I beg to move,
That this House has considered acquired brain injury.
After the last three hours, I think the expression is—and now for something completely different.
For the past hour and a half, some of us English Members have endured watching the match—Tunisia 1: Spurs 2; I mean, England 2. It is a pleasure to be in the House, and we are very grateful to SNP Members for enabling us to watch the match.
I rise to speak to the motion in the name of my right hon. Friend the Prime Minister. I pay tribute to the hon. Member for Rhondda (Chris Bryant) and my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) for their persistence at business questions and elsewhere, and for securing this debate in the House. Brain Injury Awareness Week took place last month, which makes today’s debate especially timely.
Let me first recognise the important work of organisations such as Headway and the United Kingdom Acquired Brain Injury Forum in raising awareness and in providing information and support to those living with acquired brain injury and to their friends, families and carers. I know that some of them are with us this evening, and I thank them for their persistence during the family dispute we have had in the Chamber for the past three hours.
Acquired brain injury—ABI—is an injury that takes place after birth in an otherwise healthy brain. It includes traumatic brain injuries such as those caused by road traffic accidents, falls or assaults, and non-traumatic brain injuries related to illnesses or medical conditions, including meningitis, stroke or brain tumours. While prevalence estimates for ABI are quite hard to make, the number living with it is thought to be over 500,000 and could be as high as 1 million people. The total cost of brain injury in the UK has been estimated by our officials to be at least £1 billion per year.
My hon. Friend talks about the cost of brain injuries. My constituent Stuart Tranter asked me to lobby the Government to put more money into brain tumour research, which has been very much the poor relation, and I have been successful. I congratulate the Government on having doubled that money since Tessa Jowell, who used to serve on the Opposition Benches and then went to the House of Lords, died. I am very grateful to the Minister and the Department for putting so much money into that much needed research.
I thank my hon. Friend. This is the first time I have been at the Dispatch Box since Baroness Jowell passed away. As I said during the debate when she was sitting in the Under Gallery with her lovely family, I did not know her well but the one time I met her I was left in no doubt about her determination on this subject. It is great that we are able to do so much. I pass on my condolences to Jess, her daughter, whom I have got to know a little, and her family. The trauma of the immediate is horrible and it goes on for a long time. Our thoughts are with them. I thank my hon. Friend for what she has said. We will do well by Baroness Jowell, especially through the money that we will put into research to try to instigate new research projects, which have traditionally been thin on the ground in this area. We are hoping to stimulate the research market.
ABI can have a devastating impact on our constituents’ lives; even minor head injuries can cause short-term impairment. Those surviving more severe injuries are likely to have complex long-term problems affecting their cognitive and functional ability, personality, close relationships and ability to return to any form of independent life.
Does the Minister share the concern raised with me by my Brighton constituents who travelled up to Westminster to share their stories, about the lack of funding for support for relatives and carers—in particular, the education that family members and carers need about how to look after someone with ABI? It can be incredibly stressful for the person themselves and for family members if people do not know how best to provide care. Funding can make a huge difference.
I thank the hon. Lady for that point, which I shall come to. There are other Ministers on the Bench with me, including from the Department for Work and Pensions, because I wanted them to hear other parts of this debate. The hon. Lady’s point is well made.
The Minister rightly listed a number of impacts from traumatic brain injury. Does he agree that one of those can be an increasing propensity to commit criminal offences? We are starting to wake up to the fact that a number of people in custody have sustained precisely that injury. That should be a focus for preventive work in future.
I thank my hon. Friend, who has professional experience of the criminal justice system. I shall come to his point in a moment, but I thank him for putting it on the record. Sometimes it is a difficult subject to talk about, but it is very relevant.
This debate is important to me personally; many years ago my brother had a serious brain injury as a result of racing motorbikes. That made an independent, single-minded person into someone who depended very much on others; it took him from being a person with his own business and social connections to being someone who could not co-ordinate more than one thing at a time.
I look forward to some comfort in the Minister’s response, which I know we will get. We need not only help for the person in an institution; they need to be taken home and given a semblance of order in their lives and what quality of life is possible. Does the Minister accept that families need help to take on that job for someone whom they love and want to help?
Order. Before the Minister responds, I should say that I appreciate that many want to make interventions because they do not want to stay until the end of the debate. We have only an hour and 10 minutes. A lot of people wish to make speeches and there will have to be a time limit. Interventions must be short.
I do not know what you mean, Madam Deputy Speaker, but I will certainly be here until 11 pm.
The hon. Member for Strangford (Jim Shannon) makes a good point, which follows on neatly from the point made by the hon. Member for Brighton, Pavilion (Caroline Lucas). It also leads me neatly on to the point I was about to make. The all-party group on ABI is currently conducting a very broad inquiry into the condition—its causes, treatments and societal impact—and I am sure it will consider the wider family. When I say family, I do not just mean the nuclear family but society’s family and even the Church, which can embrace people suffering the life change the hon. Gentleman spoke about so well with regard to his brother. I want the all-party group to know that I will support its inquiry as best I can. They should know that that offer is there.
As a Health Minister, I will obviously focus on the health aspects of ABI, but I just want to highlight some of the other areas—this touches on one or two of the interventions—where its impact is felt and action is under way. On education, many children and young people with ABI are rightly in education and have special educational needs as a result of their injuries. The Government recently provided some £29 million to support local authorities with ongoing implementation of individual education, health and care plans to meet those needs. It is vital to us that health, social care and education services work jointly in developing these care plans. I know my colleagues in the Department for Education share that view.
On offending behaviour—ABI touches on a lot of different Government Departments—there is an increasing body of evidence suggesting that children and young people who survive traumatic brain injury are more likely to develop behavioural problems that can be linked to an increased vulnerability to offend. NHS England’s liaison and diversion service has collaborated with the charity Headway, which I mentioned at the start of my speech, to improve awareness of ABI in vulnerable offenders and the support available—the point raised by my hon. Friend the Member for Cheltenham (Alex Chalk). Further, the Ministry of Justice is piloting approaches to improve screening and support for prisoners with ABI to prevent a cycle of re-offending once they enter the secure estate. The Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), is very kindly on the Government Front Bench to listen to the debate and I am grateful to her. The Minister of State, Ministry of Justice, my hon. Friend the Member for Penrith and The Border (Rory Stewart), who has responsibility for prisons, had hoped to be here but was pulled away. I know he will be taking a close interest in what is said tonight, because this issue will come up again.
Sport is another area for which there is a growing body of evidence and concern about the levels of risk and response to injury. This is why the Government commissioned an independent review of the duty of care that sport has to its participants, which published its findings in April 2017, and we are now working to implement its recommendations, including around awareness and prevention of head injury while playing sport.
On trauma centres, it is vital that those with the most serious brain injuries receive the best care that our NHS —our birthday NHS—can offer. In 2012, 22 regional trauma networks were developed across England. Within those networks, major trauma centres provide specialised care for patients with multiple, complex and serious major trauma injuries, including brain injury. Two years after their introduction, an independent audit of the network, commissioned by NHS England, showed patients had a 30% improved chance of surviving severe injuries and that the networks had saved some 600 lives. There is a positive story there.
A vital part of the treatment pathway for people who have suffered ABI is neuro-rehabilitation that is timely and appropriate to their needs. There is good evidence that access to high quality rehabilitation both improves outcomes for patients and can save money.
The neuro-rehabilitation centre in Goole is an excellent example of such practice. It serves north Lincolnshire and the wider area. I commend that service, and others like it, to the Minister.
I thank the hon. Gentleman for his intervention. I hope to get to his part of the world at some point while doing this job and it may be that I could visit it while I am up there.
The World Health Organisation states that rehabilitation intervention should be aimed at achieving the following five broad objectives: preventing the loss of function; slowing the rate of loss of function; improving or restoring function; compensating for lost function; and maintaining current function. NHS England’s Improving Rehabilitation programme applies those principles, rightly, in a holistic way to encompass both mental and physical health. In 2015, the programme published the “Principles and expectations for good adult rehabilitation” to support commissioners on delivering rehabilitation care locally in our constituencies. This document describes what good rehabilitation looks like and offers a national consensus on the services that we think people should expect.
It is important that we consider that it is not just trauma with regard to ABI. One of the other causes might be excessive exposure to carbon monoxide, so I was grateful to the support that Headway gave to my private Member’s Bill, which seeks to introduce mandatory carbon monoxide detectors in new-build and social rented houses.
My hon. Friend makes an excellent point. As I said at the start, obviously there are non-traumatic injuries—so, through conditions, and meningitis and stroke were two examples that I gave—but he is absolutely right to point out that issue. I congratulate him on his success with his Bill.
The rehabilitation programme includes 10 principles and expectations that were designed by people who use rehabilitation services—the carers, healthcare professionals, commissioners, strategic clinical networks and national clinical directors. Building on this, in 2016, NHS England published further rehabilitation guidance covering both adults and children. This provides local service planners with a commissioning model, a range of case studies and crucially, an evidence base for the economic benefits of delivering high-quality rehabilitation services.
While the vast majority of rehabilitation care is locally provided, NHS England commissions specialised rehab services for those patients with the most complex levels of need. Teams within trauma units assess and develop a rehabilitation prescription for patients with ABI. Through this, patients can access specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription. The teams manage ongoing patient care, including a key worker to support patients through the pathway and into rehabilitation at a level appropriate to their clinical need, in accordance with their clinician’s advice—be that highly specialised rehabilitation or through a local provider in the local network.
I want to mention the Rehab Matters campaign. As I said, rehabilitation is a key part of the patient’s recovery. I saw at first hand the impact that this can have in helping people to recover from illness or injury when I visited the Hobbs rehabilitation centre in my Winchester constituency earlier this year. The Chartered Society of Physiotherapy launched its Rehab Matters campaign here in the House at the end of October last year. It makes a very powerful case for community rehabilitation, and I think that all commissioners should ensure that levels of provision are meeting local needs and look to places such as the Hobbs centre as a good example of what can be achieved through rehabilitation care. The society produced a film that was made by the Oscar-shortlisted UK director, Chris Jones, called “Rehab Matters”, and I highly recommend it to Members interested in this area.
I am just going to skip over to research, and then close, because we have only an hour and I know that a lot of people want to speak. Let me just highlight the research being undertaken in this important area. We are investing over £1 billion a year in health research through the National Institute for Health Research. The NIHR is funding ABI research from basic science to translational research in civilians, military and sport. For example, we are investing over £100 million, over five years up to 2022, in a biomedical research centre in Cambridge that is developing new approaches to reduce the impact on patients’ health and wellbeing of neurological disorders, stroke and brain injury. We are investing £5 million to co-fund the surgical reconstruction and microbiology centre in partnership with the Ministry of Defence—that has been going since 2011. The centre specialises in research, taking discoveries from the military frontline to improve outcomes for all. We have invested about £16 million in brain injury research since 2014 through the NIHR health technology assessment programme, and we are investing just over £2 million over three years through NIHR’s global health research group on neurotrauma, which aims to advance global neurotrauma care and research to help to save lives, reduce disability from the trauma and improve the quality of life for patients with brain injury.
I fully recognise the devastating impact that acquired brain injuries can have on individuals and their families. The evidence shows that neglecting rehabilitation is a false economy. Rehabilitation equips people to live their lives, fulfil their potential and optimise their contribution to their family, their community and society as a whole. I am honoured to have introduced this debate and, as always in such debates, I look forward to hearing the views and insights from across the House on what further work or support is needed to reduce risk and improve the care available.
The debate stood adjourned (Standing Order No. 9(3)).
Motion made, and Question put forthwith (Standing Order No. 15),
That, at this day’s sitting, proceedings on the motion in the name of the Prime Minister relating to acquired brain injury may continue, though opposed, until 11.00 pm.—(Rebecca Harris.)
Question agreed to.
Main Question again proposed.
I call the Minister.
I had finished, Madam Deputy Speaker. Incredibly, it was timed to perfection.
I beg the Minister’s pardon. I have never before heard such a feat of perfect rhetoric. Thank you for being so perfect. [Interruption.]. Yes, it was quite unusual.
Thank you, Madam Deputy Speaker. That is now in Hansard. I am sure the Minister will enjoy it in the months and years to come.
It is an honour to speak in this very important debate, and I thank the Government for allowing the time for it. I pay tribute to my hon. Friend the Member for Rhondda (Chris Bryant) for calling for it and for his tenacity in ensuring it went ahead, against all the odds, when we all doubted it would and even though we are very pushed for time. I thank the all-party group on acquired brain injury and the right hon. Member for South Holland and The Deepings (Mr Hayes) for all their work and for their excellent campaign for better support and recognition for people living with ABI. I join the Minister in praising the work of the late and great Baroness Jowell. I, too, will never forget her last appearance in this Chamber in the Under Gallery.
Last month, along with colleagues from across the House, I was pleased to attend the rally for people with acquired brain injury at which they, along with their families, friends and carers, talked about their conditions and the services available to them. As we have heard, 1.3 million people in the UK live with the consequences of ABI, and each year approximately half a million patients attend UK emergency departments for traumatic brain injury. That is nearly 1,500 patients with traumatic brain injury attending A&E departments in the UK each day; one every minute. Brain injury can happen to anyone at any time, and all Members will have constituents living with the consequences of an ABI.
Despite the fact that so many people are living with ABI, it is little understood, which is why I am so pleased that the time has been allowed to discuss it in this place this evening. A brain injury can happen in an instant, but its effects can be devastating and last a lifetime. Thankfully, due to excellent advances in emergency and acute medicine, more and more children, young people and adults now survive and live with an ABI, but this brings its own challenges. As ever more people survive an ABI, further pressure is put on the vital services that people require.
For example, many individuals with an ABI require early and continued access to neuro-rehabilitation to optimise their recovery. The United Kingdom Acquired Brain Injury Forum says that the average cost of the initial rehabilitation programme is offset by savings in the cost of ongoing care within just 16 months and that this leads to an average saving over a lifetime in care costs of £1,475,760. That is a huge amount of money. Neuro-rehabilitation is therefore one of the most cost-effective services the NHS provides and one of the few services in medicine that result in long-term decreased costs to the economy. However, as is the case for many health conditions, the number of available beds across the UK is inadequate, service provision is variable and consequently long-term outcomes for brain injury survivors are compromised. What plans do the Government have to address those issues and improve the lives of patients living with an ABI? The UKABIF recommends a review of neuro-rehabilitation to ensure that service provision is adequate and consistent throughout the UK. Does the Minister agree that that is needed?
Many children and young people with an ABI are in education, and therefore the majority will receive most of their rehabilitation at school. Yet among education professionals there is a lack of awareness and understanding of ABI, its consequences, and its impact on learning. A pupil with an ABI may also require extra support when transitioning between primary, secondary and further education. What discussions has the Minister had with his colleagues in the Department for Education to ensure that children with an ABI receive the support that they need throughout their journey through the education system? Will he discuss with them the inclusion of ABI in the code of practice for special educational needs co-ordinators?
Brain injuries can be difficult to detect for people who are not already aware of them, which is why all education professionals should have a minimum level of awareness and understanding of ABI. In fact, that requirement goes beyond education and into everyday life. People living with ABI are discriminated against because of the general lack of understanding of their condition. For example, earlier this year Grace Currie was escorted out of a pub on a Saturday night because the bouncers believed that she was “too drunk”. In fact, Grace, who had suffered life-changing injuries after being hit by a car in 2010, had had just one drink. The incident must have been extremely upsetting and embarrassing for Grace, and I am sure that it really knocked her confidence.
Sadly, such encounters are not rare, and the level of misunderstanding of brain injuries is high among the general public, including assessors for employment and support allowance and personal independence payments. A study conducted by Headway found that 71% and 60% of respondents felt that assessors for ESA and PIP, respectively, did not have an understanding of brain injury. Further, assessors were widely reported to lack empathy and patience, resulting in a stressful and even traumatic experience for many brain injury survivors. Many respondents also said that their medical evidence was not taken into consideration, and that the assessment location and environment were not suitable for them, despite requests made in advance. Consequently, a strong sense of frustration and anxiety was reported by brain injury survivors and their carers about the failure to recognise or respect their needs throughout the application process. Has the Minster had any discussions with his colleagues in the Department for Work and Pensions about that issue? Will he look into those concerns with his colleagues, and ensure that they are properly addressed?
Living with a brain injury is difficult enough for people without their having to struggle to explain and prove their disability to anyone who lacks understanding of the condition. Each brain injury is different, which is why it is so important to raise awareness of ABIs. However, it is also important to recognise that such injuries affect not just the people directly concerned, but their families and friends. Headway aimed to highlight that during brain injury week last month for its “you, me, and brain injury” campaign. Headway found that 69% of brain injury survivors reported breakdowns in their friendships after the injury, and that 28% of relationships ended after an ABI. However, it is not all doom and gloom: 47% of survivors reported improvements in their relationships with family members. It was clear from Headway’s study that a little bit of understanding and time really can go a long way. That is the kind of service that is provided by its 127 groups and branches across the country.
Headway Wearside, whose representatives I met recently at the rally in Parliament, provides information, support and social activities for brain injury survivors, and works with the local community, relevant professionals and organisations to promote understanding of ABI. I spoke to Neil and Jimmy, who use the Headway Wearside service, and was touched when they explained that Headway had brought them together as a community, and they had formed friendships that they never expected to form. Headway Wearside does not just teach new skills, but helps people to form and develop friendships at a time when doing so might otherwise be hard. When I met with Neil and Jimmy we feared that this service might soon be lost, and I am pleased to say that it has been extended to June 2019, and I hope it will be extended still further so that patients can have access to this life-changing service. I pay tribute to Headway Wearside and all the work it does for the local community, and I will continue to support it so that this vital service can continue to support its 4,000 patients.
My wife suffered exactly this problem in 1999. The eldest of my three children was sitting her exams—her highers—at school, and while that school and the education system in general supported them fantastically well, there is the issue of supporting the children, quite apart from supporting the sufferer of an injury like this. Will the hon. Lady elaborate on how we might increase the support and help for families caught up in such situations? My children got through it, but it was touch and go, and I remember these events without much happiness.
I thank the hon. Gentleman for sharing such a personal anecdote from his own experience. It demonstrates why it is important that we support the Headways across the country that are giving this vital support to families in the position his family was in, and he is right to mention the children of people with acquired brain injuries; they must not be forgotten in all of this.
Unfortunately, not every patient with an ABI will have access to a service like Headway Wearside. If the Minister is to take away one thing from this debate, I urge him to recognise the need for services such as Headway Wearside and the other 126 across the country, so that the more than 1 million people living with a brain injury can access the support they need and deserve.
Order. We have to have a time limit, initially of five minutes.
I do not make a habit of exorcising personal demons in this Chamber and I am not going to start now, but we are all shaped, and are certainly affected, when we are shocked by what we see, perhaps in our constituents or other people, and so it was almost 40 years ago when I was in hospital and in the bed next to me was a young man, I suppose in his 20s or 30s, surrounded by a family—young children, his wife—being taught to feed himself and speak again following a traumatic event which had led to a severe head injury. He was a postman; he had slipped on the ice and hit his head on the pavement. As simple an event as that had changed that man’s and that family’s life for all of time.
From then on I became interested in ABI, and when I was elected to this place began my relationship with Headway, which has continued ever since. I am proud to be associated with the work it does and am delighted to endorse all that has been said by both Front Benchers about that work.
That postman all those years ago has, sadly, been followed by many others. Not always such a simple event has led to their injury; it is often a car or motorbike accident or something of that kind, which is why it is disproportionately young men who are affected by traumatic injuries of this type. But the results are common; they are complex and varied, but common themes emerge.
The first theme is of course the immediate, traumatic effect—invariably dealt with efficiently and effectively by the national health service. Those who have that kind of dramatic injury get pretty good treatment from our NHS, and it deserves credit, as do all those associated with it, for providing that treatment. But the ongoing issues associated with ABI are met with various kinds of responses. Sometimes the follow-up care is good, strong and effective, but that is not always the case because of the need to continue to respond to what are often rapidly changing circumstances. People’s speed of recovery can vary, as can the effect of their injury on their life, their competence and their skills.
In this very welcome debate—for which I was pleased to call, alongside the hon. Member for Rhondda (Chris Bryant); we have worked as a team; I am delighted that the Government have offered us this time—I want to argue for a number of simple things, which I will summarise. Co-ordination: we need to ensure that all the agencies—charitable, Government and local government— work together. Perpetuation: we need to understand that the condition might require care and treatment over a very long time. It is a dynamic condition and it needs that kind of perpetuation. Accentuation: we need to drive this issue up in the consideration of all public policy makers and those who make policy in the health service in particular. Having this debate is all about that. Concentration: we need to pool resources and target them where they can have the greatest effect. Accumulation: we need to build on the experience of the Headway groups and others that do this best. The NHS looked at this issue in 2004, and its international studies—particularly relating to the United States of America—need to be revisited.
The hon. Member for Washington and Sunderland West (Mrs Hodgson) was right to say that knowledge is vital. To get people back into work, which is often their aim, we need to work on educators and employers to enable them to understand that the pathways that people follow need to be attuned to their complex and changing needs. If we can achieve all that, we will be sending a signal to all those people affected, as that postman was all that time ago that, in the words of C. S. Lewis:
“You are never too old to set another goal or to dream a new dream”,
regardless of the misfortunes you might suffer.
It is an absolute pleasure to speak in this debate on behalf of the Scottish National party. I worked in the NHS as a psychologist for many years, and I was involved in carrying out assessments of people who had acquired brain injuries. This is often a hidden disability. I would describe it as invisible much of the time and that contributes to much of the discrimination. It can have a major impact on people’s cognition, their personality—particularly if it is a frontal lobe injury—and their planning ability. It can have an impact on individuals’ speech. Some have to relearn vocabulary and the names of people they once knew. In severe cases, it can have a significant impact on someone’s memory. Consequent to all that is the impact on people’s mental health and their confidence.
I pay tribute to the agencies that work so hard with those individuals and their families, because a systematic and systemic family approach is what is needed to support individuals. The hon. Member for Strangford (Jim Shannon) is absolutely right in that regard, as he is in so many others. It is important to provide support to all members of the family. I also pay tribute to the hon. Member for Rhondda (Chris Bryant), who has played a crucial role in bringing this debate to the House. He is vociferous on this important issue, and he has again made sure that we have time to debate it.
My own husband suffered a head injury when he was serving in the armed forces many years ago, when his tank was overturned. He was a member of the Royal Electrical and Mechanical Engineers and is now a local veterans’ spokesperson. He was fortunate to have fast, intense rehabilitation. It is important that that is provided not only to those in the armed forces, but to the general population. I am interested in what the Minister has to say about medical spending on our veterans and their access to rehabilitation services in this regard, alongside our NHS trauma units.
There are also difficulties in relation to welfare benefit assessments, particularly for employment and support allowance and for personal independence payments. Those with an acquired brain injury often feel that their difficulties are not understood and not well assessed under the current procedures, so we need not only further training for assessors, but possibly to review the assessment process itself. Assessment sometimes does not pick up the fine changes that can have such a crucial impact on the daily living skills of people with an acquired brain injury. Support will be necessary because it can be difficult for those with such injuries to complete forms, gather adequate evidence and so on. The Minister for Disabled People is in her place this evening, so I will be grateful if she will meet with me, as chair of the all-party parliamentary group for disability, to discuss that further.
Does the hon. Lady agree that there is some evidence that the mobility aspect of PIP is not being recognised in this regard?
Yes, that is a fair point. Mobility is about not just how far someone can walk, but being able to plan a journey and many other aspects of day-to-day living skills that people can find so difficult. People may require support for such things, but that may not currently be picked up properly by an assessment.
Psychology is important in the assessment of such cases, because access to neuropsychology means that individuals can have memory and cognitive assessments at the time of injury and six and 12 months later to examine which functions have been recovered. That is important because different parts of the brain can take on functions that have been lost and because the individual’s pattern of recovery can be mapped, meaning that a rehabilitation plan can be specifically adapted to their needs. Access to neuropsychology is a key part of rehabilitation, so I will be interested to hear the comments of the Under-Secretary of State for Health and Social Care on neuropsychology services, particularly for those with an acquired brain injury.
Prisoners have been mentioned. Yes, there is a high level of acquired brain injury within that population and that has an impact in three ways: acquired brain injuries can increase impulsivity, they can lead to people making the wrong decisions and not thinking through the consequences, and they can lead to difficulty in undertaking the normal treatments available in prisons, such as cognitive behavioural therapy, meaning that such treatments may have to be adapted for prisoners to benefit from them. I am unsure whether that is occurring in our prison system, but it should happen right across the United Kingdom if cognisance is taken of such difficulties.
This will be my last contribution because I know that others want to get in. The change in a person’s cognitive function, which is often perceived as a change in their ability to do things, is often also about them knowing how to do things, what to do, when to do it and why. That is different from losing a skill. It is about losing the ability to order things and to prioritise them, and that has a dramatic effect both on education and on their subsequent ability to work.
Individuals with a frontal lobe injury find planning extremely difficult and, in fact, may never again be able to plan in the way they once could. These are some of the issues that treatment would have to take on board, and perhaps further support will be required. The types of cognitive behavioural treatment that rely on people thinking things through in a sequence, which is particularly difficult for those with a brain injury, will not always be appropriate and may need to be adapted.
So many Members want to speak on this important issue, so I will finish by mentioning the funding for a new Scottish trauma network. Since January 2017, four major trauma centres, in Glasgow, Edinburgh, Aberdeen and Dundee, have been working extremely hard to try to ensure a good care pathway for those in Scotland who suffer brain injury. It is incumbent on us all to communicate and to find evidence-based practice right across the United Kingdom.
As a local councillor, I had the privilege of sitting on the board of Headway Ayrshire, which is affiliated with Headway UK, the brain injury association, a registered charity. Headway Ayrshire is based in the town of Ayr in my constituency of Ayr, Carrick and Cumnock, and it provides services to the population of Ayrshire and Arran. Its invaluable work includes the provision of information, advice and support services to people with brain injuries, their families and carers.
Up to December 2017, approximately 420 clients and 320 carers and family members were receiving support from Headway Ayrshire, with, on average, 60 referrals per annum. We have heard in this debate that acquired brain injuries may result from sports injuries, violent crimes, road traffic accidents or industrial accidents. As my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) mentioned, a simple slip, trip or fall can change the life of a person and their family for years to come.
During my 30 years in the fire and rescue service, attending road traffic collisions and cutting the occupants free from crashed vehicles, I saw the trauma at first hand. However, I acknowledge that vehicle manufacturers are constantly evolving, changing and improving in-built safety measures such as simple seatbelts, side-impact bars and not least, and more recently, airbags, which all assist in a good recovery from road traffic accidents and road traffic collisions.
I call on the Government to consider or, indeed, to address a few specific issues. First, I call on them to ensure that those assessing claimants on behalf of the DWP understand that, given the nature of their injury, the sufferer may lack personal awareness and may be under misconceptions as to their own capabilities. The sufferer may believe they will return to normality, for when they look in the mirror they still see their former self. To the onlooker, the sufferer may not present with overt symptoms, and often their life challenges are covert in nature. A sufferer may be asked whether they are able to learn a new task, and their answer might be yes. However, given an inability in some cases to retain and recall information, the fact is that the next time they are asked to undertake such a task, they may have genuinely forgotten how to do it. Appropriate questioning on forms and at assessments and hearings is crucial. For cases where the maximum recovery point has been reached, according to medical opinion, will the Government consider making long-term awards, as completing application forms is challenging for persons who lack concentration skills and who fatigue easily?
Secondly, I call on the Government to ensure that the NHS is able to offer the crucial multi-disciplinary support from an NHS team that is required in many of these cases, to provide ongoing rehabilitation and to recognise that a person’s treatment plan may need to be bespoke as, with acquired brain injuries, it is not a case of one size fits all. The symptoms and challenges faced by a sufferer have changing dynamics throughout their life. Professor Diane Playford, president of the British Society of Rehabilitation Medicine, has stated that there are not enough specialist rehabilitation facilities for those with brain injuries. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) mentioned the four additional centres in Scotland, and I congratulate and thank the staff at the Douglas Grant centre in Irvine, operated by NHS Ayrshire and Arran, on the good work they undertake every single day.
Thirdly, we should recognise the dedication of family members who do not necessarily see themselves as carers but who undoubtedly, through their own personal efforts, lighten the burden on our social care services and the NHS. This dedication on their part can lead to their own social isolation because brain injuries tend to have cognitive, physical, behavioural and emotional consequences that have an impact not just directly on the sufferer, but indirectly on the carer or the family members.
We also need to reach out to employers to ask them to consider engaging with the Government’s Disability Confident Scheme, to think about the potential to retain and, if necessary, retrain employees who have sustained acquired brain injuries and to think about these people when considering new employees. Fortunately, many make a good recovery from acquired brain injuries, but for others life becomes a constant challenge—for them and their family. As a Government and as a society, let us do all we can to assist those who have sustained an acquired brain injury.
The truth is that acquired brain injury is an invisible epidemic in this country. It is invisible because all too often we do not even know the numbers. I know the Minister means well, but I suspect his numbers were a hideous underrepresentation of the truth, because the figures I have seen suggest that there are more like 1.3 million people in this country living with a disability brought on by an acquired brain injury, with nearly half a million presenting to hospital last year. As my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) said, that is one a minute—1,500 a day. That is a very significant number of people. All too often, it feels like an invisible epidemic to the individual concerned, because they might not ever have known they had a brain injury in the first place.
Some of the most distressing work that I have seen has been done by people working in prisons. I was in Cardiff prison a couple of weeks ago—some would say not a moment too soon—to see the work being done there with prisoners, because the work Huw Williams has done at HMP Leeds showed that when we screened every prisoner arriving in through the door we found that 47% of prisoners had an acquired brain injury, that 76% of those had several and that 30% of those had more than five brain injuries. This is often invisible in the case of children, too. The latest figures I have seen show that five children in every primary school class in this country will have an acquired brain injury. If we think that figure is bad enough, the figure for poorer constituencies, and for poorer families and areas, will be considerably higher. The research is a bit difficult to be precise about, but a study in Exeter showed that it was 4.3 times higher in poorer areas, and another survey elsewhere found it was three times higher in poorer families. So, for me, as a socialist—I still like to use the word—this is still a matter of social justice as much as anything else.
As a non-socialist and member of the party of Wilberforce, Shaftesbury and Disraeli, I believe in social justice, too. The key thing that the hon. Gentleman has said, as did the hon. Member for Washington and Sunderland West (Mrs Hodgson), is that we have to get teachers to be more aware of this. If one thing comes out of this debate, it should be exactly that. We need to co-ordinate across Departments to get teachers to recognise and know this.
I completely agree with the right hon. Gentleman on that, not least because of one thing that sometimes happens to teenagers. Part of their brains will be quite well developed—the reward bit, the one that knows how to seek out pleasure—but the area of the brain most likely to be hit if they have a brain injury is the bit that is not yet well developed, which is the executive function. It is the bit that gives that youngster the ability to say no to things or to control their emotions and their functions. All too often, if that bit goes wrong, they can start to present in school as somebody who is a problem. They may then get excluded from the school, because it is not understood that this is actually about a brain injury—perhaps the student themselves does not understand that. They may then start offending and we may find several years later that they have a whole career of offending and that if we had managed to do the rehab properly right at the beginning, when the first brain injury happened, we might have been able to save that individual their self-respect and self-esteem, and we might have been able to save society the costs of all the criminality. We might, thus, be able to strengthen the whole of the way we do our business.
One memory that really strikes me is the story of Ben Robinson, the 14-year-old who was playing rugby for Carrickfergus Grammar School in Northern Ireland. He was sent back on to the field three times after brain injuries on the field and then died of double impact syndrome. He was pronounced dead when he arrived at the hospital. I am so proud of Ben’s family, who have campaigned on this issue. His mother, Karen, has always referred to these injuries as rugby’s dirty secret.
Rugby has tried to clean up its act in recent years, but in so many sports, even all these years after footballer Jeff Astle’s brain injury, which was determined to have been an industrial injury brought on by heading the ball, we still see in matches people being sent back on by the club medic. Only an independent medic should make the decision about whether somebody should go back on. If there is any doubt, sit them out. It should be simple and that should apply across all sports.
The Government have had a great success thanks to the major trauma centres which, as somebody said earlier, now manage to save an extra 600 lives every year. That is brilliant, but let us save the quality of their life as well. The miracles that can be achieved in saving lives can be matched by the miracles that can be achieved through really good, long-term, sustained rehabilitation. If we can take an 18-year-old who has had a big brain injury from needing six carers to wash, dress and feed them and get them up and so on, to a place where they no longer depend on those people, are mostly independent and need only one carer, think how many millions of pounds we can save the taxpayer across their lifetime. That must of course be the most effective way to change things.
I repeat the points made about PIP and ESA. One woman said to me, “The doctors say to me that I should spend all my emotional energy on getting my brain to work again, but I am spending all my emotional energy on trying to understand the forms and going through the process so that I can put food on the table for the rest of my family.”
I have a great deal of time for the Minister for Disabled People, Health and Work; she has had meetings with me and I know that she will want to make changes. This is about the whole of Government. I very much hope that we will be able to have another debate soon, because there are so many issues that we have barely managed to touch on in this one.
Order. I am reducing the time limit to four minutes.
I welcome this opportunity to speak briefly on such an important topic that affects a number of my constituents, either personally or through their family and friends. I echo the sentiment that has already been expressed about the great work that is done by charities such as Headway that focus on acquired brain injuries.
As we have heard, every year 1.5 million people attend A&E with a head injury, and some 200,000 of them are hospitalised. That is why it is so important not only that A&E training in the detection of brain injuries is up to date, but that there is strong public awareness of the symptoms, to ensure that help is sought immediately. Equally, that is why we must continue to invest in research so that we can detect earlier and treat more effectively.
The key point that I wish to make is that brain injuries affect all aspects of a person’s life. They are not only an issue for the NHS, because they also have massive implications for a person’s social care, eligibility for employment and disability benefits, ability to navigate the judicial system, and education, to name but a few. That is why cross-departmental working is so vital and why the support available and knowledge of it is so crucial, as is increasing general awareness, especially given the fact that every acquired brain injury is so different.
For example, I have a constituent who has been able to work a number of hours with a severe acquired brain injury and is on universal credit. However, when an error was made, a request for back-payment was issued. A factual letter was sent, but it was an inappropriate letter to send to someone with a severe brain injury. It caused great distress, and it would have been better had a personal approach been taken. I pick that up with the Minister because that could and should have been done. We also need to get individuals and families to volunteer the information to work coaches and those sectors that need it, which is why I welcome the roll-out of communities partners. That will help to facilitate that work up and down the country.
I praise the investment in the network of well-resourced major trauma centres that have been established since 2012. Treating severe and complex brain injuries is a highly specialised area and requires dedicated personnel and equipment. There are now 27 of these centres in England alone. These free at the point of use, specialised centres are predicted to save over 600 more lives a year. They are an example of the NHS at its best and highlight why protecting the NHS is so important. Centres such as these are why I welcomed the funding announcement today to give more than £20 billion extra in real terms to the NHS by 2023-24.
The NHS is not a national treasure because of nostalgia, but because it saves our families and our friends. I end my remarks by reiterating how important the work of local charities is and by stressing the great contribution that those suffering from acquired brain injuries make to our communities, our workplaces and our charities.
It is a privilege to speak in this debate today. I often think how lucky I am to be able to continue speaking in this House at all. I was incredibly lucky because, when I fell off a ladder onto a wooden block in my attic in a classic case of what not to do around the home—I was 8 feet off the ground and my head 14 feet off the ground—I did not suffer a brain bleed. I was profoundly lucky to be in a job with a support system around me and with wonderful staff who were able to take the load from me for a full two years. At first, I was not able to work much at all except in very small bursts. I slowly built that up, but I had to resign from the Front Bench. I often think how the history of these past few years might have been different had I remained a shadow roads Minister under the then Leader of the Opposition.
In listening to these moving accounts from across the Chamber, I have found so many of them to ring true. My personality changed—largely for the better in many ways—but I became much less risk averse in a way that was not healthy. I suffered from depression. As I was recovering, I was not able to spend time with my small children. My marriage broke down, and I could work only for very small amounts of time. I feel so lucky, because there are so many people whose employment circumstances would not allow that at all and who would not have the system around them. I was lucky because I was able to understand the system and to ask for the best care. I eventually was referred to the best care in the NHS and I got it and I have pretty much been able to make a full recovery. My family will tell me what a nightmare I am whenever I try to find something because my short-term recall, which was never good in the first place, will never come back to even the mediocre place that it was in before.
I want to finish by saying that, yes, we should be so proud of the positive role that the NHS can play, but it is not the case that everyone receives good care when they acquire a brain injury. I am not saying this to complain, but it is important to state what happened. I was given great care by paramedics who thought that my back could be broken when I fell off the ladder. All the tests were done. I was very, very sore. When I was released the next day, I was not even given a leaflet to say, “Look out, here are the symptoms of a head injury.”
I thought that concussion was something that lasted for 24 to 48 hours. After a couple of weeks, I found that I still could not really work, except for very short 30 to 90 second bursts, I went back to my GP who said, “You have a stressful job and a young child. I think you are suffering from stress.” I said, “No, I’ve worked for Gordon Brown; I know what stress is. This is not stress.” It was only because I was able to push and because he had a personal relationship with the lead neurologist for the area that he picked up the phone and I was seen. So many people do not have that. I congratulate both my hon. Friend the Member for Rhondda (Chris Bryant) and the right hon. Member for South Holland and The Deepings (Mr Hayes) on securing this debate and Headway on the recovery that it has given and on spreading awareness of this condition, which we have to keep on raising to ensure that people get the care that they need.
I am glad to be able to take part in this important debate.
Over the past few months, I have had the pleasure of taking part in the all-party parliamentary group on acquired brain injury, led by my hon. Friend the Member for Rhondda (Chris Bryant). I confess that I first joined what was then a new group at the request of a constituent and friend who works with the charity Headway in the north-east. He was keen that the problems faced by people with an acquired brain injury should be properly and thoughtfully considered, and for action plans to be devised that would seek to help resolve those problems. It was only during the course of the meeting that I had one of those lightbulb moments, realising that one of my family members actually has an acquired brain injury. That is a classic example of one of the difficulties faced by many people with an acquired brain injury; it can be an invisible disability that is not recognised.
This evening I will talk about the issues facing children with acquired brain injury, particularly in education, which was one of the topics on which the APPG heard evidence. Department of Health data shows that in a four-year period, 39,000 under five were admitted to hospital because of falls. Many of these children will be discharged as fully recovered, although the outcome of traumatic brain injuries in children may not become clear until their brain is fully matured. In fact, despite the early years being a key point in brain development, it is also the time when children are most vulnerable to injury. Sadly, it is also the least supported age group.
The APPG heard from the Child Brain Injury Trust in one of our meetings that children are very different from adults after acquired brain injury, because their brains are still developing and will continue to do so until they are in their mid-20s. This means that the full extent of their injuries and subsequent difficulties may not be realised until their brains have fully matured. Up to 70% of children and young people return to mainstream education following their injury.
As we heard in the APPG, in common with many other groups there is a lack of interim access to rehabilitation, whether residential or in the community—community being the main issue for children and young people—so schools and teachers are the main source of rehab for these young folk. Unfortunately those teachers, including special educational needs co-ordinators and educational psychologists, do not have access to training in how to deal with children returning to school with acquired brain injury. Of course, we know about the pressure that teachers already face in their work. Many young people do not have a formal diagnosis of acquired brain injury, so they can be misdiagnosed as being on the autistic spectrum or as having attention deficit hyperactivity disorder. This can be a real detriment to their outcomes and future development.
It is not just at school that children and young people face problems. In the family, the emotional and psychological impact of an ABI can completely change their world. They often face a lack of services in the community, isolation, and a lack of access to funding support and information. They may also be unable to access counselling. They are balanced between child and adolescent mental health services and other non-neurological services, as specialist neurological specialist for children are scarce. Where people live matters; there are few areas of excellence, with the excellent services mostly based around major trauma units.
I could say a great deal more, but I will cut my speech short in view of the time limit. I will just finish by saying that our children deserve better than what they have at present. Children with an acquired brain injury need to have their condition recognised, and need to be supported to do the best they can at school and to improve their life outcomes. I hope that this debate will help to raise awareness, and lead to positive improvements for them and other people with acquired brain injury.
I rise as vice-chair of the all-party parliamentary group on acquired brain injury.
Julian John, a dear friend and constituent of mine, is living with an acquired brain injury—an injury that led him to change his entire life path several years ago. He could have allowed his injury to dictate his life but he did not, and instead used his experience to help others to live fulfilling lives and gain meaningful employment. Every day Julian must overcome obstacles due to his ABI, such as being easily disorientated by doors or stairs. Simply entering a building or climbing stairs can be a massive task for him. But Julian advocates for the inclusion of people living with such disabilities and is an excellent example of how disability—whether visible or hidden—should not hold people back from reaching their full potential. He has used his experience to start the human resources company Delsion, which specialises in inclusion.
Julian has had excellent support throughout his rehabilitation—all the love, support and patience he needed—but this is not true for all the 1.3 million people in the UK living with an acquired brain injury. Many of these individuals require early and continued access to neuro-rehabilitation to optimise their recovery, but the number of available beds across the UK is inadequate. Service provision is variable, and this means that long-term outcomes for brain injury survivors are compromised. There is a large variation in the provision of and access to neuro-rehabilitation services across the country, and a lack of neuro-rehabilitation personnel. Can the Minister assure us that a full review of neuro-rehabilitation services will be carried out? In doing so, he will ensure that more people will have the same opportunity that Julian had to make life after an ABI productive and meaningful.
This has been an excellent debate, and I thank all Members for their contributions. I congratulate my hon. Friend the Member for Rhondda (Chris Bryant), whose persistence week after week has undoubtedly facilitated the debate. I thank the Government for allowing it time.
Although we have first-class acute care in this country, and advances in medicine in recent years that have resulted in many more lives being saved following a brain injury, it is undoubtedly in long-term rehabilitation where much more support is required in order to save and preserve the quality of lives for those suffering from acquired brain injuries—and, of course, their loved ones. Somebody who has suffered a traumatic brain injury could have had three months in intensive care, six months in therapy, and maybe a year in residential care, and then they are often sent home and the help stops. Quite often personalities will have been affected, and the person who comes home could barely resemble the one before the accident or incident that led to the acquired brain injury.
A report by the Centre for Mental Health stated that 1.3 million people live with the effects of brain injury, at a cost to the UK economy of £15 billion per annum, based on premature death, the health and social care required, and lost work contributions and continuing disability. This cost is the equivalent of 10% of the annual NHS budget.
Two suggestions have been made about rehabilitation that might change things: first, that we should have a rehabilitation prescription just like a medical prescription so that the person knows, and the family know, what support there is going to be on an ongoing basis; and secondly, that every single major trauma centre should have a rehabilitation consultant, because one in four do not. Is that not essential to be able to make sure that we change this world?
I thank my hon. Friend for those suggestions, and I hope that Minister will respond to them. It is clear that my hon. Friend cares very much about this issue.
Neuro-rehabilitation is one of the most cost-effective services that the NHS provides, and one of the few services in medicine that results in long-term decreased costs to the economy. However, the number of available beds across the UK is inadequate, service provision is variable, and consequently long-term outcomes for brain injury survivors are compromised.
ABIs can result from many different causes, including stroke, tumour or brain haemorrhage. They can also be caused by a trauma to the head through assault, a road traffic accident, and accidents at work or in the home, as we heard from my hon. Friend the Member for Barrow and Furness (John Woodcock). Sporting injuries are the cause of many acquired brain injuries and have been subject to much media attention in recent years, with concern growing surrounding the long-term effects of concussions sustained through sporting activities. Awareness must be raised as to the dangers of head injuries in sport in order to prevent ABIs, along with stricter guidelines on how long an individual should rest following a concussion.
As we heard from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), one of the most common effects of an ABI is breakdown in marriages, relationships and family units as people struggle to cope with the changes in circumstances, and often personalities, following an ABI. The hon. Member for Cheltenham (Alex Chalk) discussed the increased propensity to commit crime after an ABI. Today I spoke to Peter Taylor, the business manager of a charity based near my constituency called Second Chance Headway, which specialises in caring for people with brain injuries. He talked about the amazing work that they do. He also mentioned that quite often families fall apart as children struggle to understand why the lady who looks like mummy can no longer do the things that mummy used to be able to do—simple tasks like making tea or washing—and wonder why she is angry a lot of the time when she used to be so patient and loving. Obviously this can apply to daddy too. Those are just some of the devastating effects of ABI that often happen behind closed doors.
Peter stressed the importance of raising awareness, and especially of the fact that an ABI is a brain injury for life, that a person could face 40 to 50 years of trying to adjust and come to terms with a devastating change in their life circumstances and that they may have to learn how to live again, with some of the most basic tasks having to be relearned, including how to make a cup of tea and how to dress themselves—things that we all take so much for granted.
Peter also spoke about the lack of funding and the finger pointing between social services and health commissioners over who should foot the bill for rehabilitation services, with no clear direction over where the money should come from. Second Chance Headway survives without a penny from the Government, as do many other similar charities across the country. There has to be a more co-ordinated and systematic approach to ensure that everyone with an ABI has the same quality of care and the same life chances. This service should not be reliant on the charity sector, especially in these times of austerity in which charities are struggling to access vital funds.
I would like to end by echoing the requests of my hon. Friend the Member for Rhondda for a Government taskforce across all relevant Departments, including Health, Education, Justice, Work and Pensions and Defence and for adequate funding for services. In the words of Peter Taylor of Second Chance Headway, “A life has to be worth living, otherwise what is the point in saving it?”
I am back, Mr Speaker. Time is very tight. If I do not answer any specific questions asked, I will write to Members; I always do.
It has been a very interesting and far-reaching debate. We have heard about some of the excellent work being undertaken to improve the care, treatment and support of those with an ABI. We have also heard about so many areas where so much more needs to be done, particularly around variation in care. I am the first to admit that there is a lot more that we need to do. I am clear from the debate that we need to keep our focus on providing rapid and appropriate triage and treatment of head injury, to ensure that patients can access the most appropriate service and level of expertise from the start—especially, as the hon. Member for Rhondda (Chris Bryant) said so well, in our schools. We should be seeing joint working between health, social care and education, with multi-professional assessments of a child or young person’s needs, including all the relevant experts, to get this right earlier and to prevent the cycle of problems that often lead to exclusion, brushes with the criminal justice system and a life scarred more than it already is. Dare I say it, as someone once said, we need to understand a little more and condemn a little less. I still believe in that.
Many Members talked about the need to ensure that patients have access to the necessary specialists and services that are relevant to their rehabilitation needs and to work harder than ever to iron out inconsistencies in what is available. I mentioned in my opening remarks the regional trauma networks, which have been very successful. A number of Members spoke about those, including my hon. Friend the Member for Chippenham (Michelle Donelan). The hon. Member for Barrow and Furness (John Woodcock), as usual, spoke from the heart and gave us a very personal insight into what happens when you are unlucky on a ladder and the fall-out across family and children. I think he has recovered incredibly well.
A number of Members, including my hon. Friend the Member for Cheltenham (Alex Chalk), talked about identifying and supporting individuals in whom a previous brain injury may be informing impulsive risk-taking activity leading to crime. I also take away the clear message that we must maintain our research commitment. The hon. Member for Washington and Sunderland West (Mrs Hodgson) said that a review of neuro-rehabilitation is required. The audit that we published at the end of 2016 recommends that all providers reflect on the capacity that they have. The national clinical audit of specialist rehabilitation will address that in the next stages of the audit, which are due to complete later this year.
The hon. Lady also talked about discussions with the DWP. We have discussions all the time. Many comments were made today about the DWP, so I am grateful that the Minister for Disabled People, Health and Work was on the Treasury Bench to hear those. Through the personal support package for people on employment and support allowance, the DWP is working to improve the support that it offers to those with long-term conditions such as brain injury, including peer support and training for disability employment advisers. However, it sounds like there is a lot of work to be done, and I know that my hon. Friend is keen to see that done.
We have had to go at a bit of a gallop this evening. I wonder whether the Minister could use his best offices to ensure that we have another debate fairly soon.
I may have been called “perfect” by Madam Deputy Speaker, the right hon. Member for Epping Forest (Dame Eleanor Laing)—Mr Speaker, you do not want to know—but all I can say is that there are many things at my disposal, but scheduling debates in this House is not one of them. There are many ways in which the hon. Gentleman can bring forward debates in this House, and knowing him as I do, I have a funny feeling that he will be doing it some more. Whichever Minister responds to such a debate, I welcome that, because there are a lot of issues and we need to look at them. He talked about an invisible epidemic, and he may well be right. It has been a pleasure to listen to this debate, short as it has been, and an honour to respond to it.
Question put and agreed to.
That this House has considered acquired brain injury.