Acquired Brain Injury

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 the right hon. Member for South Holland and The Deepings (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 the hon. Member for The Cotswolds (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.

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.

You don’t say.

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.

It is a pleasure to follow the hon. Member for Rhondda (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 the Member for South Ribble (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 the hon. Member for Rhondda (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.

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.

The hon. Member for Huddersfield (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.

First, I congratulate my dear friend the hon. Member for Rhondda (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.

It is a pleasure to follow the hon. Member for Swansea East (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.

The hon. Member for Swansea East (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.

I thank my hon. Friend the Member for Rhondda (Chris Bryant) for opening the debate in such an excellent manner and the right hon. Member for South Holland and The Deepings (Sir John Hayes) for helping to secure it.

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.

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 just to 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 Child 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.

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.

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 the hon. Member for Rhondda (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 am delighted to take part in this important, wide-ranging, informative and consensual debate, and grateful to the hon. Member for Rhondda (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. The right hon. Member for South Holland and The Deepings (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 the hon. Member for Caithness, Sutherland and Easter Ross (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.

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 the right hon. Member for South Holland and The Deepings (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 the Member for Swansea East (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.

It is a real pleasure to respond to this excellent debate on behalf of the Government. I would like to begin by thanking the hon. Member for Rhondda (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 the Member for South Holland and The Deepings (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. The hon. Member for Swansea East (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 the Member for Ayr, Carrick and Cumnock (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. The hon. Member for Blaydon (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.

The hon. Member for Mitcham and Morden (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 the hon. Member for Caithness, Sutherland and Easter Ross (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 26 May. I welcome the time Parliament that has set aside to discuss this issue. Prevalence estimates for ABI are problematic to make, but it is likely that the number living with ABI is definitely over half a million and could be as high as 1 million. The total cost of brain injury in the UK is estimated to be at least £1 billion per year. Charitable organisations such as Headway and the UK Brain Injury Forum, as well as other local and national groups that hon. Members have referred to, are highly valued by those affected. They raise awareness and provide help to those with the condition, as well as to their families and carers, and I want to put on the record our appreciation for everything they do.

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.

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.

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.