VAT on Defibrillators

– in the House of Commons at 5:22 pm on 22nd June 2022.

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Motion made, and Question proposed, That this House do now adjourn.—(Steve Double.)

Photo of Ruth Edwards Ruth Edwards Conservative, Rushcliffe 5:23 pm, 22nd June 2022

It must be every parent’s worst nightmare. Last September, Dylan Rich—a talented 17-year-old footballer from Rushcliffe—was playing in a FA youth cup game between his club, West Bridgford Colts, and Boston United at the Colts’ ground in Regatta Way. Out of nowhere a couple of minutes into the match, he suffered a cardiac arrest and collapsed. His brave mother Anna performed CPR on her own son. Dylan was treated with a defibrillator at the scene and an ambulance arrived within 10 minutes. He regained cardiac output and was stabilised in intensive care, but tragically he died three days later in hospital.

Words cannot express the depth of sorrow that his death has caused—to his family, his friends, and the community at West Bridgford Colts. In their tribute to him, the Colts said:

“Dylan was one of those players that team mates love for his commitment, coaches for his attitude and adaptability, and supporters for his reliability. A fantastic club player.”

Tributes followed from Nottingham Forest and Notts County. Ahead of their World cup qualifier against Poland, the England players held up a shirt with “For Dylan” printed on it.

But the tribute that his family and his club most want is to increase the number of defibrillators across the UK, to make them cheaper for communities to buy, and to increase people’s awareness and confidence in using them. Until Dylan’s death, I had never looked at the figures for the scale of cardiac arrests. Sudden cardiac arrest is one of the leading causes of death in young people, and almost never has any prior symptoms. Officially, about 32,000 sudden cardiac arrests occur in England every year. When combined with figures from across the UK, it is estimated that the true number is as high as 60,000. There is an important caveat to this figure: it only includes incidents where resuscitation was attempted. In the UK, only 8% of people survive an out-of-hospital cardiac arrest.

Cardiac arrest can happen to anyone. This was brought home to us again in Nottinghamshire last month, when 13-year-old Samuel Akwasi collapsed from a cardiac arrest during a Young Elizabethan football league game and tragically later died in Queen’s Medical Centre. In fact, only yesterday, as I was writing this speech, I read of an assistant referee, Andrew Jarvis, who suffered a cardiac arrest while officiating at a game in Mansfield last August. Mercifully, he survived. He says he was saved by good-quality CPR, the football club’s defibrillator, and the quick arrival of the air ambulance team.

On average, as I said, a person in the UK has an 8% chance of surviving a cardiac arrest if it happens out of hospital, but this is vastly increased to as high as 70% if a defibrillator is used within the first three to five minutes of the cardiac arrest occurring. Conversely, survival rates drop by 10% for every minute of delay after this time. This further highlights why it is essential to have a defibrillator on every sports pitch and street corner possible—because these machines save lives. Average survival rates for out-of-hospital cardiac arrests vary across the country, ranging from 0.6% to 25%. The Government are doing so much to address regional inequality across the country, but we must also address regional inequality in defibrillator access and survival rates.

The main barriers to accessing defibrillators have been shown to be cost and awareness. In a survey by Vitreous World, 42% of people said that cost was the main barrier to owning a defibrillator, while 62% of people do not know how to use one and 27% are worried about how to do so. Defibrillators vary in cost, but the average unit is about £1,250. This is a considerable expense to many community groups, charities and sports clubs, especially considering that a sizeable portion of it, 20%, is VAT. Clearly, £1,250 is a lot of money for organisations raising funds through cake sales, individual donations and raffles. Some charities are exempt from paying VAT on defibrillators: not-for-profit hospitals, charitable institutions that provide care or medical or surgical treatment for disabled people, and rescue or first aid services. However, most sports clubs and community groups do not qualify.

There are several options for reducing the cost of defibrillators. The first is to apply a zero rate of VAT to all defibrillators in line with that already applied to a range of medicines and medical products, including prescription medicines and drugs. A blanket rate would be a simple and straightforward solution to cover anyone and any organisation wanting to buy a defibrillator.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Lady for securing this debate. I declare an interest, as I presented the Automated External Defibrillators (Public Access) Bill on Monday, when you were in the Chair, Madam Deputy Speaker, and it will be heard on 9 September. I encourage Ruth Edwards to come along to support the Bill, if at all possible.

I understand that children’s car seats, children’s travel systems and other safety protections have a reduced 5% rate of VAT. Should not this reduction, at least, be replicated for lifesaving defibrillators? As I know from my constituency, this would save lives.

Photo of Ruth Edwards Ruth Edwards Conservative, Rushcliffe

I congratulate the hon. Gentleman on his Bill, and I would be delighted to join him on 9 September. He has come up with an excellent option that is not on my list.

I accept there are many good candidates for zero-rate or reduced-rate VAT, one of which the hon. Gentleman has just outlined, and I am sure the Minister will say that the Government have received £50 billion-worth of requests for VAT relief since the EU referendum, which is a valid point. Our tax base funds the public services on which we all rely, including NHS treatment for victims of cardiac arrest, but surely these lifesaving devices should be a higher priority than, say, e-books, of which I am a great fan but they cannot save a life in the event of cardiac arrest.

There is a good argument that, as paper books already have a zero rate of VAT, extending it to e-books is a necessary tidying up of the system to avoid any legal challenges. That is not 100 miles away from the situation with defibrillators, where some charities benefit from zero-rate VAT but others do not. Surely, whatever the purpose of the charity, the purpose of using a defibrillator is the same.

Another option is to widen the scope of organisations that can purchase a defibrillator without paying VAT. Instead of just covering charities with care, medical, rescue or first-aid missions, could not all charities, not-for-profits and community groups be allowed to purchase a defibrillator without paying VAT? After all, businesses can currently claim back VAT on defibrillators as part of their VAT return forms. Such an approach would direct savings to the people who need them most, while not setting a precedent for the blanket removal of VAT on a specific item. It also simplifies what is currently a confusing landscape in which people are not sure whether they are eligible for this VAT exemption.

Or perhaps we can set up a fund for charities and community groups, either to claim back their VAT or to aid them in buying defibrillators. Maybe a pot of money could be announced in the Budget—I am getting my bid in early. I am sure the creative and clever minds at the Treasury can come up with all sorts of options, and I place on record my huge thanks to the Minister, who I know has asked her team to do just that.

Whatever model we go for, the end we need to achieve is making community defibrillators more affordable, especially at a time when people’s finances are increasingly stretched. Whatever route we choose, we need to publicise it and use the opportunity to address the lack of knowledge and confidence in defibrillator use. I identify with this, as I did not know how to use one until Trent District Community First Responders and Nottinghamshire Fire and Rescue Service kindly offered to train me and my team. In fact they are training all sorts of groups across Rushcliffe, and it would be great if we could offer defibrillator and CPR training to Members and staff here in Parliament. When I asked, I was told there was no course I could do.

Parliament provides many other courses. We have media training, diversity and inclusion training and courses on how to use the Library, and I am told I can be tutored in any foreign language that might be useful for my work. All these are important, but none would teach me how to resuscitate a constituent at my surgery whose life is hanging in the balance.

Any of the proposed options I have discussed would be most effective alongside a big push to increase defibrillator training and a publicity campaign to raise awareness. Many people want to learn how to use a defibrillator and save a life, and many more can already use one and want to share this knowledge with others, so why do we not help to bring them together?

I have one final thought on how to maximise the impact of such a campaign. At present, it is a legal requirement to have firefighting equipment in places of work, residences and public buildings—everywhere really. What people need to have depends on the type of premises, but fire alarms, extinguishers and exit signs are all pretty universal. However, there is no legal requirement to have a defibrillator kept at a place of work. Why not? Some 80% of people believe that defibrillators should be mandated in workplaces, but only 30% of people have a defibrillator in their workplace.

Increasing access to defibrillators is not just the right thing to do; it also makes financial sense. Patients who have had early defibrillation have a significantly reduced stay in hospital and are far less likely to need treatment in intensive care. The average hospital stay is significantly less for survivors when a defibrillator is applied within the three-to-five-minute window and they spend less, if any, time in intensive care. Figures may differ from hospital to hospital, but on average an intensive care unit bed is about £2,300 more expensive per night.

In addition, patients who have a defibrillator used on them quickly have fewer ongoing health problems due to lack of blood and oxygen circulation to vital organs such as the brain. This means they require far less ongoing treatment. In short, we estimate that reducing the cost of defibrillators and increasing the number available for people to use in the community will save the NHS tens of millions of pounds, which is much needed to reinvest as it deals with the elective backlogs brought on by the pandemic.

In conclusion, I first raised this issue in Parliament at Prime Minister’s questions back in March, and I would like to thank both the Minister and the Prime Minister for the priority they have given to this issue since. They both met my constituents Peter Stanbury and Paul Wilson, who are respectively the chairman and the coach of West Bridgford Colts, and I know the Treasury has been working on a number of options to take this forward. I would also like to thank Peter and Paul for coming to see me in my surgery and making me aware of this issue, and for the incredible work the Colts have done to raise money to buy more defibrillators for their training ground.

I would also like to thank Dylan’s family—his mum Anna, his dad Mike and his sister Lucy—for allowing us to tell Dylan’s story and for backing the Colts’ campaign at what must be the darkest time of their lives. Sudden cardiac arrest can tear through the life of any family with devastating results. I am delighted by the energy and commitment the Government have shown to working on this issue, and I hope we can now agree on the best way forward and give it the green light, so that we can get on with delivering these life-saving changes.

I would just like to leave the House with a message from Dylan’s mum Anna, who wrote to me this morning to say:

“I think it helps to emphasise the importance of community defibrillators, in the sense that we did get an output back on Dylan. Sadly, it was ultimately the time he was without adequately oxygenated blood to his brain that led to his death. Without the defibrillator, I don’t think we would have left the football pitch.”

Photo of Eleanor Laing Eleanor Laing Deputy Speaker and Chairman of Ways and Means, Chair, Standing Orders (Private Bills) Committee (Commons), Chair, Standing Orders (Private Bills) Committee (Commons)

I was not aware that the hon. Lady wished to take part in the debate, but we do have a little time. Has the hon. Lady asked the permission of the Minister and the proposer of the debate?

Photo of Jill Mortimer Jill Mortimer Conservative, Hartlepool 5:38 pm, 22nd June 2022

Thank you, Madam Deputy Speaker, and forgive me. I still have my training wheels on, and there is definitely more I have to learn. I thank my hon. Friend Ruth Edwards and congratulate her on securing this important debate.

Five days ago, on 17 June, my constituents Pam and Bill Shurmer marked the first anniversary of the loss of their son Daniel to cardiac arrest. Daniel was only 43 years old, a keen sportsman and soon to be married. Pam and Bill decided to make something positive come from their tragic loss, and set up DS43 in Daniel’s name. They set about ensuring that no one in Hartlepool will ever be more than 500 metres away from one of these lifesaving defibrillators. In just a year, they have been amazing. They have raised in the region of £60,000 and have installed 27 defibrillators. The 28th is going in next week, and they have plans to install a further 10.

Abolishing VAT on these life-saving machines would cost a negligible amount for the Treasury, but would make a huge difference, inducing people to purchase them and put them in places of work, communal spaces and local businesses, making them more accessible for all throughout our communities. Pam and Bill are right: no one should ever be more than 500 metres away from a life-saving defibrillator.

Pam, Bill and Daniel were already well known throughout Hartlepool, but through their campaign and fundraising, Pam and Bill have become true pillars of our Hartlepool community. I am proud to know them. They are truly special and an inspirational couple. I wish I could have met their wonderful son. I would like to take this opportunity to pay tribute to them in this place for all the work that they have done in Daniel’s memory. I have spoken to the Minister and I know that she understands how vital these life-saving machines are. I urge her to consider all options to make them more widely available for everyone in our communities.

Photo of Lucy Frazer Lucy Frazer The Financial Secretary to the Treasury 5:40 pm, 22nd June 2022

It is a privilege to respond to this Adjournment debate on behalf of the Government. I congratulate my hon. Friend Ruth Edwards on securing this evening’s debate. As we have heard, this follows last year’s tragic death of her constituent, Dylan Rich, at the age of just 17. It is also terrible to hear of the tragic death of Danny, the son of Bill and Pam Shurmer.

I commend my hon. Friends for the energy with which they are campaigning for a change in policy. As my hon. Friend the Member for Rushcliffe mentioned, she and I met the Prime Minister and the representatives from the West Bridgford Colts Football Club in March to discuss this issue. What she has said has touched all of us, and I wish to express again my condolences to Dylan’s family, who themselves have campaigned extremely hard on this issue, as well as to Pam and to Bill.

I have heard my hon. Friend’s argument and those of others here this evening. In answering the debate, I will briefly outline the Government’s thinking and approach. Let me begin by saying that we appreciate the importance of this issue. Automated external defibrillators—or AEDs—save lives. Understanding that, we have sought to boost their provision in many different ways. The Government encourage organisations across England to consider purchasing a defibrillator as part of their first aid equipment.

Many community defibrillators have been provided in public locations, including in shopping centres, through national lottery funding, community fundraising schemes, workplace funding or charities. The Government have also previously provided significant direct funding for the purchase of AEDs. In the 2015 Budget, the Government announced a £l million grant to support the purchase of public access AEDs. This was followed up by a further £1 million at the 2016 Budget. These schemes were operated by the British Heart Foundation. After the first round of funding in 2015, the foundation announced that more than 700 additional AEDs had been installed across the UK.

In addition, from May 2020, the Government have required all contractors refurbishing schools, or building new ones, through centrally delivered programmes to provide at least one AED. As things stand, there are already more than 43,000 registered AEDs in England.

The Government have also worked with the British Heart Foundation to develop “the circuit”, a national defibrillator network, which records information on unregistered AEDs, such as those in shops and restaurants. The circuit is now live in 13 of the 14 ambulance services across England, Scotland, Wales and Northern Ireland. This information is available in a centralised network for easy access in emergencies, meaning that ambulance services can find AEDs when they are most needed. The system also sends out reminders to make sure that AEDs are maintained and emergency-ready.

Meanwhile, the NHS Long Term Plan, published in January 2019, includes a section on cardiovascular disease and AEDs. The NHS has committed to developing a national network of first responders and access to AEDs, which will save roughly 4,000 lives a year by 2028.

Tax relief also has a part to play. VAT is not charged on AEDs donated, for example, to the NHS, rescue and first aid charities, and charities caring for disabled people. Local authorities and taxable businesses can also recover VAT on AEDs. The point of all of this is to say that there are existing reliefs, as well as historical funding and other initiatives, which are significantly improving access to AEDs up and down the country.

My hon. Friend the Member for Rushcliffe made a point about extending VAT relief. As she said, we have examined the specific merits of zero-rating AEDs. We are conscious that pass-through of a VAT relief on AEDs to consumer prices is likely to be low. Evidence on pass-through of VAT reliefs generally suggests that where markets are concentrated—as they are for AEDs—pass-through tends to be significantly less than 50%. In other words, a new zero rate would not necessarily lead to a reduction in prices. Instead, businesses might choose to absorb the tax relief as profit. If we are to take this step, we need to be sure that zero-rating AEDs would represent genuine value for money and make a real difference in expanding public access to AEDs.

As my hon. Friend recognised, we also have a wider responsibility, at a time of economic challenge, to minimise pressure on the public finances. However, I am grateful to her for all the work she has done, and continues to do, to bring this issue to public attention. I also recognise the campaigning work done by Pam and Bill, who are grieving the sad loss of their son, Danny. Therefore, notwithstanding the point I have made about VAT, I want to be clear to Members here today that, as we remember Dylan and Danny, we will continue to look at what more the Government can do to expand access to AEDs. The Prime Minister has therefore asked the Department of Health and Social Care to examine whether there are ways to further expand public access to defibrillators, and I have spoken to the Minister responsible—the Minister for patient safety—about this very issue. Like my hon. Friends the Members for Rushcliffe and for Hartlepool (Jill Mortimer), we know that AEDs save lives.

Question put and agreed to.

House adjourned.