Acquired Brain Injury

Chris Bryant Excerpts

Monday 18th June 2018 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

The truth is that acquired brain injury is an invisible epidemic in this country. It is invisible because all too often we do not even know the numbers. I know the Minister means well, but I suspect his numbers were a hideous underrepresentation of the truth, because the figures I have seen suggest that there are more like 1.3 million people in this country living with a disability brought on by an acquired brain injury, with nearly half a million presenting to hospital last year. As my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) said, that is one a minute—1,500 a day. That is a very significant number of people. All too often, it feels like an invisible epidemic to the individual concerned, because they might not ever have known they had a brain injury in the first place.

Some of the most distressing work that I have seen has been done by people working in prisons. I was in Cardiff prison a couple of weeks ago—some would say not a moment too soon—to see the work being done there with prisoners, because the work Huw Williams has done at HMP Leeds showed that when we screened every prisoner arriving in through the door we found that 47% of prisoners had an acquired brain injury, that 76% of those had several and that 30% of those had more than five brain injuries. This is often invisible in the case of children, too. The latest figures I have seen show that five children in every primary school class in this country will have an acquired brain injury. If we think that figure is bad enough, the figure for poorer constituencies, and for poorer families and areas, will be considerably higher. The research is a bit difficult to be precise about, but a study in Exeter showed that it was 4.3 times higher in poorer areas, and another survey elsewhere found it was three times higher in poorer families. So, for me, as a socialist—I still like to use the word—this is still a matter of social justice as much as anything else.

[Mr John Hayes]

As a non-socialist and member of the party of Wilberforce, Shaftesbury and Disraeli, I believe in social justice, too. The key thing that the hon. Gentleman has said, as did the hon. Member for Washington and Sunderland West (Mrs Hodgson), is that we have to get teachers to be more aware of this. If one thing comes out of this debate, it should be exactly that. We need to co-ordinate across Departments to get teachers to recognise and know this.

[Chris Bryant]

I completely agree with the right hon. Gentleman on that, not least because of one thing that sometimes happens to teenagers. Part of their brains will be quite well developed—the reward bit, the one that knows how to seek out pleasure—but the area of the brain most likely to be hit if they have a brain injury is the bit that is not yet well developed, which is the executive function. It is the bit that gives that youngster the ability to say no to things or to control their emotions and their functions. All too often, if that bit goes wrong, they can start to present in school as somebody who is a problem. They may then get excluded from the school, because it is not understood that this is actually about a brain injury—perhaps the student themselves does not understand that. They may then start offending and we may find several years later that they have a whole career of offending and that if we had managed to do the rehab properly right at the beginning, when the first brain injury happened, we might have been able to save that individual their self-respect and self-esteem, and we might have been able to save society the costs of all the criminality. We might, thus, be able to strengthen the whole of the way we do our business.

One memory that really strikes me is the story of Ben Robinson, the 14-year-old who was playing rugby for Carrickfergus Grammar School in Northern Ireland. He was sent back on to the field three times after brain injuries on the field and then died of double impact syndrome. He was pronounced dead when he arrived at the hospital. I am so proud of Ben’s family, who have campaigned on this issue. His mother, Karen, has always referred to these injuries as rugby’s dirty secret.

Rugby has tried to clean up its act in recent years, but in so many sports, even all these years after footballer Jeff Astle’s brain injury, which was determined to have been an industrial injury brought on by heading the ball, we still see in matches people being sent back on by the club medic. Only an independent medic should make the decision about whether somebody should go back on. If there is any doubt, sit them out. It should be simple and that should apply across all sports.

The Government have had a great success thanks to the major trauma centres which, as somebody said earlier, now manage to save an extra 600 lives every year. That is brilliant, but let us save the quality of their life as well. The miracles that can be achieved in saving lives can be matched by the miracles that can be achieved through really good, long-term, sustained rehabilitation. If we can take an 18-year-old who has had a big brain injury from needing six carers to wash, dress and feed them and get them up and so on, to a place where they no longer depend on those people, are mostly independent and need only one carer, think how many millions of pounds we can save the taxpayer across their lifetime. That must of course be the most effective way to change things.

I repeat the points made about PIP and ESA. One woman said to me, “The doctors say to me that I should spend all my emotional energy on getting my brain to work again, but I am spending all my emotional energy on trying to understand the forms and going through the process so that I can put food on the table for the rest of my family.”

I have a great deal of time for the Minister for Disabled People, Health and Work; she has had meetings with me and I know that she will want to make changes. This is about the whole of Government. I very much hope that we will be able to have another debate soon, because there are so many issues that we have barely managed to touch on in this one.

[Several hon. Members rose—]

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[Paula Sherriff (Dewsbury) (Lab)]

This has been an excellent debate, and I thank all Members for their contributions. I congratulate my hon. Friend the Member for Rhondda (Chris Bryant), whose persistence week after week has undoubtedly facilitated the debate. I thank the Government for allowing it time.

Although we have first-class acute care in this country, and advances in medicine in recent years that have resulted in many more lives being saved following a brain injury, it is undoubtedly in long-term rehabilitation where much more support is required in order to save and preserve the quality of lives for those suffering from acquired brain injuries—and, of course, their loved ones. Somebody who has suffered a traumatic brain injury could have had three months in intensive care, six months in therapy, and maybe a year in residential care, and then they are often sent home and the help stops. Quite often personalities will have been affected, and the person who comes home could barely resemble the one before the accident or incident that led to the acquired brain injury.

A report by the Centre for Mental Health stated that 1.3 million people live with the effects of brain injury, at a cost to the UK economy of £15 billion per annum, based on premature death, the health and social care required, and lost work contributions and continuing disability. This cost is the equivalent of 10% of the annual NHS budget.

[Chris Bryant]

Two suggestions have been made about rehabilitation that might change things: first, that we should have a rehabilitation prescription just like a medical prescription so that the person knows, and the family know, what support there is going to be on an ongoing basis; and secondly, that every single major trauma centre should have a rehabilitation consultant, because one in four do not. Is that not essential to be able to make sure that we change this world?

[Paula Sherriff]

I thank my hon. Friend for those suggestions, and I hope that Minister will respond to them. It is clear that my hon. Friend cares very much about this issue.

Neuro-rehabilitation is one of the most cost-effective services that the NHS provides, and one of the few services in medicine that results in long-term decreased costs to the economy. However, the number of available beds across the UK is inadequate, service provision is variable, and consequently long-term outcomes for brain injury survivors are compromised.

ABIs can result from many different causes, including stroke, tumour or brain haemorrhage. They can also be caused by a trauma to the head through assault, a road traffic accident, and accidents at work or in the home, as we heard from my hon. Friend the Member for Barrow and Furness (John Woodcock). Sporting injuries are the cause of many acquired brain injuries and have been subject to much media attention in recent years, with concern growing surrounding the long-term effects of concussions sustained through sporting activities. Awareness must be raised as to the dangers of head injuries in sport in order to prevent ABIs, along with stricter guidelines on how long an individual should rest following a concussion.

As we heard from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), one of the most common effects of an ABI is breakdown in marriages, relationships and family units as people struggle to cope with the changes in circumstances, and often personalities, following an ABI. The hon. Member for Cheltenham (Alex Chalk) discussed the increased propensity to commit crime after an ABI. Today I spoke to Peter Taylor, the business manager of a charity based near my constituency called Second Chance Headway, which specialises in caring for people with brain injuries. He talked about the amazing work that they do. He also mentioned that quite often families fall apart as children struggle to understand why the lady who looks like mummy can no longer do the things that mummy used to be able to do—simple tasks like making tea or washing—and wonder why she is angry a lot of the time when she used to be so patient and loving. Obviously this can apply to daddy too. Those are just some of the devastating effects of ABI that often happen behind closed doors.

Peter stressed the importance of raising awareness, and especially of the fact that an ABI is a brain injury for life, that a person could face 40 to 50 years of trying to adjust and come to terms with a devastating change in their life circumstances and that they may have to learn how to live again, with some of the most basic tasks having to be relearned, including how to make a cup of tea and how to dress themselves—things that we all take so much for granted.

Peter also spoke about the lack of funding and the finger pointing between social services and health commissioners over who should foot the bill for rehabilitation services, with no clear direction over where the money should come from. Second Chance Headway survives without a penny from the Government, as do many other similar charities across the country. There has to be a more co-ordinated and systematic approach to ensure that everyone with an ABI has the same quality of care and the same life chances. This service should not be reliant on the charity sector, especially in these times of austerity in which charities are struggling to access vital funds.

I would like to end by echoing the requests of my hon. Friend the Member for Rhondda for a Government taskforce across all relevant Departments, including Health, Education, Justice, Work and Pensions and Defence and for adequate funding for services. In the words of Peter Taylor of Second Chance Headway, “A life has to be worth living, otherwise what is the point in saving it?”

[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.

Health and Social Care (National Data Guardian) Bill

Chris Bryant Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 6th June 2018 Public Bill Committees

[The Chair]

For the sake of our protocols, I should say that I had arranged for the windows to be opened because it is rather warm in this Committee room, but I am perfectly happy if people wish to remove their jackets.

[Chris Bryant (Rhondda) (Lab)]

Thank you, Dame Cheryl. I want to raise two small points. The first is slightly to tease the hon. Member for Wellingborough: I cannot imagine another Bill making its way through the House of Commons and the House of Lords about which he would be so casual when it came to the amount it might eventually cost. I normally think of him as the most robust challenger of any public expenditure, but I note that in the order of magnitude he is drifting by about 50%. When there is a Labour Government, I look forward to him applying exactly the same logic to all Labour legislation.

--- Later in debate ---

[Mr Bone]

The problem is that we could easily say that we need to have a regulator, but that is not what the Data Guardian does. We do not want to come along afterwards and say what has gone wrong; we want to get this right at the beginning and work with the different holders of data. It is a different approach. The comparison I think of is when I was involved with combating modern-day slavery. We now have a commissioner for that whose job is not to regulate but to expose and say what is going well or badly, and that helps. There could be pressure on an organisation—for instance, if it gets really bad publicity it will do something about it, but equally the commissioner will show where things are going well. We do not want to move towards a regulator or have lots of enforcement powers because that is totally different to what we have already established with Dame Fiona. Each hospital has a Caldicott guardian in it, so we are basically putting something that works on a statutory footing for the future.

I am pleased by the conversion of the hon. Member for Rhondda to concerns about cost, and I shall remind him of that if there is ever a Labour Government in future—

[Chris Bryant]

When!

[Mr Bone]

Well, I am sure there will be a Labour Government sometime in the next century.

The hon. Gentleman makes a very important point about MPs and data provided by our constituents. Although I do not think it is particularly relevant to this, I do think all Members are wrestling with what the new regulations mean. Medical practitioners have to hold information for a very long time. I have very detailed medical information from some of my constituents, and serious issues might arise if we were forced to destroy such information. Perhaps the National Data Guardian could give some advice on that point. I get very frustrated when I have to deal with the local hospital, if I do not get a consent form. That is clearly a delaying factor and definitely needs to be cleared up.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Schedule 1 agreed to.

Clause 2

Interpretation

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[Jackie Doyle-Price]

I confirm that the Government support the clause. On the point about children, it is our interpretation that the provisions do not prevent the National Data Guardian from engaging constructively with the Department for Education on adult social care data and its interaction with or effect on children’s data. Clearly, this is something we will monitor, but, bearing in mind that the whole ethos behind the creation of the National Data Guardian is to spread good practice and make representations rather than regulations, the concern that the hon. Gentleman has expressed is important, but we do not think it will get in the way of sensible engagement.

[Chris Bryant]

Will the Minister clarify what she understands from clause 2(5)? It states:

“‘The health service’ means the health service continued under section 1(1) of the National Health Service Act 2006.”

That obviously includes ambulance services, but does it include those provided by St John Ambulance?

[Jackie Doyle-Price]

If I may, I will come back to the hon. Gentleman on that point. I would say that it would not, but I will confirm in due course.

--- Later in debate ---

[Mr Bone]

The clause introduces amendments to other legislation as a consequence of the Bill. Schedule 2 lists five Acts to be altered, following parliamentary counsel’s advice. Those are the Public Records Act 1958, the Parliamentary Commissioner Act 1967, the House of Commons Disqualification Act 1975, the Freedom of Information Act 2000 and the Equality Act 2010.

[Chris Bryant]

Why is the hon. Gentleman so keen on disqualifying a Member of the House of Commons from being the Data Guardian?

[Mr Bone]

We have taken parliamentary counsel’s advice—as always, I take advice from people. That is the reason: it is as a consequence of advice given by parliamentary counsel, and I am happy to accept that, unless the hon. Gentleman is thinking of himself in that role.

[Mr Bone]

The clause sets out the Bill’s territorial extent. The Bill extends to England and Wales only. The Committee will note that clause 1 provides for the Data Guardian to publish guidance and give advice, information and assistance, but that applies only to the processing of health and social care data in England. However, in regard to application, the provisions extend to England and Wales but apply only to England. The provisions do not extend or apply to Scotland or Northern Ireland. I hope that is perfectly clear.

[Chris Bryant]

Well no, it is not really. In fact, it is a little bit worse than that. We return to clause 2(5), which says:

“‘The health service’ means the health service continued under section 1(1) of the National Health Service Act 2006”,

but that Act states:

“The Secretary of State must continue the promotion in England of a comprehensive health service”

and so on. I therefore do not understand why the Bill extends to England and Wales. Will the provision will have any relevance whatever in Wales? If not, I do not know why it says that it does.

[Jackie Doyle-Price]

In regard to application, the provisions extend to England and Wales but apply only to England. I have to confess that my knowledge of devolution arrangements is perhaps not as good as it should be, but our view is that the Bill applies only to England. Although the provisions could extend to England and Wales, it would be within the competence of the National Assembly for Wales to appoint a guardian and make such arrangements. That said, the National Data Guardian is an advisory role—it is not a reserved power under devolution arrangements—and as is common in the operation of the health systems in all four nations, I would expect that the advice and guidance given by the National Data Guardian would be heard and, when appropriate, acted on by the health services in the other nations.

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[Sir Christopher Chope]

It may well be a standard clause, but such clauses are often abused by the Government. For example, Parliament passed a measure to outlaw exit payments for public sector workers in the Enterprise Act 2016. We are still waiting for the regulations under that primary legislation to be introduced. The Government now say that they will have to consult on them. Effectively, what Parliament thought was happening—the limiting of public sector exit payments—has not happened.

The Bill is supported across the House, as the measure I have mentioned was. I should be grateful for some indication from the Minister of when the Government will implement it. It could be delayed by the Government by means of the regulation-making powers in the clause; or by the Government’s not appointing the Data Guardian. There are other ways in which it could be delayed, and if we take the past as a guide to the future we should be suspicious of the Government when they are not prepared to include in the Bill a commitment for it to commence on a given date.

[Chris Bryant]

Christchurch and Rhondda speak as one, in a uniting of the Christophers, something that will not, I think, happen very often. It is a serious point; I understand that such clauses are a frequently used means of tidying up the process of a Bill coming into force. However, it adds cost, because the Government must go through an additional process; and frankly there is no reason why we should not just put in a date and tell the Government to get their act together—because everyone supports the measure.

I hope—I am sure—that the Minister will now say, “We intend to do it as soon as practicable after the Bill has been through both Houses,” and all the rest of it; but it would be better for the date to be in the Bill, because then she would not have to do anything later, and, to use a valleys word, it would be tidy. Let us be tidy.

[Jackie Doyle-Price]

Tempted as I am to engage in debate on the abuse or otherwise of statutory instruments, I prefer not to go down that road. Suffice it to say, we should put provisions into action only once they are tidy, to use the term suggested by the hon. Member for Rhondda. We should be governed by the integrity of the rules we pass rather than by speed, but I can confirm that it is the Government’s desire to implement the Bill, which we fully support, as soon as practicable. Clearly, we already have a National Data Guardian; the Bill would just put it on a statutory footing. It is in all our interests that we do that as soon as possible, so the Government are content with the clause.

Oral Answers to Questions

Chris Bryant Excerpts

Tuesday 20th March 2018 Commons Chamber

[Steve Brine]

We are going to integrate primary and secondary care properly through the new models of care—for instance, extended access is important in that. The new multidisciplinary teams—for example, I have talked about pharmacists working in primary care—are not only about providing the plaster when the cut happens, but about preventing the cut in the first place. The prevention agenda is very important.

[Chris Bryant (Rhondda) (Lab)]

Do we not need more salaried GPs?

[Steve Brine]

We need more GPs, which is why today’s announcement is very important. I am sure that the hon. Gentleman welcomes them.

Mental Health Act: CQC Report

Chris Bryant Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

I completely agree with my hon. Friend: they are better than they ever have been, but that does not mean we cannot do better, and we must strive to do better.

[Chris Bryant (Rhondda) (Lab)]

The mind and the brain are intimately associated, and I heard a horrible story this morning of a man who, after having been in and out of prison and in the criminal justice system and in and out of mental health institutions throughout his life, only really discovered at the age of 44 that many of his problems had originated from a traumatic brain injury at the age of 17. If he had been properly treated then, and had the rehabilitation that is unfortunately not available to so many people today, he would not have been through all of this round of problems. So will the Minister make sure that we get proper rehabilitation services for everybody who has a traumatic brain injury?

[Jackie Doyle-Price]

The hon. Gentleman gives a very powerful example, which highlights better than any other we have heard today the challenge we face. Not only was that person failed at the time of having his brain injury, but it was not subsequently picked up as he went through the criminal justice system, and I often say that we can deal with one weak link in a chain of events, but when we have a succession of them, things go horribly wrong. It is very much top of my list to make sure we have better integration of services between health and the criminal justice system, to pick up precisely those situations.