Public Health (Availability of Defibrillators) Bill 2013

Wednesday, 19th June 2013

I would also like to heap praise on Senator Quinn regarding the Bill he has introduced. I am supportive of this initiative. I understand the Minister for Health wants to conduct a technical assessment but he did not outline a timeframe. I am always concerned when Ministers do not outline a timeframe. Perhaps it could be completed before we return in September and we could then complete the passage of the Bill. I am sure Senator Quinn would give it the summer to allow that to take place.

The Bill represents a powerful legislative platform to ensure many more lives are saved through bystander CPR and early defibrillation. This is important, given that an estimated 10,000 people die each year from cardiovascular disease, of which almost half are from sudden cardiac death. A total of 70% of these deaths occur outside hospital. The survival rate for out-of-hospital cardiac arrest was 6.5% in 2012. This figure can and must be improved upon. International comparisons show that higher rates can be achieved, particularly when the equipment and training are in place to ensure early recognition, early CPR and early defibrillation. Survival rates in Norway, Sweden and Denmark are 13%, 11% and 9%, respectively. Even higher rates have been recorded in the Netherlands, where research over a three-year period to 2009 showed that neurologically intact survival was 49.6% for patients treated with an on-site defibrillator compared with 14.3% where there was no defibrillator. Perhaps this will help the Minister with his research. I fully support the efforts made in this Bill to achieve a survival rate of 40%.

Legislating to provide more defibrillators is a vital prerequisite to increasing the life-saving role of bystander CPR. Like others, I commend the excellent work of the Irish Heart Foundation’s Chain of Survival initiative, which comprises four vital links that can save a life: early access; early cardiopulmonary resuscitation; early defibrillation; and early advanced care. In addition to overseeing training in the initiative, the IHF provides significant assistance enabling communities and organisations throughout Ireland to maximise early CPR and defibrillation. The foundation has unrivalled expertise in the practical operation of the efforts we are discussing.

Senator Brennan and others mentioned that the presence of a defibrillator often creates demand for training on how it use it and, therefore, helps to create knowledge. It is important to ensure that through regulations there is adequate, ongoing and certified training. Everybody knows how important it is to regularly update training in the workplace and so on. Knowledge is power. We need to hardwire knowledge of CPR into the public consciousness by including a CPR training module in the school curriculum. This would save many more lives. I am a girl guide leader and we include it in our training. Everybody engaged in youth work and sports should include CPR in training. Young people who aim to be leaders in these organisations should have access to this knowledge. We should share such knowledge, because who knows when we will need to put it into practice?

I raised an Adjournment matter with the Minister for Health last week relating to National Stroke Awareness Week. This year’s focus is on the IHF’s Act FAST campaign, which was launched in 2010 to increase public awareness about the early signs of stroke and to encourage speedy medical intervention. During the debate, I referred, in addition to financial assistance, to other supports at the disposal of the State, such as the provision of advertising sites in high-footfall areas of Government buildings and property and consideration of a way to reimburse the 23% the foundation has to pay in non-returnable VAT for the campaign, which is proving not only to save lives and improve quality of life but also to save the State money.

There is also a VAT argument to be made regarding defibrillators. There is an anomaly in our taxation system whereby an individual can get a tax rebate of 23% on the purchase of a defibrillator whereas a sporting organisation or club of volunteers cannot. This needs to be rectified. I appreciate the anomaly is rooted in VAT law but I would like to know what is being considered in the context of existing taxation law to address this issue. I will continue to pursue this issue where the State charges VAT when it is saving money because NGOs, sporting and youth organisations and civil society organisations are doing its job and saving lives in some cases. I commend Senator Quinn on this initiative, which I fully support.

Adjournment Motion – National Stroke Awareness Week: Act FAST Campaign

Wednesday, 13th June 2013

Senator Jillian van Turnhout:

I thank the Minister for facilitating me and coming into the House. It is an extremely busy day but we both know stroke awareness is very important to both of us. This is national stroke awareness week, with this year’s focus on the Irish Heart Foundation’s Act FAST campaign, which was launched in 2010 to increase public awareness about the early signs of stroke and encourage speedy medical intervention. I welcome Mr. Chris Macey from the Irish Heart Foundation to the Gallery. Under an Adjournment motion in January last year I raised the issue of stroke rehabilitation services and the Minister knows I have raised it several times at the health committee before him.

An estimated 10,000 people suffered a stroke in Ireland in 2012 and the same number are estimated to suffer a stroke this year. Approximately 2,000 die as a result of stroke, making it Ireland’s third biggest killer. Stroke is the single most significant cause of severe disability and up to 50,000 people are living in our communities with disabilities as a result of strokes. In addition to the devastating impact stroke has on the sufferer and their families, the financial costs are huge. The Economic and Social Research Institute, ESRI, estimated that in 2010 the direct annual cost of stroke was €557 million of which as much as €414 million is spent on nursing home care and there is nothing to indicate that this cost has fallen in the past three years.

In the face of these stark figures, the Irish Heart Foundation’s Act FAST campaign is a commendable initiative which warrants State support. The campaign, while still in its infancy, has been a resounding success, particularly in raising public awareness of stroke warning signs through the first three letters of the acronym FAST, as follows: face, has the person’s face fallen on one side?; arms: can the person raise both arms and keep them elevated?; and speech, is the person’s speech slurred?

The most recent Irish Heart Foundation’s Attitudes and Behaviour study found that there had been a 190% increase in awareness of these warning signs. This increased awareness, along with the rapid development of the 24-7 thrombolysis services nationally by the HSE’s national stroke programme, has contributed to a 400% increase in the numbers receiving life-changing, clot-busting treatment and it has helped cut death and disability rates from strokes significantly against demographic and international trends.

However, the last letter of the acronym, arguably the most important one since it is the call to action, namely, “T”, time to call 999 if one sees any of the signs, has not had the desired impact. Just over half of the respondents surveyed said they would call an ambulance. Speedy medical intervention is imperative if we are to limit the detrimental impact of stroke. The average stroke destroys 2 million brain cells every minute, which means the quicker one gets emergency treatment, the more of one’s brain can be saved. The knock-on effect is reduced risk of death or severe disability and a considerable financial saving to the State.

The Irish Heart Foundation is entering a new stage of the campaign where there is clearly room to improve on awareness of the timely medical intervention, and it needs State support. In addition to financial assistance, there are other supports at the disposal of the State, such as providing advertising sites in high footfall areas of Government buildings and properties and maybe examining a way of reimbursing the 23% they have to pay in non-returnable VAT for the campaign, which is proving to save not only lives and quality of life, but is also saving the State money. I would like the Minister’s reassurance that both financial and alternative means of supporting the new phase of the Act FAST campaign are being positively considered.

Minister James Reilly:

I thank the Senator for raising this important issue and raising awareness in the week that is in it. She is right about the figures; they are staggering. Some 10,000 strokes a year is very serious. We should acknowledge the growth in public awareness of stroke warning signs, as the Senator has outlined, and the improvements noted and confirmed recently by the HSE. The FAST campaign coincided with a major development of stroke services nationally, including an increase in the number of stroke units around the country from six to 27 and the expansion of 24-7 thrombolysis treatment from a small number of hospitals mainly in urban areas to all hospitals that treat stroke patients. The FAST campaign has assisted health services to maximise the impact of the stroke service improvements. The HSE has advised my Department that it provided €268,000 last year and €308,000 this year to the Irish Heart Foundation to help with its various health promotion activities. Like the Senator I welcome the foundation’s presence here.

Such improvements in stroke services were envisioned in the policy document Changing Cardiovascular Health: Cardiovascular Health Policy 2010 – 2019 which was launched in 2010. This established a framework for the prevention, detection and treatment of cardiovascular diseases, including stroke, which seeks to ensure an integrated and quality assured approach in their management, so as to reduce the burden of these conditions.
I could go through the rest of this but I would much prefer to talk about prevention. In this country we have a long history politically of engaging in expensive developments. They are necessary, and politicians are always very pleased to open a new wing of a hospital or an MRI scanner but have been reluctant in the past to invest in public health initiatives that can save many more lives. When we look at the causes of stroke we see our old enemies again: tobacco is a major cause of stroke and if we could keep our children and the next generation from starting on this habit it would be a lot easier than trying to get them to quit and would prevent a huge number of strokes per year.

Obesity is another issue which leads to diabetes and hypertension, which is well known to be associated with stroke. The issue of alcohol must be mentioned also because it has peculiar properties with regard to blood pressure. It is known to cause vasodilation peripherally so one would imagine it would drop one’s blood pressure, but it causes vasoconstriction which causes one’s blood pressure to go up. It is a risk factor also.

Many of our figures relating to stroke are preventable if these areas are tackled. Earlier I mentioned the Government’s commitment to healthy Ireland. I am the Minister for Health but I often feel as though I am the Minister for ill-health because all we speak about is disease and illness when what we need is to keep people well. The Department of Health cannot do this alone. It needs the Department of Justice and Equality to keep our streets safe so people can exercise. It needs the Department of Finance and the manner in which it taxes and incentivises certain types of behaviour. It needs the Department of the Environment, Community and Local Government to give us safe well-lit places at night to exercise. We also very badly need the Department of Education and Skills on board and I know the Minister, Deputy Quinn, is very committed to this area.

This is about developing healthy lifestyles early in life which will stay with people. Early habits are the hardest to break. This has also been proven with regard to tobacco. If one does not start smoking before the age of 21 one is unlikely to take it up. We know this industry goes after our children. It wants to replace with new recruits those who have died, including the 5,200 who died from tobacco related illnesses this year, and those who give it up, and these new recruits are children. According to a survey 78% of smokers stated they started smoking before the age of 18. It is wonderful we have a new stroke programme and we are saving a life a week, and I am told the new initiatives we have undertaken save a life per day. While all this must be done to help those who fall ill now, we must look down the road and realise the actions we take now could save the next generation from much hardship and grief. If we do not tackle the obesity epidemic among young people and the rising epidemic of diabetes we may very well be the first generation to bury the generation behind us which is an appalling thought. No parent wants to be at his or her child’s graveside.

Senator Jillian van Turnhout:

I support the Minister on the preventive measures on tobacco, alcohol and obesity. Strokes are Ireland’s third biggest killer and I ask the Minister to give consideration to the financial assistance I have suggested and perhaps consider other measures such as using public buildings for billboard spaces or reimbursing the 23% VAT. This is a public health awareness campaign and one could argue the State should be running it. Perhaps there is a way the Government could support it such as refunding the 23% VAT to the Irish Heart Foundation.

Minister James Reilly:

I am very happy to state we have cross-Government support for these initiatives, particularly the healthy Ireland initiative. I will have to engage with my colleague, the Minister for Finance, to achieve the VAT reimbursement the Senator seeks. This is not the only area where I feel VAT needs to be examined, as we also have VAT on condoms and vaccines. There is no VAT on tablets or liquid medicine but because vaccines are in injectable form they are subject to VAT. I would like to discuss a range of areas with the Minister. We are in very constrained financial times and it is difficult to seek to reduce the Exchequer return in any real sense.

We must get the people of Ireland and Europe off their addiction to nicotine but we also need to get the governments of Europe off the addiction of the income which tobacco products bring.

The Lancet

In July 2021, Jillian co-authored an article in the world-renowned medical journal “The Lancet”