Meeting of the Parliament

Meeting date: Tuesday, January 30, 2018

Official Report 831KB pdf

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St Andrew’s First Aid

I ask members who are leaving the chamber to do so quietly. [Interruption.] Quietly, please. [Interruption.] Could I ask members to leave quietly?

The final item of business is a members’ business debate on motion S5M-08301, in the name of Johann Lamont, on St Andrew’s First Aid. The debate will be concluded without any question being put.

Motion debated,

That the Parliament acknowledges the campaign by St Andrew’s First Aid, Scotland’s only dedicated national first aid charity, to address the shortage of first aid skills in Scotland and to help save more lives in areas of social deprivation, including in Glasgow; understands that the call follows the publication of the Scottish OHCA Data Linkage Project, which looked into survival rates from out-of-hospital cardiac arrest (OHCA) in Scotland; notes that the report indicated that those living in the most deprived areas of the country were twice as likely to have an OHCA as people living in more affluent areas, with 28% against 14%, and that those from the most deprived areas were 43% less likely to survive a cardiac arrest than those from more affluent areas; notes that the report, which was delivered jointly by the University of Edinburgh and the Scottish Government, and supported by the Scottish Ambulance Service and National Services Scotland, found that survival rates in Scotland following OHCA are estimated between just six and eight per cent, with the European average sitting at 10.2%, which puts Scotland among European countries with the lowest survival rates; wishes St Andrew’s First Aid success with its efforts to ensure that people across Scotland are equipped with vital, lifesaving first aid skills, and notes calls on the Scottish Government to recognise the importance of first aid and to support efforts to establish a nation of skilled first-aiders.

16:54  

I thank colleagues from across the chamber for their significant level of support for the motion, and for attending the debate.

I also thank St Andrew’s First Aid, the British Heart Foundation and all those other organisations and volunteers who bring first aid to our communities day and daily, allowing events to take place and giving support to a range of groups across our communities.

The motion was lodged following the publication of the Scottish out-of-hospital cardiac arrest data linkage project, which looked into survival rates of out-of-hospital cardiac arrests in Scotland. It sounds like a dry report, but it speaks volumes about inequality in Scotland.

The report, which was delivered jointly by the University of Edinburgh and the Scottish Government, and supported by the Scottish Ambulance Service and NHS National Services Scotland, found that survival rates in Scotland following out-of-hospital cardiac arrests are estimated to be between just 6 per cent and 8 per cent. With the European average sitting at 10.2 per cent, that figure puts Scotland among the European countries with the lowest survival rates.

The report’s findings added further weight to the continued efforts of St Andrew’s First Aid to ensure that people across Scotland are equipped with vital, life-saving first aid skills. The first paragraph of the report reveals the scale of the problem in Scotland: around 3,000 patients each year had resuscitation attempted after a sudden cardiac arrest in the community, but only about 6 per cent of those patients survived to hospital discharge. In the best-performing comparable settings around the world, the survival rate is as high as 25 per cent.

The report has identified a number of factors that indicate a very real link between areas of social deprivation and a person’s chances of surviving an out-of-hospital cardiac arrest, which can affect people of all ages at any time. The report revealed that those living in the most deprived areas of the country were twice as likely to suffer an OHCA as people living in more affluent areas—the figures were 28 per cent, against 14 per cent. Furthermore, those from the most deprived areas were 43 per cent less likely to survive a cardiac arrest than those from more affluent areas.

Other factors were identified in the report. The average age of OHCA victims was seven years lower in areas of deprivation. The Scottish Ambulance Service recorded that bystander cardiopulmonary resuscitation was attempted in just 40 per cent of cases before the service arrived. That is lower than the figure in some parts of England—for example, in London, it is 60 per cent of recorded cases. People from more deprived areas are less likely—the figure was around 38 per cent of cases—to receive bystander CPR compared with more affluent areas, where it was 45 per cent.

Surely if it was mandatory for people to have even basic first aid skills, those factors could be greatly reduced. It is a simple solution: more lives could be saved if more people had the skills to help save others. St Andrew’s First Aid is now calling for more to be done to reduce the statistics that I have cited and to increase levels of first aid skills in Scotland. That simple approach would deliver widespread benefits, and would literally save lives.

I would like to highlight the additional benefits that first aid training would bring. Last year, a report by the British Red Cross found that first aid training could help to ease the pressures on accident and emergency departments. The report stated that more than a third of people who were surveyed attended A and E because they were

“worried and didn’t know what to do”.

People expressed a desire to use A and E services appropriately, but found it difficult to know whether a health problem was severe enough to need urgent care.

Of central importance to this evening’s debate is that the report highlighted that health care professionals themselves stated that

“most patients have not attempted first aid before coming to hospital.”

By equipping people with the proper skills and by training more first-aiders, we can begin to turn the tide on the issue.

Education is paramount in addressing the problem. In my region of Glasgow, St Andrew’s First Aid has been working in partnership with a number of secondary schools to improve and increase levels of first aid skills among young people. In the north of the city, almost 400 young people have been trained in first aid. In turn, those pupils will showcase what they have learned to their fellow pupils, passing on vital skills and knowledge.

The feedback that St Andrew’s First Aid has received from the schools has been overwhelmingly positive, with reports that pupils grow in confidence and learn to use their initiative in different ways from how they used it before. That applies in the context of not just first aid but all studies and extra-curricular activities. Although the programmes are centred on the teaching of first aid, the skills that pupils learn are transferable and can set them up for everything that they encounter, in school and beyond.

In the year of young people, and with the appointment of St Andrew’s First Aid as the official first aid provider for the European championships in Glasgow in August, the Scottish Government might consider how to encourage young people to volunteer and take up the opportunity to learn how to save a life—an experience that will be life transforming for the young person and perhaps life saving for someone else; that is a virtuous circle, if ever there was one.

The report’s findings provide a firm starting point, from which we should urge for more to be done to improve survival rates and address the shortage of first aid skills that could save lives and end the most horrible postcode lottery, whereby some people are more likely to die and less likely to be saved.

It is common sense to equip people with the simple skills that they need to save a life. Everyone will benefit. Aileen Campbell, the Minister for Public Health and Sport, has agreed to meet me, and I look forward to exploring how we can ensure that people from the most deprived areas have a better chance of survival and that more people are equipped with life-saving skills.

The campaign by St Andrew’s First Aid addresses some of the most challenging issues that are faced by people who live in Scotland’s deprived areas. I sincerely hope that the Scottish Government will work collaboratively with St Andrew’s First Aid and others, so that Scotland can become a nation of skilled first-aiders.

We all understand the massive challenge that is presented by health inequalities. The issue can be overwhelming—there are so many causes and potential solutions—but we ought not to be overwhelmed into inaction. The equipping of people with first aid skills, and an understanding that such skills are unequally distributed across the population, are just part of a big picture, but they are a part on which we can act right now. I seek the minister’s assurance that she understands and will act.

17:01  

I congratulate Johann Lamont on bringing this debate to the Parliament.

The debate gives me a chance to thank the volunteer first-aiders who turn up at so many events and whom we all take for granted. I was at the Scottish indoor athletics championships at the weekend, and the first-aiders were there. They are a permanent fixture, and they are ready, track side, to pick up us fragile athletes when we break. I take the opportunity to let them know that they are noticed and that their commitment is recognised. We thank them for the service that they provide.

In her motion, Johann Lamont highlighted the disparity in the incidence of and survival rates after cardiac arrest between deprived areas and more affluent areas. It strikes me that the place to start is the school classroom. I learned basic first aid when I was at school, and I think that first aid is an important life skill, on many fronts. The obvious advantage is the ability to intervene positively in a medical emergency. A basic understanding of emergency procedures can save lives, as Johann Lamont said.

The issue is particularly pertinent in light of the recent pressure on our A and E departments and primary care services. The British Red Cross survey that has been mentioned found that a third of A and E attendees were there because they were

“worried and didn’t know what to do”

and that health workers said that most patients had not attempted first aid before coming to hospital. The same research found that nearly 60 per cent of pre-hospital deaths from injury might have been prevented if first aid had been carried out before the emergency medical services arrived. Injury might also have been prevented had first aid had been carried out before the patient arrived at A and E.

One of the starkest revelations in the research is that three out of four parents in the United Kingdom would not be able to save their baby from choking. If ever a statistic should grab our attention, surely it is that one. I am sure that if mothers and fathers were asked, they would say that they all wanted that skill in their parenting toolkit.

Patients seem to struggle to assess the severity of health problems and do not know where best to go for help. First aid has been described as a lost skill. That must have a direct impact on the delivery of emergency services.

At a time when the preventable health problems agenda is gaining more oxygen, the introduction or reintroduction of basic first aid training in schools could be a significant element of the agenda. I have even spoken to schools that teach pupils to recognise the telltale signs of students struggling with conditions such as hypoglycaemia associated with diabetes, and what to do in those situations. It can be empowering to have that kind of skill at one’s disposal, and the confidence to intervene when that situation arises. Having friends and fellow students around them who have an understanding of their condition through that education must be a comfort to pupils; having that general understanding also allows them to tackle the potential feeling of isolation that a lack of understanding from peers can bring. We hear a lot about stigma, which is born out of ignorance in many cases, and a potential consequence of that kind of approach could be to normalise such health-related issues.

School education will not in itself tackle the disparity, in terms of the incidence of conditions such as cardiac arrest, between more-deprived communities and those that are better off. However, it would certainly have the potential to increase survival rates no matter where those issues occur. By definition, though, given that occurrences of those conditions are higher in the more-deprived areas, the impact of universal training in schools should be felt to a greater degree in the worst-affected areas—that is, the most-deprived areas.

Once again, I thank Johann Lamont for giving us the opportunity to speak on this topic in the chamber, and I thank those first aid volunteers who are all too often taken for granted. Today we have the opportunity to tell them that their contribution to our wellbeing is valued. Perhaps it is time to look at how the opportunity to learn those life skills is brought to the wider community, and I suggest that the place to start is the school classroom.

17:06  

I congratulate Johann Lamont on securing the debate, and thank her for bringing this important issue to the chamber. I do not think that there is anyone who has not, at some point in their lives, whether through family and friends or directly, been touched by heart disease and potentially by an out-of-hospital cardiac arrest.

I should declare an interest before proceeding, as all the staff in my constituency office received their first aid training and certificate from St Andrew’s First Aid. I attended a course five years ago, which I found to be a valuable experience, and Johann Lamont and Brian Whittle touched on how enriching such training can be. I certainly found that. My only regret is that it was five years ago and I am now more than a little out of date, so I thank Johann Lamont for reminding me that I need to go back not only to refresh but to relearn a lot of my skills.

Like Johann Lamont, I was really quite taken aback by the numbers. I know that Johann Lamont represented Pollok previously, and she now represents Glasgow. As I represent Renfrewshire South, a constituency that has some very affluent areas but also some areas of deprivation, I see gross health inequalities on a daily basis and I am aware of the general socioeconomic inequalities that exist. People from the most deprived areas are 43 per cent less likely to survive than those from the least deprived areas, and that is a call to action for all of us.

I commend the Scottish Government for engaging with the issue in its 2015 strategy document. The aim of having 500,000 people who are CPR trained in Scotland is laudable. I was particularly struck by a positive statistic published in that 2015 strategy, which suggested that a defibrillatory shock to the heart within three to five minutes of collapse can produce survival rates as high as 75 per cent. At the moment, survival rates here are barely one in 20, or between 6 and 8 per cent. However, in some places there is outstanding practice. In Seattle, for example, there is a 25 per cent survival rate. If we take action to ensure that more people are equipped with CPR skills, we can make a real, fundamental difference.

Brian Whittle spoke about a universal application. Another thing about the strategy that struck me was the example of Denmark, where there seems to be a greater uptake of CPR training. I believe that it has been made a mandatory part of getting one’s driving licence there, and the data suggests that there is a direct correlation between an increase in CPR bystander interventions and survival rates, so it is a key part of the chain of survival.

Johann Lamont made a point about relieving the pressure on accident and emergency departments and all members who have had conversations with clinicians at any level will know about some of the challenges and the pressure that, for example, the worried well and the unworried unwell can contribute.

People should be empowered, equipped and confident to make decisions before going to A and E, and first aid training can play a significant part in that. It can give people the knowledge to take intermediate steps before going to A and E, such as making an appointment with their general practitioner or going to their pharmacist.

First aid is about empowering individuals, which relates powerfully to the realistic medicine agenda that, ultimately, is about empowering patients. That agenda is about thinking about people not as patients, but as citizens and there is no better way to be an empowered, confident citizen than to have the skill set to deliver CPR and to save somebody’s life. I encourage members to do first aid training or, as I will do, to update their training. It is a great thing to do, so members should take that message and spread it far and wide.

17:10  

I congratulate Johann Lamont on securing tonight’s debate on St Andrew’s First Aid. I acknowledge the good work that is done by St Andrew’s First Aid and I thank the first-aiders for all the good work that they do, not just in my constituency of Ayr, but around Scotland.

The St Andrew’s first-aiders are volunteers and they are at the front line in providing often life-saving first aid at many public events in Scotland. Their presence at major public events is enormously reassuring for the public and the organisers of the events.

I thank the British Red Cross for its briefing for the debate, which highlights that 59 per cent of hospital deaths from injury might have been prevented had first aid been carried out before the arrival of the emergency services, and that only 37 per cent of people attending A and E with conditions in which first aid could have helped had received any approved first aid before their arrival at an A and E unit. Further, a third of the people who presented at A and E units had done so because they were

“worried and didn’t know what to do”;

by going to A and E, they can clog up the service, particularly in winter, when they have no need to be there.

As members have said, there is a need for us all, myself included, to be better educated about first aid. That was dramatically brought home to me during a Christmas day lunch some years ago on my farm at Ballantrae, when my father choked on a piece of turkey. Unable to breathe, he turned blue very quickly and, apart from my daughter, none of us knew what to do. She got my father to the kitchen sink and performed the Heimlich manoeuvre; up and out came the turkey and Christmas day continued without a further hiccup. That my daughter saved my father’s life that Christmas day is beyond doubt, as we were 36 miles from the A and E unit in Ayr, with the nearest ambulance perhaps 20 to 30 minutes away.

I use my family circumstances to illustrate the point that, although having first aid skills is vital in an urban environment, it is even more important in a rural one. Therefore, the need to educate our children in first aid—bluntly, in survival techniques—becomes greater as the distance from A and E units increases.

I turn to the results of the out-of-hospital cardiac arrest data linkage project. I congratulate the authors on the stark clarity of the report and its very disturbing conclusions. It concerns us all that, historically, of the approximately 3,000 people in Scotland who have an out-of-hospital cardiac arrest every year, only 180 survive to hospital discharge. That is bad enough, but it is worse still when compared against the best survival rates worldwide where, out of a similar cohort of 3,000 people, 750 survive. Therefore, we welcome the ambitious collaborative effort that was launched in 2015 to improve the survival rate by 2020 to, hopefully, 1,180 survivors out of the 3,000 annual victims of an OHCA. Perhaps we can look forward to an update from the minister tonight on how that is going.

In the meantime, we must confront the report’s findings and emphasise the need for improvement. It is not acceptable that only one in 17 people who have an OHCA survive to leave hospital. It is not acceptable that those who live in rural areas have a still further reduced chance of survival 30 days after an OHCA. It is not acceptable that people living in our most-deprived areas are twice as likely to have an OHCA as those living in better-off parts of our communities. As Johann Lamont said, it is not acceptable that the average age of those who have an OHCA in deprived areas is seven years lower than the average age of those who have an OHCA in better-off areas. That probably goes a long way towards explaining why life expectancy in the most-deprived parts of my Ayr constituency is seven years less than in the better-off areas.

It is not acceptable that up to the age of 85, men are much more likely to die from an OHCA than women. While that might be a matter of simple physiology, I certainly—as a man—would like to know the reason why that is the case, as I was unable to find an explanation in the report. Perhaps the minister can tell us.

I again thank first-aiders, wherever they are, for their selfless life-saving volunteering. I encourage the Government to increase population resilience and positive OHCA outcomes by supporting the delivery of education in first aid techniques in schools, colleges, universities and later in life. I look forward to hearing the minister respond to the many questions that have been raised in the debate.

17:16  

I thank Johann Lamont for giving us an opportunity to consider how we can all be ready to save a life and acknowledge the excellent work of St Andrew’s First Aid in Scotland, which delivers expertise with enthusiasm.

I highlight today’s health figures showing that, in the past 10 years, the rate of people dying from heart disease in Scotland has reduced by 40 per cent, while the gap in inequalities has narrowed. Additionally, the rate of new cases of coronary heart disease has decreased by 27 per cent. I thank all those working across NHS Scotland and beyond to tackle heart disease and acknowledge the real results that they are delivering.

Our out-of-hospital cardiac arrest strategy for Scotland, which, as the then Minister for Public Health, I launched in 2015, aims to increase survival after out-of-hospital cardiac arrest. Equipping people with skills to save a life is fundamental to our bold aim to save an additional 1,000 lives by 2020. Our strategy was developed and is implemented in partnership with stakeholders who are already working hard to improve cardiac arrest survival, such as the blue-light services, health services and voluntary organisations, including St Andrew’s First Aid.

We all know that the right action in the minutes immediately following a cardiac arrest—calling 999 and starting CPR—results in most gains in lives saved. Bystander CPR can increase survival chances after out-of-hospital cardiac arrest by two or three times; without it, survival chances drop by 10 per cent every minute. That is why bystander CPR is the first priority of the strategy. CPR is incredible as a life-saving skill that anyone can learn. Our commitment is to equip 500,000 people with CPR skills by 2020 and create a nation of life savers. For that, we are driving a co-ordinated national approach and asking the people of Scotland to join us to be ready to save a life.

The organisations that have come together in partnership as Save a Life for Scotland are increasing opportunities to learn CPR and raising awareness of cardiac arrest. That model is unique internationally and builds on existing work by services, communities and individuals. Notable achievements by Save a Life for Scotland partner organisations in spreading CPR learning include working directly with many schools across Scotland to support CPR education. A pack of CPR resources for schools, developed with Education Scotland, is available from Education Scotland’s glow website.

Many of tonight’s contributions have urged more first aid and CPR training in schools.

Will the minister take an intervention on that point?

I will, if the member will let me finish this point.

Under curriculum for excellence, schools already have the flexibility to provide emergency or first aid training and it is up to individual schools and local authorities to decide if and how best to deliver that.

Will the minister join me in celebrating the work of four nurses at Wishaw emergency department—Caroline, Michelle and the two Fionas—who have set up a keep to the beat initiative? They are going round schools in North and South Lanarkshire teaching CPR to young people in some of the most deprived areas. They have recently been recognised by the health board.

That is excellent, and I am sure that that initiative is being replicated across the country. Johann Lamont also highlighted what is happening in a number of schools in Glasgow. Young Scot also ran a successful social media campaign with a livestream video, where young people learned CPR with a Scottish Ambulance Service medic. That was Young Scot’s most successful video to date, with more than 43,000 views.

The Scottish Fire and Rescue Service opening its 350 community fire and rescue stations for use in training videos and using British Heart Foundation call push rescue kits is also a way of learning CPR. We are delivering CPR learning to the Scottish public in shopping centres, railway stations and leisure centres, and with community groups. I spent one cold day outside the Museum on the Mound highlighting the out-of-hospital cardiac arrest strategy.

Will the minister acknowledge that simply seeking volunteers to come and learn CPR will mean that young people in poorer communities are less likely to access that training? I understand that schools are under a lot of pressure to deliver the curriculum, but they are the most obvious vehicle for such training. What conversations might the minister have with her colleagues in education and the education minister about how we can create incentives for schools in those deprived areas to take up opportunities to train their young people in first aid?

I do not necessarily agree with the member. Fulton MacGregor highlighted that good work is going on throughout our schools and communities, and it is not necessarily the case that more deprived communities are less likely to have those opportunities. However, I take on board what the member has said.

We have seen training offered at lots of high-profile events, such as the Royal Highland Show and the Edinburgh military tattoo. Going to the Royal Highland Show means that we can highlight to the rural community how important the training is.

With the European championships coming up this year, which is also the year of young people, we have opportunities to continue to promote first aid and out-of-hospital CPR. We also continue to develop our active online and social media presence as a portal for information.

Tom Arthur mentioned communities and community groups, and I commend all the community councils and groups that have provided defibrillators in their communities. I would also like them to make sure that they register the defibrillators with the Scottish Ambulance Service so that, once someone has dialled 999, the Scottish Ambulance Service can tell them where the nearest defibrillator is.

To date, the Save a Life for Scotland partners have already equipped 200,000 people with CPR skills. Having launched the campaign in 2015, I am particularly proud of that, and I thank all the partners and people involved, including St Andrew’s First Aid, for their achievement.

To achieve that, we have listened, used evidence, and made learning CPR easy, accessible and free. We have distilled down the key requirements so that CPR can be learned in a short time. We know that out-of-hospital cardiac arrest survival rates are worse in more deprived areas, and one reason for that is lower rates of CPR. We are seeking to narrow that gap, and Save a Life for Scotland partners are proactively working in those communities.

For maximum effect, Save a Life works through organisations that are already established and credible. An example is the successful CPR week in north Edinburgh where, with the excellent and essential contribution of community shop volunteers, more than 200 people in the community took time to learn CPR. Building on that experience, Save a Life is in active discussion on CPR learning with some of the least well-off communities in Dundee and Glasgow.

A higher incidence of out-of-hospital cardiac arrest is a result of broader population health patterns that are related to deprivation. As people in the chamber will know, this Government is taking action on that by supporting people to live healthier lives, with our tobacco policies, alcohol framework, and diet and obesity consultation. Health inequalities are a reflection of wider social inequalities and they are one of our biggest challenges. We are taking action to address the underlying causes—tackling poverty, supporting fair wages, supporting families and improving our physical and social environments. We are measuring the progress and the impact of the strategy and are developing an evidence base for future plans.

I would like to thank everyone who has learned CPR. If you have not already done so, please get involved. I commend Tom Arthur and his staff for having taken a first aid course. I remember doing a first aid course in this place. My partner was Annabel Goldie, and putting each other in the recovery position was quite interesting. We should all be ready to say, “Let’s do it” and to have the power to save lives in our hands. Thank you very much.

Thank you. That concludes the debate.

Meeting closed at 17:26.