to the weather and elements, and there are other road users, and so on. That is an added dimension; it is not a controlled environment, although we would do our best to control it on arrival.

[Karen Lee]

Absolutely. I completely agree with the hon. Gentleman. After someone has attended an arrest situation unsuccessfully, they go through an algorithm and they know they have done everything properly, but they still feel bad about losing that person. My point is that going to more arrests with a lower likelihood of success—because of all the things that the hon. Gentleman mentioned—involves much greater pressure. When I was a nurse we had occupational health, and there has to be something like that for firefighters—proper support.

I have been told numerous times during visits that firefighters have less time to train because of their workload. That is another thing that is very important. People going to an arrest must feel they know what they are doing. I am very concerned at the possibility that if outstanding issues are not fully addressed and firefighters are not effectively prepared for a sustained change in their role and responsibilities, their wellbeing could be damaged.

Our firefighters are heroes, and their pay must be properly addressed. As I have said time and again, they cannot spend a pat on the back. Mind has identified money worries as a contributing factor to mental illness, and considering the sacrifices made by our firefighters, the last worry they should have should be about their pay packet at the end of the month—my hon. Friend the Member for Kensington made a good point about some firefighters needing a second job, which is utterly disgraceful.

The Grenfell disaster and its consequences for our firefighters are terrible. The work that the Fire Brigades Union and the London Fire Brigade are doing to support firefighters is outstanding, and includes support for the 80 fire officers giving oral statements at the Grenfell inquiry. As the “Journey of Recovery” report highlighted, alongside all those affected, firefighters who were at the scene may be at risk of PTSD. The consequences are clear: stress and depression have been identified as the main source of LFB sick leave post Grenfell. I commend the Government’s commitment of £50 million to tackle mental health post Grenfell, but what proportion of that money will specifically be invested in support for LFB firefighters? Eighteen months after Grenfell, those firefighters still line the route every month for the silent vigil, and they are to be commended.

I do not accuse the Government of not caring, but I believe that more could be done, and they must recognise that cuts to central Government funding and staffing levels have a subsequent effect on a workforce. Let us not get into the old argument about allocated and unallocated resources, or who is responsible for austerity—the fire service must be properly resourced. I recognise that the Minister has asked Her Majesty’s inspectorate of constabulary and fire and rescue services to assess how well services understand and meet the wellbeing needs of their workforce, and how that can be improved. Will he provide an update on that and say when we can expect additional investment or support? How much of the £7 million committed to Mind’s blue light programme is included in existing fire service resources, and how much is new money? I look forward to hearing his response.