The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I beg to move,
That this House has considered acquired brain injury.
After the last three hours, I think the expression is—and now for something completely different.
For the past hour and a half, some of us English Members have endured watching the match—Tunisia 1: Spurs 2; I mean, England 2. It is a pleasure to be in the House, and we are very grateful to SNP Members for enabling us to watch the match.
I rise to speak to the motion in the name of my right hon. Friend the Prime Minister. I pay tribute to the hon. Member for Rhondda (Chris Bryant) and my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) for their persistence at business questions and elsewhere, and for securing this debate in the House. Brain Injury Awareness Week took place last month, which makes today’s debate especially timely.
Let me first recognise the important work of organisations such as Headway and the United Kingdom Acquired Brain Injury Forum in raising awareness and in providing information and support to those living with acquired brain injury and to their friends, families and carers. I know that some of them are with us this evening, and I thank them for their persistence during the family dispute we have had in the Chamber for the past three hours.
Acquired brain injury—ABI—is an injury that takes place after birth in an otherwise healthy brain. It includes traumatic brain injuries such as those caused by road traffic accidents, falls or assaults, and non-traumatic brain injuries related to illnesses or medical conditions, including meningitis, stroke or brain tumours. While prevalence estimates for ABI are quite hard to make, the number living with it is thought to be over 500,000 and could be as high as 1 million people. The total cost of brain injury in the UK has been estimated by our officials to be at least £1 billion per year.
Mrs Pauline Latham (Mid Derbyshire) (Con)
My hon. Friend talks about the cost of brain injuries. My constituent Stuart Tranter asked me to lobby the Government to put more money into brain tumour research, which has been very much the poor relation, and I have been successful. I congratulate the Government on having doubled that money since Tessa Jowell, who used to serve on the Opposition Benches and then went to the House of Lords, died. I am very grateful to the Minister and the Department for putting so much money into that much needed research.
Steve Brine
I thank my hon. Friend. This is the first time I have been at the Dispatch Box since Baroness Jowell passed away. As I said during the debate when she was sitting in the Under Gallery with her lovely family, I did not know her well but the one time I met her I was left in no doubt about her determination on this subject. It is great that we are able to do so much. I pass on my condolences to Jess, her daughter, whom I have got to know a little, and her family. The trauma of the immediate is horrible and it goes on for a long time. Our thoughts are with them. I thank my hon. Friend for what she has said. We will do well by Baroness Jowell, especially through the money that we will put into research to try to instigate new research projects, which have traditionally been thin on the ground in this area. We are hoping to stimulate the research market.
ABI can have a devastating impact on our constituents’ lives; even minor head injuries can cause short-term impairment. Those surviving more severe injuries are likely to have complex long-term problems affecting their cognitive and functional ability, personality, close relationships and ability to return to any form of independent life.
Caroline Lucas
Does the Minister share the concern raised with me by my Brighton constituents who travelled up to Westminster to share their stories, about the lack of funding for support for relatives and carers—in particular, the education that family members and carers need about how to look after someone with ABI? It can be incredibly stressful for the person themselves and for family members if people do not know how best to provide care. Funding can make a huge difference.
Steve Brine
I thank the hon. Lady for that point, which I shall come to. There are other Ministers on the Bench with me, including from the Department for Work and Pensions, because I wanted them to hear other parts of this debate. The hon. Lady’s point is well made.
Alex Chalk
The Minister rightly listed a number of impacts from traumatic brain injury. Does he agree that one of those can be an increasing propensity to commit criminal offences? We are starting to wake up to the fact that a number of people in custody have sustained precisely that injury. That should be a focus for preventive work in future.
Steve Brine
I thank my hon. Friend, who has professional experience of the criminal justice system. I shall come to his point in a moment, but I thank him for putting it on the record. Sometimes it is a difficult subject to talk about, but it is very relevant.
Jim Shannon (Strangford) (DUP)
This debate is important to me personally; many years ago my brother had a serious brain injury as a result of racing motorbikes. That made an independent, single-minded person into someone who depended very much on others; it took him from being a person with his own business and social connections to being someone who could not co-ordinate more than one thing at a time.
I look forward to some comfort in the Minister’s response, which I know we will get. We need not only help for the person in an institution; they need to be taken home and given a semblance of order in their lives and what quality of life is possible. Does the Minister accept that families need help to take on that job for someone whom they love and want to help?
Madam Deputy Speaker (Dame Eleanor Laing)
Order. Before the Minister responds, I should say that I appreciate that many want to make interventions because they do not want to stay until the end of the debate. We have only an hour and 10 minutes. A lot of people wish to make speeches and there will have to be a time limit. Interventions must be short.
Steve Brine
I do not know what you mean, Madam Deputy Speaker, but I will certainly be here until 11 pm.
The hon. Member for Strangford (Jim Shannon) makes a good point, which follows on neatly from the point made by the hon. Member for Brighton, Pavilion (Caroline Lucas). It also leads me neatly on to the point I was about to make. The all-party group on ABI is currently conducting a very broad inquiry into the condition—its causes, treatments and societal impact—and I am sure it will consider the wider family. When I say family, I do not just mean the nuclear family but society’s family and even the Church, which can embrace people suffering the life change the hon. Gentleman spoke about so well with regard to his brother. I want the all-party group to know that I will support its inquiry as best I can. They should know that that offer is there.
As a Health Minister, I will obviously focus on the health aspects of ABI, but I just want to highlight some of the other areas—this touches on one or two of the interventions—where its impact is felt and action is under way. On education, many children and young people with ABI are rightly in education and have special educational needs as a result of their injuries. The Government recently provided some £29 million to support local authorities with ongoing implementation of individual education, health and care plans to meet those needs. It is vital to us that health, social care and education services work jointly in developing these care plans. I know my colleagues in the Department for Education share that view.
On offending behaviour—ABI touches on a lot of different Government Departments—there is an increasing body of evidence suggesting that children and young people who survive traumatic brain injury are more likely to develop behavioural problems that can be linked to an increased vulnerability to offend. NHS England’s liaison and diversion service has collaborated with the charity Headway, which I mentioned at the start of my speech, to improve awareness of ABI in vulnerable offenders and the support available—the point raised by my hon. Friend the Member for Cheltenham (Alex Chalk). Further, the Ministry of Justice is piloting approaches to improve screening and support for prisoners with ABI to prevent a cycle of re-offending once they enter the secure estate. The Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), is very kindly on the Government Front Bench to listen to the debate and I am grateful to her. The Minister of State, Ministry of Justice, my hon. Friend the Member for Penrith and The Border (Rory Stewart), who has responsibility for prisons, had hoped to be here but was pulled away. I know he will be taking a close interest in what is said tonight, because this issue will come up again.
Sport is another area for which there is a growing body of evidence and concern about the levels of risk and response to injury. This is why the Government commissioned an independent review of the duty of care that sport has to its participants, which published its findings in April 2017, and we are now working to implement its recommendations, including around awareness and prevention of head injury while playing sport.
On trauma centres, it is vital that those with the most serious brain injuries receive the best care that our NHS —our birthday NHS—can offer. In 2012, 22 regional trauma networks were developed across England. Within those networks, major trauma centres provide specialised care for patients with multiple, complex and serious major trauma injuries, including brain injury. Two years after their introduction, an independent audit of the network, commissioned by NHS England, showed patients had a 30% improved chance of surviving severe injuries and that the networks had saved some 600 lives. There is a positive story there.
A vital part of the treatment pathway for people who have suffered ABI is neuro-rehabilitation that is timely and appropriate to their needs. There is good evidence that access to high quality rehabilitation both improves outcomes for patients and can save money.
Nic Dakin (Scunthorpe) (Lab)
The neuro-rehabilitation centre in Goole is an excellent example of such practice. It serves north Lincolnshire and the wider area. I commend that service, and others like it, to the Minister.
Steve Brine
I thank the hon. Gentleman for his intervention. I hope to get to his part of the world at some point while doing this job and it may be that I could visit it while I am up there.
The World Health Organisation states that rehabilitation intervention should be aimed at achieving the following five broad objectives: preventing the loss of function; slowing the rate of loss of function; improving or restoring function; compensating for lost function; and maintaining current function. NHS England’s Improving Rehabilitation programme applies those principles, rightly, in a holistic way to encompass both mental and physical health. In 2015, the programme published the “Principles and expectations for good adult rehabilitation” to support commissioners on delivering rehabilitation care locally in our constituencies. This document describes what good rehabilitation looks like and offers a national consensus on the services that we think people should expect.
Eddie Hughes (Walsall North) (Con)
It is important that we consider that it is not just trauma with regard to ABI. One of the other causes might be excessive exposure to carbon monoxide, so I was grateful to the support that Headway gave to my private Member’s Bill, which seeks to introduce mandatory carbon monoxide detectors in new-build and social rented houses.
Steve Brine
My hon. Friend makes an excellent point. As I said at the start, obviously there are non-traumatic injuries—so, through conditions, and meningitis and stroke were two examples that I gave—but he is absolutely right to point out that issue. I congratulate him on his success with his Bill.
The rehabilitation programme includes 10 principles and expectations that were designed by people who use rehabilitation services—the carers, healthcare professionals, commissioners, strategic clinical networks and national clinical directors. Building on this, in 2016, NHS England published further rehabilitation guidance covering both adults and children. This provides local service planners with a commissioning model, a range of case studies and crucially, an evidence base for the economic benefits of delivering high-quality rehabilitation services.
While the vast majority of rehabilitation care is locally provided, NHS England commissions specialised rehab services for those patients with the most complex levels of need. Teams within trauma units assess and develop a rehabilitation prescription for patients with ABI. Through this, patients can access specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription. The teams manage ongoing patient care, including a key worker to support patients through the pathway and into rehabilitation at a level appropriate to their clinical need, in accordance with their clinician’s advice—be that highly specialised rehabilitation or through a local provider in the local network.
I want to mention the Rehab Matters campaign. As I said, rehabilitation is a key part of the patient’s recovery. I saw at first hand the impact that this can have in helping people to recover from illness or injury when I visited the Hobbs rehabilitation centre in my Winchester constituency earlier this year. The Chartered Society of Physiotherapy launched its Rehab Matters campaign here in the House at the end of October last year. It makes a very powerful case for community rehabilitation, and I think that all commissioners should ensure that levels of provision are meeting local needs and look to places such as the Hobbs centre as a good example of what can be achieved through rehabilitation care. The society produced a film that was made by the Oscar-shortlisted UK director, Chris Jones, called “Rehab Matters”, and I highly recommend it to Members interested in this area.
I am just going to skip over to research, and then close, because we have only an hour and I know that a lot of people want to speak. Let me just highlight the research being undertaken in this important area. We are investing over £1 billion a year in health research through the National Institute for Health Research. The NIHR is funding ABI research from basic science to translational research in civilians, military and sport. For example, we are investing over £100 million, over five years up to 2022, in a biomedical research centre in Cambridge that is developing new approaches to reduce the impact on patients’ health and wellbeing of neurological disorders, stroke and brain injury. We are investing £5 million to co-fund the surgical reconstruction and microbiology centre in partnership with the Ministry of Defence—that has been going since 2011. The centre specialises in research, taking discoveries from the military frontline to improve outcomes for all. We have invested about £16 million in brain injury research since 2014 through the NIHR health technology assessment programme, and we are investing just over £2 million over three years through NIHR’s global health research group on neurotrauma, which aims to advance global neurotrauma care and research to help to save lives, reduce disability from the trauma and improve the quality of life for patients with brain injury.
I fully recognise the devastating impact that acquired brain injuries can have on individuals and their families. The evidence shows that neglecting rehabilitation is a false economy. Rehabilitation equips people to live their lives, fulfil their potential and optimise their contribution to their family, their community and society as a whole. I am honoured to have introduced this debate and, as always in such debates, I look forward to hearing the views and insights from across the House on what further work or support is needed to reduce risk and improve the care available.
Steve Brine
I had finished, Madam Deputy Speaker. Incredibly, it was timed to perfection.
Madam Deputy Speaker
I beg the Minister’s pardon. I have never before heard such a feat of perfect rhetoric. Thank you for being so perfect. [Interruption.]. Yes, it was quite unusual.
Steve Brine
I am back, Mr Speaker. Time is very tight. If I do not answer any specific questions asked, I will write to Members; I always do.
It has been a very interesting and far-reaching debate. We have heard about some of the excellent work being undertaken to improve the care, treatment and support of those with an ABI. We have also heard about so many areas where so much more needs to be done, particularly around variation in care. I am the first to admit that there is a lot more that we need to do. I am clear from the debate that we need to keep our focus on providing rapid and appropriate triage and treatment of head injury, to ensure that patients can access the most appropriate service and level of expertise from the start—especially, as the hon. Member for Rhondda (Chris Bryant) said so well, in our schools. We should be seeing joint working between health, social care and education, with multi-professional assessments of a child or young person’s needs, including all the relevant experts, to get this right earlier and to prevent the cycle of problems that often lead to exclusion, brushes with the criminal justice system and a life scarred more than it already is. Dare I say it, as someone once said, we need to understand a little more and condemn a little less. I still believe in that.
Many Members talked about the need to ensure that patients have access to the necessary specialists and services that are relevant to their rehabilitation needs and to work harder than ever to iron out inconsistencies in what is available. I mentioned in my opening remarks the regional trauma networks, which have been very successful. A number of Members spoke about those, including my hon. Friend the Member for Chippenham (Michelle Donelan). The hon. Member for Barrow and Furness (John Woodcock), as usual, spoke from the heart and gave us a very personal insight into what happens when you are unlucky on a ladder and the fall-out across family and children. I think he has recovered incredibly well.
A number of Members, including my hon. Friend the Member for Cheltenham (Alex Chalk), talked about identifying and supporting individuals in whom a previous brain injury may be informing impulsive risk-taking activity leading to crime. I also take away the clear message that we must maintain our research commitment. The hon. Member for Washington and Sunderland West (Mrs Hodgson) said that a review of neuro-rehabilitation is required. The audit that we published at the end of 2016 recommends that all providers reflect on the capacity that they have. The national clinical audit of specialist rehabilitation will address that in the next stages of the audit, which are due to complete later this year.
The hon. Lady also talked about discussions with the DWP. We have discussions all the time. Many comments were made today about the DWP, so I am grateful that the Minister for Disabled People, Health and Work was on the Treasury Bench to hear those. Through the personal support package for people on employment and support allowance, the DWP is working to improve the support that it offers to those with long-term conditions such as brain injury, including peer support and training for disability employment advisers. However, it sounds like there is a lot of work to be done, and I know that my hon. Friend is keen to see that done.
Chris Bryant
We have had to go at a bit of a gallop this evening. I wonder whether the Minister could use his best offices to ensure that we have another debate fairly soon.
Steve Brine
I may have been called “perfect” by Madam Deputy Speaker, the right hon. Member for Epping Forest (Dame Eleanor Laing)—Mr Speaker, you do not want to know—but all I can say is that there are many things at my disposal, but scheduling debates in this House is not one of them. There are many ways in which the hon. Gentleman can bring forward debates in this House, and knowing him as I do, I have a funny feeling that he will be doing it some more. Whichever Minister responds to such a debate, I welcome that, because there are a lot of issues and we need to look at them. He talked about an invisible epidemic, and he may well be right. It has been a pleasure to listen to this debate, short as it has been, and an honour to respond to it.
Question put and agreed to.
Resolved,
That this House has considered acquired brain injury.