The next item on our agenda is a debate on a Member's legislative proposal on a Welsh hearts Bill. It is to be moved by Alun Davies. 

Motion NDM7427 Alun Davies, Rhun ap Iorwerth, Dai Lloyd, Andrew R.T. Davies

To propose that the Senedd:

1. Notes a proposal for a Welsh hearts Bill to improve the outcomes for people who suffer out-of-hospital cardiac arrests.

2. Notes that the purpose of the Bill would be to place a duty on:

a) Welsh Ministers to publish a strategy to improve the outcomes of out-of-hospital cardiac arrest and to develop pathways for survival for the whole country;

b) local authorities to plan to ensure sufficient access to community defibrillators in each part of their area;

c) Welsh Ministers to ensure that training in CPR is provided for people throughout Wales;

d) health boards to collaborate in the production of regional pathway of survival for out-of-hospital cardiac arrests; and

e) Welsh Ministers to report to the Senedd on the progress of their strategy against objectives every year.

Motion moved.

Thank you very much, Presiding Officer. I'd like to start my contribution today by thanking Dai Lloyd, Rhun ap Iorwerth and Andrew R.T. Davies for their support in bringing forward this legislative proposal. But, Presiding Officer, I would also want to start by thanking Thoma and Mike Powell, who saved my life by performing CPR on me; Tom, who cycled like mad to find a defibrillator; to all those people whose names I don't know who helped when Thoma needed a rest; to the paramedics; and, then, to Sean Gallagher and his cardiac care team in the Heath hospital. In thanking all these people, we also tell a story of a cardiac arrest and the people who need to be able to save a life.

Now, I would be first to accept that I'm not a natural athlete. But, when I decided to go for a quick run one evening in the spring, I had no reason to believe that it may well have been the last thing I would ever do. I'd experienced no pain or discomfort at any point in the days leading up to this happening. I had no sense of being unwell and had no underlying issues that led me to believe that I was at particular risk. It was a bolt out of the blue. There were cuts on my face because it was instantaneous. I wasn't even able to break my fall. When this happens the person needs immediate help: immediate CPR and the use of a defibrillator. But we know that both of those things can be frightening and intimidating for any bystander. I was unconscious before I had any understanding of what was happening to me. There's no time to call for help. 

Tom wrote me an e-mail, which explained what happened. Let me say it in his words: 'When I arrived at the scene, they were already giving you CPR. All seemed frantic but organised. To make use of myself I offered to direct the ambulance in. A frantic dog walker told me they couldn't locate the defibrillator, as directed to them by the 999 operator. I knew locating the defibrillator was critical, so I set my mind to finding one. A very nice lady on the security desk at the college handed it over with minimal questions asked. I then rushed back with it. The adrenaline was coursing and I was too squeamish to do it myself, but your friend knew what to do. She had obviously had training.' And it was that training, Presiding Officer, that saved my life and that enables me to make this speech today.

I recognise and understand that Wales has an out-of-hospital cardiac arrest strategy, which was launched back in 2017, and I understand that it sets out a collaborative programme of work to improve both survival and aftercare. In many ways, this strategy touches on the main issues that I seek to address this afternoon. I'm making this legislative proposal today because I do not believe that this plan has had the reach or the impact that we would all like to see.

In essence, there are two main elements to this proposal. First of all, to ensure that we have the opportunity to save a life when a person suffers a cardiac arrest, and, secondly, that they receive the care required to lead a normal life afterwards. I recognise that the British Heart Foundation, and many Members, have been campaigning for some years for CPR training to be delivered in schools and colleges. I agree. In this proposal, I am simply asking that the Welsh Government takes responsibility for ensuring that such training takes place. The Government has resisted formal training in a school environment. Therefore, the Government has a responsibility to outline its alternative. 

The location of community defibrillators is also essential. Unless a defibrillator can be found and used within minutes, then it will be too late. I was very lucky, but I'm aware that a young man suffered a cardiac arrest close to where I did a few years ago. At that time, a defibrillator was not found, and that young man lost his life. I'm also reminded of the campaign being led by the family of Justin Edinburgh, the former manager of Newport County, who died after suffering a cardiac arrest in a gym where there was no defibrillator. I can see no way forward unless we specify a direct duty on local government to ensure that there is access to these life savers through each one of our different communities.

The second aspect of this proposal is to ensure that health boards work together and collaborate to create pathways of survival. This means clinicians and NHS management working together across health board boundaries to develop and deliver not only the best diagnosis and care, but to deliver the best outcome for patients. I fear sometimes that our health boards do not work together as well as perhaps they should. There is no purpose in competition, and no purpose in duplication of resources. I would like to see the ambitions and the words of the existing strategy become a reality. And that's why I want to see this thing on the statute book. There is much to learn from this example, and much to learn from other places and other countries.

Again, in Tom's words: 'Your chest must have been feeling bruised and sore. A number of members of the general public worked hard on you. It was dramatic stuff. Having seen it done, if ever it happens again, I feel confident I could take charge of the situation.' It is that confidence and that belief that I want to become commonplace in Wales. In April, I became one of only 3 per cent of people who've survived an out-of-hospital cardiac arrest. I feel strongly that we all now have a profound responsibility to all those who have not survived and did not survive to ensure that, in the future, we can all have the same opportunity to survive and to live. Thank you very much. 

Alun, I'm delighted that you brought this to the Chamber today. Nothing is more powerful than personal testimony, personal experience that has inspired you to try and change something that really does need changing. Unfortunately, as you said, 97 per cent of those people who suffer a cardiac arrest aren't here to share testimony in the way that you've been able to do.

I think your call for a strategy and a pathway is really well made. Personally, I'd like to see it sit alongside a new disease-specific heart condition delivery plan. Cardiology is not something that can be cut and shut with other delivery plans, and yet what you're talking about should certainly be part of this, because cardiac arrest is not the same as heart failure or a heart attack. You can be as fit as a flea, as you discovered, and you can still have this. You can't prepare for it, and that's why I'm going to be supporting these proposals. 

In so doing, though, I hope you won't mind, Alun, allowing me to remind you all that I introduced some very compatible legislative proposals right at the beginning of the process when you were able to do that. And one of the elements of that—because there were many that were in common with what you're asking for today—was for basic lifesaving skills to be mandatory on the curriculum. And, at the time, the Assembly was in favour of that, which is why I'm pleased you've raised in the debate today the need for Welsh Government to explain what it would do instead—something that would achieve the same results as efficiently and as cost-effectively. To be honest, I'm not sure that anything would be quite as efficient and effective in overcoming the bystander CPR problem, as two hours of training every year in schools is a pretty tiny amount of time to be spent on it. I think two hours is not cluttering up a curriculum. And what it does, of course, is introduce or create that ability to step in, just like the people who stepped in to save you. And I don't think a general availability of training will quite create that.

The Members of the Youth Parliament get that and that's why it's their top ask in terms of curriculum—delivering on a promise to give young people the skills for adult life. And I suppose the question that springs from that is: why should delivery of their top ask be pretty much a postcode lottery, where Scotland and England are making sure that their children know how to step in and save a life? Denmark is an exemplar in this—mandatory curriculum training is part of why they are so great at this and why their survival rates are so high.

But I want to finish, if you don't mind, Llywydd, with a big shout out to all our communities who actually put their money where their heart is. You'll know what I mean, Alun: hundreds and hundreds of people in our communities have been fundraising to put defibrillators into places where the community can benefit from them? I wouldn't want any legislative proposals to take away from the social capital, and I'm sure that's not your intention. Let our constituents be active players in solving a problem, and I'm sure that anyone watching today will be more than willing to support your legislative proposals. Thank you. Oh, I only had three minutes.

No, that's fine. Rhun ap Iorwerth.

Thank you very much, Llywydd. I'm very pleased to support this legislative proposal today. We heard Alun Davies saying that he considers himself very fortunate to be here. Only 3 per cent who suffer out-of-hospital cardiac arrest survive, and research shows that CPR is only attempted in some 20 to 30 per cent of cases. So, generally speaking, there is work to be done to ensure that everyone has the best possible opportunity to survive. We need to look at why people aren't willing to try CPR—maybe they don't know how to or they fear that they would injure somebody; people might even fear transferring diseases in this current crisis. 

Cardiopulmonary resuscitation and learning CPR is so hugely important. I received training myself, as many Senedd Members have. I've allowed my constituency office to be used for CPR training purposes, and we need to extend this to as many people as possible. The Welsh Government recommends that CPR be taught in school, but it's not mandatory, as it is in Scotland and in England. We need to change that.

But of course, it's not just in schools where we need to provide this training. There are plans by the British Heart Foundation, St John's Ambulance, the British Red Cross and so on and so forth. We need to extend those and have strategies in place to ensure that that happens—that everyone has that opportunity to participate in such training. 

Another element, of course, is the need for sufficient access to defibrillators, and there is excellent work being done by grass-roots campaigns in my constituency and the constituencies of many other Members here to ensure that more of these defibrillators are available in our constituencies. It's one thing to have them, but people need to be able to use them too. But I am particularly pleased to be able to draw attention to a clause in this legislative proposal asking for sufficient access to community defibrillators in each part of Wales. We cannot rely on active volunteers in some areas who want to ensure that their village or their part of town or city will have one—it has to be part of a national strategy. 

So, yes, proposals have been made in the past, and yes, in a way there are things that could be done without legislation to introduce some of these changes, but I urge you to support the underpinning intention of this legislation to use every possible tool, including legislative tools, so that more people get that second chance that Alun had.

David Melding took the Chair.

I very much welcome this debate and the underpinning proposal that lies behind it. Alun, when we heard the news of what had happened to you, it did send shockwaves through and was particularly poignant to me at the time because five and a half years earlier, my wife had a cardiac arrest and didn't survive. She was on her own at the time; I gave CPR for what seemed an eternity, but I think the point is how many families are actually affected by it and the actual numbers of cardiac arrests that there are.

For me, one of the issues that perhaps wasn't mentioned in it but might form part of the debate is, in fact, the need for, I think, a more proactive scanning to take place to identify some of the causes of cardiac arrest and how they occur. When one looks with hindsight at these situations, you wonder how many lives might have been saved had that been the case.

In Tonyrefail, there's been a fantastic group led by PC Steve Davies, and in Tonyrefail now we have the highest density of defibrillators: there are well over 30 defibrillators around Tonyrefail and there are several lives that have been saved already by those. And that group as well has also provided training and support, with the British Heart Foundation, in schools and so on, so the issue of training is very, very important.

One thing that is raised, though, that again might form part of this in respect of defibrillators is that communities come together, they raise considerable funds to provide the defibrillators—this is about communities working for one another collectively, but there is a need for some support in that, once those defibrillators are there, the batteries need replacing periodically and there may be a certain amount of maintenance and so on. And I think once you've gone to the effort of actually getting those defibrillators in place, I think there is a need for some sort of support to actually enable the maintenance of those assets as they are. So, that would be one of the key points I would like to see developed and discussed.

So, just to thank Alun Davies for bringing this—I think there are probably many families around who have experienced this, and, as has been said, most that experience cardiac arrest do not survive. Hopefully, by having this debate, and potentially by using the tools and, potentially, legislation, we can actually reduce that failure rate in the future. Thank you.

The aim of this motion for a Welsh hearts Bill is to improve outcomes for people who suffer out-of-hospital cardiac arrests, and I very much support that motion. The emphasis on the out-of-hospital is important: if somebody is to fall to the ground unconscious in the middle of the street or in a shop or when they're out jogging and you're the only one who's there, would you know what to do?

So, in the first instance, may I congratulate Alun Davies—I congratulated him yesterday; this is turning into a habit—but can I congratulate him specifically today on working so hard behind the scenes to bring forward this motion, and also congratulate him on the fact that he survived this out-of-hospital cardiac arrest because it's very uncommon to do so, as we've heard? It's miraculous, almost. We've heard his eloquent contribution, and thank you for that. It was a very important insight. 

Now, we know about the expertise of our surgeons, our nurses in our major hospitals who deal with heart disease, specialist surgery with regard to cardiac surgery, and they innovate every day of the week, but the emphasis of today's motion is on out-of-hospital and out-of-surgery treatment, where there are no medical professionals available. It's important, as we've heard, to have the confidence in the first instance to intervene, and on top of that the ability to take action in this emergency situation. Now, the Denmark experience shows that if everybody learned CPR in school, we could save around 200 lives every year.

Now, in finding someone unconscious on the street, it must be ensured that they have suffered a cardiac arrest, and ensure that they are breathing, look for a pulse, and ensure that it is safe for you to intervene. You then place two hands on the chest, to the words of 'Nellie the Elephant' or 'Staying Alive'—that's the rhythm that you need—then you must find a defibrillator and phone 999 for an emergency ambulance. Because these people have died. People are concerned about causing harm, but these people to all intents and purposes have died. Alun Davies had died. You can't make the situation worse. It's 3 per cent of these people who survive; in some cases, 8 per cent. So, it's 3 per cent who had died and are now alive, and Alun is one of them. That's how much of a miracle it is, and we need to give praise for that. But, of course, more people survive in countries where there is additional training for people, and more confidence for people to intervene in the first instance. And with that confidence, more people can take action. People will know what to do, people won't panic and people will give first aid and CPR, as they'll know what to do instinctively. So, that's why it should be mandatory in schools.

And to conclude, we have to improve the availability of defibrillators in community settings. They have to be prominent; we know that they're there. People have been fundraising for them—we do know that they're there. We need more of them. There needs to be a register of them, as Mick Antoniw said. Somebody needs to take care of them because there's no point having one that doesn't work. We have to know where they are and we need that register of defibrillators, and they need constant maintenance.

Every minute counts in this kind of emergency, the emergency that Alun Davies faced. That's why we need to have people willing to intervene with the defibrillators, and we need the ambulances too. Alun Davies has crystallised this perfectly in his inspirational story. It's incumbent on all of us to play our part—support the motion.

I call the Minister for Health and Social Services, Vaughan Gething.

Thank you, acting Deputy Presiding Officer. I want to start by saying 'thank you' to all Members who contributed to the debate, but in particular to Alun Davies and Mick Antoniw for sharing their personal experience. Just as with last week and the debate on endometriosis, I think it is powerful—not just for other Members, but for the watching public—where Members share their own experience of the issues being discussed. Suzy Davies did so very effectively last week, and again today with both Alun Davies and Mick Antoniw. And on Mick's specific point on maintenance—that is covered in the work that I'm going to describe in more detail, because he's right, it isn't just about having more defibrillators, it's about making sure that they're properly maintained as well as being properly accessible. And I am genuinely pleased, of course, that Alun is part of the 3 per cent of survivors. All of us, regardless of where we sit in this virtual Chamber, want to see more survivors in the future. The only real question is how.

Now, Members, I hope, will know that I'm committed to improving people's chances of surviving an out-of-hospital cardiac arrest. So, to support that aim, in June 2017 I launched an out-of-hospital cardiac arrest plan for Wales. That was an ambitious plan to see the general public, third sector, emergency services and healthcare professionals work together to respond to people having cardiac arrests in the community. It is a sad fact that, as Alun has outlined, a patient's chance of surviving an out-of-hospital cardiac arrest decreases by an estimated 10 per cent with every passing minute. Survival rates are low, but there is a real potential to save many more lives, as has been demonstrated in number of countries who are taking active steps to improve each stage in what is called the 'chain of survival'.

It's also worth reflecting that the starting point would be if we could avoid cardiac arrests in the first place, in improving our broader public health. We shouldn't forget the debates we have here about exercise, about smoking, about alcohol and having a healthy weight. I was pleased to hear Suzy Davies mention Denmark: it's a part of the world where I have family, and part of our challenge in understanding why Denmark has a significantly different outcome is partly about the out-of-hospital provision, but they start in a very, very different place culturally, but also start in a very different place with significantly better public health outcomes as well. And so our challenge is to learn from all parts of how cardiac arrest survival is improved in other parts of the world. But we recognise that we do need to take concerted action to improve survival rates here. Improving outcomes requires that broad range of activities, including early recognition and call for help to try and prevent cardiac arrest happening—Alun described how there was recognition and a call for help—the early provision of CPR to buy time for the patient, early defibrillation to restart the heart and then optimal post-resuscitation care, which all play a part in giving people the best quality—the best outcome and the best potential for a good quality of life afterwards. I do recognise that progress was initially slower than I and Members would have liked, and that there has been an impact of the coronavirus outbreak, but we have made real progress nevertheless. The progress includes improving pathways within both the Welsh ambulance service and health boards to ensure that, once a 999 call is received, people receive the help necessary and the support to increase the chance of survival both prior to the paramedic's arrival on the scene and before transport to an appropriate hospital for definitive treatment.

There's been a steady increase in the number of defibrillators mapped into the Welsh ambulance dispatch system. We now have, on the last count available to me, 5,042 defibrillators across Wales available to the public now registered, and the establishment of an out-of-hospital cardiac arrest register to better map the data surrounding out-of-hospital cardiac arrests across the entire pathway from onset to treatment and discharge from hospital—and I know sometimes that looking at data isn't always that interesting, but it's really important to whole-system improvement—and the development of all-Wales guidelines for CPR and defibrillation training.

I established the Save a Life Cymru partnership in January last year, supported by £586,000 of Welsh Government funding over two years. That initiative launched in the Cardiff City Stadium, again, because there had been a commitment from people involved around the city and also experience of loss from cardiac arrest. But we're working to build on the efforts already made by partner organisations that I've already described in the third sector, Welsh ambulance, health boards and others. The Save a Life Cymru partnership is now working collaboratively in a number of ways to understand how individual organisations within the partnership work—part of our challenge is that not all of our third sector partners are aware of what each other is doing; not all of our areas of our whole system have a proper awareness of where help can be provided—and working with youth organisations, the Wales Council for Voluntary Action, public services, universities and employers to look at opportunities for joint working. Last Friday, the partnership launched a new campaign, Touch Someone's Life. That lays the foundation for saving lives across Wales. As part of the campaign, a free online training video has been created—I hope that Members will have had an opportunity to look at it, but, if not, after this debate will do so and share it. Save a Life Cymru is encouraging everyone to spend a few minutes watching the training video and learning how to save someone's life.

So, collectively, we are determined to improve the outcomes of people suffering a cardiac arrest. We do have a plan in place that has not yet run its course, and, as I've outlined, there is real progress in it. So, whilst I have a great deal of sympathy for the motion and I want to see the improvements made, I don't believe, at this point in time, it's necessary to legislate on this area or place additional statutory duties on organisations. However, the Government will not rule out future legislation or future legislative action if we do not see the improvements that we all want to see in saving lives. So, the Government will abstain today, rather than opposing the motion, and all Government supporting backbenchers will have a free vote. And I do want to say I do think this has been a useful exercise in how we spend our time within the Senedd in debating an issue and greater awareness. I look forward to the outcome of the vote, but, more importantly, to the outcome on our progress as a country in saving more lives.

The Llywydd took the Chair.

I call on Andrew R.T. Davies to reply to the debate. Andrew R.T. Davies.

Thank you very much, Presiding Officer. And can I thank everyone who's participated in this debate moved by Alun today? I was very pleased to be a co-signatory to the motion. I'll bring a bit of levity, if I may, to my opening remarks. When Alun rang me up about this debate that he was looking to put forward and seek my support as one of the Conservative Members, I was in a middle of a beef shed chasing a load of cattle around the shed, trying to sort them out. If anything will raise your blood pressure, as anyone who understands agriculture, chasing cattle that are about 600, 650 kg, and, nine times out of 10, they are coming for you—. And then you suddenly get a phone call with Alun Davies showing up on the screen, and you start thinking that that's really going to do your blood pressure no good at all, to be honest with you. So, I am grateful, but the timing of when he did call me was not the most opportune moment, and that's why maybe the brevity of the conversation was, 'Yes, I'll do it, Alun. Thank you very much.' 

But, in the intervening period, what I've learnt is a great deal about what we can do as a legislature to try and improve outcomes for patients and, indeed, people who go through the very experience that Alun Davies and Mick Antoniw highlighted in their contributions today. Sadly, for Mick, the outcome wasn't as good as Alun's outcome was, and both participants in this debate—both Alun and Mick—highlighted how only 3 per cent of people who have an out-of-hospital cardiac experience do survive that. That's 97 per cent not surviving that experience. That, in itself, should encourage us all to focus on what we can do.

Whilst I agree with the Minister that there's much good work going on, especially some of the programmes that have been brought forward—and the Minister was candid enough to highlight how he didn't think that the plan had moved at the pace that he would have liked, which he introduced earlier in this Assembly term—it is important that, where things are failing, as was highlighted by Alun's opening remarks, we do try and turn to legislation to try and give people rights, important rights, that, ultimately, will, hopefully, improve the experience wherever you live across Wales.

Both Rhun ap Iorwerth and Dai Lloyd and Suzy Davies in their contributions highlighted the other benchmarking that we can put ourselves against. And, indeed, the Minister alluded to it as well. When you look at Denmark, for example, and the gold standard that exists in Denmark—. I appreciate what the Minister said; there are cultural differences, in particular, that most probably have driven some of those performance indicators that show what an improvement you can make when you do get it ingrained in society, life-saving skills. But, for me, Dai Lloyd's remark—and this was most probably based on his medical experience—that, you know, in Denmark they are saving 200 lives a year plus by having that life-saving experience in their society as a norm, that isn't something that we should look at lightly, to be honest with you.

The point that all Members contributing in this debate made was the great community spirit, in particular, when it comes to deployment of defibrillators. I think the Minister highlighted that it was nearly 6,000—I think that's the figure that he referred to—now that are deployed across Wales. I, in my own home area of Rhoose, have had the privilege and pleasure to work with community groups and contribute to the deployment in the last 18 months of three defibrillators in that area. But, regrettably, there would be a lot of uninformed individuals who wouldn't know exactly where those defibrillators are. That awareness, and that campaigning to make sure that those defibrillators, when they are deployed, are serviced on a regular basis, is a critical component of making sure that people understand that those defibrillators exist in the community that they live in and they can be used.

Every single contributor made the point about learning the skills to use the equipment, because there's no point in deploying it if people don't feel confident enough to use the defibrillators. I have to be honest myself: I, most probably, even after—like Rhun ap Iorwerth said—undertaking sessions here in the Assembly or, indeed, in our constituency or regional offices, wouldn't necessarily feel that confident to go and use a defibrillator. I certainly, after this debate today, will make sure that I double up on my skills on that, because who knows when we might be walking in that park and see what happened to Alun Davies, for example, and be able to step in and, hopefully, save a life.

I do hope that Labour backbenchers and all party members here today—whether it's Plaid Cymru, the Conservatives or the independents—do agree with this motion that's on the order paper today. Because it really is a proposal at the moment. I understand the Minister's point, when he says that the Government will abstain. But we are going into an election period, and it is incumbent on Members, if they do believe in improving cardiac services across Wales, that they do put pressure on their individual parties to put this in their manifestos. Because it's taking the words that people speak in this Chamber and putting them into reality that actually makes improvements in our society and our communities across Wales.

So, I do hope that support from across the Chamber will come for Alun's proposal, and I do thank him for the eloquent and informed way he delivered his opening remarks today. It's a pleasure to see him on the screen as being one of only those 3 per cent of individuals—. And I will repeat that—. I can see the Presiding Officer looking at me with the red marks on—[Interruption.] But I will make this point to all Members: only 3 per cent of people survive an out-of-hospital cardiac experience. That's 97 per cent don't. That, in itself, should make us all want to redouble our efforts and make those improvements, and, by voting for this proposal this afternoon, we can make that difference. Thank you, Presiding Officer.  

The proposal is to note the motion. Does any Member object? [Objection.] Yes, I see that there are objections and therefore I defer voting until voting time.

Voting deferred until voting time.