PARLIAMENTARY DEBATE
Acquired Brain Injury - 6 February 2020 (Commons/Westminster Hall)

I beg to move,

That this House has considered acquired brain injury.

In 1980, I woke up in the middle of the night on a train from Barcelona to Madrid. All I could sense was the world moving in and out. It was not the worst headache that I had ever had or anything that could even be described as a headache; it felt as though my brain was struggling to burst out of my skull. As it turned out, I had viral meningitis. In the end, I was fine after a lumbar puncture and treatment in Madrid, but I feel very lucky, because many people who have had meningitis—with that precise feeling of the world going in and out as the brain pushes against the meninges and the skull—now have permanent brain damage.

Because of the work that I have done on the issue over the last couple of years, I am very conscious that there are some phenomenal people working with those who have brain injuries. Last year, I spent a beautiful day with the Children’s Trust in Tadworth, where a third of the children have had a haemorrhage of some kind, while others have been in road traffic accidents. The trust does phenomenal work to rehabilitate those children—restoring in them a sense of themselves—and to get them back into the education system.

I spent a day with the National Star College near Cheltenham, which does phenomenal work teaching many of these youngsters skills that they can take into the work environment. I saw people whose injuries put them in a challenging position learning to socialise again, and to understand their personal lack of inhibition and its impact on other people. Professionals working in south London explained to me the difficulty in moving people out of hospital and into other forms of community support, especially when families may have been broken up by, for example, the same road traffic accident that led to the injury.

Whether in Norwich, Lincoln, Birmingham or Manchester, the most extraordinary people are doing what looks like miracle work. They can take somebody from needing five or six people just to be able to clean, feed and clothe themselves during the week to the point where, after a year or two of neurorehabilitation and care and support of every different kind, they can do the vast majority of those things more or less on their own, relying perhaps on only one person. The narrow-minded might say, “That is a great success, because it means that the state will not have to spend so much money on them,” but it is a miracle to see such a transformation of those people’s lives. It is also depressing to see, for example, a young lad who has been sitting in an east London hospital for far too long because there is nowhere else for him to go that is safe and can provide the right kind of care.

In Cardiff, I met a young lad for whom we recently held a fundraising dinner at the football stadium—he is a magnificent chap. He had to go all the way to Tadworth because it is the only place in the country with residential neurorehabilitation of that kind for children. I want to that care to be provided closer to home so that parents do not have to make enormous journeys and children do not feel discombobulated and uncertain about their role in the family and how their life will proceed.

The Disabilities Trust has done amazing research—partly in Cardiff prison, but in other prisons, too—that the Government now wholly accept as factual and as the basis on which we should proceed. Who would have thought, even five or 10 years ago, that analysis of both male and female prisoners arriving in prison would show that more than half had sustained a significant brain injury at some point in their lives? The Government’s website states that someone who has suffered a significant brain injury is twice as likely to commit a serious crime. There is perhaps not just a correlation between the two, but a causal link. Maybe this is not, as some of us have said, a hidden epidemic affecting 1.3 million people across the country, but something much more systemic. If we can spot those who need support, ensure that they get it and deal with brain injuries sooner, so many other societal issues might be addressed.

Work with young offenders in my patch of south Wales, where we have a very good co-ordinated approach, made it clear that a child from a poor background is four times more likely to suffer a brain injury under the age of five, with similar figures for teenagers from poor backgrounds. Those ages are both important developmental periods for the brain, which is a soft organ inside a hard, craggy shell, and is therefore extremely vulnerable if pushed around or jarred. In my patch, three quarters of the youngsters in the criminal justice system who caused the biggest problems were those who had suffered significant brain injuries that had been left largely untreated. If we had dealt with those injuries in the first place, we might have been able to help those children in the education and health systems long before they entered the criminal justice system. That would have meant a much better outcome for those individuals, their families and society, and a much greater saving to the public purse.

Members will know that a brain injury can come about for all sorts of different reasons: a traumatic incident, such as a fall or a crash, or just a single punch. I can remember so many horrific incidents in my constituency, outside pubs and so on, where somebody has been punched in a fight. That punch, or the individual hitting the pavement or the wall, may lead to an injury that completely changes their life. The cause of a brain injury could be that, or it might be a haemorrhage, an aneurism, a tumour or carbon monoxide poisoning. Carbon monoxide poisoning can particularly affect people in rental accommodation, and we have to make sure that landlords properly test all the equipment in the house to ensure that a faulty boiler or heating system does not poison those who live there. We now have a much better understanding of carbon monoxide; not only can one big exposure to it do damage to an individual, but even relatively low levels sustained over a period of time can damage the brain in the same way.

Hypoxia is another cause of similar problems, as is stroke. I am quite conscious of this issue, because quite a lot of people have got in touch with me and said, “Why don’t you talk more about stroke?” It is not because I do not understand the problems in relation to stroke and brain injury—many of the issues are exactly the same; it is an injury, just by a different means—but because there are organisations specifically dedicated to stroke, such as the Stroke Association, which have been dealing with it. We in the all-party parliamentary group on acquired brain injury have tended to leave that to one side. But when we bring it all together, we realise that we still have a limited understanding of how to look after, treat, care for, provide for and protect the part of our body that we think of as the place where our personality resides, and therefore as the bit that is most intimate to us as human beings.

It is only recently that people at the Ministry of Defence have started to think that perhaps some people who have been diagnosed with post-traumatic stress disorder actually had brain injuries that were not treated and that led to all the other issues.

I congratulate the hon. Gentleman on securing the debate. As other Members want to speak, I will not intervene for long. A lot of diagnoses were not made at the time, sometimes because the symptoms were just not there. There needs to be an understanding, not just in the Ministry of Defence but in the medical profession—I will come on to social services—of what a brain injury is. A brain injury does not necessarily show itself straight away, and it does not necessarily have physical symptoms; it is inside this little cocoon that we rely on so much.

Perhaps we have thought, “Well, a little blow to the head is okay; we don’t mind and we’re not going to worry about that.” The right hon. Gentleman is right; perhaps we have been a bit blasé about it, and perhaps even more so in the armed forces, where people want to show that they are tough and can carry on.

Incidentally, the appearance of symptoms some time later is equally an issue in education. A child might come back to school wearing a bandage, at which point everybody is warm, friendly, loving, caring and supportive. Nine months later, when the bandage is gone and everyone presumes that the child is getting on with their life, the child may start becoming difficult in class, finding it difficult to concentrate and falling asleep in lessons. They may be less in control of their inhibitions, and all the rest of it. The teacher may not recognise that as part of what happened nine months before.

Unless teachers and the whole education system are trained to understand fully the concept of neurocognitive stall, there is a real danger that the child will end up becoming increasingly difficult because they do not know anything else; they get shouted at, which sends them into panic rather than making them say, “Please, Miss or Sir, I need some support and help.” Then the child ends up getting excluded and falling into the criminal justice system. If the support had been sustained from day one for at least a year, and if we had made sure that all the teachers in the school understood those issues, we might have been able to save that person’s education.

I commend the hon. Member on bringing this debate to the House, and on the work he has done in this area for some time. He is right to point to some obvious potential ABIs and the lack of knowledge and response. Will he reflect on some areas where there are changes in social norms and ideas about how brain injury can be acquired, such as in the heading of footballs? The Scottish Football Association has considered banning children from heading footballs.

Interestingly, I had a phone call yesterday morning with Dawn Astle, the daughter of the famous footballer Jeff Astle, who was particularly renowned for heading the ball. I am a Welshman, and we have been boycotting the World cup for very long time—certainly the finals, anyway—so football is not my area of expertise. However, something I have been particularly disappointed about since the APPG produced its report “Time for Change” is that, even though we have been making recommendations about concussion in sport for quite some time, the Government want to wash their hands of it.

There is legislation in every state in the United States of America about sport’s duty of care to participating individuals. Sport is good for you; playing football, rugby and all these things are good for you. I do not want to mollycoddle or wrap anybody in cotton wool, but there may be subtle changes that one can make to each sport to prevent unnecessary damage to people’s brains. Also, I still think that there has not been a cascade of information and understanding of concussion from the professional medics in the organisation down to the grassroots of each sport. That will happen only when there is a shared set of protocols for all sport.

There is clear evidence that a professional footballer is three-and-a-half times more likely to suffer from dementia. There is lots of evidence to suggest that that is to do with heading the ball—not the weight of the ball, as may people say, but the physical process of heading the ball, because it pulls the brain from one side and hits it on the other, which leads to a significantly increased risk of dementia. It seems bizarre that that is not thought of as an industrial injury, which football needs to look at seriously. It also seems bizarre that, at the very highest level of football, a footballer who is taken off to be tested for concussion cannot be replaced, and that player gets only three minutes, which is nowhere near enough time for a proper analysis of whether somebody has suffered concussion.

Football still has some considerable way to go. The Department for Digital, Culture, Media and Sport must play a role in bringing all the sports bodies together round a table to analyse this problem. Otherwise, sports will end up facing massive court cases and very big fines, as has happened in the United States of America. I would prefer us not to go down that route.

There is a spectrum stretching from those who have suffered the worst traffic accidents or have had a severe stroke to those who have had a minor head injury and have lost consciousness for less than 15 minutes. Incidentally, there is a lot of misunderstanding about what losing consciousness and concussion means—I will not go into that, but there are different parts of the brain that might be affected.

My hon. Friend is making an excellent speech. Regarding road traffic accidents, there is a spectrum of vulnerability, and cyclists are some of the most vulnerable road users. There have been many studies about the efficacy of cycle helmets. The Cochrane review found that using a cycle helmet reduces the likelihood of brain injury by up to 88%. Should the Government not do more to encourage the use of cycle helmets for cycle safety?

I will not go beyond my area of expertise, so I hope my hon. Friend does not mind that I hesitate to respond. I have read the piece of work that he refers to, and he is right. Other work suggests that there are other things we must do to ensure that cyclists are safe. We need a mixture of all those measures because in future more people will cycle, and we do not want that to lead to a significant increase in road traffic accidents.

The one thing I must praise the Government for, though, is the development of the major trauma centres in England. Despite in many cases not being particularly popular, because it has felt like a service is being made less local and a more regional centre of excellence, the centres have undoubtedly led to at least 1,000 extra lives being saved every year. I praise the Government for their work on that, and I am glad that we will have something similar in south Wales soon. I will not go into the issues about the accident and emergency unit at the Royal Glamorgan hospital today.

The downside of saving lots of lives is that there is a duty of care to provide the neurorehabilitation needed to ensure that those people have a decent quality of life. It is perfectly possible to do that, but at the moment a quarter of major trauma centres do not have a neuro-rehabilitation consultant. There has been significant progress in relation to neurorehabilitation prescriptions. When I last raised that subject, the Government said that around 90% of people were receiving such prescriptions, but whether they are going to the individual and their families, to ensure that that can be pursued, or whether those prescriptions remain with the doctors only, I do not know.

If the Minister looks only at one specific issue, I am keen she looks at how patients get written to. Some doctors, such as consultants, always write to the patient’s GP or other doctor, sometimes in highly technical language. Some local health trusts copy that letter to the patient, but some doctors are now doing something far more effective—certainly far more effective in this area. They are writing not to the other doctor, but to the patient and copying that to the doctor. Of course, they have to use language that the patient can understand, but it is about empowering the patient. One message that I have heard more than any other from many patients and families I have talked to is that they feel completely powerless. Lots of other people are making decisions about them, but they do not understand how those decisions have been reached. They do not know whose door to knock on—or whose door to knock down for that matter—to ensure that their loved one gets the care and support they need. I wonder whether turning those letters on their heads so that the doctor writes to the patient, putting that information in their hands and empowering them, and similarly giving the prescription to the patient and family rather than to somebody else in the medical establishment, would not have a profound cultural effect.

I want to talk briefly about prejudice, because a degree of prejudice is another thing that sometimes comes with a brain injury. Perhaps the person in front of us in the queue in Morrisons or Sainsbury’s or wherever is slurring their words. It is all too easy to get judgmental and think, “Oh well, they’re drunk, and it’s only eight o’clock in the morning,” or whatever, but it might be because they have had a brain injury. It is great that work has been done on the London underground—it needs to be rolled out across the whole country—to explain that some disabilities are not visible, so we should suspend our tendency to be judgmental. We should probably suspend it more often in life generally, but we should do specifically in relation to potential disability.

In commenting on a story from earlier this week, I make absolutely no criticism of my hon. Friend the Member for Salford and Eccles (Rebecca Long Bailey), who I think mistakenly used the word “vegetable” when she meant to say “vegetative state.” Actually, I would like to get rid of the concept of vegetative state. It just sounds wrong. To any ordinary person, it sounds like vegetable, but these are people with all their humanity still in there, even if their personality may have changed in all sorts of ways because of the damage. The Minister will not do this, but I beg the medical establishment to come up with another term that is more sympathetic and genuinely expresses not just the downside of the condition, but hopefulness about the possibilities that may still be to come.

As I said, brain damage is not a pandemic and it is not catching, but it is in a lot of people’s brains. The damage has been done, and many people who have suffered that brain damage do not know that the reason why they find it terribly difficult to concentrate or to get up in the morning—they suffer from phenomenal fatigue that hits them like a sledgehammer—why they find it difficult not to lose their temper, or why they get frightened of loud noise or chaotic circumstances and so on is because they had a brain injury at some point. That is all out there and it affects so many Departments of Government. We have had many wonderful warm words from lots of Ministers—this is my fifth or sixth debate on the subject—but now I really do want the Cabinet Office or Downing Street to set up a cross-departmental body to look at the issue in the round, rather than in each of the different silos. I am serious about this, and I am not asking for lots of money. I hope that the Minister will take that back to the Cabinet Office and Government. At some point, I would like the Prime Minister to chair that body, because we could bring about real, positive societal changes if we get this right.

I will set out what specific Departments can do. In the Ministry of Justice, we should be screening all new prisoners coming in so that we can give them proper rehabilitation. We know there will be many people who have not had their needs met heretofore. That will make it easier to run prisons and much easier to rehabilitate those people not just physically, but back into society to lead fruitful lives. The Justice Committee produced a report in 2016 on youngsters in the criminal justice system, which made specific reference to brain injury. I really hope that all the recommendations in that report will be taken up by the MOJ.

I turn to the Department for Work and Pensions. All MPs have experience of the assessment process not being able to comprehend varying conditions. That is one of the problems with many brain injuries: someone might be all right today and, probably because of their brain injury, they want to please the person sitting in front of them, assessing them. They say, “Yes, I’m fine. I am absolutely fine. Honestly, I am fine,” but tomorrow they will not be able to get out of bed, not out of laziness, but because of completely debilitating fatigue. All assessors for personal independence payment, disability living allowance, universal credit DLA, universal credit, and employment and support allowance—everyone—must have a full understanding of brain injury and the way it works.

In the NHS, I know there are shortages in many categories of personnel. If I have one hope for something that might come out of a Government who have a significant majority, it is for more long-term personnel planning. Specific work needs to be done, because we are falling a long way short in the number of beds needed for neurorehabilitation and, in particular, in being able to take children out of hospital and into community services. I have already referred to the rehab prescription.

There are two other bodies that I want to thank as I end. The first is the United Kingdom Acquired Brain Injury Forum, run by Chloe Hayward. The all-party parliamentary group has worked extremely closely with it, and later this year we intend to do more roundtables to gather more evidence to take this work forward. I have discovered there are many spheres in medicine where all the organisations do not speak to one another or sit round the same table. I have been doing work on melanoma, and I would love to bring all the many melanoma charities together so that we have a co-ordinated approach. UKABIF provides that co-ordinated approach, I really want the Government to adopt that model. We could really crack something here if we manage to work on it not just with one Department at a time but with all of them co-ordinated together.

Finally, I am sure my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) will refer to this in a moment, but I want to thank Headway. I had an amazing day speaking to the Headway conference last year. I have referred to some of the professionals, but the most amazing people are probably those who have been through a version of hell that none of us would ever want to experience, having sometimes lost significant members of their family as well. I remember one woman said to me, “I know I have to use all the energy in my head to make my head better, but I am using all the energy in my head to try to work out this DWP form.” That is not what the state should be doing. That is when we really do want a nanny-state to help, to sustain and to support. All too often, of course, it is charities that provide exactly that, and I pay an enormous tribute to Headway for the work it has done.

Order. I want to start the Front-Bench speeches at half-past 2; please bear that in mind. We must also allow a couple of minutes for Mr Bryant to wind up at the end.

I thank the all-party parliamentary group on acquired brain injury for its continued determination to ensure that the issue is given the time and attention it deserves; I particularly thank my hon. Friend the Member for Rhondda (Chris Bryant), who has campaigned admirably. Politicians’ stock is low at the moment, but anyone who heard his contribution, with its passion, hard work, determination and sincerity, would feel a lot better about what we do.

As the right hon. Member for South Holland and The Deepings (Sir John Hayes) said, one person is admitted to hospital in the UK every 90 seconds as a result of brain injury, so it is imperative that the recommendations in the APPG’s report, “Time for Change”, are implemented without delay. I fully support the excellent report and endorse all its recommendations.

As hon. Members may know, I have a long-standing association with the brain injury charity Headway, mainly through its chief executive, Peter McCabe, who has been my friend and colleague in Mitcham for more years than I care to say. His charity does incredible work across the UK to support individuals and families affected by brain injury. The help provided by Headway is seen as a lifeline to those who receive it, whether through its helpline—inquiries to which have more than doubled in the past decade; through the provision of free, award-winning publications to help people understand and adapt to life after brain injury; or through grants distributed via its emergency fund.

Many hon. Members will also testify to the exceptional work done by Headway groups and branches in their own constituencies. The APPG report rightly calls for a national review of neurorehabilitation to ensure that service provision is adequate and consistent throughout the UK. This report must not confine itself to acute care settings. Headway groups and branches are under severe financial pressure as a result of cuts to local authority budgets. The fact that they continue to provide such vital support, through rehabilitative therapies and social interaction programmes, is a testament to their determination to support this vulnerable community.

Let us be clear: the pressure under which Headway groups operate must be eased, and they must be afforded the funding they need to continue to support people who may otherwise be cut adrift from society. “Time for Change” also calls for improvement to how the criminal justice system meets the needs of brain injury survivors. In a previous debate on acquired brain injury, I highlighted Headway’s brain injury identity card, which helps to identify brain injury survivors when they come into contact with the criminal justice system. To date, more than 7,000 such cards have been distributed to vulnerable adults in the UK.

The ID card is part of Headway’s Justice Project, which is helping to increase understanding of brain injury within the criminal justice system. That includes the provision of training to the police, liaison and diversion services, the Crown Prosecution Service, the Public Prosecution Service in Northern Ireland and other agencies. As highlighted in the report, this work is vital and charities such as Headway must be supported in delivering the training required.

I have also previously spoken of the Headway emergency fund, which provides grants to families to ensure that they can be by the bedside of a loved one in the acute stage of care following a brain injury. Since it was established, the fund has distributed more than £400,000 to almost 2,000 families with limited income or savings. About 82% of those grants are spent on travel, accommodation or parking at hospitals when no alternative transport is available—an issue I would like to focus on.

In December, the Government announced a new approach, giving access to free hospital car parking for thousands of NHS patients and visitors. I congratulate the Government on that announcement, which stated:

“From April, all 206 hospital trusts in England will be expected to provide free car parking to groups that may be frequent hospital visitors, or those disproportionately impacted by daily or hourly charges for parking”.

Each year, thousands of patients admitted with ABI will have sustained severe brain injuries, putting them at the greatest risk of a fatal outcome. If they survive, they face many weeks or months in acute care and rehabilitation. The development of major trauma centres and specialist brain injury units results in improved outcomes for patients. However, the emergence of such centres has meant patients being treated many miles from the family home, resulting in families facing financial hardship to be by the bedside of their loved ones.

If the patient is the main breadwinner or self-employed, the financial stress placed on the family can force them into impossible choices. The families of patients who have sustained potentially fatal acquired brain injuries will be desperate to be by the bedside of their loved ones at such a critical time, often for periods of several weeks or months. I am sure everyone agrees that they should be classified as “frequent hospital visitors” who are

“disproportionately impacted by daily or hourly charges for parking”.

Will the Minister confirm that that will be the case? It is vital that we receive confirmation today that it will, so that that vulnerable group receive the support they so clearly deserve.

It is a pleasure to take part in this debate. I campaigned for free car parking with my right hon. Friend the Member for Harlow (Robert Halfon), and I completely agree with what the hon. Member for Mitcham and Morden (Siobhain McDonagh) said about it. Perhaps the Minister cannot commit now to abolishing car parking charges, but I am sure that the Government will do so because we campaigned for that all the way through. No distinction should be made between one type of case and another; people who need to be by their loved one’s bedside should not be paying car parking charges. The NHS was designed to be free at the point of delivery, and that includes car parking for people in that position.

The hon. Member for Rhondda (Chris Bryant) is right in most, if not all, of what he said. His personal experience has given him an outlook that someone like me could not possibly have. Interdepartmental work is the only way to take this forward. Like my right hon. Friend the Member for South Holland and The Deepings, I have been a Minister—in my case, in seven Departments, before I managed to upset the last one and came to the Back Benches. This will only work if the Prime Minister says that there will be an interdepartmental group that will meet regularly and will be chaired by so-and-so—probably the Deputy Prime Minister, as it was then, or the Cabinet Office—and that they will report back what each Department is doing.

As we have heard, nearly every Department will be affected, from the Department for Digital, Culture, Media and Sport—the hon. Member for Airdrie and Shotts (Neil Gray) has alluded to football, and I will declare an interest about rugby and boxing in a moment—to the Department for Work and Pensions, which deals with how personal independence payment is assessed, and where I used to be a Minister. As I said earlier, because of the nature of the injury, it is not always visible; very often, it is inside.

I will touch on some other points. I understand exactly where the Scottish Football Association is going in looking at the issue of younger people and heading, but if those young people go on to play professional football later, they will head the ball. The rest of the world of football must take a leaf out of rugby’s book—particularly rugby union. I declare an interest: I stupidly started playing rugby when I was 11, and I am still playing now. I will be playing against the Welsh Assembly at Richmond in a couple of weeks’ time; that game might be slightly more interesting than the England-France one was.

Perhaps because we have seen some shocking injuries and we know what is going on, the game has changed, not just in that we now pull people off the pitch to be assessed, but in how we tackle. To be fair, a lot of that has to do with American football, where they used to lead with their head because they had the protection of the helmet, and because of machismo. Women’s rugby is the fastest-growing female contact sport in the country, and it has been for years; quite right, because it is brilliant to watch. However, in women’s rugby as well as men’s rugby, the game had to change to protect the players—those going into the tackles as much as those coming out of them.

Like the right hon. Gentleman, I declare an interest in view of my past, rather diminished career as a rugby player. Football certainly has a lot to learn from rugby, not least when it comes to what he is saying about the contact area. The enforced absence of a player from the pitch for a period of time following a concussion diagnosis is also important, and it is something that football needs to learn from.

I could not agree more, and I was just coming on to that point. The Football Association and FIFA do not need to reinvent the wheel. We need to take time to assess whether a person has been concussed and, if so, they should not play the following week or the week after that. Those assessments have to be done by professionals, away from the pitch, and sometimes with scans.

Rugby has led the way. I watched a rugby league match this weekend—I have a rugby league team in my constituency, even though I am deeply in the south. Some of the tackles just would not be allowed in rugby union any more. As far as I could work out, they were old-fashioned spear tackles—the player is allegedly going for the ball, but they catch their opponent around the top of the neck, and that causes damage to the brain, which rattles around inside the piece of bone that protects the brain. It is plainly obvious that we needed to change, and it has taken time—probably too long—but it has happened.

Boxing also has to change for the better. I declare an interest, in that I boxed for many years. I am talking not just about the terrible things have gone on in the ring, as a result of which people have died for a sport that they love and want to be involved in, but about what happens to people years later. I will not name names, but I know several former world boxing champions who now suffer the consequences of the brain damage that they incurred. They can be read about in the papers. I do not need to name them, and it would be improper to do so.

This is not just about concussion. People in this situation have gone through clinical depression, and their injuries affect them and their loved ones for the rest of their lives. We must support more awareness and encourage the sport to do all it can to open up. We do not need to reinvent the wheel, but we must learn from other sports. I wish the hon. Member for Airdrie and Shotts luck in Scotland on Saturday, and I hope that England play somewhat better than they did against France. Let us hope that there are no injuries like some of the ones we have seen in the last couple of weeks. There was a neck and spinal injury at the Saracens-Worcester game the other week, and it was spine-chillingly horrible. People want to play the sport and it is their passion—stupidly, I still play—but we have to make sure that we protect them.

I want to touch on long-term care and the assessments that are carried out when people with a pre-existing brain injury of some description get dementia. Continuing healthcare is an absolute minefield. I have heard about this from too many of my constituents, and from colleagues in the House over the years. Even though someone who is going into care has a medical condition—a brain injury—before dementia comes on, that seems to be put to one side when the panel look at continuing health provision for them. That is fundamentally wrong.

Just because someone develops dementia or Alzheimer’s, it does not mean that their other medical conditions have vanished off the face of the earth. They have not. But time after time, I have had to help individuals and their families to go to appeals and tribunals to get something that they would probably have got if the individual had not got dementia, but that that they do not get because they have dementia alongside the pre-existing injury. It sounds very complicated, but it is actually very simple. If someone has a medical condition, such as a brain injury, that brings on dementia—we do not really understand that, and I was reading some research last night on the reasons for it—surely, the medical and nursing care that they needed for that brain injury should not be put to one side when they go for an assessment if they have Alzheimer’s or dementia.

I give praise where praise is due. I was a shadow Health Minister for four and a half years when the last Labour Government were in power, and they started the major trauma centres. The debate started with them, and they progressed it. The issues with major trauma centres are about where they should be, how quickly people can get to them and whether enough people are using them to make them viable, given the required expertise. To be honest, it is the same old story as with A&Es. Major trauma centres are not A&Es; they are specialist units for people who need specialist care. People who need to go to A&E should go to A&E, and people who need to go to a minor injuries unit should go to a minor injuries unit. It is about making sure that people go to the right place.

With major trauma, the decision is made for people. All the major trauma centres have helipads now. I truly hope that as they develop as centres of expertise, we will recognise that people need travel to the right place to see the specific consultant specialist who can save their life. That may not be the centre that is just down the road or the one in London—for my constituents, such things often involve coming into London—but it might be one that is 20 minutes away by helicopter ride. That is absolutely right, if that is where the expertise is. The time when people need to be closer to home, and to the support of their loved ones, is when they come out of major trauma centres and into rehabilitation.

Public understanding about major injuries is better these days. I was a fireman for many years and, sadly, I went to too many road traffic incidents. People are increasingly surviving major road traffic incidents or collisions. We tend not to call them accidents these days, because they are not accidents—they are preventable—and victims feel very strongly that we should not call them accidents. I understand that view. I made a big booboo as road traffic Minister when I talked about road traffic accidents. I did so because that is what firefighters did, but I respect the point: every accident is preventable, and these are collisions in which people’s loved ones are involved.

Today’s survival rate has a lot to do with the manufacture of the vehicles, airbags and how crush plates work inside vehicles. Those things mean that more people are surviving, but with very serious injuries. As I alluded to in my intervention, some of those injuries are physical and show themselves there and then, but a lot do not show signs until much later—sometimes nine weeks or nine months, or sometimes many years later.

That brings me to my final point, which is about our armed forces. We send our armed forces around the world. They work in a very dangerous occupation, and we try to make it as safe as possible. Sometimes, there are injuries in training. We sadly lost one of our Royal Marines only the other day; he was doing the job he loved and training to do something he was passionate about. Our thoughts and prayers are with his family, friends and loved ones.

We must look after our armed forces personnel after they are injured. I can remember so many incidents around head injuries when I was a squaddie, and there was no way that I would have gone down to the medical officer the day after a head injury with a headache. The barrack room humour would have been all about, “Get on with it. You are supposed to be robust.” I have been the Minister for the Armed Forces, and I think we are getting there, but the way forward is to improve public awareness. That involves debates such as this, and perhaps an overall Government body that can look at the issue in general terms. I hope we do not need too many of these debates—I have been around a long time—before we get to a better position in Government.

It is a pleasure to contribute to this debate on behalf of the SNP with you in the Chair, Mr Robertson. I strongly commend the hon. Member for Rhondda (Chris Bryant) for bringing the debate to the House, for his contribution over many years and for the erudite and informed way he goes about his business on this subject. I hope it means that ears are open to what he has to say, not least today. He has certainly earned respect for his erudite contribution in the debate today. I am only sorry that the debate is happening on a Thursday—normally a day when colleagues take time in their constituencies to carry out constituency business, which is why so few are here with us today.

The speeches today have been consensual in nature and informed and have added a very real quality to the debate, which I am sure the Minister will reflect on as she comes to sum up. The contribution of the hon. Member for Rhondda was very personal. He rightly mentioned the report of the all-party parliamentary group that he chairs, whose publication my party welcomed. He drew on examples of people he has worked with who require and deserve specialist provision as close to their home as possible. All Governments in these isles need to reflect on that, and on the wider societal impacts of ABI, which require earlier and greater intervention to prevent them from happening at all. The hon. Gentleman was also right to raise the issue of language in this context; he himself cited an unfortunate example and I hope that we will all reflect on it in the future.

The right hon. Member for South Holland and The Deepings (Sir John Hayes) too made a very erudite contribution, which was also informed by his personal experience, and I commend him for the work that he has done with the all-party parliamentary group, too. And he was right about the need for cross-departmental and cross-Government co-ordination, which I will come on to later in my speech.

I commend the hon. Member for Mitcham and Morden (Siobhain McDonagh) for her work with Headway. The point about a brain injury ID card was a very interesting focus of her speech. The benefits of such a card, which she articulated, are quite clear.

Like other colleagues, not least the right hon. Member for Hemel Hempstead (Sir Mike Penning), who have campaigned strongly on hospital parking charges, I am sure that the hon. Lady will be aware that in Scotland we have already got rid of them. I encourage them to keep pressing the Government in that regard, because of the very obvious benefits that such a change would provide for people using hospitals.

The right hon. Gentleman was right to focus on sport; our exchange on that subject is on the record. I entirely agree with him that sport undoubtedly has a role to play and can do immeasurable good for society, not only in terms of physical health but in terms of mental health. However, a lot of work needs to be done, especially in the particular sports that he mentioned but also in sport generally. The hon. Member for Rhondda rightly highlighted that issue as well.

As for myself, I will relate the Scottish experience. Be it in relation to ABI or any other issue, disabled people—regardless of their condition—deserve the right to live as independently as possible, and they should have freedom, dignity, choice and control over their lives. Accessibility is at the foundation of the approach that the Scottish Government are taking in providing disability support. I point Members towards “A Fairer Scotland for Disabled People”, which is the Scottish Government’s plan in response to the UN convention on the rights of persons with disabilities. It aims to make equality of opportunity, access to services and independent living a reality for all disabled people, as well as being a national plan for accessible travel, an awareness-raising campaign about the barriers that disabled people face, and a review of the legislation regarding adults with incapacity. It also aims to increase the uptake of modern apprenticeships by disabled people, to provide a new social security system that treats people with these conditions with dignity and respect, and to call for more work to tackle disability hate crime and violence against disabled women and girls. The Scottish party’s vision is that children and adults in Scotland with acquired brain injury should have equal access to the highest quality brain injury care, regardless of where they live.

The Scottish Acquired Brain Injury Network was established in 2007, with the key objective of enabling improvements in access to and the quality of services in Scotland. SABIN comprises service user representatives, healthcare professionals, service providers and voluntary sector groups, and it has published the traumatic brain injury and adult standards. Those standards have ensured that there is a joined-up approach to immediate and long-term care for people with an acquired brain injury. The right hon. Member for South Holland and The Deepings raised that earlier, and the Government here in Westminster should look at it.

The Scottish Government have also made significant investment in the health service to provide the care that is required, including opening two major trauma centres in Dundee and Aberdeen, with further centres due in Glasgow and Edinburgh soon. I hope that all these centres will be adequately staffed with neurorehabilitation consultants, as the hon. Member for Rhondda suggested.

Clearly, there is work to do, not just in Scotland but elsewhere in the UK. Nevertheless, I hope that colleagues will recognise that Scotland is working hard on this issue. I thank the hon. Gentleman once again for bringing this debate to the House. I hope that his demands are taken seriously, and that that is reflected in the Minister’s response to this debate.

It is a pleasure to serve under your chairmanship this afternoon, Mr Robertson.

I begin by congratulating my hon. Friend the Member for Rhondda (Chris Bryant) on securing this very important debate, on his excellent speech, and on his continuing honesty and willingness to share details of his personal experience, in order to further the vital campaigning on acquired brain injuries.

I also thank the other right hon. and hon. Members who have taken part in the debate: the right hon. Members for South Holland and The Deepings (Sir John Hayes) and for Hemel Hempstead (Sir Mike Penning); my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh); and the hon. Member for Airdrie and Shotts (Neil Gray), who spoke for the Scottish National party. It has been an excellent debate and I am definitely looking forward to hearing the Minister’s response to it.

First, like my hon. Friend the Member for Rhondda, I thank the charities working in this field, including the United Kingdom Acquired Brain Injury Forum and Headway, whose chief executive, Peter McCabe, I also have the pleasure of knowing well. I thank them all for their invaluable work to support people with acquired brain injuries and their families. I also give special thanks to Headway Wearside, which goes above and beyond for people in my region in the north-east, especially for people in my constituency. Headway Wearside has given me a lot of help over the years with constituents’ cases.

As we have heard, acquired brain injury is a leading cause of death and disability in the UK. A brain injury can happen in an instant at any age or at any stage of life, and the effect can be devastating and life-changing. ABI is a hidden epidemic, affecting many hundreds of thousands of people’s lives in many ways. As a result, and as we have heard, people with ABI face challenges that are related to more than just one Government Department. That is why I am pleased to echo my hon. Friend the Member for Rhondda and the all-party group on acquired brain injury in asking the Minister to work with her colleagues across Government Departments to ensure that people with brain injuries get the care and support they need, whatever that care and support might be.

As we have heard, every 90 seconds someone is admitted to hospital with an acquired brain injury. Thankfully, improvements in medical procedures and acute care have led to improved survival rates, which is welcome. However, as we also heard—I think it was the right hon. Member for Hemel Hempstead who made this point—that brings its own challenges and places further pressure on already stressed, indeed overstretched, health and social care services.

Early and continued access to specialist rehabilitation has been shown to optimise the chances of recovery and to be extremely cost-effective. However, there is an NHS workforce crisis, and we need more neurorehabilitation health professionals, such as physiotherapists, occupational therapists, speech and language therapists, and educational psychologists, to deliver services. What is the Government’s plan to attract prospective professionals to neuro-rehabilitation, and what are the Government doing to retain the current workforce, especially when service provision is variable across the UK?

It is crucial that people with ABI get the support they need, because this issue is also about the quality of their lives. What consideration has the Minister given to the APPG’s recommendation to establish a national review of neurorehabilitation provision? Also, rehabilitation prescriptions are very important in continuing communication and care across individual services, so will the Minister ensure that they are mandated across the services?

It is important that a patient and their family or carer know what care and support they need and what services they are currently accessing. That includes services provided by schools and other educational professionals, who may teach young children and young people with brain injuries. Best practice guidelines must be approved and followed for children and young people who return to education after an acquired brain injury, and operate throughout the rest of their education.

I will pick up on a point that my hon. Friend the Member for Rhondda made earlier, namely that if a child suffers a brain injury in their early years before they have even attended school—when they are under five—the school may never be aware of the link between their acquired brain injury and their behaviour in class, their educational ability, or indeed their behaviour in society, leading to all the issues that my hon. Friend mentioned with regard to youth offending and the need to screen prisoners, so that those who have slipped through the net throughout their school years can start to receive the help and support that they need and deserve.

All education professionals must have an awareness and understanding of ABI and the education requirements for children and young people with the condition. What conversations has the Minister had with her colleagues in the Department for Education about supporting children and young people with ABIs throughout their education? For those with pre-school ABIs—perhaps from a fall or meningitis—at the start of their education, what is being done to ensure that that information is captured and recorded in the child’s confidential record which that will follow them throughout their school years, in case issues begin to manifest themselves many years later?

What conversations has the Minister had with her colleagues in the Department for Work and Pensions about ensuring that all benefits assessors are trained to understand the problems that affect individuals with ABIs? A few hon. Members also mentioned that issue. I am talking not just about medical issues, but about how people’s behaviour or speech may be affected, as my hon. Friend the Member for Rhondda said,. Those effects may make them seem difficult to deal with, and that needs to be explained to assessors; otherwise, individuals with ABI could perhaps be harshly dealt with for something entirely outside their control. Will the Government ensure that a brain injury expert is on the consultation panel when changes in the welfare system are proposed, to ensure that the system works for people with ABI and their unique needs?

As we have heard, ABIs can be complex and therefore require attention from numerous Departments to ensure that patients and their families and carers receive the support that they need. I therefore hope that the Minister will consider everything that she has heard said in this excellent—small but perfectly formed—debate and will work in a co-ordinated and consistent way with her Government colleagues to deliver on the recommendations set out in the excellent all-party group report.

It is a great pleasure to serve under your chairmanship, Mr Robertson. I add my congratulations to the hon. Member for Rhondda (Chris Bryant) on again securing a really important debate on this issue. He is such a brilliant and effective champion of people with acquired brain injuries. His passion is incredibly infectious and set the tone for the rest of the debate, which I think everybody would agree has been incredibly constructive and thoughtful; there have been excellent contributions from everybody. The hon. Gentleman leads the all-party parliamentary group on acquired brain injury, about which all its members are very passionate. They have done superb work.

I thank everybody who took part in the debate: my right hon. Friends the Members for South Holland and The Deepings (Sir John Hayes) and for Hemel Hempstead (Sir Mike Penning) and the hon. Members for Airdrie and Shotts (Neil Gray), for Mitcham and Morden (Siobhain McDonagh) and for Washington and Sunderland West (Mrs Hodgson).

As hon. Members will know, it is estimated that the total cost of brain injury in the UK is at least £1 billion per annum and that the number of people living with ABI is more than half a million and could be as high as 1 million. Many hon. Members have explained that, as with many long-term conditions, the impact of ABI is not limited to an individual’s health but is felt across many aspects of their life, including family, work, relationships and finances. Of course, such an injury could happen to any one of us. My right hon. Friend the Member for Hemel Hempstead spoke about traffic incidents and collisions. That could happen to any one of us on our way home today.

I join the hon. Member for Rhondda in taking this opportunity to recognise, first, the outstanding work done by professionals in this field and, secondly, the wonderful work undertaken by charitable organisations such as Headway, the United Kingdom Acquired Brain Injury Forum and the Children’s Trust, which he mentioned. They are incredibly highly valued by those affected. They do invaluable work in raising not only money but awareness and by providing incredible support to those with the condition, as well as to their families and carers.

I have had quite a long-standing involvement with Headway in my region of Portsmouth and Gosport, since before I became an MP; as an MP, I have met my local team on a number of occasions. They are remarkable and offer the most fantastic support to people in my area. They certainly make a difference to people’s lives and they are so inspiring. On one occasion, I visited them with a member of my team, and she was so buoyed up by the visit that she decided to go off and do the Great South Run to raise funds for the Headway charity. I am not going to follow her example: literally nothing apart from someone chasing me would make me run 13 miles, but people can see how—

It could be arranged.

Thank you; that is a very generous offer. People can see what an inspiring group Headway is.

We have heard a lot about the excellent and wide-ranging APPG report from 2018. As the hon. Member for Rhondda said, the Department of Health and Social Care co-ordinated with officials from across Whitehall to deliver the response, which was a truly cross-Government response, but I certainly feel his frustration at how silo working across Whitehall can be an impediment to getting the change that he wants. A number of right hon. and hon. Members have mentioned that today, and I will certainly take forward the idea of a real, collaborative cross-Whitehall group to discuss this. Even from the issues raised today, the Department of Health and Social Care, the Department for Work and Pensions, the Department for Digital, Culture, Media and Sport, the Department for Transport, the Department for Education, the Ministry of Defence and the Cabinet Office—I am sure there will be others—all need to be involved in the conversation.

I thank the Minister for her contribution thus far. It was remiss of me, not just as someone who comes from an armed forces family but as a constituency MP with cases involving constituents who have been medically discharged from the armed forces, not to highlight and focus on the contribution from the right hon. Member for Hemel Hempstead (Sir Mike Penning) on the greater work that needs to be done within the MOD and across Government to ensure that we are treating our armed forces personnel, particularly when they leave service, with greater respect, and to ensure that we are providing for them, given the level of service that they have provided to all of us.

The hon. Gentleman is absolutely right to raise that issue. NHS England has a veterans trauma network, which delivers comprehensive medical care to veterans, including those suffering from brain trauma. It does excellent work, but there are also many individual charities up and down the country that work to support veterans who may not have been diagnosed; they may have been diagnosed with post-traumatic stress disorder or something else, but never actually had the original head injury diagnosed.

Almost as if to highlight the fact that this is a hugely cross-Government issue and the inadequacy of Ministers working in their individual silos, I will today be able to focus massively only on the issues relevant to our health service, but I will try to come on to a lot of the questions that right hon. and hon. Members asked.

Yes, I am very happy to commit to doing that.

Before I go on to talk about the health implications of ABI, I want to deal with a couple of other things. They are not within my realm of expertise, but I want to touch on them.

The hon. Member for Mitcham and Morden spoke about the Headway brain injury identity cards—how important they are and how important it is that they are recognised across the criminal justice system. I wanted to mention how Headway has been integral in partnering NHS England’s health and justice liaison and diversion services programme team, to provide workshops in London and Leeds to raise the awareness of the prevalence of ABI within criminal justice populations. The objectives were designed in a “train the trainer” format, so that the attendees could return to their services and cascade the learning on how to identify people with brain injury, how to identify the brain injury cards that Headway has brought forward and how to understand the implications. I thought that was quite positive.

My right hon. Friend the Member for Hemel Hempstead was right to mention the positive progress that has been made in some sports. The Rugby Football Union’s Headcase campaign and the British Horseracing Authority have also made great strides in this area. However, he was also right to say that other sports have a long way to go.

The hon. Member for Rhondda spoke about trauma centres. As he knows, in 2012 22 regional trauma networks were developed across England to ensure that those with the most serious brain injuries received the best care. Two years after their introduction, an independent audit showed that patients had a 30% improved chance of surviving severe injuries. Since then, as he says, the network has saved literally hundreds of lives.

For people who have ABI, neurorehabilitation that is timely and appropriate to their circumstances is a massively important part of their care. Access to high-quality rehabilitation saves money and, more importantly, significantly improves outcomes for patients. NHS England commissions specialised rehabilitation services nationally for those patients with the most complex level of need. As we have already heard, trauma unit teams work to assess and develop a rehabilitation prescription for brain-injured patients. At the unit, patients can access care from specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription.

These rehabilitation prescriptions are an important component of rehabilitation care, because they reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient. The APPG argued that all patients should benefit from an RP; as I understand it, at discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialist or local rehabilitation, supported by the RP. However, I take on board what the hon. Gentleman says about ensuring that the letter and the prescription itself are written in language that people can understand, are easily accessible and are available to them and their family members.

The “National Clinical Audit of Specialist Rehabilitation for Patients with Complex Needs Following Major Injury”, published in 2016, found that, on average, 81% of patients had a record of a rehabilitation prescription. That audit appears to have had a significant impact, because the latest data shows a rise to an average 95% completion rate. In April 2019, the third and final report of the Audit Commission to NHS England’s audit programme was published, and it is encouraging to see that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

However, the audit report also suggests that much more work needs to be done to ensure that all patients who could benefit from specialist rehabilitation can access it. Using data provided from participating centres, the audit’s authors estimate that the current provision caters for about 40% of those who need the services. To address the capacity issues highlighted, the audit makes a range of recommendations.

It is important to recognise that these audits play a massively valuable role in helping services to improve. They shine a light on variation and help to support services to best meet the needs of patients. However, there will always be different models of improving access to specialist rehabilitation, depending on the set-up of the services around the country. Therefore, local service providers and commissioners should review capacity in the pathways for specialist rehabilitation in the light of this audit, taking action where they can.

The majority of rehabilitation care is commissioned and managed locally, and NHS England has produced some documentation and services plans to help with that. “The Principles and Expectations for Good Adult Rehabilitation” describes what good rehabilitation care looks like and offers a national consensus on the services that people should expect. The NHS long-term plan has also set out some key actions on this, designed to improve care, treatment and support for people with long-term conditions such as ABI.

Community services, which play a crucial role in helping people remain as independent and well supported as possible, are going to receive significant investment, with £4.5 billion of new investment in primary and community care. Furthermore, NHS England has set out plans to roll out the NHS comprehensive model of personalised care, which includes self-care care planning, personal health budgets and social prescribing. It will reach 2.5 million people by 2023-24 and is particularly relevant to people with acquired brain injury. The model is currently implemented across one third of England, but by September 2018, more than 200,000 people had already joined the personalised care programme.

The hon. Member for Mitcham and Morden asked about free car parking. From April, all hospital trusts will be expected to provide parking to groups who may be frequent visitors. I interpret that to mean families visiting people who are in hospital for a long period of time, which I think is what she was asking me.

I thank the Minister for giving way on this important issue. There are many terrible stories of people spending their life savings in an effort to keep being able to visit children and partners. Could the Minister specifically say, or could we have a response in writing to this effect, that that includes the families of people with acquired brain injury? I have been seeking some clarification from the Department, but all the responses have so far been obscure.

I will certainly seek to get that in writing for the hon. Lady.

My right hon. Friend the Member for Hemel Hempstead spoke about continuing healthcare. I know that that is a concern for many people, but what concerns me is that actually, CHC is needs-based, not diagnosis-based, so eligibility should be assessed by looking at all of an individual’s needs and considering their nature, complexity, intensity and unpredictability. If he wants to drop me a line about an individual case that he is concerned about, I will be more than happy to look at it.

It might be a lot of cases; I think the Minister will have had a lot of cases from across the House. I completely agree that that is what the principle should be. In practice, however, I ask her to look at the amount of appeals that have taken place, and she will realise it is not quite working.

I will very much take that on board.

The hon. Member for Washington and Sunderland West asked me a number of questions. I may not have written them all down, but she asked about workforce. We have the people plan, which Baroness Harding has been working on, which will be released later this year. It will look at all forms of medical professionals, but also the allied health professionals that the hon. Lady mentioned.

The hon. Lady asked what conversations I had had with the Department of Education. That Department is currently undertaking a review of special educational needs and disability, which will look at all aspects of supporting young people through their education. We are playing a key role in that SEND review. She also asked what conversations I had had with the Department for Work and Pensions about training. Case discussions about claimants with ABI now form part of a new entrant training for all healthcare professionals undertaking work capability assessments, and they all have access to a learning module on ABI, which was updated in 2018 and has been quality assured by Headway.

I hope that today’s debate has continued to demonstrate how seriously the Government take ABI. We are committed to ensuring that people get treatment, care and support when they need it.

Well, yes and no is the answer. Of course it is great—all the Ministers that I have ever heard speak to any of these debates have wanted to be warm, friendly and nice and to say nice things. However, I note that Ministers still stick to a number of 500,000 to 1 million, whereas I think most of the people who work in this field think that it is more like 1.3 million or 1.4 million. If there is a difference between 500,000 and 1.4 million, then there is a hidden epidemic, which even the Government are not really recognising yet.

That is my fundamental central point: it is not as though this were a disease out there that people might catch from each other; it is just that in many people’s brains there are things that are not quite working right because they have had a brain injury. That is leading to all sorts of medical, societal and educational problems that we are not able to address because we have not gone to the root cause.

Let me take one single issue: homelessness and veterans. I would bet my bottom dollar that a very large percentage of the veterans sleeping on the streets in Westminster and London—and, for that matter, around the country—have had a significant brain injury at some point in their life and have not had the proper support and treatment that they required.

We will not be able to solve any of these individual issues unless we go to the centre and deal with this in a co-ordinated way. The right hon. Member for South Holland and The Deepings (Sir John Hayes) is absolutely right: David Lidington was clear that this was going to happen. There were some other things going on last year, but none the less, this was going to happen. I hope that the Minister will go back and kick some shins, metaphorically and physically, to ensure that we get the co-ordinated approach that we need across the whole of Government.

I went to John Bercow’s book launch last night; in his book, he says of me that I am not shy of repetition. I can assure the Minister that I will not be shy of repetition. I will not be shy of repetition.

Question put and agreed to.

Resolved,

That this House has considered acquired brain injury.