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The Minister for Care (Caroline Dinenage)
It is a great pleasure to serve under your chairmanship, Mr Robertson. I add my congratulations to the hon. Member for Rhondda (Chris Bryant) on again securing a really important debate on this issue. He is such a brilliant and effective champion of people with acquired brain injuries. His passion is incredibly infectious and set the tone for the rest of the debate, which I think everybody would agree has been incredibly constructive and thoughtful; there have been excellent contributions from everybody. The hon. Gentleman leads the all-party parliamentary group on acquired brain injury, about which all its members are very passionate. They have done superb work.
I thank everybody who took part in the debate: my right hon. Friends the Members for South Holland and The Deepings (Sir John Hayes) and for Hemel Hempstead (Sir Mike Penning) and the hon. Members for Airdrie and Shotts (Neil Gray), for Mitcham and Morden (Siobhain McDonagh) and for Washington and Sunderland West (Mrs Hodgson).
As hon. Members will know, it is estimated that the total cost of brain injury in the UK is at least £1 billion per annum and that the number of people living with ABI is more than half a million and could be as high as 1 million. Many hon. Members have explained that, as with many long-term conditions, the impact of ABI is not limited to an individual’s health but is felt across many aspects of their life, including family, work, relationships and finances. Of course, such an injury could happen to any one of us. My right hon. Friend the Member for Hemel Hempstead spoke about traffic incidents and collisions. That could happen to any one of us on our way home today.
I join the hon. Member for Rhondda in taking this opportunity to recognise, first, the outstanding work done by professionals in this field and, secondly, the wonderful work undertaken by charitable organisations such as Headway, the United Kingdom Acquired Brain Injury Forum and the Children’s Trust, which he mentioned. They are incredibly highly valued by those affected. They do invaluable work in raising not only money but awareness and by providing incredible support to those with the condition, as well as to their families and carers.
I have had quite a long-standing involvement with Headway in my region of Portsmouth and Gosport, since before I became an MP; as an MP, I have met my local team on a number of occasions. They are remarkable and offer the most fantastic support to people in my area. They certainly make a difference to people’s lives and they are so inspiring. On one occasion, I visited them with a member of my team, and she was so buoyed up by the visit that she decided to go off and do the Great South Run to raise funds for the Headway charity. I am not going to follow her example: literally nothing apart from someone chasing me would make me run 13 miles, but people can see how—
Caroline Dinenage
Thank you; that is a very generous offer. People can see what an inspiring group Headway is.
We have heard a lot about the excellent and wide-ranging APPG report from 2018. As the hon. Member for Rhondda said, the Department of Health and Social Care co-ordinated with officials from across Whitehall to deliver the response, which was a truly cross-Government response, but I certainly feel his frustration at how silo working across Whitehall can be an impediment to getting the change that he wants. A number of right hon. and hon. Members have mentioned that today, and I will certainly take forward the idea of a real, collaborative cross-Whitehall group to discuss this. Even from the issues raised today, the Department of Health and Social Care, the Department for Work and Pensions, the Department for Digital, Culture, Media and Sport, the Department for Transport, the Department for Education, the Ministry of Defence and the Cabinet Office—I am sure there will be others—all need to be involved in the conversation.
Neil Gray
I thank the Minister for her contribution thus far. It was remiss of me, not just as someone who comes from an armed forces family but as a constituency MP with cases involving constituents who have been medically discharged from the armed forces, not to highlight and focus on the contribution from the right hon. Member for Hemel Hempstead (Sir Mike Penning) on the greater work that needs to be done within the MOD and across Government to ensure that we are treating our armed forces personnel, particularly when they leave service, with greater respect, and to ensure that we are providing for them, given the level of service that they have provided to all of us.
Caroline Dinenage
The hon. Gentleman is absolutely right to raise that issue. NHS England has a veterans trauma network, which delivers comprehensive medical care to veterans, including those suffering from brain trauma. It does excellent work, but there are also many individual charities up and down the country that work to support veterans who may not have been diagnosed; they may have been diagnosed with post-traumatic stress disorder or something else, but never actually had the original head injury diagnosed.
Almost as if to highlight the fact that this is a hugely cross-Government issue and the inadequacy of Ministers working in their individual silos, I will today be able to focus massively only on the issues relevant to our health service, but I will try to come on to a lot of the questions that right hon. and hon. Members asked.
Sir John Hayes
I am extremely grateful to the Minister for giving way. We had meetings as an all-party group with the former Chancellor of the Duchy of Lancaster, the former right hon. Member for Aylesbury. I believe that at that point there were suggestions, at least, that a Cabinet Office piece of work would be initiated. Can we take it from the Minister’s assurances that she will write to the Cabinet Office colleagues who are now responsible for these matters and copy that letter to participants in this debate?
Caroline Dinenage
Yes, I am very happy to commit to doing that.
Before I go on to talk about the health implications of ABI, I want to deal with a couple of other things. They are not within my realm of expertise, but I want to touch on them.
The hon. Member for Mitcham and Morden spoke about the Headway brain injury identity cards—how important they are and how important it is that they are recognised across the criminal justice system. I wanted to mention how Headway has been integral in partnering NHS England’s health and justice liaison and diversion services programme team, to provide workshops in London and Leeds to raise the awareness of the prevalence of ABI within criminal justice populations. The objectives were designed in a “train the trainer” format, so that the attendees could return to their services and cascade the learning on how to identify people with brain injury, how to identify the brain injury cards that Headway has brought forward and how to understand the implications. I thought that was quite positive.
My right hon. Friend the Member for Hemel Hempstead was right to mention the positive progress that has been made in some sports. The Rugby Football Union’s Headcase campaign and the British Horseracing Authority have also made great strides in this area. However, he was also right to say that other sports have a long way to go.
The hon. Member for Rhondda spoke about trauma centres. As he knows, in 2012 22 regional trauma networks were developed across England to ensure that those with the most serious brain injuries received the best care. Two years after their introduction, an independent audit showed that patients had a 30% improved chance of surviving severe injuries. Since then, as he says, the network has saved literally hundreds of lives.
For people who have ABI, neurorehabilitation that is timely and appropriate to their circumstances is a massively important part of their care. Access to high-quality rehabilitation saves money and, more importantly, significantly improves outcomes for patients. NHS England commissions specialised rehabilitation services nationally for those patients with the most complex level of need. As we have already heard, trauma unit teams work to assess and develop a rehabilitation prescription for brain-injured patients. At the unit, patients can access care from specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription.
These rehabilitation prescriptions are an important component of rehabilitation care, because they reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient. The APPG argued that all patients should benefit from an RP; as I understand it, at discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialist or local rehabilitation, supported by the RP. However, I take on board what the hon. Gentleman says about ensuring that the letter and the prescription itself are written in language that people can understand, are easily accessible and are available to them and their family members.
The “National Clinical Audit of Specialist Rehabilitation for Patients with Complex Needs Following Major Injury”, published in 2016, found that, on average, 81% of patients had a record of a rehabilitation prescription. That audit appears to have had a significant impact, because the latest data shows a rise to an average 95% completion rate. In April 2019, the third and final report of the Audit Commission to NHS England’s audit programme was published, and it is encouraging to see that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.
However, the audit report also suggests that much more work needs to be done to ensure that all patients who could benefit from specialist rehabilitation can access it. Using data provided from participating centres, the audit’s authors estimate that the current provision caters for about 40% of those who need the services. To address the capacity issues highlighted, the audit makes a range of recommendations.
It is important to recognise that these audits play a massively valuable role in helping services to improve. They shine a light on variation and help to support services to best meet the needs of patients. However, there will always be different models of improving access to specialist rehabilitation, depending on the set-up of the services around the country. Therefore, local service providers and commissioners should review capacity in the pathways for specialist rehabilitation in the light of this audit, taking action where they can.
The majority of rehabilitation care is commissioned and managed locally, and NHS England has produced some documentation and services plans to help with that. “The Principles and Expectations for Good Adult Rehabilitation” describes what good rehabilitation care looks like and offers a national consensus on the services that people should expect. The NHS long-term plan has also set out some key actions on this, designed to improve care, treatment and support for people with long-term conditions such as ABI.
Community services, which play a crucial role in helping people remain as independent and well supported as possible, are going to receive significant investment, with £4.5 billion of new investment in primary and community care. Furthermore, NHS England has set out plans to roll out the NHS comprehensive model of personalised care, which includes self-care care planning, personal health budgets and social prescribing. It will reach 2.5 million people by 2023-24 and is particularly relevant to people with acquired brain injury. The model is currently implemented across one third of England, but by September 2018, more than 200,000 people had already joined the personalised care programme.
The hon. Member for Mitcham and Morden asked about free car parking. From April, all hospital trusts will be expected to provide parking to groups who may be frequent visitors. I interpret that to mean families visiting people who are in hospital for a long period of time, which I think is what she was asking me.
Siobhain McDonagh
I thank the Minister for giving way on this important issue. There are many terrible stories of people spending their life savings in an effort to keep being able to visit children and partners. Could the Minister specifically say, or could we have a response in writing to this effect, that that includes the families of people with acquired brain injury? I have been seeking some clarification from the Department, but all the responses have so far been obscure.
Caroline Dinenage
I will certainly seek to get that in writing for the hon. Lady.
My right hon. Friend the Member for Hemel Hempstead spoke about continuing healthcare. I know that that is a concern for many people, but what concerns me is that actually, CHC is needs-based, not diagnosis-based, so eligibility should be assessed by looking at all of an individual’s needs and considering their nature, complexity, intensity and unpredictability. If he wants to drop me a line about an individual case that he is concerned about, I will be more than happy to look at it.
Sir Mike Penning
It might be a lot of cases; I think the Minister will have had a lot of cases from across the House. I completely agree that that is what the principle should be. In practice, however, I ask her to look at the amount of appeals that have taken place, and she will realise it is not quite working.
Caroline Dinenage
I will very much take that on board.
The hon. Member for Washington and Sunderland West asked me a number of questions. I may not have written them all down, but she asked about workforce. We have the people plan, which Baroness Harding has been working on, which will be released later this year. It will look at all forms of medical professionals, but also the allied health professionals that the hon. Lady mentioned.
The hon. Lady asked what conversations I had had with the Department of Education. That Department is currently undertaking a review of special educational needs and disability, which will look at all aspects of supporting young people through their education. We are playing a key role in that SEND review. She also asked what conversations I had had with the Department for Work and Pensions about training. Case discussions about claimants with ABI now form part of a new entrant training for all healthcare professionals undertaking work capability assessments, and they all have access to a learning module on ABI, which was updated in 2018 and has been quality assured by Headway.
I hope that today’s debate has continued to demonstrate how seriously the Government take ABI. We are committed to ensuring that people get treatment, care and support when they need it.