Emergency Cardiac Care

I have a short statement to make, if I may. Thank you for inviting me to provide evidence. Addressing cardiac arrests, strokes and sudden cardiac deaths is very important to the Scottish Government, so I am pleased to be here to talk about the petitions.

I want to begin by focusing on the two petitions that relate to defibrillators. As part of the Save a Life for Scotland partnership, the Scottish Government works to improve outcomes from out-of-hospital cardiac arrest. The partnership has made significant progress since 2015, and I am pleased to say that more than a million people have been trained in cardiopulmonary resuscitation, which achieves the target set out in our strategy. Bystander CPR rates and defibrillator usage have also increased, as have survival rates, which is important.

The petitioners highlight the importance of defibrillator provision and usage. Recently, the First Minister and I were pleased to meet Rodger and Lesley Hill, who founded the DH9 Foundation, in memory of David Hill. We discussed their proposal for the placement of defibrillators in schools. The First Minister asked that the DH9 Foundation and the Save a Life for Scotland partnership provide the Government with an agreed position on the best way to increase defibrillator availability and usage in Scotland. In response, our partners have recommended taking a data-driven and localised approach to increasing defib access. That means using PADmap, which shows the location of public access defibrillators, to identify the areas where defibs are most needed, and working with local communities to place them effectively and to support increased awareness and confidence in their usage.

Our partners were also clear about the importance of cardiac responder networks in areas where fixed defib positions might not be the best approach. We are considering how we can contribute to the shared vision of ensuring that communities across Scotland are prepared and supported to respond to cardiac arrest.

Petition PE2067, which was lodged by Sharon Duncan, David Hill’s mother, focuses on improving data relating to sudden cardiac death and the conditions that are associated with it. I strongly agree about the importance of such data, and I am pleased to make the committee aware that, just yesterday, Public Health Scotland published the Scottish cardiac audit programme. That expanded report includes data on inherited cardiac conditions for the first time. In addition, the programme has been working alongside the inherited cardiac condition service along the west coast of Scotland to develop a proof of concept for a sudden cardiac death registry. It is hoped that preliminary data will be included in next year’s report. Those are really important developments that, I hope, encourage the committee and Mrs Duncan that we are working to address the challenges relating to data on sudden cardiac death and the conditions associated with it.

On the petition that relates to the review of the FAST stroke awareness campaign, I very much welcome the work that the Bundy family have undertaken. In May 2024, I met the family to discuss their campaign, and I was moved by their determination to improve awareness of stroke symptoms. Following a meeting with the family, the Cabinet Secretary for Health and Social Care asked the stroke speciality adviser to the chief medical officer to review stroke awareness education for clinical staff, which led to the development of an education package funded by the Scottish Government and delivered to more than 1,500 staff in general practices, emergency departments and the Scottish Ambulance Service. The education package also covers the less common presentations of stroke, including symptoms relating to visual field defects and certain presentations of loss of balance. We will keep our position on stroke symptom awareness under review and be guided by the best evidence at all times.

I thank all the petitioners for raising these extremely important issues. The Scottish Government and I take these matters very seriously, and I hope that I have outlined to the committee the steps that we are taking to address them.

Thank you for acknowledging the importance of listening to people with lived experience. In the role that I carry out, which is focused on public health and women’s health, the best support that we can get is from people who have experienced trauma and from those who have had positive experiences in healthcare. It is important to acknowledge that.

The evidence session that you had with Steven Short from the Save a Life for Scotland partnership, Kirsty Morrison from Chest Heart & Stroke Scotland and Kym Kestell from the British Heart Foundation was really important, because you were able to tease out a lot of detailed information from them on the work that has been going on regarding out-of-hospital cardiac arrests.

I represent Argyll and Bute, which has a wide footprint and fewer urban areas. When I was first elected, I heard about decisions on the location of defibrillators and the volume of them on islands. There was, I think, one per 1,000 of the population there, which, in theory, meant that Mull would have only three. In considering the expanse of Mull, the community recognised that they needed an awful lot more defibrillators, so they did a lot of community fundraising. I recognise that that has happened across Scotland. I commend the support that we get from the British Heart Foundation in helping people to purchase defibrillators for their communities.

It is clear that one size does not fit all, as came through in the evidence that you heard from Steven Short and Kym Kestell. PADmap is a great help in allowing us to focus on where there is need. Kym Kestell stated that people who live in the more deprived areas of Scotland are more likely to experience an out-of-hospital cardiac arrest, so there is a need for defibrillators in those areas.

You specifically asked about what the Scottish Government is doing. As you heard from Steven Short, we are active partners in Save a Life for Scotland. As I noted in my opening remarks, as a result of the recent meeting that Save a Life for Scotland had with Rodger and Lesley Hill, we received a submission from them, which we are currently considering. We will make decisions on the best way for the Scottish Government to ensure that we have the right placement of defibs across all of Scotland’s vast and beautiful geography.

09:45

If I may, I will refer to my constituency. I met community responders at the Islay show. They have a local community set-up that is led by a couple of retired GPs, who have pulled in other people who are interested, including those in the retained fire service, coastguards and people involved in the lifeboat service. Those people are very community oriented and, as a result, they are community responders. We talked about the cost of ensuring that responders have the right equipment to allow them to respond quickly, so I am very aware of that issue from my constituency.

Part of our work with Save a Life for Scotland relates to—I think that Steven Short talked about this, too—understanding how to have the right co-ordination across Scotland, so that communities understand what they need to be able to do and how to learn. I know of a retired nurse who has supported her community by ensuring that knowledge and training are maintained so that the community can respond to someone having an out-of-hospital cardiac arrest.

It is very much about engaging with communities and with all the Save a Life for Scotland stakeholders, including the Convention of Scottish Local Authorities. I know that Davy Russell asked about how local community areas and planning groups could support the work. That collaboration, which Steven Short talked about, is very important.

I know that you had dialogue with Steven Short about training young people and those of us who are slightly more advanced. I remember getting CPR training in the brownies and in the guides—and, more recently, at a walking football event in Glasgow. He commented that, as long as you know the basics, being prompted by the call handler as to what you should be doing will give you confidence.

All the stakeholders need to be involved, including the Scottish Ambulance Service and the Scottish Fire and Rescue Service. As I said, in my community, on Islay, other people have been pulled in. Through our connection with Save a Life for Scotland, the Scottish Government is very much looking at the proposals that it has sent us.

My questions are on sudden cardiac death research and data co-ordination. How will the Scottish Government ensure that existing data on PAD locations, out-of-hospital cardiac arrest incidents and cardiac outcomes is shared effectively, is accessible and is used across all relevant agencies to support strategic planning and improve survival rates?

Last Friday, I was at Public Health Scotland’s annual review. PHS collects a wealth of data across healthcare and, as I indicated in my opening remarks, the Scottish cardiac audit was published just yesterday. It includes some additional information on out-of-hospital cardiac arrests—this is the first year that that has been included, and we recognise the importance of it. As you pointed out in your question, that will allow us to plan better for the pathways and the support that we can give to communities.

I am pleased that PHS is able to collect that data. We are hoping that the next stage will be that health boards feed in directly to that process, as opposed to there being a two-stage approach. That is really positive and it will not only help the Scottish Government but help health boards to understand more about the needs in their communities.

My second question covers part of that. What steps will be taken to strengthen research into sudden cardiac deaths, inherited cardiac conditions and behavioural barriers to bystander intervention, so that the evidence can guide policy development, public health campaigns and targeted interventions?

There is quite a lot in that question. Kym Kestell from the British Heart Foundation Scotland gave the committee good evidence on the research that the BHF is doing, which the Scottish Government is very pleased to support. We also have the Chief Scientist Office, which is in charge of research into health in Scotland, and the chief scientist is very open to receiving applications from organisations and universities to undertake specific research into heart conditions. Alongside the data, the research that we can undertake in Scotland, given our population, is really important.

I think that we, as MSPs, all have a responsibility in that regard. A few months ago, there was a debate in Parliament about that, explaining to members the importance of ensuring that the defibrillator in their area is logged on to the circuit. As Steven Short explained in his oral evidence to you, that is how the Scottish Ambulance Service can direct people to the closest defibrillator in the area.

Last Friday, I was in Oban, visiting the Happy Wee Health Club. Outside the gym, there is a defibrillator on the wall. We need to ensure that it is well known where the defibrillators that are dotted around communities are situated.

We usually tweet and do other things during awareness-raising campaigns, but I am very happy to take away that suggestion. Members also have access to the PADmap tool, and it is possible to tweet the URL for that.

Absolutely—it is a great idea.

As you know, the Cabinet Secretary for Health and Social Care and I have written to the UK NCS, which is an independent body, and we understand that, over the next three years, it will be reviewing evidence. The evidence must be robust and peer reviewed, so we are pleased that that is part of the screening committee’s work programme.

We are already considering what we can do once the UK NCS makes a decision. It was clear, when Kym Kestell answered a question on screening, that it is not just about screening; we need to ensure that we have the pathways in the various health boards to ensure that they can support people who are screened and might have a condition. We do that work regularly with health boards.

With regard to data, I touched on the Public Health Scotland Scottish cardiac audit, which was released yesterday. There is an iterative process to ensure that we are collecting the right data, and the scope has been extended, as this is the first year in which the audit has contained additional information on congenital, if I can use that word—

It contains additional information on inherited cardiac conditions.

When the First Minister and I met the Hill family, one of the outcomes concerned the need to understand clearly what sportscotland is doing. Sportscotland has some guidelines, and Scottish Rugby and the Scottish Football Association have clear pathways to ensure that people who are participating in sport have the right healthcare monitoring that they need. In that meeting, I was struck by the work that the Hills have been doing on monitoring young children who have been playing sport. We have been looking at that in preparation for any change in the UK NSC guidelines.

As I said, the UK NSC is an independent body. Our chief medical officer is represented on it, along with the other three chief medical officers. I think that the fact that we have written to the UK NSC emphasises the Scottish Government’s interest in its work timetable. As I said, however, the UK NSC makes decisions based on robust evidence that has been peer reviewed, and we need to ensure that that process is followed properly and correctly.

10:00

I understand the concerns that you have raised, Mr Ewing. That response prompted us to start thinking about, if that decision was changed, what we need to do in Scotland to work with clinicians to ensure that we have the right processes. Those questions prompted us to review whether we would change what we do if the UK NSC’s decision changes in three years.

Yes, and I was, too. That is why it is important that Public Health Scotland is now gathering the inherited cardiac conditions information to allow us to shift, and is also gathering information from sportscotland about what is done through sport. As I said earlier, the information that the Hill family gave us at the meeting with the First Minister was very compelling and we are looking at that.

I appreciate the questions and it is important for us to get the right healthcare results for Scotland. Robust questions are fine, Mr Ewing, and if I cannot answer them, I am happy to respond in writing.

I will take away what you have just said about reviewing the evidence from Italy. I believe that the work in Denmark was also highlighted to the committee. I am content to have a look at that and respond to the committee with our thoughts. If you will allow me, I will gather some clinical views on that, too.

Extrasensory perception, and all that.

I am sure that Mr Ewing is aware of the impressive and thought-provoking time for reflection contribution that we heard from Cameron McGerr in the chamber a few weeks ago. I happened to be sitting next to the Cabinet Secretary for Education and Skills and the Cabinet Secretary for Health and Social Care. The three of us have written to Cameron. I was hoping to have heard where the matter had got to, but we are hoping that a group of us, if not all three of us, will be able to meet Cameron to hear more from him about the importance of ensuring that young children receive CPR training, as he recognised.

I have also had the privilege of meeting a father and son. The son was able to save his father’s life because of the CPR training that he had received in early secondary and later in secondary school. I recognise the importance of that training. As you will appreciate, education does not sit in my portfolio, but I am content to speak further with the Cabinet Secretary for Education about the issue. We can come back to the committee once we have met Cameron McGerr.

I am content to take that away and have a conversation with the Cabinet Secretary for Education and Skills about it. You are right that, in different areas of Scotland, different training is given. I have highlighted that people from the Royal National Lifeboat Institution may be going into schools, and I know that the St John Ambulance service has a very good plan to go into schools to provide support with that. I completely understand where you are coming from.

I would be happy to have that engagement. From a public health perspective, we have very good relationships with Scottish Women’s Football, which has supported us with an anti-vaping campaign as well.

At the start of this evidence session, we talked about the importance of community engagement and ensuring that the community has guardians—that is how Steven Short and others described it. That ensures that, in the community, there is continual refreshment of skills. As I said earlier, when someone is on the phone to the call handler, they will get prompts to tell them what to do.

I would suggest that, if you fancy refreshing those skills, there are a lot of events happening around Scotland. I highlighted the walking football event that I was at. St John Ambulance was there, giving support alongside the Stroke Association—I think, although it might have been Chest Heart & Stroke Scotland. At a lot of events, and certainly a lot of the agricultural shows in Argyll and Bute that I go around, there is an opportunity for people to get refresher training. There are also good online resources on the Save a Life for Scotland website.

That important question ties into a question that you asked at the previous meeting as well. I know that you recognise that local authorities know their communities and who the key drivers are in different parts of their communities, whether that is the more deprived areas or the less deprived ones. Partnership working is definitely happening, and COSLA is part of the Save a Life for Scotland partnership, as you know.

10:15

Another important thing, which Steven Short touched on, is that businesses are often willing to get involved in supporting fundraising, as is the British Heart Foundation. As I said, we are looking at a paper that was worked on at the most recent Save a Life for Scotland meeting, and we will be taking decisions based on that.

I was very disappointed to read the statistics that came out recently on the stroke bundles. I agree that improvement has to be made.

Just last week, I chaired a round table of all the stroke leads from the health boards across Scotland, at which we talked specifically about door-to-needle time as a major concern. We have considered how health board staff are configured and we have helped boards to introduce nurses who will specifically support people who could be presenting with stroke symptoms. I think that I am right in saying that NHS Lanarkshire has made really good improvements there. At the meeting last week, it was great to hear about what NHS Lanarkshire has been able to do. The other health boards heard about that and they can consider the changes that they could make. The Scottish Government has provided some funding to allow additional training for nurses across the health boards.

As you will know, the Scottish Government provides funding to health boards directly. The total health budget is about £21 billion. Of that, about £15 billion goes directly to health boards, and it is for them to make their decisions on how to allocate that among the various conditions that they have to support.

Having met the Bundy family and representatives of the Stroke Association and Chest Heart & Stroke Scotland, I felt very strongly that it was important for each health board to have a stroke lead and for me to meet them regularly. We also have a stroke specialist in the Scottish Government, who is part of the chief medical officer’s team. He engages regularly with the stroke leads to ensure that we can improve, because that is what we have to do. You are absolutely right that we have to improve the statistics.

It is a target. If a target is challenging, that is great, because it challenges people to ensure—

I absolutely agree. The targets will have been set with clinical advice and guidance. Targets should be a stretch, because we want people in Scotland to be healthy and to maintain healthy lifestyles. I know from the people who I have met who are living with stroke that some have had better journeys than others. That is how we learn. It is through sharing those stories widely among MSPs and more broadly across Scotland that change can happen. I was very heartened by the meeting that I chaired last week, because I heard a group of people who have the same determination to reach those targets.

I have had a number of conversations about that with officials and third sector organisations such as Chest Heart & Stroke Scotland and the Stroke Association. As you will know, Chest Heart & Stroke Scotland ran an awareness campaign either late last year or earlier this year that was based on the FAST guidelines.

I mentioned in my introductory remarks that, as a result of his meeting the Bundy family, the cabinet secretary asked the chief medical officer to do a piece of work on the issue. As a result, we have provided and funded an education resource—which 1,500 people from emergency departments, general practice and wider healthcare have gone through—to ensure that people are aware not only of the FAST symptoms but also of those that are not in that acronym, which can be around balance and visual impairment. That work has been done and it is continuing.

We need to be aware that the FAST acronym is very well known. Bringing in the “BE”—the balance and the eyes—could produce some false positives, which we would be concerned might impact on clinicians’ ability to treat. That is why, in the additional training resource, we have been very clear that we are focusing on FAST, but we are also ensuring that people are aware that there could be other symptoms. The evidence and the discussions that I have had with the Stroke Association and Chest Heart & Stroke Scotland show that their views tie in with that.

Most definitely. As Davy Russell highlighted, a pilot is happening in NHS Forth Valley—we have not had any outcomes from it yet—and I note that NHS Ayrshire and Arran is also considering it.

I absolutely agree that there is no intransigence. Davy Russell pressed me on the targets, which are there because we expect to meet them. However, as knowledge changes, we need to be flexible enough to ensure that we provide the people of Scotland with the right support for their health.

That is a very fair question. As NHS Forth Valley is taking forward the pilot, I have no information on when it will be complete or when we will get the report. However, your questions are all on the record. Martin Macdonald is here with me today and we will converse with the health board to understand what it is doing, where it is in the pilot and when we can expect the report.

I would just like to say thank you. I appreciate the evidence that you gathered in your previous evidence session.