Education Bill

Memorandum submitted by the British Heart Foundation (E 56)


· The Education Bill provides an opportunity to ensure that children leave school with essential life skills

· Research shows that children are capable of learning these skills and using them in an emergency

· At present, too few children are taught Emergency Life Support (ELS) Skills that could enable them to help save someone’s life in an emergency

· 30,000 people each year in the UK have cardiac arrests outside of the hospital environment – less than 10 per cent will survive to be discharged from hospital

· These skills are particularly crucial at times of cardiac arrest, when the heart stops beating, and can significantly improve the chances of survival

· ELS should become a core part of the new National Curriculum


1.1 The British Heart Foundation (BHF) is the nation’s heart charity and is dedicated to saving lives through pioneering research, high quality patient care and information, and by campaigning for change.

1.2 Around 88,000 people die as a result of a heart attack every year in the UK. [1] Heart attack is a leading cause of cardiac arrest, where someone’s heart stops pumping blood around the body and they stop breathing normally – it only takes a few minutes for irreversible brain damage to occur. 30,000 people each year in the UK have cardiac arrests outside of the hospital environment. Less than 10 per cent of these people will survive to be discharged from hospital. [2] During this time, bystanders are crucial to maximising a person’s chance of survival. By teaching ELS at school we can create a new generation of lifesavers and equip children with the skills to help keep people alive in an emergency until professional help arrives.

1.3 Part 4 of the Education Bill focuses on "Qualifications and the Curriculum". We believe that the Education Bill provides an excellent opportunity to ensure that all children are taught essential skills through the National Curriculum, including the skills to support community-based responses to cardiac arrest and other emergencies.

Learning key skills that are vital in emergencies

2.1 ELS is the set of actions needed to keep someone alive until professional help arrives. It includes performing cardiopulmonary resuscitation (CPR), putting an unconscious person in the recovery position, dealing with choking, serious bleeding and helping someone who may be having a heart attack.

2.2 These skills are particularly important in cases of cardiac arrest. Many people who might otherwise die could be saved if someone applies ELS on the scene. Evidence shows that around two thirds of cardiac arrests that occur outside of hospital occur in the home, and that nearly half that occur in public are witnessed by bystanders. [3] With each minute that passes in cardiac arrest before defibrillation, chances of survival are reduced by about 10 per cent. [4] CPR given immediately following a cardiac arrest within a community setting, buys time before using an Automated External Defibrillator, and so can triple the chance of survival. [5]

2.3 In each case of cardiac arrest, assistance that can be provided at the scene can help to keep the person alive before the emergency services arrive. A lack of blood circulation for a few minutes will lead to irreversible brain damage. In the UK the ambulance services have an 8 minute target to arrive at a scene following a 999 call to a cardiac arrest – this is far too long an interval to hope to treat the great majority of victims of sudden cardiac death. A cardiac arrest is the ultimate medical emergency and the correct treatment must be given immediately if the patient is to have any chance of surviving. In 2009-10, of the twelve NHS organisations providing ambulance services in England, only seven met or exceeded the 75 per cent standard for 8 minute response times. [6] People who are trained in ELS will buy time for the casualty, until professional help arrives, which could improve the chance of a successful outcome. [7] Too few people in the UK have the skills necessary to be able to save a life.

Teaching emergency lifesaving skills to children

3.1 Children are often present at accidents and emergencies. If properly trained they can be as effective as adults in administering ELS, helping to prevent disability and save lives. [8] Children aged 10 and above can learn the full range of ELS including CPR, and younger children are also able to learn many of the skills. [9] Those children who are not yet strong enough to compress the chest adequately are still able to learn the technique adequately, which can then be effectively used as they develop. [10] Research has also shown that skill retention among children who are taught ELS is good. [11]

3.2 Since 1996, the BHF has operated the Heartstart programme, helping to train children in ELS skills. To date, Heartstart has successfully trained over 2.6 million people in ELS skills, of which over 760,000 are children. We provide training for teachers to then train children at their schools, in addition to resources required for successful ELS training. Older children also have the opportunity to become peer mentors at their school, assisting with the ELS training of younger groups.

3.3 The BHF has found that a significant number of children taught these lifesaving skills have had to use them in practice. Around one in five schools registered with Heartstart reported in 2008 that students have used ELS skills in a real life situation, with on average three students in each of these schools having done so. [12]

3.4 We have also seen first-hand that children enjoy and value this training. For example, a review of the BHF’s Heartstart programme in Northern Ireland found that 98 per cent of children enjoyed the training, and 67 per cent had shared what they had learnt with family and friends, indicating this may be an effective way of reaching the wider community. [13]

3.5 Research shows that after initial training or retraining, ELS skills do deteriorate nominally but many people remain competent for up to 1 year. [14] This highlights the importance of ensuring that ELS is taught regularly to children. Incorporating ELS in the school curriculum would ensure that it is provided in a structured and consistent way.

The national curriculum in England

4.1 Since September 2008 first aid training, which covers some of the parts of ELS, has only been included in the curriculum for English secondary schools as an optional part of the non-statutory subject of Personal, Social, Health and Economic Education (PSHE). Essential component parts of ELS such the recovery position and CPR are only provided as discretionary examples in the guidance notes, and not explicitly spelt out. There is no requirement for those schools already teaching PSHE to include these skills.

4.2 PSHE is not the only subject where ELS can be easily included. There are also several other opportunities within the curriculum that provide a suitable environment for ELS to be taught, including Physical Education, Citizenship and Science.

4.3 The Department for Education’s Schools White Paper stated that the new National Curriculum will focus on "essential knowledge and understanding that pupils should be expected to have to enable them to take their place as educated members of society". [15] Given the curriculum is being broadly reassessed, we believe the time is right to ensure that essential life skills such as CPR are included.

4.4 A number of organisations including the BHF have already shown that ELS skills can be effectively taught within schools, and have provided suitable models to provide training and support for teachers so they can successfully deliver ELS. We believe that as part of the new curriculum secondary school pupils should be taught these skills from year 7, and they should be refreshed every year until they leave school. For each pupil, this would take as little as two hours of teaching over the course of the school year, which we estimate to be just 0.2 per cent of annual teaching time a child receives. [16]

Public support for teaching ELS on the curriculum

5.1 Last month, we commissioned research to assess the views of children, parents and teachers on the idea of making ELS a part of the curriculum to be taught to all secondary school pupils. The results showed strong support for this measure. OnePoll surveyed 2,000 parents across the UK, and found that 1,393 (70 per cent) thought that children should be taught ELS at school. [17] The support was higher still among children. 1,000 children in the UK aged 11-15 were asked whether thought they should be taught how to save someone’s life in an emergency as part of their lessons at school, and 778 (78 per cent) believed that they should. [18] We were most encouraged by the support from teachers themselves. Of the 500 teachers in the UK survey, 428 (86 per cent) thought that ELS, including CPR, should be part of the curriculum in schools – only 25 (5 per cent) disagreed. [19]

5.2 The proposal is also supported by a number of organisations and ambulance services, including the Resuscitation Council UK, British Medical Association, Royal College of Nursing, Royal College of Physicians, the College of Emergency Medicine, and the Joint Royal Colleges Ambulance Liaison Committee.

International comparison

6.1 There are successful examples internationally where countries have successfully included ELS skills as a core part of their curricula taught to all pupils at state-funded schools. Within Europe, countries including France, Denmark and Norway already have ELS as a mandatory part of their school curricula – in Norway it was made compulsory as long ago as 1961. [20] They have been using strategies ranging from self-learning with DVDs and manikins to structured teaching – all as part of the curriculum. [21] In all three countries ELS is taught in a staged approach according to the child’s age and capabilities. In Denmark for example basic first aid principles are taught to primary school children (6-8 years of age), secondary school children (8-11 years of age) are taught expanded first aid skills including dealing with bleeding, and from 12 to 15 years pupils are taught additional ELS skills including CPR.

6.2 Within Australia, education is devolved to state level. Several states have already included basic CPR and ELS training as mandatory requirements in their school curricula. In 2004 in Queensland for example, the State Government announced an $11.1 million Safe and Healthy Schools Policy in which $1 million was provided for 'training the lifesavers of tomorrow'. Since 2005 state schools have been required to provide CPR skills training to all students before leaving Year 12. [22]

6.3 Research by the American Heart Association (AHA) from January 2011 has also shown that 36 of the 50 US State Governments have passed legislation, curriculum content standards, or frameworks referring to teaching CPR in schools. [23] The AHA has recommended that CPR be required for graduation from secondary school in all US states.

Education Bill 2011

7.1 The Education Bill provides an excellent opportunity to ensure children leave school with essential life skills. It is crucial that ELS are included in this. By teaching children how to save a life in an emergency, we can provide them with essential practical knowledge that could help them support their families and communities in the future.

7.2 We believe that the Education Bill would benefit from the insertion of a new clause to include ELS skills at secondary schools. This clause would require ELS to be taught at Key stages 1, 2 and 3 (thus amending Section 84 of the Education Act 2002). Annex 1 contains the proposed text to this effect.


· There is a clear need to increase the number of children trained in ELS skills and as a result improve survival prospects for people following a cardiac arrest

· The Education Bill provides an excellent opportunity to ensure that these vital skills are included as a crucial component of the new curriculum

· Such a change has considerable support amongst the public and from several well-respected public health organisations

· Annex 1 details an additional clause to add to the Education Bill to enable these skills to be taught

Annex 1 – proposed insertion to the Education Bill 2011

To insert the following new clause-

"Emergency life support skills

Emergency life support skills and the national curriculum for England

(1) Section 84 of EA 2002 (curriculum requirements for first, second and third key stages) is amended as follows.

(2) In subsection (3)(h)-

(a) in paragraph (i), omit "and"

(b) after paragraph (ii) insert ", and

(iii) emergency life support skills".

(3) In subsection (4) , at the end insert ", and

""emergency life support skills" means skills which enable the individual who has them to assist in keeping another individual alive in an emergency.".

March 2011

[1] Scarborough, P. et al (2010) Coronary heart disease statistics 2010 edition. British Heart Foundation: London.

[2] Resuscitation Council (2010) Guidelines – chapter 1

[3] Virdi, G. et al (2010): London Ambulance Service Cardiac Arrest Annual Report 2008/09

[4] Nolan, J.P. et al (2010): European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2010;81:1219-76

[5] Koster R.W. et al. (2010): European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2010;81:1277-92

[6] NHS Information Centre (2010): Ambulance Services, England 2009-10

[7] London Assembly Health and Public Services Committee (2007): A heartbeat away – Emergency life support training in London

[8] Thurston, M. and May, S. (2005): Emergency life support training for school children. Exploring local implementation and outcomes of the Heartstart UK School Programme within the context of the National Healthy School Standard. Centre for Public Health Research, University of Chester

[9] Lester C. et al. (1996): Teaching schoolchildren cardiopulmonary resuscitation. Resuscitation, 31(1): 33-38

[10] Jones, I. et al (2007): At what age can schoolchildren provide effective chest compressions? A prospective observational study from the Heartstart UK schools training programme. BMJ. 2007 June 9; 334(7605):1201

[11] Fleischhackl, R. et al. (2009): School children sufficiently apply life supporting first aid: a prospective investigation. Critical care (London, England) 2009;13(4):R127

[12] British Heart Foundation (2008): Setting up a Heartstart UK Schools Programme

[13] North Eastern Education and Library Board (2009): Heartstart Schools Programme Audit Report 2007/2008

[14] Christenson, J. et al. (2007): The effect of time on CPR and automated external defibrillator skills in the Public Access Defibrillation Trial. Resuscitation 2007 Jul;74(1):52-62

[15] Department for Education (2010): The Importance of Teaching – The Schools White Paper 2010

[16] Figures based on 25 hours of lessons per week for a 38 week school year

[17] Research was carried out online by OnePoll in February 2011. Total sample size was 2,000 parents of children aged 11-15 years old. The figures have been weighted and are representative of UK parents for this age range.

[18] Research was carried out online by OnePoll in February 2011. Total sample size was 1,000 children aged 11-15 years old. The figures have been weighted and are representative of UK children for this age range.

[19] Research was carried out online by OnePoll in February 2011. Total sample size was 500 teachers. The figures have been weighted and are representative of UK teachers.

[20] British Red Cross: Life. Live it. The case for fi rst aid education in UK schools

[21] Isbye, D.L. et al. (2007): Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children. Circulation 2007:116;1380-85


[23] Cave D.M., Aufderheide, T.P., Beeson, J. et al. (2011): Importance and implementation of training in cardiopulmonary resuscitation and automated external defibrillation in schools: A science advisory from the American Heart Association. Circulation. 2011;123:691-706