I beg to move,
That this House
notes the report of the All Party Parliamentary Group on acquired brain injury and supports its conclusions;
and urges the Government to work through all of its departments to ensure that those who have sustained brain injuries are guaranteed full neuro-rehabilitation as needed.
I rise to speak in support of the motion in my name and those of my hon. Friends, including those on the other side of the House—I see Sir John Hayes taking his place now.
Sometimes a brain injury is really obvious—jagged bone where the skull has been fractured or penetrated—but often the sheer force of the soft tissue colliding at speed against the hard inside of the skull bruises the brain, leading to a contusion or a haemorrhage that is outwardly invisible. Likewise, blunt trauma, where the head smashes into a windscreen or the road, means that the brain is pulled away from the opposite side of the skull, leading to even worse damage. The same can happen on the rugby, football, or hockey field, in the boxing ring and on the racecourse. Repeated incidents, even minor ones, can lead to chronic traumatic encephalopathy or what is often known as “punch drunk syndrome”.
Injuries can also be caused by stroke, tumours, infection, carbon monoxide exposure and hypoxia—oxygen starvation. These are hidden injuries with complex and fluctuating life-changing effects that strike close to the heart of what it is to be human, to be conscious, to be alive and, in many cases, to want to be alive.
I am sorry that I cannot stay for the whole debate but, prompted by my hon. Friend’s excellent work in this area, I recently visited the Second Chance Headway Centre in Wakefield, which supports people with brain injuries. I was struck by the spectrum of conditions that the centre deals with and by the dedication of its wonderful staff and volunteers. I encourage all Members to visit a Headway centre in their constituency, and I want to make the House aware that it operates a free helpline, which is driven by nurses, that people can call for advice.
My hon. Friend is absolutely right. I know that many Members in the Chamber today and others, including Ministers who are unable to participate in the debate due to their ministerial responsibilities, have also visited Headway groups in their constituencies. I have been to the group in Cardiff, which does a magnificent job. This is also about those who work in the NHS and alongside many of the voluntary organisations that do magnificent work. For many people, the work is thoroughly rewarding, because somebody can be taken from complete dependency on others to needing much less frequent support through neuro-rehabilitation, enabling them to stand on their own two feet and have the quality of life that they had before.
Will my hon. Friend commend the vocational rehabilitation provided to 10 of my constituents by Momentum Skills in Newcastle? The organisation asked me to pass on its massive support for the “Time for Change” report and its recommendations.
My hon. Friend has done a lot in this field herself. She has met with that group, which has been to see us here in Parliament, and I hope that they will be taking part in our lobbying event in a couple of weeks. Next week is Brain Injury Awareness Week, which is why this is such a timely debate. Tomorrow, I am going with Sir Geoffrey Clifton-Brown to visit the National Star College outside Cheltenham, which does an awful lot of work.
I am grateful to my hon. Friend for mentioning the damage that long-term exposure to carbon monoxide can have on the brain. He knows that I was one of those who organised the seatbelt legislation 25 years ago. One of the really worrying things that the Parliamentary Advisory Council for Transport Safety found last week is that we are getting relaxed and that people are beginning not to wear seatbelts and not to put their children in vehicle restraints. If that continues, people are in terrible danger of serious brain injury or death.
My hon. Friend is absolutely right. One reason why carbon monoxide exposure matters so much to me is because it involves an element of social justice. Children from poorer backgrounds are four times as likely to have a significant brain injury before the age of five as those from wealthier backgrounds. We do not fully understand why as yet, and we need to do more work on that. However, it is also true that elderly people, who maybe cannot afford to have their boiler checked as often as others or may have landlords who do not check their boilers as often as necessary, may be suffering low levels of carbon monoxide poisoning over such a long period that they are not even aware that they are being poisoned. The memory loss, the fatigue and the problems they are having may be associated with their boiler rather than with anything else. We need to look further at legislation in that area.
The thing about brain injury is that it is often internal and completely unseen. It can add a whole new layer of stigma because people can often misjudge a sufferer standing in a queue in front of them or coming to work with them as being drunk. However, the reason why the person is slurring is because they have had a brain injury. That is why I and others—I pay particular tribute to my hon. Friends the Members for Blaydon (Liz Twist) and for Swansea East (Carolyn Harris) and the right hon. Member for South Holland and The Deepings—wanted to set up an all-party parliamentary group on acquired brain injury to look at the issue, which is a hidden epidemic. Every 90 seconds, someone in this country is admitted to hospital with an acquired brain injury.
The APPG produced a report because we wanted to see more evidence. The Select Committee on Health produced a report in 2001, and some of its recommendations were implemented, but many were not. We wanted to go further, so we produced the “Time for Change” report, which calls for real investment in neuro-rehabilitation. We have major trauma centres that have saved so many lives—I pay tribute to the Government for the brave decision to take them forward—but it is depressing that a quarter of trauma centres still have no neuro-rehabilitation consultant. That means that people sometimes fall between two stools when they leave the acute setting and go back to their home and to their community.
A great friend of mine suffered a brain aneurysm, and she may not have survived were it not for the Royal London Hospital and its support. My hon. Friend makes a good point about the need for that wider specialism in other hospitals and for transition support to provide much-needed rehabilitation.
My hon. Friend is absolutely right. If there is one thing that I have learnt from my experience of melanoma this year—incidentally, the thing on the back of my head is not a brain injury; I am still getting over the melanoma being cut out—it is that I, as the patient, wanted to go to the real expert, and I would travel as far as I needed to do that. Sometimes in politics it is easy to join the bandwagon when people say, “No, everything’s got to be intensely local,” but the decision on major trauma centres was a brave one taken by this Government. The Conservatives are not a party that I support, but it was the right decision for saving people’s lives. We can now save people’s quality of life as well.
The APPG also called for proper return-to-school plans for every child with acquired brain injury, training for teachers, prison officers and benefits assessors, and proper protocols shared across all sports for concussion in sport.
The effects of a brain injury can be profound. Some sufferers have severely impaired physical mobility, and there can be major behavioural challenges. I have heard of patients losing all sense of inhibition, suddenly becoming tactless, using crude and abusive language, divulging private information and becoming impulsive, irritable and aggressive; or, on the opposite side, completely passive, unresponsive and lacking initiative. Others become obsessive, repeatedly checking their possessions or becoming profoundly self-centred.
I thank the hon. Gentleman for securing this debate. I have experienced some of the characteristics he mentions within my family—my auntie experienced a riding accident and my cousin experienced a motorcycle accident, and they both suffered brain shears. I also understand it from the experience of constituents.
Does the hon. Gentleman agree that, although trauma centres are very successful in trying to get the right expertise in the right place, they are required throughout the UK? Outreach is also required for subsequent rehabilitation, especially in rural constituencies such as mine.
That is one of the key points that everyone on the all-party group wanted to make. It is all very well saving someone’s life but, because we have seen so many miracles done by good neuro-rehabilitation in the community, we need to make sure it is available where people live. Otherwise we are condemning people to a half-life existence when we could restore real quality of life—they might go back to work and be fully independent.
The hon. Gentleman is absolutely right to say it is a matter of getting social care to work with NHS and getting all the different organisations to work as a whole. That is why we hope that the Government—there are signs of this, but we would like to see more signs—will not work in silos of departmental and organisational thinking. We have to think across the whole, because this affects nearly every Government Department.
Many patients lose their executive functions, so they find it next to impossible to plan, make decisions, monitor what they are doing or control their emotions—that can make it difficult even to cook for themselves. In particular, a brain injury to the frontal lobes during the teenage years, when that part of the brain is still developing, can turn a charming, ambitious and able young person into an out-of-control youngster. All too often, if the brain injury is missed or misunderstood, they get into trouble, they are excluded from school and they fall into the criminal justice system. I read Edward Timpson’s report this week. It is an important piece of work, but it is a shame that it does not mention brain injury at any point. I will be writing to him about that to see whether it is another element that we need to address if we are to stop exclusions, which are currently so prevalent.
Even a minor brain injury can lead to headaches, dizziness, fatigue, depression, irritability and memory problems. Sometimes the effects last long after the injury, and sometimes they do not even appear until some time after the injury, which makes them particularly difficult to spot.
Partners and family members have a tough time, too. Luke Graham will know from his own family how complicated it is to make sure that people get the support they need. Loved ones have the terrible fear of the unknown. What is going on inside their loved one’s head? Will the anger and frustration they seem to be suffering get stronger, or will it ease off? How much will they be able to recover their former abilities and personality? And how hard will they have to struggle to get the support they need?
In too many instances, families and patients are being pushed from pillar to post when it comes to benefits. Listen to what happened to Jordan Bell, who had a motorcycle accident some six years ago, when he was 17. The accident left him in a coma for six weeks and in rehabilitation for six months before he went home. He had to learn to walk, talk, eat and socialise all over again. I am glad to say that he has made a remarkable recovery and is now a father, but he lives with significant, serious and completely unseeable impairments.
Jordan’s father describes dealing with the welfare system as
“the most demoralising and depressing experience for us all.”
This is a professional family. The initial application for personal independence payment took six months, with interventions from the family’s MP. David Bell writes:
“A year or so after our son’s condition had improved we contacted the relevant department to advise them that he was in our judgement no longer entitled to some elements of the PIP. We were ‘quietly’
advised not to inform them of the changes at all, but as we are honest people we felt duty bound to inform them of our son’s improvement. The advice given to us was correct;
instead of adjusting the PIP in what would have been a sensible way the PIP was cut entirely. This then set in motion another six months of huge effort and stress and again the involvement of our MP to get the PIP reinstated. We eventually succeeded. But two years later it was reduced again to nothing.”
I cannot emphasise enough the stress this process puts on people with ABI.
One woman told me:
“I know I should use all my energy to try and get my brain back together. But I end up spending all my energy on forms”— filling in forms and fighting bureaucracy. An unresponsive, intransigent welfare system is effectively preventing people from healing. I beg Ministers to take this issue seriously and to make sure that all PIP advisers are trained in the fluctuating and unseeable nature of brain injury. After all, one common feature is that patients become over-keen to please people. Often, they will tell the assessor everything they think the assessor wants to hear, because that is part of the condition.
Notwithstanding what I will say later, in casework I find that a surprisingly high number of disability living allowance claimants are having the mobility element carved away as they move to PIP, perhaps because, as the hon. Gentleman says, they have exaggerated their ability to get from A to B or to move into work.
That specific point has not been raised with me in relation to brain injury because it is one of the seeable bits. It is the unseeable bits that are particularly difficult for PIP assessors and other assessors to get right, which is why it is important that they all have proper experience and training in assessing brain injury.
I do not want to take too much time because I know that many others want to speak, but I will refer to a few more elements, the first of which is the prisons system. All the latest research shows that a very high percentage of inmates, both male and female, have had a brain injury. One survey shows that 47% of inmates at Leeds Prison have had an ABI, and Huw Williams’s work shows that more than 60% of prisoners at Exeter Prison have had a traumatic brain injury. In both surveys, the majority of injuries occurred before the prisoner’s first offence, suggesting that the brain injury may be a key factor in why they offended in the first place. If we really want to tackle their reoffending, we will have to deal with their brain injury, too.
Research at HMP Send and HMP Drake Hall also finds that the most common way for women inmates to acquire brain injuries is through domestic violence— 45% of injuries. Again, we may be criminalising people who are actually victims. We need to get this right. If we really want to tackle reoffending, we must do a better job of recognising and treating brain injury. That means screening all new prisoners, training prison staff, providing proper neuro-rehabilitation for all prisoners with a brain injury and making special provision for women that recognises the likely different causes of their injury—particularly domestic violence.
I will not say much about education, because I know other hon. Members will. The Government have been good in responding to our report in detail, but the section of their response with which I am most dissatisfied is on education. There is a hidden problem across our schools estate, and we will store up problems for the future if we do not take this issue seriously. In particular, I urge the Government to reconsider our recommendation that acquired brain injury should be included in the special educational needs and disability code of practice.
The final area is sport. I make it clear that sport is good for people’s health, and I do not want to prevent anyone from taking part in sport. I do not want all our sportspeople and youngsters to be mollycoddled and wrapped in cotton wool, but the record on sports concussion is shockingly bad, particularly in football. I am no football expert.
All right. I am no expert, but I know about concussion in football. The last season has been especially bad. Mohamed Salah, Jan Vertonghen, David Ospina, Anthony Lopes and Fabian Schär have all been involved in high-profile, very dubious decisions by the on-pitch medics. UEFA rules since 2014 seem clear:
“In the event of suspected concussion, the referee stops the game to allow the injured player to be assessed by the team doctor. In principle this should take no more than three minutes, unless a serious incident requires the player to be treated on the field of play or immobilised on the field for immediate transfer to hospital”.
Honestly, three minutes is nowhere near enough to be able to judge whether somebody has suffered a concussion or any other kind of brain injury. Moreover, FIFA, UEFA and the Football Association have different definitions of concussion and, unlike rugby—where it is now standard that a player should be off the pitch for 10 minutes and can be replaced—football allows no subs for concussion, so all the incentive is to get the player back on and playing as fast as possible and in less than three minutes.
Let me be very clear to the football authorities. Football is failing its players. It is giving a terrible message to youngsters, parents and amateur coaches. Those authorities are putting players’ lives at risk. If they do not get their house in order, they will face massive class actions in the courts and we will have to legislate to protect players from what is, frankly, an industrial injury.
I want to end by talking about my own patch. I am delighted that south Wales will soon have a new major trauma centre at the University Hospital of Wales, but it would be cruel in the extreme to save people’s lives without ensuring that we can guarantee their quality of life. So we must make sure that when the centre opens there are proper neuro-rehabilitation services in Wales and that there is continuity of care once people leave hospital.
There is another issue for us in south Wales. In 2009, Kyle Beere was a typical healthy, intelligent, active 12-year-old—a bit too interested in fishing for my liking, but none the less. That November, he suffered a massive brain haemorrhage that left him fighting for his life. With no paediatric rehabilitation service in Wales, Kyle had to travel to Surrey for treatment. He is grateful for his treatment and his family is working all God’s hours to ensure that he gets all the support he needs. But I would dearly love there to be paediatric rehabilitation services in Wales.
Many medical miracles have been performed over the years, and I pay tribute to the doctors, nurses, scientists, pharmaceutical companies and staff who have constantly experimented and reviewed their work to see whether they can do more. I pay tribute to Chloe Hayward and everybody involved in the UK Acquired Brain Injury Forum. But we need a political miracle now.
The Health Committee produced a great report in 2001, but many of its recommendations have never been implemented. That cannot happen this time—please. We need a champion in Government to instil a real sense of urgency into dealing with brain injury: someone who can bring together all the different Departments and make them work together to deliver a quality of life that is more than just a collection of vital functions. I dearly hope that that champion will be speaking from the Dispatch Box in a few minutes.
It is a pleasure to follow Chris Bryant and to endorse and amplify his remarks about the Minister. Many people achieve office in this House, but few are more deserving of that opportunity than the Under-Secretary of State for Health and Social Care, my hon. Friend Seema Kennedy. We are delighted to have her with us today. We will be even more delighted when she answers some of the questions posed by the hon. Member for Rhondda and gives us an assurance that the Government will continue—for they have begun well—to take this subject seriously and will act on the recommendations in this excellent report, which would not have happened without the initiative, enterprise and energy of the hon. Gentleman. His commitment has been exemplary.
The work of the all-party parliamentary group on acquired brain injury is illustrative of this House doing what it does best: coming together, highlighting a subject, and bringing it to the attention of the wider world and of those who exercise power. We have, I believe, done a good job, but it is only the beginning of a journey. The destination we seek is our recommendations being enacted in full. Perhaps I am being a little ambitious, but at the very least the Government have taken a renewed and reinvigorated interest—I would not for a moment suggest that they were not interested already—in this subject, which affects so many people.
Perhaps that is the place to start. The hon. Gentleman spoke about the definition of brain injury, but I want to speak about the scale of the problem. The number of families affected by acquired brain injury, which, as the hon. Gentleman described, includes anything from traumatic events through to brain tumours, is immense. Hospital admissions for head injuries number 162,544—one every three minutes. ABI admissions have increased by 10% since 2005-06. Although men are 1.6 times more likely than women to be admitted for head injury, the incidence of female head injury has increased by 24% since 2005-06. Families across our nation and in all our constituencies are affected. The challenges are profound, for the reasons that the hon. Gentleman described.
I, too, welcome the report. May I add to my right hon. Friend’s list what I have discovered in my constituency? Even babies can acquire brain injuries from contracting meningitis, or during childbirth. I hope he will join me in encouraging the Government to consider that issue as well.
I will—very much so. I have been terribly unlucky, by the way, having suffered a severe head injury as a result of a road traffic accident and, like the hon. Member for Rhondda, contracted bacterial meningitis. We both speak with some authority on this subject.
The patterns that those families endure are similar, one to another. Initially, of course, there is shock—a sense of disbelief—and the question that most people pose in these circumstances: “Why me?” Then there is a gradual realisation of the depth and scale of the effects of acquired brain injury, and an unhappy initial concentration on what the person can no longer do, followed eventually by a reconcentration on what they can do. Most families follow that pattern when they suffer this kind of event, and that is why all that is done beyond the treatment of the initial trauma is so critically important.
Neuro-rehabilitation is vital because of the dynamic character of these conditions. Most people who acquire a brain injury will change. Many will recover fully and some will recover partly, but all that takes place over a long period and is particular to each case. There is an unpredictability about the effects of acquired brain injury; it can affect physical capacity of course, psychology and cerebral function, as well as personality. Families dealing with that must cope with those kinds of changes, which can be terribly frightening for the individuals concerned and those who love them. The point is that a difference can be made by the quality of care that they receive during that rather difficult journey.
May I add one more category to those listed by my right hon. Friend and Chris Bryant? I am talking about service personnel who were blown up in Iraq and Afghanistan, some of whom, although apparently uninjured as a result of the great advances in vehicle technology that enabled them to survive improvised explosive devices, are believed to have been misdiagnosed with post-traumatic stress injury, when in reality they are suffering from mild traumatic brain injury. I believe that only two scanners in the whole country are capable of identifying mild TBI. There is not yet an adequate programme to make sure that the condition is discovered before irreparable damage is done.
I am grateful to my right hon. Friend for making that point. The hon. Member for Rhondda talked about the understanding that we need in the welfare system and the expertise that we need to acquire in dealing with the repercussions of a traumatic event. Often, misdiagnosis is part of that problem. Because of the characteristics of acquired brain injury that I described earlier—the changes in personality and the effect on cerebral function—misdiagnosis is all too easy. Part of our mission in bringing the all-party group’s report to the House’s attention, and doing so again in today’s debate, is to get all of Government, including the Ministry of Defence, working together to understand the breadth and scale of the problem. That kind of intergovernmental approach is essential to the recommendations of our report, and I shall say more about it in my concluding remarks.
Before I do that, I wish to say a little about the difference between the initial responses to acquired brain injury, whether acquired through a traumatic event such as a road traffic accident—indeed, many are acquired that way, which is why so many young men are affected—or through the kind of illness that the hon. Member for Rhondda spoke about, such as a brain tumour, meningitis or some other disease. By and large, the initial response is, as is so often the case in the NHS, routinely excellent. People are treated quickly and highly effectively. It is what happens afterwards that is more variable in its effectiveness.
When people leave hospital, invariably having been treated extremely well by our superb NHS, whether their subsequent treatment is effective is a matter of some uncertainty. It can be, and often is; indeed I pay tribute to the good work of Headway—I am a patron of Headway Cambridgeshire and have been for many years—and the other organisations that play a part in supporting families, spreading understanding and sharing good practice, but it is to some degree a lottery. It is partly about where someone lives and how effective the local agencies are; it is partly about how well Government Departments and local government work together and how meaningfully they address some of the challenges that are the inevitable consequences of these kinds of injuries. The all-party group’s report deals with them and the hon. Member for Rhondda highlighted some of them. There are educational effects and effects in the workplace and in socialisation; perhaps there is even the risk of criminality as a result of the consequences of a brain injury. It is the business of neuro-rehabilitation, which we emphasise so strongly in the report, that lies at the heart of what we believe the Government need to do to improve the outcomes for the people and families concerned.
When I was a Minister, which I was for a long time but not for long enough, many people in the House tell me—it is not for me to say, of course—I found that perhaps the greatest challenge Ministers face is in dealing with matters that cut across Departments. It has become almost routine to talk about Departments working in silos, but it is certainly true that the character of the vertical structure of the way we run Government and organise ministerial responsibilities makes it quite difficult for Departments to interact, or sometimes even to interface. On this subject, perhaps as much as on any subject that I know of, it is critical that Departments do just that. We speak in our report of the Departments concerned, and my right hon. Friend Dr Lewis mentioned another, the Ministry of Defence. I urge the Government to continue to explore how we can take a cross-departmental approach. We have had strong support from the Cabinet Office, but I hope that the Minister will take that further forward.
The right hon. Gentleman is absolutely right about cross-departmental working. I am obsessively concerned with road deaths and road injuries; does he accept that getting the Department of Health and Social Care, the Department for Education and the Department for Transport together to push for proper head and brain protection for cyclists, motorcyclists and people who drive cars is very difficult?
Not for the first time, the hon. Gentleman is absolutely right. The hon. Member for Rhondda spoke of, for example, sports injuries. The response we have had from Departments has been mixed. It is certainly true that they have all responded, but it is fair to say that some have done so with greater enthusiasm and clarity than others. The convivial and collaborative nature of this debate forbids me from being more critical than that, but the Minister will want to look at those responses, as we have, and at how those Departments that have been rather slower to take their responsibilities seriously can be brought up to speed.
Mr Sheerman is right that cross-departmental working is vital. It is important that we also look at local government and other Government agencies and organisations. Given the breadth of local government responsibilities, of which housing is a good example as well as education, which the hon. Member for Rhondda spoke about and which is critical to our report, it is really important that local government is involved in this work, too. It is therefore not only a lateral challenge but about connecting the local approach to the national one.
Furthermore, it is important that we recognise the dynamic character of individual needs. Governments are quite good at disabilities that are fixed. People have dreadful things happen to them and either acquire disabilities or perhaps start life with disabilities, and the Government can be quite effective and the national health service is highly effective in dealing with those kinds of challenges, but dynamic disabilities are different again, because of course by its nature that dynamism means changing needs and that requires changing provision. It might be in respect of benefits—the hon. Member for Rhondda mentioned support for benefits—or simply a matter of providing additional resource to an individual to allow them to get back to work or to return to education. It might be a matter of ensuring that the teachers, employers and others associated with an individual are well equipped with an understanding of what that dynamic disability might mean and might lead to. It is vital that the Government appreciate that many people have changing circumstances that require a changed approach.
Others wish to contribute, so I shall end by highlighting some of the things we said in the report and to which we would like the Government to respond. First, simply raising awareness is vital, and I hope that the report and this debate have done that. Secondly, I have spoken about neuro-rehabilitation and the need for a joined-up approach across Government. Thirdly, I wish to amplify an excellent point made by the hon. Member for Rhondda about education: it is really important that acquired brain injury is included in the special educational needs and disability code of practice. Fourthly, in the justice system, it is vital that all agencies that work with young people—including schools, psychologists, psychiatrists, general practitioners and youth offending teams—should ensure that the needs of the brain injured are individually and carefully assessed.
I could highlight many other things—our recommendations are broad, and I hope deep, too—but I shall end by quoting G. K. Chesterton, who said:
“How you think when you lose determines how long it will be until you win.”
When someone loses as a result of an acquired brain injury perhaps some cerebral function or the ability to mix and work with other people, or has some permanent disability, how long it is before they again see themselves as someone with a chance to win can be determined by what we here do, and on how the Government allocate their time, energy and resources to fight for, care for and campaign for people so affected.
First, I congratulate my dear friend Chris Bryant on securing today’s debate.
Every year, an estimated 350,000 people are admitted to hospital in the UK as a direct result of an acquired brain injury; to put that figure into perspective, that is one person every 90 seconds. Whether that is due to illness, accident or some other form of trauma, the severity of that injury and consequently the rehabilitation they require varies considerably. For those with severe brain injuries, the long-term issues can be vast, affecting their personality, relationships and behaviour. It is quite obvious that early diagnosis and better access to timely and effective rehabilitation will greatly improve a patient’s chance of eventually regaining their independence, but it is essential that we also look at the wider long-term complications of acquired brain injury and particularly at the associated problems that patients face.
At a recent session of the all-party parliamentary group for gambling-related harm, I met George. Back in 2009, George was a typical 23-year-old young man with a bright future. He had a decent job, a supportive family and a strong network of friends. It was on a night out with those friends that his life changed forever. In an unprovoked attack outside the nightclub where he had been spending the evening, George was punched with such force that he suffered lasting trauma to the left side of his brain. After spending several weeks in a coma and months in hospital, George was left with significant psychological, emotional, cognitive, behavioural and physical impairments.
As a result of the severity of his injuries and the complexity of his ongoing disabilities, George was eventually awarded significant compensation, but this only led him to further problems. A friend introduced George to online gambling, something he had no previous interest in, but he now had the time and the money. George very quickly became addicted, making frequent and significant deposits with a wide variety of online gambling platforms. The result is that George has lost all his compensation, as well as money obtained by taking out additional loans and credit cards. At one point, he gambled and lost—this is breathtaking—£67,000 in just 40 minutes. He is now at least £15,000 in debt and, with no income, has no hope of meeting these liabilities.
George is not alone. Research has identified that brain injury survivors are 27% more likely to develop problem gambling or addiction than the general population, and that risk is found particularly among people with frontal lobe damage. Headway, the brain injury association, which celebrates its 40th anniversary this year, is doing a fantastic job supporting people like George, but it has highlighted that much more needs to be done within the gambling industry to protect these vulnerable individuals.
Survivors of a brain injury are prone to impulsive behaviour, lacking in reasoning skills and often socially isolated. Add to this in some cases the fact that they are suddenly in possession of a large sum of money that they are not necessarily capable of controlling independently, and it is not difficult to see how quickly and easily addiction can develop. The gambling industry needs to offer more and to work alongside brain injury specialists to provide support for individuals. The Gambling Commission has said it will be strengthening the requirements of licences to better identify customers and make self-exclusion schemes more effective, but this is not enough on its own.
Brain injury survivors such as George have already suffered so much, with their bright futures indefinitely stolen from them because of the trauma or illness they have experienced. They continue to suffer daily from the lasting effects of their injury as well as the associated anxiety and emotional difficulties. From an early stage in George’s addiction, the gambling platforms were made aware of his vulnerability, but despite this knowledge they continued to allow him to gamble on their sites, robbing him of his much needed compensation, which was intended to give him a stress-free existence after his injury. Brain injury survivors are vulnerable, and at the moment the gambling industry appears to be exploiting that vulnerability.
It is not just about gambling. The consequences of brain injury affect so many people in so many ways, and we have to start looking more closely at this issue. We need better diagnosis, better care, and rehabilitation support, and I am very pleased to be a vice-chair of the APPG on acquired brain injury that my hon. Friend the Member for Rhondda has established and chairs with such great passion, and I congratulate him.
It is a pleasure to follow Carolyn Harris.
I note and welcome the valuable work of the all-party parliamentary group on acquired brain injury, including its most recent report. I agree that Governments together need to lend their support and implement, where reasonably practicable and borne out by evidence, the measures that will bring about improved neuro-rehabilitation for those with acquired brain injury. About 1.4 million people in the UK are living with a brain injury. According to Headway Ayrshire and as has been mentioned, every 90 seconds someone in the UK is admitted to hospital with an acquired brain injury, and in 2016-17 some 1,816 people with a diagnosis related to acquired brain injury were admitted to hospital from the Ayrshire and Arran area within which my constituency lies. These are large figures and very worrying statistics.
It has been acknowledged that more persons are surviving trauma to the brain, which may occur after birth or because of disease, an accident, sport, military service or a criminal act. Let me stop for a moment on the question of accidents. Having spent 31 years in the fire service and attended numerous needless road accidents, I commend those who created, invented and install airbags—we have no measure of the number of brain injuries that they have prevented—and the Governments who introduced the compulsory wearing of seatbelts and of crash helmets. The number of people saved from accidents by that is wonderful. I will leave this hanging for a moment, but would it be possible and worth considering the compulsory wearing of safety helmets for cyclists? I am sure that that would reduce brain trauma injuries in the future.
Those people’s survival is to be welcomed, although regrettably some could have a degree of disability and might have a different persona, which can prove difficult for all to cope with. The individual and their families undoubtedly need an informed and readily available bespoke support package. The onus is on us to enable these individuals to regain their dignity, which they so richly deserve, and to have an active role in our society, which is their society as well.
To date, rehabilitation provision for in-patients and those returning to the community appears to have been sadly lacking, or, when it is provided, of varying standards and not always in line with those narrated by the National Institute for Health and Care Excellence, NHS England’s best practice tariff and the all-important person-centred rehabilitation prescriptions. Those prescriptions are so important to that individual, their family and their carers.
I support the desire for a specialist acquired brain injury rehabilitation consultant who would guide, oversee and co-ordinate matters. Oversight and co-ordination appear not to be as good as they could be. That is not to detract from the excellent work of charities mentioned in the Chamber this afternoon, such as Headway Ayrshire, which is part of Headway, the brain injury association, raising public awareness and working to improve life after brain injury by providing simple things like information on where people go for help. When someone puts their hand out for help, someone has to grasp it, and in many ways Headway does that, providing advice and support to the person, their family and their carers. Having previously sat on that charity’s local board, I have seen for myself how it is able to benefit my constituents and many throughout the UK in other branches of Headway. I thank Headway—its staff, volunteers and those who raise money for it—and welcome the contribution and support it gives individuals.
In 2017, the Scottish Government’s community justice funding enabled Supporting Offenders with Learning Difficulties, also known as SOLD. SOLD was able to assist those with alcohol-related and acquired brain injuries out of the dreadful cycle of reoffending. The prison community often does not understand these issues.
Carolyn Harris made an incredibly important contribution—as my hon. Friend is doing—highlighting that many people become involved in alcohol, gambling or some other pursuit, which would never have happened had they not had their brain injury. The Government need to look at that aspect of the issue, because the consequences of brain injury can be as unpredictable as that.
I thank my right hon. Friend for that welcome intervention. It is easy to identify someone with a physical injury—the leg in plaster or the arm in a sling—but an injury to the brain is not visible, and we need to be aware of that.
Scotland has seen the development of a brain injury e-learning resource, created under the umbrella of the Scottish Acquired Brain Injury Network, with funding and technical support provided by the national services division of the NHS. Glasgow University’s excellent Centre for Rehabilitation Engineering also undertakes work on the neuro-rehabilitation of hand and arm functions, neuropathic pain and the possibilities of retraining the central nervous system after spinal cord injury or a stroke. I should also mention a facility from which I benefited: the Douglas Grant rehabilitation centre, which is operated by NHS Ayrshire and Arran. The centre gives confidence back to people who have been subjected to brain injury or nervous system injury. It also gives them back their ability to find their own way in life, and great credit is due to the staff there.
As was mentioned earlier, the effect of sports injuries involving concussion is not quite fully understood, but it is better recognised, particularly in rugby, but such injuries can also happen in football. There has been great success in football of late. Dare I mention Tottenham Hotspur and Liverpool? Perhaps clubs should invest some of their money protecting their valuable players—not for today or tomorrow, but for later in their life—from the consequences they may suffer. Football still has some way to go on that front.
We may still need to educate the educators to understand the hidden disabilities and lifelong consequences for young people with acquired brain injury. Medical science is leading to a better understanding of ways to address rehabilitation, and organisations are seeking to communicate what is available. However, it is vital that this work is co-ordinated, and that a holistic treatment plan and the functioning needs of acquired brain injury patients are considered and acted on promptly. This should not be delayed, waited for or pushed down the line; we have to respond timeously.
Some patients may reach a plateau, but for others sadly the condition may be progressive, so there is no one-size-fits-all approach for victims of acquired brain injury. We need to continue to build on the Government’s good work in achieving and maintaining specialist centres of excellence and enhanced community support services for persons with acquired brain injury, their families, and—let us not forget—their carers.
I ask the Minister to look favourably on further measures to support those with acquired brain injury, their families and carers, and to ensure that the Departments of all Governments communicate with one another to make contact for these service users easier. Communication and form-filling may be extremely difficult for people with acquired brain injury, as their concentration levels are often depleted. Ease of application—a simple thing—would be a great step forward, with Departments sharing information, instead of individuals repeatedly filling in forms and going back to repeat the process several times. It is, indeed, time for change.
Acquired brain injury is often a hidden disability. It is so hidden that, before this all-party parliamentary group inquiry, I had failed to recognise that people I know—family members, friends and colleagues—have an acquired brain injury. Some people may have outward, visible signs of the trauma that they have been through, but for many there are no outward clues. That can mean that, instead of people recognising the disability and responding in a helpful or understanding way, they may be impatient or downright rude, or try to rush those with acquired brain injury. This may not just be the case for people we bump into; it could be the officials of one Department or another who really do not get it. For example, assessors for personal independence payment or employment and support allowance may not have sufficient understanding of the effects of acquired brain injury and fail to recognise that what may appear as a reasonable response can actually hide the reality of the disability.
It has been a real privilege to be involved in the inquiry and the report, “Time for Change”, to reach so many people affected by acquired brain injury, to hear their personal stories, to hear about the positive impact of effective neuro-rehabilitation and, sadly, sometimes to learn where such rehabilitation has not gone so well and people are struggling to cope. At the presentation of our report last year, we watched a very moving film showing people suffering from acquired brain injury describing their experiences. I found it a very moving experience that really brought home the difficulties that people can face.
The practical effects of acquired brain injury affect many areas of life, and our evidence sessions covered neuro-rehabilitation, education, criminal justice and sport-related concussion and touched on the welfare benefits system. The launch of “Time for Change” was well received, and was attended by Ministers, the shadow Secretary of State for Health and many other Members of Parliament. Most importantly, some of those who have acquired brain injury told us their personal stories. Our report made a number of recommendations in each area that we studied and, most importantly, called for Departments to work together to improve services and join things up. It was clear to us, as I am sure it will be to the House, that this is not just a health issue to be left to the Department of Health—although neuro-rehabilitation and physiotherapy, along with many other health services, are of huge importance in recovery and development—but one that needs to be joined up across other Departments.
If we are to make the real change that we have called for, we have to link up what happens in health with what happens at school, in the Department for Work and Pensions and in so many more Departments. Since the report was launched, there have been meetings with a number of Ministers, including the Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office and the Economic Secretary to the Treasury, to name but two. The Government have now responded to our report, with the Department of Health pulling together responses to our recommendations from other Departments. I will refer to one of those Departments in particular—the Department for Education—and introduce a new area that was not covered in our report but that has been mentioned today.
It becomes clearer and clearer the more we look at it that acquired brain injury and its impact spread into so many different areas of everyday life, but I will focus on education and children. “Time for Change” called for some very specific measures. As we have heard from my hon. Friend the Member for Rhondda, this condition affects many more people in disadvantaged areas than elsewhere, so it is really important that we get to grips with it. Our recommendations were fairly straightforward. Acquired brain injury should be included in the special educational needs and disability code of practice. All education professionals should have a minimum level of awareness and understanding about acquired brain injury and about the educational requirements of children and young people with this condition—for example, with the completion of a short online course for all school-based staff.
Additional training should be provided for the named lead professional who supports the individual with acquired brain injury and for special educational needs co-ordinators. We recommended that the acquired brain injury card for under-18s produced by the Child Brain Injury Trust should be promoted in all schools, hospitals and local education authorities. Many children and young people with acquired brain injury require individually tailored, collaborative and integrated support for their return to school and throughout their education. As agreed return-to-school pathway is required—led and monitored by a named lead professional—to provide a consistent approach and support for the individual, their family and their teachers. An enhanced education campaign should be implemented in schools to improve awareness and understanding of sport-related concussion, with the support of Departments.
During filming for the launch of the report, I had the chance to talk to a young man from Scotland who had returned to school following an acquired brain injury and who told me about his experience of doing so. Simple things were not happening, like making sure that he had off-white paper because the white paper was far too bright for him to be able to take in. There was also the impact of noise affecting his concentration. They were all quite small things, in themselves, that were supposed to be planned for but actually did not happen. That brings it home to us that it is those small things that can make a big difference to children.
My hon. Friend is making a really important point. There are two other areas where we could do more in exactly the same way. One of those is in prisons, where toning down some of the sounds and noises makes it much easier for those with brain injury, and the other is in our supermarkets. It is great that Morrisons, certainly in my patch, has an hour at the beginning of the day when the lights are a bit dimmer. It would good if all supermarkets had a similar sort of event.
I thank my hon. Friend for those remarks; I most certainly agree. As I say, we just do not think about these things sometimes, and they can have such a huge impact in improving things for people with acquired brain injury.
I am afraid that the Government’s response in this area was rather disappointing. As in earlier answers to parliamentary questions, the Department for Education seemed to just restate the current responsibilities of schools and governors for SEND—special educational needs and disability. Our inquiry showed that there needs to be a greater understanding, very specifically, of both the presence of an acquired brain injury in young children and the practical steps needed to help staff to support these children with what is often a hidden disability. We also need greater co-ordination between health and education professionals to support children returning to school after a brain injury.
We have recently had much discussion in this Chamber and in Westminster Hall about the funding pressures on schools and the impact that that is having, particularly on special educational needs. We really have to bear that in mind. It is not enough to restate the law and the theory—the thinking—behind special educational needs and education, health and care plans, and then leave it to staff and governors who are increasingly under pressure just to hold things together at school. I would have hoped for a more positive response in this area. I hope that Education Ministers will look at it again and address the need for more practical steps to ensure that pupils have what they need to develop and be supported at school.
The hon. Lady is making powerful points. The key is that these plans have greater specificity and quantification so that the development of the response to someone’s needs could be as particular as it needs to be. That means quantifying exactly what happens once the needs and the response to them are drawn up.
I thank the right hon. Gentleman for those comments. I most certainly agree that we need to have very specific proposals on how we can support people and to make sure that the support is actually put into place as well. As we know, there can sometimes be delays in achieving the ECHP, so I hope that more work can be put into that as well.
The Chid Brain Injury Trust, which does excellent work in this area, has issued a call for action that includes some quite practical steps. It tells me that professionals across the field of acquired brain injury educational psychology are working hard to achieve the changes needed to support children in education following an acquired brain injury, but this requires all parties to listen and to implement the recommendations of the “Time for Change” report.
An acknowledgement of the support and interventions needed for paediatric acquired brain injury is required to limit the long-term societal costs and impact that this disability can have. Of course, it affects society as a whole, not just the individual. We want to give people the best chance in life, and that is why it is particularly appropriate to look at how we can support children who have an acquired brain injury. There needs to be improved training for newly qualified teachers—currently, acquired brain injury is not covered in that training—and a national campaign of recognition that acquired brain injury affects an additional 40,000 children and young people every year and has a significant impact on society.
The Child Brain Injury Trust says that acquired brain injury continues to be misdiagnosed and misunderstood, and our current system, and lack of knowledge and support, is letting down thousands of families. Funding is required for whole-family support. We need improved training for educators and youth justice teams, because over 60% of young people in custody report prior head injury. As other Members have mentioned, many young people affected by acquired brain injury are excluded from school due to their “inappropriate behaviour” and then go on to commit crime. Therefore, better knowledge of the condition and improved support has the potential to save society huge sums of money otherwise needed for youth justice.
The Child Brain Injury Trust calls for involvement and commitment from the Department for Education to support and fund some of these recommended initiatives. As I said, I hope that the Department for Education will take a more active part in looking after these young people and look again at its response to see how it can be improved.
The other area I want to touch on, which has already been mentioned by a number of Members, is acquired brain injury and carbon monoxide poisoning. This is not something that I had thought of myself. It shows, again, how many areas of our lives and our environment affect people and can cause acquired brain injury. I am a member not only of the APPG on acquired brain injury but the APPG on carbon monoxide, and earlier this year we had a special roundtable meeting chaired by my hon. Friend the Member for Rhondda. One of the difficulties is recognising when people are suffering from carbon monoxide poisoning, especially the impact that that can have on the brain. The shortage of support is particularly difficult for people with an acquired brain injury caused by carbon monoxide poisoning, as they are less likely to receive specialist treatment if they experience low-level carbon monoxide exposure that results in more subtle neurological effects. To address this, the APPG on carbon monoxide recommends that NHS England develop a specialist clinic for people with long-term neurological effects caused by carbon monoxide exposure. This will help to plug the gap in care provision and enable future studies that will innovate treatment methods.
We must also remember that, as the Government said in their November 2018 health and social care policy paper, prevention is better than cure, and preventing carbon monoxide poisoning will also prevent some of these acquired brain injuries. The APPG recommends that the Government introduce preventive measures, including mandating carbon monoxide alarms in all tenures. I know that the Government are already looking at this in certain tenures, but it should be across all tenures. Carbon monoxide monitors should be provided for those in first-time pregnancy. We must tackle substandard housing that increases the risk of carbon monoxide exposure. We also recommend that Public Health England and the Foreign and Commonwealth Office do more to raise public awareness of carbon monoxide, to encourage risk-lowering behaviours at home and abroad. The special roundtable meeting that we had was very productive. We had a high number of medical people there who were recognising this problem that perhaps the rest of us had not recognised until now. We need some practical steps to improve that.
I have mentioned the Child Brain Injury Trust’s recommended actions, particularly on education. There is so much more that I could say, but much of it has already been said, so I will only mention a few things. We are seeing more people survive severe trauma, and we must give more effective support after they recover from their immediate injury, to help them develop their life.
I thank the hon. Lady for giving way. I have personal experience of this through my brother, who unfortunately had a very severe accident, which left him brain-damaged. Owing to the determination of my parents and family, who took the time to care for and look after him, we were able to give him some sort of an independent life, which is very important. He is happy and safe with his carers, friends and family. Does the hon. Lady agree that more needs to be done to support the families of those with ABI, to give them hope that there can be more than Sunday visits to a designated place—there can be a home life as well—and there is a chance of a semblance of normal life for people with ABI? Intensive care packages are essential to rehabilitation, and funding must be available for them. It is so important to give people who have acquired brain injury a normal life, if at all possible.
I thank the hon. Gentleman for his comments. I certainly agree that we must give more support to the carers and families of young people or adults with acquired brain injury, while allowing the person who is directly affected to have as full and good a life as they can.
I want to mention the “One Punch” campaign. We are becoming increasingly aware of the impact that one punch on a night out, perhaps after a lively evening, can have. It can be devastating, and I am glad to see campaigns around the country aiming to ensure people are aware of that. We have talked about how sports must keep up the level of support and awareness and, if in doubt, sit people out. That is really important. We have also heard about the huge impact on our prison community. We must develop a response to that, so that we can take account of acquired brain injury and how it affects people’s behaviour and development.
Headway has made some recommendations. It says:
“Brain injury can happen to anyone, at any time. Living with the effects of a brain injury creates challenges in almost every area of life.”
That is so true. Headway is calling on Members of Parliament to recognise and support the needs of service users, families and carers, including greater understanding of the complexity and hidden effects of brain injury; wider recognition of the symptoms of brain injury, to ensure rapid and accurate diagnosis; access to timely, specialist rehabilitation and support services; an end to lengthy waits for social service assessments for support funding; changes to disability benefit assessments, which currently fail a large number of brain injury survivors and their families—Headway has a campaign called “Right First Time”—and more effective data gathering across the NHS, to provide clearer evidence of the needs of survivors, around diagnosis, acute care, longer-term rehabilitation and support to regain independence. Acquired brain injury is life changing, and we must do everything we can to support people across all spheres of life.
I praise the remarkable work of the APPG on acquired brain injury for its dedication to this issue and for securing this particularly important debate. Research from Headway, the brain injury association, shows that every 90 seconds someone in the UK is admitted to hospital with an acquired brain injury-related diagnosis. That is approximately 350,000 people a year. If this debate lasts for an hour and a half, another 60 people will have been struck by brain injury while we are in the Chamber. The majority of those people will need at least some form of short-term support or long-term rehabilitation to help them rebuild their lives, re-learn lost skills and regain a degree of independence.
Excellent work is done in the charity sector to support people with acquired brain injury. I am sure that many colleagues across the House will want to join me in congratulating Headway on reaching its 40th anniversary this year. I am proud to say that the charity is based in my constituency and led by my friend and colleague, Peter McCabe, as chief executive. For four decades, it has been supporting brain injury survivors and their families and carers, to ensure that lives saved by significant advances in neurosurgery are lives worth living.
When a brain injury strikes, it is usually without warning. Put simply, it can happen to anyone, at any time. The support provided by Headway starts from the moment brain injury strikes and continues for as long as it is needed. With the introduction of major trauma centres, the chances are that a patient with a significant brain injury will be quickly transferred to a unit that is better equipped to provide specialist emergency care. That can be many miles from the family home. I am sure we can all agree that, if a loved one were involved in an accident or suddenly became seriously ill, we would want to be at their bedside, but for some people—particularly in low-income families—that can be a challenge if the patient is transferred to a unit many miles away.
That is why I would like to raise the importance of the Headway emergency fund, which provides grants to families to ensure that they can be by the bedside of a loved one in a coma. To date, the charity has distributed more than £369,294 to 1,783 families across the UK. In addition, families can receive emotional and practical support to help them to cope with the overwhelming situation and to make sense of what is happening. They can also rely on the charity’s nurse-led helpline, which has seen an increase in demand of 131% over the last 10 years.
Given that there will be many people watching the debate who are working on this issue, I would like to raise the Headway brain injury identity card, which is endorsed by numerous agencies in the criminal justice system, including the Police Federation and the National Police Chiefs’ Council. The House has previously discussed the high prevalence of brain injury among the offender population. This new initiative from Headway is helping the police to identify brain injury survivors at the earliest opportunity, to ensure that they receive appropriate support.
We should all be proud of our national health service, particularly when it comes to emergency and acute care, but a life worth saving has to be a life worth living. Many of my hon. Friends here today will be aware of the excellent work being done by Headway groups and branches in their constituencies. Whether through rehabilitative therapies to improve speech and language skills or facilitate a return to work or education, or social interaction to prevent isolation, the work being done in our local communities by these groups and branches can be a lifeline to families affected by brain injury, helping people to rebuild their lives and become less dependent on costly state support.
May I add briefly to that catalogue of virtues the fact that Headway has been reaching out to parliamentarians like ourselves? The reason I am here for this debate is that Jo Hillier of Southampton Headway got in touch with me and asked me to be here. That is why I am learning so much more about this condition than I would otherwise have had the possibility of knowing.
That is my experience as well. Had Peter McCabe not called me, I might not be here, and I would know so much less about the volume of people who experience brain injury and the sort of problems they and their families and carers have.
We are very grateful for Headway’s intervention. However, Headway cannot do this alone. Local charities are under incredible pressure. Funding cuts are causing harm to the lives of some of society’s most vulnerable people, who are being cut out of society due to a lack of access to vital support services. For many people, Headway provides a route back to independent living, further education or employment. The reality is that, aside from Headway, most people—particularly those who cannot afford private healthcare—will receive insufficient support or rehabilitation after leaving hospital. Unless action is taken to enable people to access the vital support needed to ensure that these services survive, more and more people will be cut out of society and taxpayers will be left footing the bill for the longer-term care of those without the means to care for themselves. Considering that another four people will have been struck by brain injury during my speech, there simply is no time to delay.
I thank Chris Bryant for bringing forward this debate and I compliment all the speakers on their contributions. It would be churlish of me not to say a word of congratulation to the Minister on her appointment. It is a delight to see her in her place. I am going to give the House something of a personal account, which I will try to keep fairly brief. I hope that I can draw from that personal account a number of conclusions and suggestions.
Yesterday and today, several Members have remarked on the fact that this is the 20th anniversary of the foundation of the Scottish Parliament. In early 1999, I was canvassing in north-west Sutherland. I always start canvassing early, but don’t tell the SNP. I pulled up at a phone box at Inchnadamph—this was back in the days when we had phone boxes even in remote parts of the highlands—I tried to ring home and there was no reply. So I carried on. When I got home at 5 or 6 o’clock that night, I discovered that my wife was in hospital—at Raigmore Hospital in Inverness.
My wife had been due to drive to Inverness to get the messages, as we say in the highlands, but found—as it turned out, very luckily—that the car had a flat tyre, so she caught the bus to Inverness. Having got her shopping, she was at the bus stop waiting to come home again when she took a massive epileptic fit. She woke up in Raigmore Hospital. Very shortly afterwards, when the staff took an X-ray of her head, they discovered that she had an extremely large meningioma, which is a form of tumour. Luckily, it is a benign tumour, but they reach some size. Within weeks, she had an operation to remove the meningioma. Unfortunately, in the recovery ward shortly after her operation, she took a further brain haemorrhage and had to go straight back into surgery. She was then in intensive care, but she did survive. I want to say that, for my family, for me and for my dear wife, it was an incredibly difficult time. How my eldest daughter, who was then aged 17, got through her studying for her highers, I will never know. I always think that my three children were in fact braver than I was; I put that on the record.
I want to say something else for the sake of the record. Reference has been made to the NHS and just how good it is. The then consultant neurosurgeon at Aberdeen Royal Infirmary, where my wife was operated on, was Mr David Currie. He and his team, as well as the nursing staff, were absolutely astonishing. I owe them and my wife owes them absolutely everything. They may think it was churlish for me to carry on canvassing to be an MSP but, when my wife could speak, which was not for a few weeks, I said, “Look, it’s only March and the election isn’t until May, I think I’ll pull out”, and she said, “Don’t.” She said it very quietly—she could only speak very softly. She said, “You must carry on. I think you might win.” And so I did. So there is a happy end to the story.
My wife is left somewhat disabled—she has a weak left leg and she has lost the use of her left arm—but, as we always say in my family, she is alive. She remains better than I am at the crossword. I cannot tell hon. Members how annoying that is, but that is just the way it is. She suffers from mild anxiety about things; much comment has been made about the side effects of this sort of surgery. However, I am intensely grateful to the NHS.
There are one or two conclusions that I would draw in this short contribution. The first is that we could see that Mr David Currie, the consultant neurosurgeon, and his staff—I admit this was 20 years ago—were stretched. Mr Currie always said to my wife for some years afterwards, “You see these white hairs. I got these operating on you for the second time.” But they were pushed. They were working extremely hard, but we could see they were pushed.
Secondly, as I have said already, we could see the sheer importance of the NHS and what a great British institution that is. I think, rightly, all parties in this place cherish and nurture it. I have to say, as an aside, that when I hear some of the comments coming across the Atlantic from the United States about how they do not want anything like the NHS, I think that they are just plain dotty. It is something of which we are very proud.
A third point arises from this experience, which was difficult. I admit that it was 20 years ago but, when my wife came out of hospital and came home, there was the business about what occupational therapy and physio help she could get, what was the social work package and how that was going to be handled. I think things have improved since then—I give credit to the Scottish Government for that—but how this is put together is very traumatic for the patient and for the patient’s loved ones. I was 44 and my wife was 42, and we had a family in their teens. An event such as this is a crisis and a change that you can hardly understand at the time. But, as I say, life goes on and we are where we are.
I have a habit of talking about disability issues because of my wife. One of the reasons why I volunteered—I was probably completely insane—to go on the small Committee charged with building the Scottish Parliament was that I could see that the old temporary Parliament at the top of the Mound in Edinburgh was utterly unsuitable for disabled people. Because of my wife’s experience, I got involved in what was known as the Holyrood project. It damn nearly lost me my seat at my second Scottish election because it was a very controversial issue, as I am sure Bill Grant will recall.
I have mentioned several times in this place the issue of getting disabled people back into work. At a time, whatever happens with Brexit, when we must play to all our strengths—we must play every card we hold—we have a lot of people who have been ill or are partially disabled who have great abilities that they could contribute to the functioning of the United Kingdom and to forging a new and better future for the United Kingdom. It remains a challenge for Governments of all colours to harness those people. If nothing else, it makes them feel that they are contributing to the country and it makes them feel useful and that they are important. Self-esteem and the esteem of your peers is incredibly important to happiness and to quality of life.
I want to take up the point, which I think was made by the hon. Member for Rhondda, that notwithstanding the desirability of local delivery of services, there is something to be said for amalgamation when it comes to something as crucial as neurosurgery. At the time of my wife’s treatment, there were four neurosurgical units in Scotland and Mr David Currie was the sole consultant neurosurgeon at Aberdeen Royal Infirmary. Had the four units been put together as one, there would have been better peer working and peer support. I think the hon. Gentleman made the point that, when it is something as traumatic as neurosurgery, people do not mind travelling. From the northern highlands, it did not really matter to me whether it was Aberdeen, Edinburgh or Glasgow—I just wanted my loved one to get the best possible treatment. I know it is always the case that we will get a local campaign saying, “No, no, no—not this”, but I think we can draw a line on some services, where centralisation for the maximisation of making people better is important. We should not lose sight of that.
A meningioma is a tumour that can kill you. It is a meningioma whether people live in Scotland, England or Wales—anywhere at all. I therefore appeal both to the Scottish Government and the UK Government for maximum co-ordination across borders on health delivery, the health service and making people better. I would hate to think that a line drawn by people on a map would in any way get in the way of that because this is about saving lives and making people better, which is surely one of the most important things.
I am going to end, as is my wont in this place, with a very short anecdote. I was lucky in May 1999. I would not say if they are sad enough, but if Members have a dull moment they can look at this week’s edition of Holyrood magazine and remark how young I looked then; I have aged terribly badly since then. I did win my seat. The Times decided to do a vox pop of my new constituents only a few days after I was elected. It asked one lady from the village of Kildary in Easter Ross, “How do you feel about Jamie Stone being elected to be an MSP for this constituency?” She replied, famously, “Well, at least it keeps him off the street.” When I read that to my wife in her hospital bed, she roared with laughter and I knew then that she was better.
I am delighted to take part in this important, wide-ranging, informative and consensual debate, and grateful to Chris Bryant for securing and opening it. I thank the all-party parliamentary group on acquired brain injury for its considered work, and the United Kingdom Acquired Brain Injury Forum for its report. The hon. Gentleman covered much of the ground in his opening remarks, which included a thorough summary of the subject. He reminded us that ABI affects nearly every Department and has a major impact on the families and support networks of those affected.
On behalf of my colleagues in the SNP, I welcome the publication of the report and congratulate the APPG on its amazing work. I encourage anyone who has not read the report to do so. The infographic on ABI key facts is an eye-opener; it informs us that 1.3 million people are living with traumatic brain injury-related disabilities, at an estimated annual cost of £15 billion. Sir John Hayes covered many other facts in that report. I recommend the report for that graphic alone, but the whole publication is fantastic and contains lots more information. Indeed, it may even underestimate the position, because much of the published information relates to traumatic brain injuries, not just to ABIs; none the less, it puts the scale of the problem in perspective. We have heard a number of case studies today, and I am grateful to Jamie Stone for his personal anecdotes, which helped to bring this subject home. I cannot help but think, “There but for fortune,” as such a thing could happen to any of us at any time.
I have suffered two head injuries in my lifetime, thankfully both fairly minor. Once I was hit by a golf ball—I was not even on a golf course at the time, which proves that such a thing can happen anywhere—and the other time was when as a child I was hit by a swing. I had listened to my mother who told me not to run in front of swings, but let me state for the record that it is equally dangerous to run behind them—that might save someone else from getting a knock. Thankfully, I was left without any lasting effects, but I know of constituents who suffered injuries that appeared to be no worse that the ones I incurred, but that had long-lasting effects that were traumatic to see.
In Scotland we are committed to ensuring that those with disabilities such as ABI get the support and care they need to live as independently as possible. The report is a welcome addition to that debate. It brings together key findings in a range of sectors, looking specifically at the impact that an acquired head injury can have on a person’s interaction with many different services. ABI can be caused by a variety of events and have a variety of implications. It is important that specific pathways are available to those who have suffered ABI and have had to go through the pain and trauma of coming to terms with the impact of that injury on their day-to-day lives. Fundamentally, this is about ensuring that people with disabilities can live as independently as possible. Our vision in Scotland is that children and adults with acquired brain injury should have equal access to highest quality brain injury care, regardless of where they live.
It is estimated that ABI is the most significant case of disablement for people of working age in Scotland. We know that around 40% of working age disabled adults are in employment, compared with more than 80% of those without a disability. Our key ambition is to reduce that gap. Many of those with ABI have complex rehabilitation and support needs.
Before I go on to mention some of the national services available in Scotland, I wish to pay tribute to some of the local work undertaken in my area by CRABIS, the West Lothian Community Rehabilitation and Brain Injury Service. CRABIS is funded by NHS Lothian and West Lothian Council, and it provides multi-disciplinary assessment and rehabilitation within the home or community settings—that is important—to those over 16 who have an acquired brain injury. The CRABIS team comprises occupational therapists, physiotherapists, clinical psychologists, speech and language therapists, and rehabilitation assistants. The model they use is being looked at by other areas within Scotland as good practice.
At national level, the Scottish Acquired Brain Injury Network—SABIN—was established in 2007 with the key objective of enabling improvements in and access to services in Scotland for children and adults with ABI. It comprises service user representatives, healthcare professionals, service providers and voluntary sector groups. SABIN published the traumatic brain injury in adults standards, which ensure a joined-up approach to immediate and long-term care for people with an acquired head injury. To achieve those aims, it works with partners to bring together healthcare professionals, service providers, parents, carers and voluntary sector groups who support brain-injured patients. SABIN undertakes events and workshops to raise awareness, including the Brain Detectives event for children who have a relative with a brain injury, which provides education on the effects of such injuries.
Last year, Scotland’s first major trauma centre opened at Aberdeen Royal Infirmary. It will treat the most seriously injured patients in the north of Scotland, and is the first of four major trauma centres to open as part of Scotland’s trauma network, with further centres due to open in Glasgow, Edinburgh and Dundee. A number of speakers have raised the point that in the case of such a traumatic event, people do not mind travelling—I certainly would not mind that should anything happen to me or one of my loved ones. The network will ensure that each year Scotland’s 6,000 seriously injured people get the best possible care and chances of recovery, wherever their location. The new centres will host dedicated trauma services, including rehabilitation support to help patients with significant injuries to recover more quickly. Backed by £15.2 million investment so far, the new Scottish trauma network will also include the Scottish Ambulance Service and existing trauma services.
I could, of course, touch on many other aspects, given the wide-ranging impact of ABI on services and public agencies, many of which—including education, the criminal justice system and health—are devolved in Scotland. I will therefore conclude with an issue that remains largely reserved: welfare benefits. The disability employment gap that I mentioned compounds the problems for those with ABI when interacting with that complex service. I echo the report’s call for less frequent reassessments and for assessors to be trained to understand the problems faced by those with ABI. I hope the Minister will cover that point when she sums up the debate.
I thank all Members for their contributions to an excellent debate, as well as the Backbench Business Committee for selecting this important subject. I congratulate my hon. Friends the Members for Rhondda (Chris Bryant) and for Blaydon (Liz Twist), and Sir John Hayes, who tabled the motion before us. In particular, I thank my hon. Friend the Member for Rhondda for his extensive work to raise awareness of acquired brain injury. I acknowledge the important work of Headway and the United Kingdom Acquired Brain Injury Forum, and I pay tribute to the excellent APPG for its sterling work to improve our understanding of the wide impact that ABI can have. Its comprehensive report, “Time for Change”, sets out a range of recommendations for the kind of support and rehabilitation that must be made available. I found that excellent report immensely interesting and informative, and I will now go on to champion awareness of acquired brain injury.
As the term suggests, acquired brain injury applies to injury caused to the brain after birth, and it can happen to anyone at any time. All Members have constituents who live with the consequences of ABI. A brain injury can happen in an instant, but its effects can be devastating and lead to lifelong challenges. The effects of ABI vary; those affected may suffer from headaches, dizziness, memory loss, extreme fatigue and depression, as well as diminished co-ordination and motor skills, irritability, and inability to concentrate. The right hon. Member for South Holland and The Deepings reminded us that we must be aware of the dynamic nature of the condition, and we heard about the wider impact of ABI when my hon. Friend Carolyn Harris spoke about George’s experiences and the wide impact that ABI has across all walks of life.
Improvements in medical procedures and acute care have led to improved survival rates for those who acquire an injury to the brain. That is welcome, but it brings its own challenges and places further pressure on already 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. As for many health conditions, however, the number of available beds across the UK is inadequate. Service provision is variable; consequently, long-term outcomes for brain injury survivors are compromised. As my hon. Friend the Member for Rhondda powerfully reminded us, this is all about quality of life, and it is cruel to save lives without the following support and rehabilitation.
Many Members spoke of the scale of the problem, and many people—including me before this debate—have little awareness of ABI, even though the numbers affected are so great. Currently, 1.3 million people in the UK live with ABI, which has rightly been described as the invisible epidemic. Some 900,000 people attend A and E with a traumatic brain injury every year, and every 90 seconds someone is admitted to hospital with an acquired brain injury.
It is estimated that 24% of children have some sort of brain injury, compared with 1% who have autism. ABI in children is often misdiagnosed as autism or attention deficit hyperactivity disorder. The point about misdiagnosis across the board was made effectively. A particularly good example was the misunderstanding of cases involving servicepeople. The combined cost of brain injury, including health and social care costs, disability support, lost work contributions and premature death, is estimated to be £15 billion a year, which equates to about 10% of the NHS budget. This is an issue of such seriousness and magnitude that it cannot and should not ignored.
In September 2018, the APPG report called for reform is all areas and Departments. This is not just a matter for the Department of Health and Social Care, although that would be a good starting point. As the report so rightly demonstrates, this should be an issue for the Department for Education, the Ministry of Justice and the Department for Work and Pensions, too. The report recommends change in several key areas. A national review of neuro-rehabilitation is required to ensure that service provision is adequate and consistent throughout the UK. We have heard Members describe current provision as a lottery. All affected individuals should be given a rehabilitation prescription, and there should be a significant increase in the number of neuro-rehabilitation beds. We heard about excellent trauma centres, but would it not be wonderful if an ABI consultation could be available in each of those units?
On education, Members expressed disappointment that the Timpson report made no mention of this issue. My hon. Friend the Member for Blaydon talked about small details, such as adjusting lighting or the colour of paper, that could be embedded in education. That would require all education professionals to have a minimum level of awareness and understanding about ABI and the educational requirements of children and young people with the condition. It is essential that special educational needs co-ordinators are given special training and that it is embedded in all SEN provision.
It was shocking to hear about the record of football in this country, and that, as a football nation, we have so little regard for sports-sustained concussion injuries. There is much work to be done in that area. Sport, Government and professional clinical bodies must work collaboratively to improve health professionals’ knowledge of concussion management.
Criminal justice procedures, practices and processes need to be reformed to take into account the needs of individuals with ABI. My hon. Friend the Member for Rhondda made the powerful point that ABI could be at the root of some crime and that, in the instances of female victims of domestic violence, we may be punishing victims. An assessment carried out ahead of imprisonment and sentencing would be useful in getting to the root cause of the problem, and would hopefully prevent further crime and further custodial sentences.
All benefits assessors in the DWP should be trained to understand the problems that affect individuals with an ABI. The story of Jordan Bell and his experience of filling in forms and the exasperation with the bureaucracy of the system was powerfully told. Those issues need to be addressed by the appropriate Department.
Much has been done to prevent ABI. Bill Grant talked about the benefits of seatbelts and airbags in reducing such damage. Comments were made about the considerable work of charities, but we cannot rely on charity to deliver on its own.
As this debate is being held under the aegis of the Department of Health and Social Care, may I ask the Minister, in the first instance, to focus on neuro-rehabilitation? NR can avoid or minimise disability and optimise recovery. Early access to NR is critical and there is substantial evidence that demonstrates NR is both clinically effective and cost-effective. Outcomes for those affected would be significantly enhanced if every individual was given an NR prescription that specified the individual’s specific needs and a care pathway. Will the Government ensure that every individual with an acquired brain injury gets just that? Will the Minister commit to introduce a neuro-rehabilitation consultant in every major trauma centre? The UK is facing a shortfall of 10,000 beds for neuro-rehabilitation services. Will the Minister commit to addressing that issue? Will she ensure that all health professionals in the community in primary care and secondary care are trained to recognise the symptoms of ABI?
We heard the powerful personal story from Jamie Stone, which reminds us all about the impact on the families of ABI sufferers. So many people find themselves in a frightening situation. They need structured and planned support that is assured wherever they live. Significant mention has been made of the great work Headway does, but, as I have said, addressing ABI cannot be left to the work of charities.
Will the Minister commit to work with her colleagues across Government Departments to implement the recommendations in the APPG’s report on education, justice and welfare? As the debate has shown, there is support for action in all parts of the House. The report’s recommendations cannot be ignored, but must be regarded as the beginning of a journey. In the words of the all-party group, it really is time for change.
It is a real pleasure to respond to this excellent debate on behalf of the Government. I would like to begin by thanking Chris Bryant for securing the debate. I commend him for the all the work he has undertaken as chair of the all-party group on acquired brain injury. He began by giving us a very vivid description of the physical impact of brain injuries, and went on to describe a whole gamut of mental health and emotional effects they have on people—and, of course, their families. He set me a challenge and I shall endeavour to meet it.
My right hon. Friend Sir John Hayes spoke with his usual eloquence. He reminded us about the scale of ABI, and emphasised the complexity of the issue and how it touches on many areas. Carolyn Harris told us all about George, reminding us that ABI can have extremely unexpected and devastating effects on the people who live with it and their families.
My hon. Friend Bill Grant, with his long career in the fire service, saw many people who had an ABI. He set us a very interesting challenge about having compulsory helmets for cyclists. I will take that point away and speak to my colleagues in the Department for Transport about it. Liz Twist outlined how people “just don’t get it”. That is a very important point, and it shows how important it is that we are debating ABI here today. She made a point about carbon monoxide poisoning, and I am due to have a meeting with the hon. Member for Rhondda on that very issue.
Siobhain McDonagh told us that the excellent charity Headway, which was mentioned very many times during the debate, is based in her constituency. She reminded us that a brain injury can strike any of us at any time. We also heard from Jamie Stone. He spoke very movingly, as he did in the debate last year, about his wife’s experience and his. All I can say is keep going on the crossword.
Brain Injury Awareness Week is from 20 to
As we have heard, in 2018 the APPG held a wide-ranging inquiry into the causes, impact and treatment of ABI. My predecessor, my hon. Friend Steve Brine, to whom I pay tribute for the energy he brought to this matter, agreed to respond to that report, and my Department co-ordinated with officials across Whitehall to deliver that response on
I thank my hon. Friend for giving way, and I know she will address these matters with her usual acumen and assiduity. I spoke about dynamic disability and the pace of recovery, but will she take into account the fact that aligned with that is the subtlety of the effects of brain injury? Sometimes a person may be deemed to have recovered completely and to have returned to normal—whatever normal is—but their manner, meter and mood might have changed and their sense of appropriateness might have altered, and that has effects in education and employment, in particular, as well as in personal relationships.
My right hon. Friend makes an extremely important point, showing that this is an issue not only for the health system and my Department but for others across Government.
While the majority of rehabilitation care is locally provided, NHS England commissions specialised services for patients with the most complex levels of need. For people who have ABI, neuro-rehabilitation that is timely and appropriate is an important part of their care. Access to high-quality rehabilitation improves outcomes for patients and can save money. The shadow Minister mentioned rehabilitation prescriptions. RPs reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient and are an important element of rehabilitation care. The APPG report was clear that all patients with ABI should benefit from an RP.
NHS England’s major trauma service, where acute phase rehabilitation begins, sets out that patients should be reviewed by a rehabilitation consultant. The shadow Minister asked about this. The development of major trauma centres, which the hon. Member for Rhondda supported, has improved recruitment to this specialty, while the national clinical audit of specialist rehabilitation recommended that all trauma networks review access to rehabilitation consultants and make improvements. Patients should have either a rehabilitation consultant or an alternative clinician with skills and competencies in rehabilitation to provide an initial formulation and plan to complete and perform the initial RP. At discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialised or local rehab.
The “National Clinical Audit of Specialist Rehabilitation for Adults Patients with Complex Needs Following Major Injury”, published in 2016, found that on average 81% of patients had a record of a rehabilitation prescription. The audit recommended that MTCs take action to improve compliance. The audit report appears to have had a significant impact. The latest data, from the last quarter of 2018, from the trauma and audit research network shows that the national average rose to a 95% completion rate for RPs. This is good news. NHS England has worked with patients, clinicians and charities to improve the RP design and set new standards for communication and involvement of patients, families and carers. It is hoped that the new RP will support the development of a rehabilitation dashboard to monitor the performance of the system. Audits play an important role in helping services to improve. The report also recommended that all organisations within a trauma network work together to review capacity.
The majority of rehabilitation care is commissioned and managed locally. To support commissioners to plan services for local populations, NHS England has produced a document, “Principles and Expectations for Good Adult Rehabilitation”, that describes what good rehabilitation looks like. Additional guidance covering adults and children sets out a commissioning model and the evidence base for delivering high-quality rehabilitation services.
The hon. Member for Rhondda mentioned that ABI spans many Departments, and I shall take away all the comments that concern my ministerial colleagues and will ask them to respond. On support for children with ABI in school, the special educational needs and disabilities system is designed to support all children and young people with additional needs. The arrangements for SEND are intended to support joint working between health, social care and education; multi-professional assessment of a child or young person’s needs involving relevant experts; and the development of an individual education, health and care plan to meet those needs. This should provide a basis for the sharing of information and expertise to ensure the needs of children and young people with ABI are supported in school.
Liz Twist mentioned the ABI card. The Department for Education has said that promotion of the card is a matter for individual schools, but as far as my Department is concerned, Professor Chris Moran, a national trauma director, said that he would be happy to promote the card in trauma networks, working with the Brain Injury Trust. The statutory guidance on supporting children with medical conditions at school covers a range of areas, including the preparation and implementation of school policies for supporting pupils, the use of individual healthcare plans, consulting with parents, collaborative working with healthcare professionals and staff training. The Department for Education continues to work with organisations such as the Health Conditions in Schools Alliance to help to raise further awareness of the duty on schools.
On prisons, there is an increasing body of evidence linking ABI to offending behaviour. NHS England’s liaison and diversion service has collaborated with Headway to develop workshops to improve awareness and identification of ABI in vulnerable offenders and the support available. The “train the trainer” workshops were designed so that attendees could return to their services and cascade workshop learning to their colleagues. Representatives of all NHS England-commissioned liaison and diversion services attended. Over the past two years, the Ministry of Justice has also piloted approaches to improve screening and support for prisoners through new link worker roles at six sites on the male secure estate. I take the point about female offenders and will speak to the relevant Minister. There was a pilot at a female prison between 2016 and 2018, but I will take away the point about the female estate.
I want briefly to touch on the point raised by my right hon. Friend Dr Lewis, the Chair of the Defence Select Committee. The veterans trauma network delivers comprehensive medical care to veterans, including those suffering from brain tumours, and, as he knows, the Prime Minister opened the successor Defence centre to Headley Court last year. We do not recognise his statistic that there are only two machines, but I will take that away and report back to him.
I was not talking about tumours; I was talking about traumatic injury caused in explosions. My understanding is that only Nottingham and Aston Universities have the special types of scanners that can detect that particular injury. Will the Minister check that point and consider a screening programme for such people?
I will happily take away that challenge from my right hon. Friend and will write to him.
The hon. Member for Rhondda spoke passionately about sport, although he claims not to be a sportsman. It is important that we do more to reduce the risk of ABI in sport. The Department for Digital, Culture, Media and Sport asked Baroness Grey-Thompson to carry out an independent review of the duty of care that sport owes to its participants; her report dedicated a chapter to safety, injury and medical issues. National governing bodies are responsible for the regulation of their sport and for ensuring that appropriate measures are in place to protect participants from harm. The DDCMS expects everyone in the sports sector to think carefully about the recommendations in Baroness Grey-Thompson’s report and in the all-party group’s report. Progress has been made over the years, for example through the Rugby Football Union’s Headcase campaign and action by other groups.
It is important that the welfare system appropriately supports people with ABI. Work capability assessments for the employment and support allowance are conducted by healthcare professionals for the Centre for Health and Disability Assessments. Case discussions about claimants with ABI form part of new entrant training for all healthcare professionals who undertake such assessments. They should all have access to a self-directed learning module on ABI, which was updated in 2018 and quality-assured by Headway.
Since September 2017, those who are placed in the ESA support group and the universal credit equivalent, who have the most severe and lifelong health conditions or disabilities and are unlikely ever to be able to move into work, will no longer be reassessed. Changes have been introduced so that existing claimants with the most severe lifetime disabilities whose functional ability has remained the same are more likely to have their evidence reviewed by a Department for Work and Pensions decision maker, and not need a face-to-face assessment with a healthcare professional.
I hope that this debate demonstrates how seriously the Government take the issue and the devastating impact that it can have on people’s lives. We are committed to ensuring that people are better protected. I look forward to responding to further debates.
I will be very brief, because the next debate is also very important. I was delighted with the speeches of all hon. Members; my only complaint is that my constituency is not “Rhonda”, but Rhondda—if everybody could practise that before our next debate on acquired brain injury, I would be very grateful. I am conscious that lots of people have been watching the debate, including clinicians at the clinical neuropsychology department in Oxford and at the Child Brain Injury Trust.
There are some issues still to be tackled, including armed forces personnel, cost recovery caps for insurance companies, school exclusions, and training and recruitment to get more people working in the area. I very much hope that the new champion, who did magnificently in this debate and will do even better in the next one, will ensure that we can have a cross-departmental meeting with all Ministers who have responsibilities in the area.
Question put and agreed to,
That this House
notes the report of the All Party Parliamentary Group on acquired brain injury and supports its conclusions;
and urges the Government to work through all of its departments to ensure that those who have sustained brain injuries are guaranteed full neuro-rehabilitation as needed.