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The Minister for Care (Helen Whately)
It is a pleasure to serve under your chairmanship, Ms Eagle. I congratulate the hon. Member for Rhondda (Chris Bryant) and thank him for securing a debate on this important matter. I give him so much credit and pay tribute to his passion and his huge knowledge of this subject—I know that he has debated it at length with other Ministers—which he has brought to this debate and other debates on the matter. I also pay tribute to his commitment to this cause and the tireless work that he does. Of course, I know that he speaks on this subject from direct personal experience. I pay a huge tribute to him for all that he brings to these debates.
It is also good to have the hon. Member for Blaydon (Liz Twist) here. I thank her for the work she is doing with the APPG and the hon. Member for Rhondda to campaign for those with acquired brain injury.
I recognise the vital work of charitable organisations such as Headway, the United Kingdom Acquired Brain Injury Forum and the Disabilities Trust. Their work is invaluable not only in raising awareness but in providing hands-on help and support to patients, families and carers. I am aware that acquired brain injury affects not only an individual’s health but their family, work, relationships and education, in the case of children, so it has a huge impact on people’s lives.
I have met people with brain injuries. Shortly after I was elected, I visited Kent and Canterbury Hospital, which has a neurorehabilitation unit, and I spoke to staff and patients and saw the really impressive work that they were doing. I appreciate the points that the hon. Gentleman makes about the importance of effective neurorehabilitation.
As the hon. Gentleman set out, the pandemic has had a real impact on the care and treatment of people with acquired brain injuries. As he said, staff have been redeployed on to frontline covid work, and that has affected people’s care. For instance, some consultations have been moved online, and services are not what we would want them to be. Face-to-face neurology rehabilitation services are being restarted as quickly as possible. Guidance has gone out from NHS England and NHS Improvement and the Association of British Neurologists, and every effort is being made to catch up on delayed care. I will look into the point that the hon. Gentleman made about his concern that services are not yet up and running. I recognise that the pandemic has been a really difficult time for those affected by ABI across a range of areas, not simply access to healthcare services.
This debate and previous debates owe a debt to the all-party parliamentary group and the hon. Gentleman’s leadership. I want to flag the wide-ranging inquiry into the causes, impact and treatment of ABI, culminating in the report published in October 2018, which set out a host of things that we need to address across Government. As he knows, my Department worked with officials across Whitehall to give a response in February 2019. I welcome the fact that the APPG, along with UKABIF, continues to drive the “Time for Change” agenda, most recently in an online summit held on 16 November.
One of the key issues highlighted in the report, as the hon. Gentleman said, is the importance of better Government co-ordination. I absolutely take his point. He mentioned a conversation with the Chancellor of the Duchy of Lancaster. I speak directly for Health, but I am very aware that brain injury cuts across almost all aspects of an individual’s life, from education to work and welfare, and sadly sometimes the justice system, so we need to work on this across Government. I will work with my officials to drive stronger co-ordination for ABI across Government.
On the services available to patients with ABI, the hon. Gentleman will know that since 2012 we have had 22 regional trauma networks across England, and those major trauma centres can provide the specialist care needed by patients with major trauma, including brain injury. Alongside that, timely and appropriate neurorehabilitation is a critical part of care. As the hon. Gentleman set out, that is absolutely crucial for improving the outcomes for people with brain injury. For patients with the most complex need, NHS England commissions specialised rehabilitation services nationally. Trauma unit teams then work to assess and develop a rehabilitation prescription for brain injured patients. RPs are rightly regarded as very important for rehabilitation, as they reflect an assessment of the needs of the patient in the round. That approach is showing results. As the hon. Gentleman knows, the latest data shows that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.
The hon. Gentleman spoke about local commissioning and the differences across the country. The majority of rehabilitation is commissioned locally. To support that, NHS England has produced guidance setting out what good rehabilitation looks like and what services people should expect. Community services clearly play a crucial role.
Chris Bryant
I am grateful for the nice comments that the Minister has made, but one of the problems with the guidance is that it does not feel very enforceable, and until the money goes with the guidance, as it were, I think it is unlikely that people will invest in this. It feels sometimes—not to use a cliché—a bit too Cinderella-like. I just wonder whether there is a means of twisting it into enforceability.
Helen Whately
I absolutely take the hon. Gentleman’s point, and I have heard the argument made about the service we are discussing and other services that are commissioned locally. There is the holy grail—people want a locally responsive health service to respond to what the community needs, but on the other hand they want consistency. Achieving both of those is hard and, arguably, not entirely possible, because the mere fact of having something locally responsive will involve some variation. However, I will also take away the hon. Gentleman’s point that there are ways to try to achieve a higher overall standard and more consistency without necessarily going all the way and saying that it must be done in exactly that way everywhere. Oversight is one way of doing that, so I shall see whether there is further we can go with regard to the point that he made.
I want to pick up on the list of questions—or the wish list, as we are approaching Christmas—
Helen Whately
In that case, demands: I shall see which of them I can answer. One was about a national neurorehabilitation lead. During the period of covid-19 there is indeed a national lead. Suzanne Rastrick has been designated the national clinical director for rehabilitation, co-ordinating clinical advice and leadership in that area. That is for the period of covid. I appreciate that the hon. Gentleman’s demand is that it should go beyond the period of the covid pandemic.
As to whether all neurorehabilitation services will be restored after covid, I have no reason to believe that they will not, but I shall, again, take the matter away, and make sure that we see that happening. The hon. Gentleman asked whether neurorehabilitation is one of the 12 specialties that are protected during covid, and I can broadly answer yes. NHS England has made a specific provision for a subset of services, to ensure that they are protected, and complex rehabilitation services are included in that. I hope that answers the hon. Gentleman, at least on that issue. I shall look at his ask on a national neurorehabilitation strategy and consider whether it is something we can do. It is a clear request.
Helen Whately
I was just about to conclude, and I believe that the hon. Gentleman has a couple of minutes at the end.
Chris Bryant
I am grateful. I fully get that one of the dangers of having a postcode lottery is that trying to overturn it can mean ending up with no freedom locally, and all the rest of it; but I just say again that the Chancellor of the Duchy of Lancaster really needs to get everyone together. There are real benefits that we could deliver to people, as well as financial savings across the piece.
Helen Whately
The hon. Gentleman makes a good point, and I shall, as I say, take that matter away, as the Chancellor of the Duchy of Lancaster has done as well. In conclusion, I take the matter absolutely seriously. Clearly, covid has put huge pressure on the Department, Ministers and the whole health service, but the hon. Gentleman raises a really important point about how seriously we must take the care, treatment and rehabilitation of those with acquired brain injuries. I thank him again for all that he is doing to campaign on it, and for the impact that he has in doing so.
Question put and agreed to.