That this House has considered the potential merits of a comprehensive acquired brain injury action plan.
Dickens wrote,
“Reflect upon your present blessings—of which every man has many—not on your past misfortunes, of which all men have some.”
There are few greater misfortunes than an acquired disability. Among those, a brain injury can challenge every aspect of life, whether people can walk, talk or think—or at least think straight. The effects are various: they can be mild or severe, and recovery will often take not just weeks or months, although the initial trauma can be treated in that timeframe, but many years. However, an improvement can be made over the long term.
Most of us think, “This will never happen to me.” I guess that is true of most misfortunes, including ones of this severity. Brain injury is the leading cause of disability and death among people under 40 in the UK. It can happen at any time, in any place. The causes, again, are various. One thinks of sporting injuries, or perhaps an attack—a violent incident. Of course, the principal causes are things like road traffic accidents, motorcycle and car accidents. Acquired brain injury, for the reasons I have given, has long warranted more attention than it has received, both publicly and among policymakers.
While the Department of Health and Social Care plays a central role in dealing with the immediate trauma caused by the sorts of accidents I have described, many other Government Departments have a relationship with the effects of brain injury. That is well illustrated by the work done by the all-party parliamentary group for acquired brain injury, which I am now proud to chair, and published in a report to which I will refer later in my speech.
We made the case that a cross-departmental approach to brain injury is required, for exactly the reasons I have set out. Of course, it affects the Department of Health, but it also affects the Department for Culture, Media and Sport—I spoke about sporting injuries a moment or two ago. It affects the Ministry of Justice, because such a high proportion of the incarcerated have brain injuries. It affects almost all aspects of Government, on which I know other contributors to this debate will focus, so a lateral approach to the way that public policymakers consider brain injury and its effects is critical.
As you will know, Dame Siobhain, as an extremely experienced and very wise Member of this House, might I say—
I was hoping it might. Lateral policymaking is not easy in Government, because of the way Government works and ministerial responsibilities are exercised. It is a challenge, therefore, to get that sort of approach adopted by a Government of any colour or persuasion.
The right hon. Gentleman is making a typically thoughtful contribution, and I congratulate him on securing this debate. I also thank Clare Harrison, a constituent of mine, from the Brain Injury Group for bringing this important matter to my attention.
The right hon. Gentleman makes a point about the Government’s role, and as he mentioned, sporting injuries populate such issues. Among those affected are former professional footballers, who are four times more likely to develop a neurodegenerative disease, support for which is patchy. For female former professional footballers, that support is non-existent. Will he join me in encouraging the Minister to consider the creation of an independent, football-funded body, alongside any wider action plan that his APPG is advocating for?
I am grateful for the hon. Gentleman’s contribution. He makes a valuable point and an interesting suggestion that I will reflect on. He is certainly right that more can be done to affect brain injury in the first place. I have spoken a bit about its effects, but he is right to speak at greater length than I did about its causes. In the area of sport, of course, he is right that we now know that heading a football does all kinds of damage that no one imagined a generation or two ago. His suggestion is well made and worthy of further consideration.
Around 350,000 people a year are admitted to hospital with acquired brain injury—that is one every 90 seconds. About 125,000 of those are admitted following a traumatic brain injury, around 43,000 with brain tumours and others following strokes. I pay tribute to Lincolnshire brain tumour support group, of which I am president, and to Headway, which I will say more about in due course. The end result of those admissions is that about 1.3 million people are living with the consequences of acquired brain injury every day. They and their families, loved ones and friends, and the communities of which they are part, are dealing with the effects.
According to our all-party group’s latest report, the cost to the UK economy through healthcare, social care, lost productivity and wider public services is £43 billion annually, which equates to 1.3% of GDP. Of that, £20 billion is accounted for within the NHS and social care budget for acute long-term care, £21.5 billion is attributed to lost productivity, £1.5 billion is spent in the criminal justice system and the Department for Education—yet another Government Department that needs to be involved in the consideration of this issue in the lateral way I mentioned—and about £1.9 billion is spent on benefits. Leaving aside the human cost and the visceral effects brain injury can have on affected individuals and those who care for them, this has a considerable effect on Government, the Exchequer and the public purse.
Following representations from myself and others, the Minister, who has responsibility for public health and prevention, kindly responded to say that the Government will publish an action plan in 2026. I hope that it will be published as early as possible—if not before Christmas, perhaps as an early new year’s resolution.
After years of campaigning by charities and MPs, the excellent news is that there now seems to be momentum on this issue, which is what sufferers and their families deserve; it is what they warrant and certainly what they need. The plan needs to include a focus on better community rehabilitation and on how that will help to achieve real change for people with ABI. It could also include national training for local authority and integrated care board commissioners, and for social workers, on the complexities of ABI. I have talked about the subtlety of the effects that ABI can have, including the changed personality that many people experience as a result of a brain injury. Addressing such subtle changes requires a level of understanding and expertise, so national training could be really important and of immense value.
I hope that the plan will also include funding for community-based specialist brain injury services. Staggeringly, the vital research by Dr Alyson Norman found that a third of serious case reviews in social services involved someone with a brain injury. Dr Norman lost her own brother to suicide after he suffered a lifetime of untreated brain injuries sustained in childhood.
Given that brain injury is no less than a hidden epidemic, it is imperative that the Government take further action to collect statistics about it, so that we can accurately ascertain the numbers impacted. We need a UK-wide consensus on which conditions are classified and coded as brain injury, and to make that data freely available. Access to hospital admission data on brain injuries must be free; currently, charities face significant costs.
I ask that Members consider a four or five-minute time limit on their speeches so that everybody can be heard this afternoon, although I do not want to do that on a forced basis.
It is a pleasure to serve under your chairmanship, Dame Siobhain. I pay tribute to the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing this debate and for all his ongoing work leading on this issue.
One of the most remarkable features of the human brain is its ability to change. Neuroscience tells us that the brain has what is known as plasticity: the ability to rebuild, adapt and form new connections after injury. But that is not automatic; as with any muscle, recovery happens only when the brain is exercised, challenged and supported.
If someone breaks a leg, we do not simply discharge them and hope that they walk again; we provide structured rehabilitation, physiotherapy and ongoing care. Yet for many people with brain injuries, that is exactly what we do not do. Too often, rehabilitation is determined by postcode rather than need. Some parts of our country offer specialist support; others offer little or nothing at all. Patients are discharged from hospital and sent home often not because they are ready, but because the hospital bed is needed. Families suddenly become care co-ordinators. People struggle with memory, fatigue, speech and personality change without professional help.
Let us be clear about the scale of the issue. As has already been mentioned by the right hon. Member for South Holland and The Deepings, acquired brain injury is the leading cause of death and disability among people under 40 years old. Every year, around 900,000 people experience a brain injury and over 160,000 of them are hospitalised. Around 350,000 hospital admissions involve an acquired brain injury.
As has already been mentioned, the cost is enormous. Analysis shows the real cost is over £43 billion, with wider wellbeing costs exceeding £91 billion. We also know that every £1 spent on neuro-rehabilitation saves £16 for the state. Yet community services are underfunded and overstretched, and voluntary organisations warn that systems are close to collapse. This is not just moral failure; it is also economic failure.
It is a pleasure to serve with you in the Chair, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on securing this important debate. Every 90 seconds, someone in the UK is admitted to hospital with an acquired brain injury. Participation in sport carries some of the highest risks. This is most evident in children, adolescents and young adults.
The University of Bath was recently named sports university of the year, and we are all very proud in my constituency. It is a national leader in making sports such as rugby safer while preserving the hugely positive health and community benefits of participation. Rugby is at the forefront of developing ways to identify and manage brain injuries and, crucially, to prevent these injuries in the first place.
It is about improving safety without losing what makes sports so valuable, exciting and enjoyable for players and communities. The University of Bath works directly with teams and governing bodies to research, trial and refine new safety protocols, ensuring that evidence rapidly translates into safer play at all levels. One such example is the Activate exercise programme, an evidence-based strategy to cut youth concussions by up to 60%, which has now been adopted internationally.
The University of Bath is also partnering with schools, including Beechen Cliff school in my constituency, to use instrumented mouthguards to monitor head impacts and guide approaches to preventing injuries in young players. I pay special tribute to Headway Bath, which provides specialist relief, cognitive rehabilitation and support to adults who have suffered an acquired brain injury and their families and carers.
My hon. Friend is right to congratulate Headway Bath. These local groups are so important in providing support within our constituencies and are sometimes used by us to signpost people on. I highlight Graham Geddes, who set up Headway North East Fife in my constituency and has been nominated as volunteer of the year. Does my hon. Friend agree that we need to support this vital charity?
I could not agree more with my hon. Friend. I congratulate her branch of Headway on its wonderful work and the award it is about to receive. What would we do without local charities leading the way and, often, guiding us?
In Bath, North East Fife and other constituencies across the country, Headway provides day services throughout the week, online groups and bespoke one-to-one outreach rehabilitation support. That vital support makes a real difference to the lives of sufferers of acquired brain injuries, but I am sure many hon. Members will echo the fact that local Headway charities are under severe financial strain. Seven have closed in the last three years and others are struggling to meet rising demand with shrinking resources.
This debate is a crucial opportunity to ensure that the ABI action plan tackles these challenges. The 2024 report of the Lancet commission on dementia prevention, intervention and care estimates that almost half of dementia cases worldwide could be prevented or delayed if we act on 14 modifiable risk factors. Among them is traumatic brain injury, which alone is estimated to contribute to around 3% of global dementia cases.
As we have mentioned, some high-contact sports, such as rugby and boxing, carry a higher risk of traumatic brain injury, but we must not forget that regular physical activity is one of the most powerful tools we have to protect brain health. Exercise improves memory, supports thinking skills and lowers the risk of dementia through its wider benefits to cardiovascular and metabolic health.
Addressing the full range of modifiable risks such as high blood pressure, smoking, physical inactivity and obesity, alongside reducing exposure to head injury, means we could lower dementia risk for an estimated 27 million people worldwide. Our task now is not to pit exercise against safety, but to balance the risks of head injury with the overwhelming health benefits of sport. Protecting athletes of all ages from avoidable head injury must sit at the heart of that effort.
It is a pleasure to serve with you in the Chair, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on his opening remarks. We have served together on the all-party parliamentary group for acquired brain injury for a number of years. He gave a very effective summary of the impact of brain injury. I thank Chloe Hayward and everyone at the United Kingdom Acquired Brain Injury Forum and its constituent organisations for all the work and campaigning they do to improve services for people with acquired brain injuries.
There are so many aspects of this issue, including sport, other conditions and the justice system, but I will focus on children. I thank the Child Brain Injury Trust for its long-standing support in my constituency. A few weeks ago, its representatives accompanied me on a visit to Chopwell primary school, as they have come to other schools in past years, during GloWeek, which is always a big hit with children in Blaydon and Consett. It turns out that road safety is even more memorable if there are high-vis armbands and a visiting police car and fire engine. The purpose is not just entertainment; it is to say to children, “Be seen and be safe,” because so many acquired brain injuries in children are from road traffic accidents. It is entertaining, but it has a very serious message: “Let’s avoid those brain injuries in the first place.”
UKABIF and N-ABLES—the National ABI in Learning and Education Syndicate, a young people’s group—point out that acquired brain injury is an under-recognised and often hidden condition that can affect every aspect of a person’s life. About 40,000 children and young people report to hospital with an acquired brain injury every year, but it is likely that many thousands more have an undetected mild brain injury.
UKABIF and N-ABLES also say, however, that even mild injuries can be associated with a range of cognitive, behavioural and emotional symptoms, which can inevitably have an impact on a child’s education and health—indeed, on every aspect of their life, as we have heard. For those with moderate and severe injuries, the effect on all aspects of their life is often profound. The UK’s major trauma centres and advances in healthcare are saving more children’s lives than ever—thank goodness—but investment is needed in the quality of those lives after a brain injury. We hope those children will have a long life, but the support remains desperately poor. It is actually left to families and schools to provide much of that support.
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Those ramifications only scratch the surface of the wider social cost. The real cost is in lives disrupted, plans abandoned and ambitions jettisoned as a result of brain injury; in parents seeing a child’s personality change overnight and carers stretched to their limits, with little or no respite, because symptoms are dismissed as being mild or imperceptible or attributed to some other cause entirely. Although less obvious, those effects are just as devastating. When those costs are added to the ones I have described, the all-party group estimates that the real cost of acquired brain injury is £91.5 billion. That is about half of what the NHS spends every year. It is extraordinary that this issue is not given greater consideration. I am delighted that this debate gives us a chance to do so, at least for this short time. I thank all colleagues across the House who have been part of these efforts.
We have argued for what we call a right to rehab. Putting aside the substantial financial cost, the physical and emotional costs are still higher. The estimates do not include many of the costs associated with homelessness, addiction, mental health services and psychiatric stays. The cost to the NHS and welfare of lengthy treatment and recovery is huge and rises quickly during spells in hospital before one even receives community support and longer-term social care provision. Much of this could be prevented, and many of the costs could be reduced, if we had the right to rehab.
Much work has been done on this subject, including by Headway, which I mentioned earlier, and the United Kingdom Acquired Brain Injury Forum. A report from earlier this year, commissioned by the APPG, urged the Government to invest in specialist neuro-rehabilitation to save long-term societal costs. The report called for brain injury to be treated on a par with cancer and dementia. A statutory right to rehab in every region means that specialist neuro-rehabilitation services after an acquired brain injury would be put in place.
None of the failures that we see today in response to brain injuries is inevitable. The Ministry of Defence already guarantees the right to rehabilitation for military personnel, so we have a precedent. We want to build on that precedent, across Government, for those affected by brain injury.
We know from the MOD the results of having that right for rehabilitation—shorter recovery times, better outcomes, restored lives and improved prospects. The same approach is being piloted by the National Rehabilitation Centre, where every £43,000 invested in rehab yields savings of up to £680,000. That is a remarkable 16:1 return on investment.
Now is the time to extend the entitlement adopted by the MOD much more widely. We must establish a national neuro-rehabilitation framework that guarantees that access to specialist care is not a lottery, but a certain path to recovery. In doing so, money would certainly be saved, but life chances would be improved immeasurably, too. High-quality rehabilitation reduces the risk of homelessness, addiction and a drift into lawlessness. It allows people to contribute, return to work and rebuild lives and relationships—to begin to stand tall again.
Now is the time for the Government to act. I have every confidence that the Minister will rise to her feet at the summation of this debate and tell us that she has not only thoroughly studied the all-party group’s report—daily, perhaps—but that she is ready to respond in the way that we invite.
I pay tribute to the hon. Member for Rhondda and Ogmore (Chris Bryant), who chaired the APPG before I did—I was his vice-chairman for many years. He drove the original version of the report, which was republished more recently. It is an outstanding piece of work. We all know that APPGs vary, but this one is focused on the subject for which it is responsible and is determined to make its voice heard, because of the all-party support it attracts and because of the salience and significance of this subject.
Given the number of people affected by brain injury, the comparatively low cost of effective interventions, such as rehabilitation and community support, and the ongoing lack of support services, there continues to be a strong need for a proper strategy to be put in place.
I spoke earlier about a lateral approach. We are calling for a national strategy on brain injury. Around 60% of prisoners report having an acquired brain injury. We discussed that at a recent APPG meeting, where we heard from experts in the field. I have served as a Minister in multiple Departments—I will not list them all—and I know that cross-departmental working is tough, and the Minister will know that too, but it can be done. It requires structures to be created that facilitate Ministers to come together. The Cabinet Office might be able to play a part. I served in the Cabinet Office and its purpose, in a sense, is to deal with those issues that could otherwise fall between the cracks and departmental silos. However it is done, we need a national strategy.
As far back as 2001, the Health Committee published a report on head injury, issuing 28 recommendations that included, as a matter of urgency, finding ways of improving methods of data collection on incidence, prevalence and severity. In 2005, the national service framework for long-term neurological conditions was launched; it contained many good ideas, but had no mandate and no funding. In 2010, the National Audit Office published a report, “Major Trauma Care in England”, which highlighted the need for improvement in major trauma care. That led to the establishment—you may remember it, Dame Siobhain—of trauma networks, with a centralised and specialised approach to trauma care and service across the country.
The excellent work of the APPG for acquired brain injury, which was reformed in 2017, showed that there was a strong case for a cross-party commitment to action. I have already spoken about the 2018 report, which called for a national reconsideration of rehabilitation and the collation of reliable statistics, given the problems with data collection and analysis that prevail.
To be fair to the previous Government, our report was well received by Ministers. Indeed, they responded to what we had called for by committing to publish a strategy on acquired head injury in 2021. The following year, there was a call for evidence to inform the development of such a strategy. The previous Government said that they were going to do it, committed to the principle and welcomed the work that we were doing. However, we then, of course, had the inconvenience of an election—one of the aspects of democracy that sometimes gets in the way of these sorts of things. Therefore, the work was not brought to a conclusion.
Earlier this year, the current Government announced their intention to develop an “action-oriented, and accountable” ABI action plan
“with input from NHS England and other Government departments”.
It was due to be published “this year”—well, the year is running out, Minister. However, there are still a couple of sitting weeks left: a statement could be brought to the House and perhaps a document could be published that responds to the calls that we have made. We have the work that the previous Government and this Government have done. There has been no party politics; over time, Ministers have recognised the challenge—the scale of the problem—and the reasons for addressing it, which I have set out.
We can hope that this Minister, who I know is dutiful and diligent, will rise to exactly that challenge. I do not know whether I am flattering her, Dame Siobhain—I am doing my best.
The charity Headway, which has done so much in this field, is not an immensely wealthy organisation and so those costs are significant to it. I hope that we get some reassurance on that point. Research by Headway has shown that over three quarters of brain injury survivors encounter daily challenges due to the hidden nature of their injury, and that nine out of 10 people affected by a brain injury cite societal misunderstanding as a major obstacle in navigating life with a hidden disability. Collecting those facts and figures is important because of the nature of acquired brain injury.
I will not say too much more about the costs to the sector, except that over the past three years several local Headway charities have permanently closed, including one in the last month. Three local volunteer branches have also shut down. That is because of rising costs of all kinds, which I do not need to list here. Closures really do risk brain injury survivors feeling lost. This is an area of work and a need that can go unrecognised and unseen. The feeling of isolation and loneliness—this is, as I described, a hidden epidemic—can place immense strain on families as survivors are no longer able to access, for example, the specialist daycare centres that they might otherwise enjoy.
We need to find a way of granting exemptions for charities from things such as the employer national insurance charges. I hope that the Minister will look at that, or even speak about it in this debate. Some 57% of Headway charities say that they have experienced delays in receiving payments from local authorities and integrated care boards. Some charities have even had to employ additional staff members purely to chase the debts that they were owed. These are small organisations with limited budgets; they just need help.
I know that other hon. Members want to contribute to the debate and can see their eagerness to do so, so I will draw my remarks to a close. For survivors, a head injury is just the beginning; the real challenge after survival lies in the days, months and years that follow. Individuals and their families struggle to navigate, with minimal support, a fragmented and underfunded system of rehabilitation. I know that because more than 40 years ago, like so many other young people, I suffered a serious head injury. But the key for me is that it did not stop me from doing what I wanted or being what I became. That is fundamental for anyone with an acquired disability.
It is a matter of record that I decided to become a Conservative MP when I was seven—I was probably six, actually. That did not alter as a result of my head injury, but it might have done. I have seen those much more seriously affected by the traumatic injury they endured. As I looked at them I thought, “There but for the grace of God go I”, so I was determined thereafter to do all I could to fight for people with serious head injuries who struggle with their effects. I have been determined to champion their cause and to turn my hopes on their behalf, and their hopes too, into reality.
I started with Dickens, one of our greatest writers, and I will end with Tolstoy, the great Russian writer. He wrote:
“As long as there is life, there is happiness. There is a great deal, a great deal before us.”
For everyone, regardless of what they suffer, to be able to glean that happiness, through the care and support that they receive, should be the ambition of every Government Minister and every Member of this House.
Behind every statistic is a life, and one of those lives belongs to my constituent, Jonathan Purnell. While playing rugby 34 years ago, Jonathan suffered a massive brain haemorrhage—he was 27 years old. He spent three years under neurosurgical care, and when discharge day finally came, he believed he was starting again, but then the reality hit him, as he describes it, “like a steam train.” There were no services, no pathway and no road map to recovery, so he built his own. Out of his experience, determination and quiet defiance, Jonathan created the 1492 Group, not as a charity in theory, but a lifeline in practice—a place for people with brain injuries to come together, share, rebuild and be heard. I am so proud that it operates today in my constituency of Hartlepool.
Jonathan did not wait for the system to change; he began the change. Today, he is not only a survivor, but a force—a campaigner, an advocate and a builder of hope for others still trying to understand their new reality. He should not have to do this alone, and no one else should either. The case for reform is overwhelming. The Government have committed to their acquired brain injury action plan—a process, I have to say, that started as a strategy in December 2021. How long does it take to get this done? It started in December 2021, and here we are in December 2025.
What matters now is delivery. We need a statutory right to rehabilitation, consistent national provision, proper data collection and sustainable funding for community services. Above all, we must ensure that people with brain injuries are not written off because recovery is complex. Brain injuries change lives, but failure to act destroys them. Jonathan Purnell shows what is possible, and the Government must now do what is responsible. I urge the Minister to set out a clear timescale for that action plan, the necessary funding commitments and the accountability mechanisms. When it comes to acquired brain injury, warm words are no longer enough: people need support, and they need it now.
I echo the call from Alzheimer’s Research UK for dedicated funding from national Government, sport governing bodies and research councils to advance research into the complex relationship between sport, traumatic brain injury and dementia prevention. I hope that the Government listen.
Brain injuries are common, but the symptoms often go unrecognised or are mistakenly attributed to conditions such as autism or attention deficit hyperactivity disorder. Even with a diagnosis, there is no special educational needs category for acquired brain injury, which forces schools to record affected children under more generic categories. Many teachers say that they have never taught a child with a brain injury, but the evidence suggests that one child in every class will have sustained one by the time they leave school. It is vital that clinicians, teachers and carers consider the question, “Could this be a brain injury?” If that question is not asked, too many will miss out on the specialist support that they need. That is true not just at school but throughout their lives.
Rates of brain injury are alarmingly high in our mental health system, in prisons, and among those accessing domestic abuse support services. The risk of suicide is two to three times higher following a brain injury. One in four people report suicidal thoughts within a year of diagnosis, and that risk persists throughout life. Despite that, more than half of people with neurological conditions have not been asked about their mental health in the past three years.
Many people experiencing suicidal thoughts might not even be aware that they have a brain injury, particularly survivors of domestic abuse who might have experienced repeated mild injuries rather than one significant event. Research suggests that up to half of survivors have experienced brain injury, yet frontline support workers are rarely aware of that link. This matters because people experiencing mental health issues as a result of their brain injury require specialist neuro-psychiatric support. Often they are excluded from mental health services or told that the services they need do not exist.
With fewer than 20 full-time neuro-psychiatrists in the UK, there is a postcode lottery in accessing support, so those most likely to experience high rates of traumatic brain injury and mental illness also face the most significant barriers to accessing healthcare. That includes those who are homeless, those who struggle with substance abuse or those in prison. Some 60% of offenders are thought to have a brain injury, and yet there are no secure services in the UK for women with an acquired brain injury. Given the links between domestic abuse, offending, brain injuries and suicidality, that is particularly concerning.
What steps is the Minister taking to improve the integration of mental health and neurological care, and to ensure that clinicians are trained to recognise and respond to the needs of patients with brain injuries? The national service framework for long-term neurological conditions emphasises the need for provision at all levels, delivered through co-ordinated networks of specialist hospital and community rehab services. Having met local professionals in the north-east—in Newcastle and south of the River Tyne—I know that community provision varies significantly by postcode, some receiving none at all and others receiving great support. Without support, patients go on to have poorer outcomes, relying more heavily on other parts of our NHS and the care system.
What steps is the Minister taking to ensure that we develop the care pathways we need to give patients the best chance of recovery? I welcome the Government’s commitment to a more focused action plan, and I look forward to hearing the Minister’s thoughts on what steps will be taken to achieve it. If we get this right, we can transform outcomes for thousands of people and build a system that supports them throughout their lives.