It is always a great honour to have a subject chosen for discussion by the House. I am grateful that my subject was selected for debate this evening. I am also glad that my hon. Friend the Minister is here to reply to the debate—first, because, as we all know, he has a high reputation for care in the community, particularly of school pupils. Secondly, I well remember his able presentation of prizes to winners of the St. John Ambulance three-cross award at Britannic house a few weeks ago an award sponsored by British Petroleum. I remember how well he did so, how well it was received and how well the event was organised by the director general of St. John Ambulance, Mr. Robert Balchin, and his able wife who organised the school pupils in a convincing way. I hope that my hon. Friend will agree with that.
I wish to declare two interests—one in the health industry and the other as the unremunerated parliamentary representative for the Order of St. John, which is the parent body of the St. John Ambulance Association and Brigade. The subject before us is first aid in schools. Two points are involved. The first is the teaching of first aid to school pupils. Under the new national curriculum, that could be included in the optional subjects. The second point is that some core subjects lend themselves to a certain amount of first aid. For example, to facilitate safe instruction in science there may be some leaning towards protection and first aid. Another example of physical education, where first aid might be involved in swimming activities.
I welcome the fact that the National Curriculum Council is to give guidance on first aid. I also welcome any moves in schools towards the teaching of first aid with the one, two and three-cross awards of St. John for children of six, 10, 12 and beyond. That has been highly successful.
The main thrust of the debate relates not so much to the teaching of first aid, although that is important as to the first aid cover available for school pupils. The Government have wisely pushed preventive medicine in diet, screening processes and so on. I welcome the fact that the National Health Service is being streamlined, which makes it more efficient and effective in offering health care.
First aid is part of the whole process of preventive medicine. If it is correctly administered, first aid can minimise damage—for example, by restraining the loss of blood which, if excessive, could lead to brain damage. It can also reduce the long-term knock-on costs to the NHS. If an injury is properly treated immediately it happens, there may be less long-term damage to the patient and therefore much less long-term cost to the NHS. Of course, the most important prerequisite is that it is correctly applied, so training is absolutely vital. If it is wrongly applied, it could be extremely dangerous and could even cause death. For example, if someone with spinal or neck injuries is moved incorrectly, he could easily be killed.
Training in first aid is offered by the British Red Cross Society and the St. John Ambulance Association and Brigade. The latter is ably directed by Mr. Robert Balchin, who is well known to my hon. Friend the Minister. First aid means the local availability of qualified first aiders.
Training to become a qualified first aider takes about three days. First aid also means the location and the contents of first aid boxes. It also means the publication of lists and telephone numbers of local general practitioners and local casualty stations. We must always remember that first aid is not simply the ability to dial 999 for the emergency services; it is much more than that.
There are more than 250,000 accidents in the United Kingdom every year, which represent a serious drain on the resources of the National Health Service. That is a clear example of the need for the wider availability of qualified first aid cover. To meet that historical but increasing need, previous Governments introduced the Health and Safety at Work etc Act 1974, which requires that places employing more than 150 people must have at their disposal at least one qualified first aider.
When I examined that legislation, I was stunned to discover that no such cover is required in schools. There are some 8·5 million school pupils in this country, and the absence of any legal requirement for first aid cover in respect of those young people concerns me. I would have thought that a school was inherently more dangerous than a bank. Short of a hold-up, a bank is a relatively safe place to work. A member of the staff could get electrocuted by a computer, but the same is true of a pupil using a school's computer, which might be less well insulated electrically.
Young people of school age are also more prone to accidents. It is often at school that, for the first time, young people light matches and illicitly smoke cigarettes—when there is a risk of their clothes catching fire and of other accidents. Youngsters also swallow things that they should not, break their legs, and so on. The school age population is more prone to accidents than the employees of an industrial or commercial company.
The record shows that last year there were more than 8,000 accidents in schools—some of them fatal, and all of them serious. That figure does not include minor accidents. But while there is a legal requirement for first aid cover in industry, no such requirement exists in respect of schools, at which 8·5 million pupils work. Instead, the Government rely on guidelines that are essentially voluntary.
In the past, Governments have resisted the temptation to legislate, preferring to rely on voluntary co-operation. What is the result of that approach? The St. John Ambulance Brigade undertook a survey of 13,000 out of the country's 23,500 schools—18,500 of which are primary schools. St. John received 4,256 replies, which statistically is an excellent sample. What is not so excellent is what the sample reveals.
It showed that only 32 per cent. of schools follow the Government's voluntary guidelines. Worse still is the mirror image of the 68 per cent. of schools that do not follow them. The survey also revealed that 76 per cent.—or more than three quarters—of all schools do not have the first aid cover that is required by law of commerce and industry under the Health and Safety at Work etc Act 1974. It showed also that 20 per cent., or one fifth, of the schools have no cover by a qualified first aider. Those figures suggest that the Government's guidelines are not being observed but are being honoured in the breach.
The guidelines also require the display of lists of local general practitioners and casualty stations, but the survey shows that 72 per cent., or just under three quarters, of schools do not display such information. Indeed, 63 per cent. of the schools do not even have the lists.
In summary, the facts show that when schools are not required to have the same cover as industry, they do not bother. Why is there such discrimination? Why do the Government allow a voluntary regime for schools while there are legal requirements for industry and commerce?
The Government guidelines are not working. Obviously there is a need to strengthen the law, beef up the health and safety at work regulations, extend them to schools and make the voluntary guidelines legal requirements. That is a priority need, as was demonstrated in the last Session of Parliament, when I tabled an early-day motion which received the cross-party support of no fewer than 336 hon. Members. It was the 11th most strongly supported early-day motion since records began. Surely that must tell the Government that the House really feels that action should be taken as a matter of priority.
I urge the Government to amend the legislation to bring schools up to the standards of places of work. As I said, Ministers have resisted demands for change on two grounds—cost and excessive work load on the schools. The costs are very small. The training to qualify as a first aider costs roughly £70. A qualification lasts for three years, so for a school of 150 or more pupils and staff, the cost would be £70 spread over three years, or about £25 a year. I appreciate that the Government have made many changes in education, including the introduction of the national curriculum and first aid provision would require extra effort on the part of school administrators and staff. I do not say it lightly, but I believe that that added duty should be introduced because it is a priority—even above some of the duties they are already being asked to undertake.
In allocating that requirement I urge my hon. Friend to consider three things: need, priority and precedent. As I have said, the need is obvious. There are 8,000 serious accidents in schools each year; 8·5 million schoolchildren are vulnerable and, under the voluntary system, three quarters of the schools are not offering the first aid cover that is required legally of industry and commerce. The priority is that old adage, "safety first", and 336 right hon. and hon. Members believe that we must put safety first now as a matter of priority. Finally, there are precedents. The Health and Safety at Work etc Act already applies to industry and commerce, so why should it not apply to schools?
I am asking the Minister to overturn any advice he may have received to continue avoiding the extension of the regulations on the grounds of cost and excess work load. I am asking him to act now in response to a really obvious market need and in response to demands from the House. I am asking him to give 8·5 million schoolchildren in the United Kingdom safety first in their schools now. I very much look forward to a robust reply from my hon. Friend. I hope that he will fill that urgent need for schoolchildren and the priority demand by Members of the House to put safety first.
I congratulate my hon. Friend the Member for Winchester (Mr. Browne) on raising on the Adjournment a topic of the greatest interest and importance to us all—the safety of schoolchildren. His championship of first aid in schools is well known. I hope that what I have to say will give him and other hon. Members some reassurance about the seriousness with which the Government approach this question.
The debate covers two separate but related matters—the provision of first aid in schools and the teaching of first aid in the curriculum. I shall deal with each in turn.
First, the debate covers the regulations that govern the provision of first aid in places of employment and how these relate to the situation in schools and other educational establishments. I am sure that the House will agree that, for any such arrangements to be effective, they must be seen as primarily the responsibility of those who are directly providing the services concerned. That is, indeed, the case under our law. The responsibility falls, in the case of maintained schools, to the local education authorities to ensure that proper arrangements are made, and, in the case of other sorts of school, to the relevant governors or other providers of the schools.
I shall go into more detail later about the nature of those legal responsibilities and the moral responsibilities that stem from them. Meanwhile, what implication has this for the role of the Department of Education and Science and other education departments?
There is, first, a valuable inspectorial function to be carried out, and I pay tribute to members of Her Majesty's inspectorate for the work done in their day-to-day monitoring of the system and in the advice they give, drawing on that experience, to authorities.
Secondly, there is a further role for the Department and for other education departments in making sure that the system has available to it an up-to-date and useful range of guidance on all important safety matters. My Department's "Safety in Education" series has provided regular bulletins of advice for teachers to help them to be more aware of the kind of hazards they are likely to meet at their work and to cope with accidents and emergencies occurring at school. I pay tribute to the many teachers who have displayed great presence of mind and great practical skill in some very difficult situations in recent days and particularly last week during the great storm.
We also issue a range of publications going into more detail on particular aspects of safety. The most recent of these, concerned with safety in outdoor education, was published last year. It has been our practice to include in each of these publications a specific section on first aid.
Nevertheless, a little while ago it became clear to the Department that local education authorities and others would benefit from more specific guidance on various matters concerning the provision of first aid. Accordingly, following an extensive consultative exercise that included some extremely valuable assistance given by the St. John Ambulance and the British Red Cross Society, the Department of Education and Science, together with the Welsh Office and in co-operation with the Health and Safety Executive, sent all chief education officers in England and Wales a document of guidance on arrangements for first-aid provision in schools and colleges. At the same time, the document was sent to relevant organisations in the non-LEA sector.
It may be useful if I look briefly at the main content of that document. First, it provided advice on an issue that clearly concerns hon. Members—the background of legislation, regulation and common law. In particular it drew attention to the desirability of paying heed to Health and Safety Executive guidelines on such matters as the contents of first-aid boxes, and specifically recommended that education authorities should take account of criteria laid down in the approved code of practice stemming from the Health and Safety at Work etc. Act 1974.
Next, the document gave information on other relevant publications and other useful materials, such as films and videos produced by a range of agencies with an interest in this area, including the Health and Safety Executive, the British Red Cross Society and St. John Ambulance.
Next, we thought it right to lay emphasis on the resources needed for proper first-aid provision and in particular on the need for suitable training for teachers. As the document says:
it has been a long-standing principle that all teachers should have a basic working knowledge of first aid and for them to be able to recognise situations where medical advice is necessary. It is highly desirable that a proportion of the teaching staff of every school and college should have attended a course of training and have acquired a relevant certificate.
That clearly states the Department's policy over the years on the importance of proper training for teachers in each establishment. The document describes in greater detail what should be done and gives some practical recommendations about particular types of training that may be helpful.
The next section of the document provides guidance on the very important question of procedures, including arrangements for contact with medical and other emergency services, and suggests some practical measures, such as displaying up-to-date lists of addresses and telephone numbers, which could easily be followed and with little resource implicaton. Advice is also provided on procedural matters such as the recording of accidents, which is a most important consideration if lessons for the future are to be learned. There follow sections on the prevention of accidents, on the particular problems created by the AIDS virus and a reference to the particular treatment needed for children with special needs of various kinds.
The final component in the document is a checklist of 15 important questions, which were aimed at individual establishments rather than local education authorities, with the intention of prompting them to think again about their practices and procedures.
I hope that that brief account of the Department's most recent comprehensive publication will reassure my hon. Friend that this is not an issue which the Department is reluctant to consider or on which we are backward in giving a lead.
Will my hon. Friend allow me to proceed'? I have little time left.
As my hon. Friend said, our friends in the St. John Ambulance organisation like my hon. Friend, I pay tribute to Mr. Robert Balchin—reported to us last year on the results of a survey that they had undertaken of a large number of schools, and which, among other things, looked at how the schools were in practice implementing certain of the Department's recommendations, including some of those that I mentioned.
The picture that emerged was mixed, with generally good practice on some issues, such as the response to the AIDS threat, and a less obviously adequate response on other matters, including some simple ones such as the provision of notices about emergency procedures. I am bound to say that, like my hon. Friend, I was disappointed overall by what it indicated—that there was some way to go before we could be confident that the schools and other educational establishments were doing all that they reasonably could to observe the best practice.
My Department has accordingly undertaken a consultation exercise, on the basis of the St. John's findings, with a number of relevant national bodies, including the Health and Safety Executive, the Welsh Office and the main local education authority associations, in order to consider jointly what further steps might sensibly be taken.
We have already received a number of responses to that, but the consultative exercise is not yet complete and it will need to be followed by careful consideration of the options for change or further action.
One obvious subject for further consideration is the regulatory background to first-aid provision in schools. Perhaps I could remind the House what the present position broadly is, as there is a certain amount of mythology on that point. First, it is not the case, as is sometimes claimed, that schools or other educational establishments are exempt from the general provisions of the main relevant statute, the Health and Safety at Work etc. Act 1974. I hope that I can reassure my hon. Friend on this important point. Like all other places where people are employed, they are covered by those general requirements, which require employers to have regard for the health arid safety not only of employees who are on their premises but of other persons. In the case of schools and colleges, the latter category obviously includes students or pupils who are on the premises.
The confusion has arisen because of the detailed provisions on first aid set out in the approved code of practice accompanying the Health and Safety (First-Aid) Regulations 1981, which come from the 1974 Act. The requirement concerning provision for 150 or more employees is in the code of practice. Again, in the nature of things, that requirement is unlikely to bite other than on the largest schools.
But it is sometimes forgotten that there is another and, in my view, at least equally important legal provision that applies to the schools but does not apply to employment generally. That is the common law doctrine of in loco parentis, which has the effect of placing on those responsible for schools a duty of care towards pupils in their charge of a kind that a responsible parent would expect to carry out.
That is a fact that we shall certainly have to bear in mind in considering the outcome of the consultative process to which I have referred. Would an overt attempt to equate educational institutions more closely with industrial and commercial premises with respect to safety be a positive move in practice? I stress that we shall look at the issue in an open-minded way.
Inevitably, an important consideration in looking at the way forward will be the issue of resources, whether of staffing costs or others, and we shall have to pay careful attention to what the local authority providers say to us on that point. I am sure that there will be many opportunities in the House to look further into those matters.
My hon. Friend also mentioned the importance of first-aid education for pupils taking place in schools. I have no doubt that schools have a significant part to play in providing young people with guidance about first aid.
The Royal Society for the Prevention of Accidents has estimated that over 500,000 people are admitted to hospital each, year for accidental or other violent injuries. A further 11 million new cases are dealt with by hospital accident and emergency departments annually. Those figures demonstrate the value of first-aid skills among the general population. There is no doubt that they can help enormously in relation to both minor and life-threatening accidents and injuries.
My hon. Friend spoke of the preventive value of first aid in terms of saving health and resources that can be put to better use. He also referred to the work of St. John Ambulance in connection with first-aid education in schools and the fact that he and I recently attended the launch of the new St. John Ambulance video on emergency aid for use in its three cross award.
My Department has been associated with that award since its inception in 1984, the scheme having been launched originally by my noble Friend Lord Joseph when he was Secretary of State for Education and Science. I understand that since then, over 200,000 children have taken part in the award scheme. St. John Ambulance is to be congratulated on the success of the award in such a relatively short space of time.
Whether or not schools cover first aid in the curriculum is, of course, at present a matter for individual schools to determine. That is likely in the main still to be the case under the new national curriculum, but there will be opportunities for schools to cover first aid as a direct result of a number of provisions contained in the national curriculum.
All the foundation subject working groups so far established have been asked to cover relevant aspects of health and safety education in their recommendations. My hon. Friend referred to specific aspects of the national curriculum.
In recent years, education about first aid has increasingly featured in the context of personal and social education. I know that this is often the case with the St. John Ambulance three-cross award. PSE is an area which the Government regard as particularly important. As a result, the National Curriculum Council is in the process of issuing guidance to all schools on the place and content of PSE in the curriculum. I understand that it is likely to include guidance on the need for education about first aid, and that is also to be welcomed.