Acquired Brain Injury

I beg to move,

That this House has considered acquired brain injury.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Today, like every other day, some 954 people will be admitted to hospital with an acquired brain injury. That is one person every 90 seconds. As the hon. Member for Rhondda (Chris Bryant), who has done such great work to highlight the issue, has already said, all kinds of events can be involved. It could be a brain tumour; I am president of the Lincolnshire brain tumour support group. Alternatively, it could be a traumatic event, such as a car accident or a blow to the head, or something else, such as a stroke. The effects are so varied that they are hard initially to diagnose, and then hard to rehabilitate—but that does not mean that we should not do so.

The initial NHS response to strokes, tumours and dramatic, traumatic events is invariably good, but the multitude and diversity of the effects of these events, as well as the difficulties faced by those with acquired brain injury, will often not be obvious until long after the patient has left hospital. Indeed, the unpredictability of the consequences, as described in the previous speech, is immensely distressing for both the person concerned and those around them. There can be inappropriate behaviour and changes of personality, as well as the obvious matter of decreased capacity.

Proust said:

“Happiness is beneficial for the body, but it is grief that develops the powers of the mind.”

Grief is, of course, for the departed, but it is also for any kind of loss. People grieve the loss of capability and capacity—the inability to do the things they once did or the lost chance to do the things they had hoped to.

I had a serious head injury in my youth, but I was able to do all that I had hoped to. As I have said before, I wanted to be a Conservative MP from the age of seven; when I say that, the hon. Member for Rhondda usually raises his eyebrows in disbelief—right on cue, Mr Robinson, he is doing it again. My head injury did not stop me from achieving that ambition, but it might have done if I had had other ambitions, if the treatment and care I received had been different, or if, to be frank, I had not enjoyed the same good luck.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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