In the final NFWI resolution to be presented to Sotonettes members for ballot, provision of carers for hospital patients with dementia is debated.

Sotonettes members are entitled to vote on this issue; for more information, click here, or download a handy booklet here. Or visit our Facebook page!

“We call upon HM government and the NHS to provide facilities to enable carers to stay with people with Alzheimer’s disease and dementia that have been admitted into hospital.”

Proposer’s position

The proposer’s intention is to improve the hospital care of those suffering from Alzheimer’s disease or other forms of dementia (but who may have been admitted to hospital for an unrelated condition) by calling for hospitals to provide facilities to enable their carer to stay with them for the duration of their hospitalisation.  This, the proposer argues, will improve the health and wellbeing of patients both with and without dementia, reduce long-term financial burdens on the NHS, and ensure that institutional dementia care is person-centred.

Outline of the issue

Dementia is a syndrome that can be caused by variety of progressive mental disorders. This syndrome can impair cognitive processes such as memory, spatial orientation, and language skills, compromise someone’s ability to perform every day activities, and alter their behaviour and mood. Alzheimer’s disease is the most common type of dementia, but is by no means the only one and symptoms of dementia are varied, complex, and sometimes difficult to diagnose. There are 850,000 people in the UK living with dementia and that number is expected to rise to over a million in just five years.[1]

Dementia is a local, national, and global health crisis, affecting more people than cancer, heart disease, or stroke. It is the leading cause of death among women and one in three people who die after the age of 65 have it.[2] In the UK twenty-one million people have a close friend or relative who has the syndrome and 550,000 people in the UK care for someone with it. Women are two and a half times more likely than men to become carers for someone with dementia.[3] Globally there is a new case of dementia every four seconds and by 2020 there will be seventy million people worldwide living with the condition.

Dementia costs in the UK total £19 billion per annum and, according to the King’s Fund, total dementia spending will reach £35 billion by 2026.[4] Its emotional and intangible cost to carers and loved ones is immeasurably devastating. It is not an overstatement to say that dementia is the health crisis of our time.

Dementia Care in Hospitals

 The pervasive and widespread reach of dementia means that dementia care will invariably be impacted by the wider health policy context and vice versa. Due to the National Dementia Vision for Wales (2011)[5], the National Dementia Strategy (2009)[6], the Prime Minister’s Dementia Challenge (2012)[7], and the Prime Minister’s Challenge on Dementia 2020 (2015)[8] there is a greater awareness amongst health professionals, carers, and the wider public about the needs of people with dementia and an explicit recognition that dementia care must be a health and social care priority. Significant progress has been made over the past five years: fifty-nine per cent of dementia sufferers now receive a diagnosis and appropriate post-diagnosis support, over 500,000 care and hospital workers have received Tier 1 dementia training, and £50 million has been invested in dementia friendly environments in hospitals and care homes.

However, despite this investment and stated commitment to dementia friendly hospitals, hospital care for people with dementia remains a key area of concern, whether these patients are admitted because of their dementia or for another, ostensibly unrelated condition (although often those other conditions are germane to the dementia). Seventy-two per cent of people living with dementia also suffer from other conditions or disabilities, which means they are routinely admitted to general hospital wards in high numbers. Today over one-quarter of all hospital beds in the UK are occupied by a patient who has dementia.

The evidence base concerning the detrimental effects of a hospital stay for people with dementia is stark and concerning:

• One third of people with dementia who are admitted to hospital for an unrelated condition never return to their own homes
• Forty-seven per cent of people with dementia who go into hospital are physically less well when they leave than when they went in and fifty-four per cent are less well mentally[9]
• People admitted to hospital for dementia stay in hospital longer, face the possibility of readmission more frequently, and are more likely to die in hospital than patients without dementia[10]
• Fifty-four per cent of carers report that a stay in hospital has made the symptoms of dementia worse, resulting in the dementia sufferer becoming more confused and less independent

The evidence proves that a hospital stay for someone with dementia can often be catastrophic, despite the cure or resolution of their acute condition that prompted admission in the first place.

Since dementia sufferers are often admitted for an acute physical condition such as pneumonia or a fractured bone, dementia patients can typically be found in general medical and surgical wards where their carer is often not able to stay with them outside of traditional visiting hours. Since people with dementia can be distressed by being in unfamiliar surroundings, a stay in a busy, noisy, and confusing hospital ward without their carer present can be deeply unsettling for them and further cause their mental state to deteriorate. The patient loses the ability to have much-needed social interaction and family members often feel helpless because they are prevented from providing care for their loved ones. To compound this, nurses and doctors may be unaware that the patient even has dementia, so the patient’s additional dementia related needs are neglected.

Involving a family member or other trusted carer from admission into hospital until discharge has been proven to ensure a better quality of care and leads to improved outcomes for the patient. Yet, currently there is no obligation for hospitals to ensure that their patients with dementia have access to their carer whenever they need them. Carers are typically treated like visitors, constrained to normal visiting hours only. It remains up to each individual hospital to set their visiting hours policy.

The campaigning group John’s Campaign was launched last year by campaigner Nicci Gerrard after her father’s hospital experience completely accelerated his dementia. Even though the nurses and doctors provided excellent care for his acute condition, Nicci believes that the lack of care continuity and the inability of John’s caring family members to stay with him during his hospitalisation had a detrimental impact on his overall health. The campaign is calling for families and carers of people with dementia to have the same rights as parents of sick children, and be allowed to remain with their loved one in hospital for as long as they deem necessary. The campaign is calling for this to be a right, not a duty. Since the launch of the campaign, the Care and Support Minister wrote to the Chief Executives of all trusts asking them to allow carers to stay on the ward like parents and over one hundred hospitals and wards have publicly committed to making changes in order to allow carers to stay with their dementia patients. However, it still remains up to the individual hospital to decide its own policy to create a dementia friendly hospital.

Arguments for the resolution

• It is clear from the evidence that not all hospitals have taken steps to be dementia friendly and vulnerable patients with dementia are suffering as a consequence. Now may be the time for the WI to urge more action to achieve the important goals set out in the Prime Minister’s Dementia Challenge to create dementia friendly spaces.
• As this campaign does not call for a national right, but rather for facilities to enable carers to stay with patients, there is scope not only for the NFWI to lobby on the issue nationally, but for individual WIs to work with their local wards up and down the country to help hospitals voluntarily achieve the aims of the resolution. This approach can foster innovation in how hospitals create dementia friendly wards.
• Just as the WI led the campaign for parents to be able to stay with their sick children in hospital with a 1950 resolution on that topic, the WI can again take the lead on transforming hospital care practices for the better.

Arguments against the resolution

• John’s Campaign is already the established voice on this issue and due to this campaign hospitals are starting to adapt their practices for carers of people with dementia; is there really more for the WI to add?
• Hospitals face a very challenging care climate at the moment, with the financial environment forcing hospitals to make difficult efficiencies. This resolution may be an unreasonable and unfeasible ‘ask’ at this time.
• An unintended consequence of this resolution is that hospitals displace the burden of adequately caring for their dementia patients onto family members and carers. Not everyone has a carer, but every dementia patient deserves to be treated in a dementia friendly environment. Might this resolution lead to inequities in care further down the line?

Groups to contact for further information

John’s Campaign- for the right to stay with people with dementia in hospital

Nicci Gerrard and Sean French

57 Hemingford Road, London N11BY

Nicci.gerrard@icloud.com

www.johnscampaign.org.uk/partnerships.html

The Alzheimer’s Society

Devon House, 58 St Katharine’s Way, London, E1W 1LB

Tel: 020 7423 3500

enquiries@alzheimers.org.uk

www.alzheimers.org.uk

@alzheimerssoc

Alzheimer’s Research UK

3 Riverside. Granta Park, Cambridge CB21 6AD

Tel: 0300 111 5333

enquiries@alzheimersresearchuk.org

www.alzheimersresearchuk.org

@ARUKnews

Carers UK

20 Great Dover Street, London SE1 4LX

Tel: 020 7378 4999

advice@carersuk.org

www.carersuk.org

@CarersUK

References:

[1] Living and Dying with Dementia in Wales: www.mariecurie.org.uk/globalassets/media/documents/policy/policy-publications/february-2015/living-and-dying-with-dementia-in-wales.pdf

[2] Prime Minister’s Challenge on Dementia 2020: www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020/prime-ministers-challenge-on-dementia-2020

[3] Alzheimer’s Research UK: www.alzheimersresearchuk.org/about-dementia/facts-stats/10-things-you-need-to-know-about-the-impact-of-dementia/

[4] The King’s Fund: www.kingsfund.org.uk/sites/files/kf/field/field_publication_summary/future-trends-overview.pdf

[5] National Dementia Vision for Wales: gov.wales/docs/dhss/publications/110302dementiaen.pdf

[6]National Dementia Strategy: www.gov.uk/government/uploads/system/uploads/attachment_data/file/168220/dh_094051.pdf

[7] Prime Minister’s Dementia Challenge 2012: www.gov.uk/government/uploads/system/uploads/attachment_data/file/215101/dh_133176.pdf

[8] Prime Minister’s Challenge on Dementia 2020: www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020/prime-ministers-challenge-on-dementia-2020#fnref:20

[9] Alzheimer’s Society, ‘Counting the Cost’: www.alzheimers.org.uk/site/scripts/download_info.php?fileID=787

[10] Prime Minister’s Challenge on Dementia 2020: www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020/prime-ministers-challenge-on-dementia-2020#fnref:20

In the penultimate NFWI resolution to be presented to Sotonettes members for ballot, the allocation of surplus food from supermarkets is discussed.

Sotonettes members are entitled to vote on this issue; for more information, click here, or download a handy booklet here. Or visit our Facebook page!

“The WI calls on all supermarkets to sign up to a voluntary agreement to avoid food waste, thereby passing surplus food onto charities thus helping to address the issue of increasing food poverty in the UK.”

Proposer’s position

The proposer is concerned by the amount of edible food that is thrown away by supermarkets annually, especially in light of the growing numbers of people struggling to afford food, as well as the environmental consequences of food waste. The proposer’s intention is reduce food waste by supermarkets by encouraging them to redistribute surplus, usable food to charities and food banks. This would have the twin benefits of alleviating the growing problem of food poverty in the UK, as well as reducing the environmental footprint of wasted food production.

Outline of the issue

It is estimated that around 200,000 tonnes of edible surplus food is thrown away by supermarkets annually. Only two per cent of this is being collected and redistributed (with the remaining 98% turned into compost or energy, or disposed of in a landfill) – an amount that the House of Commons Environment Food and Rural Affairs Committee classed as “pitifully small” in its 2015 report.[1] It is currently cheaper for retailers to dispose of food by anaerobic digestion or animal food as opposed to redistribution of food surpluses to charity, leading to a distortion in the waste management hierarchy.[2]

In its Feeding Britain report, the All Party Parliamentary Group on Hunger and Food Poverty found that doubling this redistribution (which would still be only 4% of usable food) would save the voluntary sector £160 million over the course of this Parliament.[2] Most of the food that is currently distributed by the Trussell Trust has been donated by consumers – largely through collections at schools, churches and supermarkets-not supermarkets.[3]

The Department of Health defines food poverty as “the inability to afford, or to have access to, food to make up a healthy diet.”[4] The Trussell Trust estimates that from 2012-2013 they fed almost 350,000 people through their food banks (a significant increase from 128,000 of the previous 12 months).[5] Research by the Trussell Trust, FareShare and Tesco found that: 18% of people in the UK have suffered from some form of food poverty (including skipping meals, parents going without food to feed their children or relying on family or friends to provide food), and this rises to 21% for households with children; more than 80% of parents in food poverty worry that they will struggle to provide nutritious food for their children in the near future; and only a third of people currently suffering from food poverty expected their situation to improve in the coming year.[6]

From 2012-2013 WRAP examined the role that surplus food redistribution by supermarkets could have in the overall food waste reduction strategy, and in particular looked at possible barriers and potential solutions to food redistribution. The research found that while the tonnages of surplus food available in a store are small compared to whole supply chain, these volumes are still significant enough to have a measurable benefit to those in need. Additionally, it found significant barriers to delivering redistribution on a nationwide scale due to capacity and resource limitations within both charities and retailers.[7]

In the UK, there have been a number of voluntary initiatives between supermarkets and organisations to cut down on food waste by retailers. For instance, Tesco has recently introduced a new app for store managers to alert local charities to surplus food available for collection at the end of the day which it is piloting in 10 stores.[8] Tesco is also the only supermarket to publish its own independently assessed food waste data. Its most recent data (2014-2015) showed that while it had reduced the amount of food that it had thrown away (to 1%), it still had some way to go on food redistribution as 30,000 tonnes of that 55,400 tonnes was food that could otherwise have been eaten.[9] [10]

WRAP, in consultation with the retail industry amongst others, is currently developing the fourth Courtauld Commitment: Courtauld 2025 – a resource efficiency and waste reduction initiative.  Most of these initiatives however look at system-wide food waste reduction, with businesses sharing efficiency savings along supply chains, wasting less, and getting more value from unavoidable waste. Courtauld 2025 focuses on four themes: changing what we supply, changing how we supply, changing how we consume, and changing what we do with the waste and by-products throughout the life-cycle.[11] Food waste has not only an economic cost, but also an environmental one.  This is through the energy and resources used to produce the food, as well as the carbon emissions from transportation and methane emissions from landfill.

Arguments for the resolution

• While food has been a longstanding concern for the WI, the NFWI has no mandate to address food poverty. This resolution would empower the NFWI nationally and WI members locally to lead on reducing food poverty.
• In this current economic climate, we cannot afford to continue such wasteful practices where good food is wasted, families go hungry, and the environment suffers. Now may be the time for the WI to add its voice to those calling for innovation in not only how we eat food, but how we dispose of our food.
• This resolution harkens back to the WI’s historic roots in food production and feeding the nation – it would be a fitting resolution to carry us into our second century.

Arguments against the resolution

• The WI has already done significant work on food waste. Additionally, while national work on food poverty has not been possible due to a lack of mandate, a number of WIs have been working locally to support food banks. Is a national mandate necessary?
• Is the voluntary approach that this resolution calls for the best approach? Consumers, advocates, and charities have already tried to voluntarily persuade supermarkets to address food waste, thus far with limited success. Should the WI call for legislative or mandatory action on this issue instead?

Groups to contact for further information

WRAP

Second Floor, Blenheim Court, 19 George Street, Banbury OX16 5BH

www.wrap.org.uk

@WRAP_UK

FareShare

Unit 7 Deptford Trading Estate, Blackhorse Road, London SE8 5HY

Tel : 020 7394 2468

enquiries@fareshare.org.uk

www.fareshare.org.uk/

@FareShareUK

The Trussell Trust

Unit 9 Ashfield Trading Estate, Ashfield Rd, Salisbury, SP2 7HL

Tel:  01722 580 180

enquiries@trusselltrust.org

www.trusselltrust.org/

@TrussellTrust

References:

[1] Food security DEFRA committee 2015 www.publications.parliament.uk/pa/cm201415/cmselect/cmenvfru/703/703.pdf

[2] Feeding Britain, 2014 foodpovertyinquiry.files.wordpress.com/2014/12/food-poverty-feeding-britain-final.pdf

[3] Food banks and food poverty, 2014. researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06657#fullreport

[4] DH Choosing a better diet: a food and health action plan, 2005 – quoted in Ibid.

[5] Food banks and food poverty, 2014. researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06657#fullreport

[6] www.trusselltrust.org/resources/documents/Press/1-in-5-parents-struggling-to-feed-children.pdf

[7] www.wrap.org.uk/sites/files/wrap/Food%20Connection%20Programme%20Final%20Published%20Report.pdf

[8] www.theguardian.com/business/2015/jun/04/tesco-fareshare-charity-reduce-food-waste

[9] ‘Food Waste’ www.parliament.uk/briefing–papers/sn07045.pdf

[10] www.tescoplc.com/index.asp?pageid=17&newsid=1173

[11]  www.wrap.org.uk/content/courtauld-2025

In the sixth of the NFWI resolutions to be presented to Sotonettes members for ballot, equal funding of care for people with poor mental health is debated.

Sotonettes members are entitled to vote on this issue; for more information, click here, or download a handy booklet here. Or visit our Facebook page!

“The National Federation of Women’s Institutes calls upon the government to ensure that the care of people with poor mental health receives funding and respect equal to that provided for people with physical health problems.”

Proposer’s position

The proposer is concerned about under-funding for mental health services, citing news reports of  mental health budget cuts, long delays for patients seeking treatment, and paucity of resources and research.  If the resolution is successful the proposer would like to see the WI campaign for shorter waiting times, more research into mental illness and its treatment, and more financial support for patients and families.

Outline of the issue

The Mental Health Policy Group – made up of the UK’s leading mental health NGOs – stated in its pre-Election manifesto that: ‘funding for mental health services has been cut in real terms for three years in a row. Mental health problems account for 23% of the total burden of disease. Yet despite the existence of cost-effective treatments they receive only 13% of NHS expenditure.’[1]

Demand for mental health services is on the increase, the Policy Group estimates two million more UK adults will have mental health problems by 2030. Significant numbers of the UK population have mental health problems that are never treated; suicide remains the leading cause of death for UK men under fifty, self-harm rates are amongst the highest in Europe, and more than one in ten women experience mental health problems during and after pregnancy.

Those with mental health problems often find them compounded with serious physical health challenges. Labelled one of the starkest health inequalities in our society, people with serious mental illness are at risk of dying, on average, 20 years prematurely. One in three of the 100,000 ‘avoidable deaths’ every year happen to people with mental health problems. Compared with the general population, people with serious mental illness experience: twice the risk of diabetes, three times the risk of dying from coronary heart disease, and over four times the overall risk of dying prematurely (aged under 50).

In 2011, the Government set out a strategy to improve mental health and wellbeing, ‘No Health Without Mental Health.’[2] This strategy was enshrined into law with the 2012 Health and Social Care Act[3] which introduced an explicit recognition of the Secretary of State for Health’s duty towards both physical and mental health. This Act placed a legislative requirement on the health service to address the disparity between mental and physical health through a concept known as parity of esteem.[4] Parity of esteem recognises that mental health impacts on physical health, and vice versa, and therefore they should both be treated together and equally. A key aspect of implementing this parity is an equal distribution of resources, as well as equal consideration given both aspects of health when commissioning services.

Mental health services were given a boost in the 2015 coalition government budget when the then Deputy Prime Minister, Nick Clegg, announced he had secured £1.25bn to enable the NHS to treat more than 100,000 young people suffering mental illness by 2020.  The announcement built on Clegg’s 2014 announcement of the first waiting-time standards for mental health treatment and £120m funding for service improvements designed to put  a stop to ‘discrimination against mental health.’

Given demand on services and reduced budgets, services are inevitably patchy.  Intervention is often at crisis point, waiting times can be lengthy, and the majority of mental health treatments, such as non-consultant led talking therapies, are excluded from the NICE recommended treatments that the NHS Constitution gives people the right to access.

Arguments for the resolution

• Poor mental health is a big, and growing, problem in the UK. It can lead to a range of physical health problems and increases the risk of dying. Achieving funding equal to that spent on physical health will help treat many people, save many lives, and increase efficiency in the long-term.
• Many mental health problems are hidden, especially that suffered by new mothers in the postnatal period. A WI campaign can extend the reach of mental health awareness, help improve attitudes toward mental health and encourage people to seek help.
• This resolution fits nicely with the NFWI’s previous resolution on Care not Custody, calling for liaison and diversion services for people in the criminal justice system with mental health problems.

Arguments against the resolution

• Parity of esteem requires the health service to deliver joined up care, tackling both mental and physical health together in a holistic approach. Is separating mental health helpful towards this? Is it even possible to effectively separate the treatments and funding streams for physical and mental health?
• Whilst this is a worthwhile resolution that all members can take action on, it may not be a campaign that allows for hands on involvement in local WIs and local communities. It is not obvious how WIs can get involved and therefore might fail to engage our core audience: WI members.

Groups to contact for further information

Centre for Mental Health

Maya House, 134-138 Borough High Street, London, SE1 1LB

Tel: 020 7827 8300

contact@centreformentalhealth.org.uk

www.centreformentalhealth.org.uk

@CentreforMH

Mind

15-19 Broadway, Stratford, London E15 4BQ

Tel: 020 8519 2122

contact@mind.org.uk

www.mind.org.uk

@MindCharity

Rethink

89 Albert Embankment, London, SE1 7TP

Tel: 0300 5000 927

www.rethink.org/about-us/our-mental-health-advice

www.rethink.org

@Rethink_

Mental health network, NHS Confederation

NHS Confederation, Floor 4, 50 Broadway, London, SW1H 0DB

Tel: 0207 799 6666

Mentalhealthnetwork@nhsconfed.org

www.nhsconfed.org/mhn

@NHSConfed_MHN

References:

[1] www.mind.org.uk/media/1113989/a-manifesto-for-better-mental-health.pdf

[2] www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf

[3] www.legislation.gov.uk/ukpga/2012/7/contents/enacted

[4] www.rcpsych.ac.uk/policyandparliamentary/whatsnew/parityofesteem.aspx

In the fifth of the NFWI resolutions to be presented to Sotonettes members for ballot, the promotion of first aid training in the local community is discussed.

Sotonettes members are entitled to vote on this issue; for more information, click here, or download a handy booklet here. Or visit our Facebook page!

“The NFWI considers that suffering could be minimised and lives could be saved if more members of the general population were trained in first aid. We propose that HM government should promote first aid training in schools, colleges, universities and in the workplace. Furthermore, that all WIs should support and encourage first aid training and volunteer first aiders in their communities so that we become a safer and better informed country ready to help save lives.”

Proposer’s position

The proposer’s intention is to increase the number of people with emergency life support skills, and to increase the number of people with the confidence to use those skills to respond to an emergency situation. Acknowledging that a number of national organisations offer training and support in first aid, the proposer would like to see the promotion of first aid training and time allocated for it within schools, colleges, universities and workplaces. The aim would be to minimise the ill effects of a sudden illness and save lives.

Outline of the issue

There are tens of thousands of medical emergencies every year in the UK, resulting in deaths, injuries and disabilities. According to the British Heart Foundation (BHF) approximately 30,000 people each year in the UK have an out of hospital cardiac arrest in which the emergency services attempt resuscitation. Of this number, only 1 in 10 people recover to leave hospital. This survival rate lags considerably behind other developed countries such as Norway, with a survival rate of 25%. Evidence shows that in some cases CPR can double the chances of survival and that if an emergency ambulance is called and immediate bystander CPR is applied, followed by early defibrillation and effective post-resuscitation care, survival rates following cardiac arrest can exceed 50%. Whilst cardiac arrest is not the only emergency that can be tackled by first aid training, these statistics show that, even in this one area, emergency first aid can have a great effect.

Several surveys in the UK have shown that around three quarters of people do not know how to perform CPR.[1] Whilst 47% of people say that they have received formal training, only 29% report that they are confident at performing it on close family members and only 22% are confident to perform it on a total stranger.[2] Several European countries teach CPR in their schools, such as Denmark and Norway. In countries that do teach CPR in schools, the rate of survival for out of hospital cardiac arrest is almost double that of the UK.[3] Looking at first aid more widely, the British Red Cross found only 7% of people felt confident that they could carry out emergency first aid. This figure is 80% in Germany and Scandinavian countries where Emergency Life Skills are taught in schools.[4]

At present, there is no requirement for schools in England to train children in ELS, or basic first aid. However, the BHF estimates that around one in seven children in secondary school in England do receive ELS training. First aid training, which covers many of the parts of ELS, has been included at some English secondary schools as part of Personal, Social, Health and Economic Education (PSHE). PSHE does not have any statutory basis and is not part of the National Curriculum – schools have therefore not been required to teach it. In Wales, ELS is part of a framework within Personal and Social Education (PSE). PSE forms part of the basic curriculum which must by law be taught alongside the national curriculum for all registered pupils aged 5 to 16 at maintained schools, however the framework that includes ELS is not statutory.[5] During the latest curriculum review (which was implemented in 2014), the Education Secretary did not accept calls from expert groups for ELS to become a mandatory part of secondary education.

On 16 September 2015, Teresa Pearce MP, along with St John Ambulance, the BHF and the British Red Cross, launched the Every Child a Life Saver campaign.[6] This campaign calls on the Government to make first aid training compulsory in all state-funded secondary schools. Alongside this campaign Pearce tabled the Emergency First Aid Education Bill in Parliament, which would require secondary schools to give young people the skills and confidence to deal with a range of medical emergencies including cardiac arrests, heart attacks, choking, bleeding, asthma attacks, and seizures.[7]

This bill is due to receive its second reading on 20 November 2015[8], where it will need the support of 100 MPs to force a vote, and then a majority of MPs in the house in order to take it to committee stage. As this is a private members bill, as opposed to a government bill, it is possible that it will not be scheduled enough time in Parliament for it to be passed into law and will need the government to allocate it time for debate. The Every Child a Life Saver campaign is raising awareness of this bill and encouraging people to take action and show MPs that this bill has widespread support.

Across the UK, the government have encouraged the development of Community First Responder (CFR) schemes. CFRs are volunteers who can respond to emergency calls within their local community, which is helpful in areas where the emergency services can’t get to the emergency in the target time. In April 2007 the Healthcare Commission in England found that there were 10,158 CFRs in England, however, these volunteers responded to just 1.8% of all emergency calls.[9]

Arguments for the resolution

• Increasing the first aid skills of the population can double cardiac arrest survival rates and help save many lives.
• The campaign to get first aid skills taught in schools is backed by the Red Cross, the British Heart Foundation and St John Ambulance. These organisations would be excellent for partnerships.
• Members can get involved on a very local level through training to be a community first responder and promoting first aid training to local schools and workplaces.

Arguments against the resolution

• The government currently encourages schools to teach PSHE and first aid, but it is not mandatory. This resolution doesn’t call for a mandatory approach, so can the government do any more?
• Schools, colleges, Universities and workplaces are all under pressure. Would it be feasible to ask them to add first aid training to their programmes?
• Three other large charities currently offer first aid training and encourage people to take it up. Can the WI give them enough extra reach to make a difference?

Groups to contact for further information

British Red Cross

British Red Cross, UK Office, 44 Moorfields, London, EC2Y 9AL

Tel: 0344 871 11 11

information@redcross.org.uk

www.redcross.org.uk

@BritishRedCross

St John Ambulance

St John’s Gate, Clerkenwell, London EC1M 4DA

Tel: 08700 104950

www.sja.org.uk/sja/default.aspx

@stjohnambulance

British Heart Foundation

Greater London House, 180 Hampstead Road, London NW1 7AW

Tel: 0300 330 3322

www.bhf.org.uk

@TheBHF

Teresa Pearce MP – Introduced the Emergency First Aid Education Bill and launched the Every Child a Lifesaver campaign

House of Commons, London, SW1A 0AA

Tel: Westminster Office – 0207 219 6936

www.teresapearce.org.uk/2015/09/teresa-launches-campaign-for-emergency-first-aid-education-in-schools/

@tpearce003

References:

[1] BHF research in 2006 found that nearly three quarters of people were not trained in CPR (CPR training research, British Heart Foundation, Ed Coms, 2006.) A survey undertaken in 2010 by St John Ambulance, St Andrew Ambulance and the British Red Cross found that 77% of people either did not know how to perform CPR, or were unsure – see: www.sja.org.uk/sja/about-us/latest-news/news-archive/news-stories-from-2009/february/national-first-aid-awareness.aspx

[2] www.bhf.org.uk/~/media/files/publications/policy-documents/final_nation_of_lifesavers_policy_statement_14102014.pdf

[3] Ibid.

[4] www.redcross.org.uk/About-us/Media-centre/Press-releases/2009/February/No-first-aid-teaching-in-1-in-4-schools-despite-backing-from-teachers

[5] www.bhf.org.uk/~/media/files/publications/policy-documents/final_nation_of_lifesavers_policy_statement_14102014.pdf

[6] www.everychildalifesaver.org

[7] www.sja.org.uk/sja/what-we-do/latest-news/every-child-a-lifesaver.aspx

[8] http://services.parliament.uk/bills/2015-16/compulsoryemergencyfirstaideducationstatefundedsecondaryschools.html

[9] The role and management of community first responders. Findings from a national survey of NHS ambulance services in England, Healthcare Commission, December 2007. Available at: www.bristol.gov.uk/committee/2008/wa/wa048/0418_7.pdf

In the fourth of the NFWI resolutions to be presented to Sotonettes members for ballot, the prevention of sudden cardiac death in young adults in the UK is discussed.

Sotonettes members are entitled to vote on this issue; for more information, click here, or download a handy booklet here. Or visit our Facebook page!

“Every week in the UK at least 12 apparently fit and healthy young people die suddenly from undetected cardiac abnormalities. The majority of these deaths are preventable. This meeting urges Her Majesty’s Government to put in place a national strategy for the prevention of young sudden cardiac death to ensure that all young people between the ages of 14 and 35 have access to heart screening by appropriately qualified professionals to identify any potentially life-threatening conditions.”

Proposer’s position

The proposer’s intention is to prevent sudden cardiac death in young people through the implementation of a national prevention, treatment, and research strategy. This includes providing access to heart screening technologies.

Outline of the issue

Young sudden cardiac death (YSCD) is usually defined as ‘death occurring within one hour of the onset of symptoms in a young person without a previously recognised cardiovascular abnormality.’[1] In various forms it is also known as Sudden Arrhythmic Death Syndrome (SADS), Sudden Cardiac Arrest (SCA), Sudden Infant Death (SID), or Sudden Unexplained Death (SUD).  For the purposes of this briefing the condition will be referred to as YSCD.

YSCD is one of the biggest killers of young people in the UK; 12 British people between the ages of 14 and 35 die every week from these ‘hidden’ heart complications, often demonstrating no symptoms prior to their death. Indeed a leading cardiologist in Australia explained that in half of the cases of YSCD the ‘first sign of something wrong is when they die.’[2]

The underlying causes of YSCD are fundamentally different than those of sudden cardiac arrest in older adults, which is one of the biggest causes of fatalities worldwide and is responsible for approximately 100,000 deaths in the UK each year. Myocardial infarction, also known as a heart attack, and coronary artery disease are two of the principle underlying causes of sudden cardiac death in adults over 35. For both of these many underlying causes are preventable and linked to lifestyle, rather than genetic predisposition or inherited characteristics. Many cases of heart attacks do not lead to sudden cardiac arrest.

This is markedly different from the underlying causes of YSCD, which are overwhelmingly genetic and do invariably lead to sudden cardiac arrest and then death. Unlike in cases of cardiac arrest solely, the heart does not fail due to a lack of blood supply. Rather, many cases of YSCD result from an inherited predisposition for muscular heart disease or disease of the electrical circuits of the heart, such as an arrhythmia.

It is estimated that in the UK there are over 200,000 young people living with these heart abnormalities, usually unaware and asymptomatic. YSCD is usually precipitated by intense physical activity, although it can strike those who are sedentary. YSCD has been sensationalised in the media because of its rarity and the fact that it strikes famous athletes at the prime of their life while they are playing sport. An example of this is the 2012 case of Fabrice Muamba who nearly died on the football pitch in front of a global audience.

National Prevention and Treatment Strategy

There is currently no national strategy in place for diagnosing, treating, or researching YSCD, which means that those who thankfully survive an attack or those diagnosed with a heart problem often face confusing or contradictory advice on how they should get treatment and the families of those that have died from YSCD are often left with no answers or bereavement support. The campaigning group Cardiac Risk in the Young (CRY) is calling for a national strategy to be implemented to combat YSCD and synchronise government policy on the disease, a four pronged strategy consisting of screening, support, awareness, and research.[3]

The utility of a national screening programme or one directed solely at athletes to detect those with heart abnormalities remains the subject of much debate.[4] Campaigners argue that a large proportion of these deaths can be prevented as these heart abnormalities can be detected by an electrocardiogram (ECG), a non-intrusive test that evaluates the electrical and muscular functions of the heart. Screening young and ostensibly healthy people will pick up minor abnormalities in around 1% of the population and serious, potentially life-threatening abnormalities in .3% (almost one in three hundred) of the population. CRY recommends that screening be made available to every fourteen year old and they cite the national Italian screening programme (in place since 1971) which has reduced the rate of YSCD by 89% among those involved in competitive sport as proof that screening works.

However, detractors argue that both the efficacy and feasibility of a screening programme to detect YSCD remains in doubt and, therefore, should not be implemented. They further allege that the Italian case is predicated on faulty data.[5] Instead, many argue that screening not only does not detect all heart abnormalities, but actually has a twenty per cent false positive rate.[6] Further, they argue that screening is extremely cost-inefficient. For example, the American College of Cardiology concluded that conducting electrocardiographic screening of all young competitive athletes in the US could cost up to $69 billion over a twenty-year period and save 4,813 lives, making the cost per life saved between ten and fourteen million dollars.[7] Further studies in the United States have concluded that there is no direct evidence that an ECG or any other cardiovascular screening programme will reduce the incidence of YSCD in any of the ‘at risk’ populations.

This position is supported by the National Screening Committee with their July 2015 recommendation that a universal screening programme for the young not be implemented because:

• ‘There are a number of uncertainties over the test, the conditions that cause SCD, and the overall benefit of identifying those at risk when weighed against the potential harms.
• There is very little research into the reliability of the tests for identifying those at risk of SCD
• There is no agreed treatment or care pathway for supporting those who have been identified at risk of SCD.’[8]

The National Screening Committee will review this decision in 2018/2019. This decision has been met with dismay by campaigners, advocates of screening, and some paediatric cardiologists who argue that doing nothing is not an option. Advocates for screening also argue that the NSC recommendation is fundamentally at odds with notable bodies, such as the European Society of Cardiology, which recommends mandatory screening for athletes. Following the tragic July 2015 death of footballer Junior Dian from YSCD, sports minister Tracey Couch stated in Parliament that she would be examining a prevention strategy that included screening.

Arguments for the resolution

• Many of the barriers that the National Screening Committee have identified can be overcome; now is the time to act before the 2018/2019 review of screening policies to build the robust evidence base and treatment and care pathway that the Committee identifies as necessary.
• These tragic deaths are preventable; is doing nothing really an option?
• Other nations like Italy and Israel have instituted screening programmes. Even though the United States does not have mandatory screening, it does have a system in place for detecting at risk individuals involved in athletics. The UK must explore options along these lines to prevent the needless deaths of young people.

Arguments against the resolution

• The National Screening Committee has just recommended against a national screening programme to detect SCD in July 2015. This resolution directly contravenes current government policy that will not change until the 2018/2019 review.
• Although these deaths are tragic and senseless, they are miniscule in comparison to those who perish from other heart diseases. Might the WI have a greater impact campaigning on wider heart health issues?

Groups to contact for further information

Cardiac Risk in the Young

Unit 1140B The Axis Centre, Cleeve Road, Leatherhead, KT22 7RD

Tel: 01737 363222

cry@c-r-y.org.uk

www.c-r-y.org.uk

@ CRY_UK

British Heart Foundation

Lyndon Place, 2096 Coventry Road, Sheldon, Birmingham, B26 3YU

Tel: 020 7554 0000

www.bhf.org.uk

@TheBHF

UK National Screening Committee Secretariat

Floor 2, Zone B, Skipton House, 80 London Road, London, SE1 6LH

Tel: 020 3682 0890

www.gov.uk/government/groups/uk-national-screening-committee-uk-nsc

References:

[1] M Montagnana, G Lippi, M Franchini, G Banfi, GC Guido. “Sudden Cardiac Death in Young Athletes.” Internal Medicine 47, no. 15 (2008): 1373-1378.

[2] “Sudden Cardiac Arrest: Up to Five Australians under 35 die each week” www.theguardian.com/world/2014/aug/12/sudden-cardiac-arrest-up-to-five-australians-under-35-die-each-week

[3] Their national strategy objectives were outlined in their 2015 election manifesto: www.c-r-y.org.uk/wp-content/uploads/2015/04/Manifesto.pdf

[4] More a comprehensive overview of some of the recent evidence and literature pertaining to screening for SCD see: Mark S. Link and N.A. Mark Estes III, “Sudden Cardiac Death in the Athlete: Bridging the Gap Between Evidence, Policy, and Practice,” Circulation 125 (2012): 2511-2516 circ.ahajournals.org/content/125/20/2511.full.pdf+html

[5] Critics argue that the Italian study does not definitively prove that sustained use of ECG screening is effective. Principally, they argue that the methodology of the study is flawed because it was not a controlled comparison of screened versus unscreened populations, but was a population based observational study and also did not compare ECG screening to non-ECG screening methods, such as physicals.

[6] British Heart Foundation, “Policy Statement: Cardiac Screening for Professional Athletes”: www.bhf.org.uk/~/media/files/publications/policy-documents/policy_statement_screening_of_athletes_external_sep2013.pdf

[7] A Halkin, A. Steilvil, R. Rosso, A. Adler, U Rozovski, S. Viskin, “Preventing sudden deaths of athletes with electrocardiographic screening: what is the absolute benefit and how much will it cost?,” Journal of the American College of Cardiology 60, no. 22 (Dec. 2012): 2271-6.

[8]  National Screening Committee Recommendation on Screening:        legacy.screening.nhs.uk/suddencardiacdeath

In the third of the NFWI resolutions to be presented to Sotonettes members for ballot, free sanitary protection for homeless women is discussed.

Sotonettes members are entitled to vote on this issue; for more information, click here, or download a handy booklet here. Or visit our Facebook page!

“We call upon WIs to campaign for homeless shelters to be provided with a funding allowance to enable them to provide sanitary protection (tampons and towels) for homeless women.”

Proposer’s position

The proposer’s intention is to ensure that homeless shelters adequately provide for the needs of homeless women with respect to menstruation in the same way they do for other items deemed essential and in doing so address a great inequity in how the needs of homeless women are currently assessed. While items such as condoms and razors are routinely provided to homeless shelters, sanitary ware is not consistently offered, meaning that women in shelters are often forced to choose between spending their limited income on food or sanitary towels. This resolution seeks to mobilise WI members to campaign for national and local authorities to make  provisions within their commissioning arrangements to provide free sanitary protection for women accessing homeless shelters.

Outline of the issue

Homelessness is on the rise in the UK. Government statistics show that between 2011 and 2012 alone the number of people categorised as homeless grew by ten per cent and more troubling, the number of the people recorded as sleeping rough has risen by thirty-seven per cent over the last five years. At the same time as homelessness is rising, funding for support for the homeless is being cut at both local and national levels.

The homeless advocacy group and charity St.Mungo’s Broadway highlights that most services for the homeless are catered towards men, who comprise the majority of those homeless or sleeping rough. However, in 2013 women comprised slightly more than one-quarter (26%) of the homeless population, a significant percentage. Experts also believe that many more women are what they term ‘hidden homeless’, never encountering formalised support services. Yet, despite their high numbers, the funding for services targeted at women is woefully inadequate, disproportionate, and heading in the wrong direction. For example, the funding for support services for women actually fell from 12% of the total budget in 2011 to only 8% in 2013.

Why are women homeless?

Research from St. Mungo’s has concluded that ‘women who are homeless have a number of severe, interrelated and exceptionally complex problems which contribute to their homelessness and make recovery challenging.’ Their research into the life experiences of their homeless women clients has demonstrated that:

• 44% were the victims of domestic abuse (with 32% saying that their abuse contributed to their homelessness)
• 19% experienced abuse as children
• 70% had mental health problems (often stemming from their experiences of abuse)
• 48% had a substance abuse problem
• Over 33% had experience of prostitution
• 49% are mothers (79% of whom have had their children taken into care or adopted)
• 42% have an offending history
• 6% were pregnant

It is clear from the above figures that homeless women are a particularly vulnerable group of women, characterised by experiences of domestic or childhood abuse and poor mental health.

One Size Does Not Fit All

Women have unique needs as women that homelessness services are systematically and consistently failing to address. Homelessness services are often configured around the male service user, which helps explain why condoms and razors are often provided to homeless shelters free of charge for male use, but sanitary ware for female use is not. ‘Kits’ for the homeless that are donated often also include items for dental care and shaving, but not for when women have their periods. If shelters do provide sanitary ware, many women report feeling too embarrassed to ask for it. At the moment shelters can request condoms free of charge from the NHS, but sanitary ware is not considered to have medical utility so it is not freely provided by the NHS.

Arguments for the resolution

• If WI members don’t speak up for vulnerable women, no one will. Members have shown through past campaigning for women’s refuges that the WI can make a tangible difference in the lives of women displaced from their homes due to violence and abuse.

• The reality of menstruation for homeless women is often demeaning because their needs are not fully taken into account. This resolution seeks to rebalance the services shelters provide to better reflect the needs of women, while also educating members of the public that sanitary ware items should be donated to shelters along with other needed items.

• In addition to national campaigning, with the WI’s network of groups across England, Wales, and the Islands members could raise awareness and support efforts to ensure that local shelters have access to these products.

Arguments against the resolution

• A nationwide campaign was already launched earlier this year by three advertising agency interns who, shocked after reading an article about the humiliation and suffering if women on the streets, decided to take action. Their website- The Homeless Period- has secured over 100,000 signatures for their petition for free sanitary products.

• In the current fiscal climate, with cuts to shelters across the board, is now an appropriate time to call for this?

• Homeless women face a multitude of interrelated problems- should awareness and support be directed at those issues, such as poor mental health or sexual abuse, instead?

Groups to contact for further information

The Homeless Period

us@thehomelessperiod.com

@HomelessPeriod

St Mungo’s Broadway

Griffin House, 161 Hammersmith Road, London W6 8BS

Tel: 020 8762 5500

info@mungosbroadway.org.uk

mungosbroadway.org.uk

@MungosBroadway

References:

• rebuildingshatteredlives.org/wp-content/uploads/2014/03/Rebuilding-Shattered-Lives_Final-Report.pdf

• www.crisis.org.uk/pages/homeless-diff-groups.html

• www.telegraph.co.uk/women/womens-life/11465037/Period-Tampon-Tax-George-Osborne-stop-taxing-our-bloody-periods.html

• www.wssinfo.org/fileadmin/user_upload/resources/MENSTRUAL-HYGIENE-MANAGEMENT-Paper-for-END-group-1.pdf