Acquired Brain Injury

Alex Sobel Excerpts

Thursday 6th February 2020 Westminster Hall

[Chris Bryant]

Interestingly, I had a phone call yesterday morning with Dawn Astle, the daughter of the famous footballer Jeff Astle, who was particularly renowned for heading the ball. I am a Welshman, and we have been boycotting the World cup for very long time—certainly the finals, anyway—so football is not my area of expertise. However, something I have been particularly disappointed about since the APPG produced its report “Time for Change” is that, even though we have been making recommendations about concussion in sport for quite some time, the Government want to wash their hands of it.

There is legislation in every state in the United States of America about sport’s duty of care to participating individuals. Sport is good for you; playing football, rugby and all these things are good for you. I do not want to mollycoddle or wrap anybody in cotton wool, but there may be subtle changes that one can make to each sport to prevent unnecessary damage to people’s brains. Also, I still think that there has not been a cascade of information and understanding of concussion from the professional medics in the organisation down to the grassroots of each sport. That will happen only when there is a shared set of protocols for all sport.

There is clear evidence that a professional footballer is three-and-a-half times more likely to suffer from dementia. There is lots of evidence to suggest that that is to do with heading the ball—not the weight of the ball, as may people say, but the physical process of heading the ball, because it pulls the brain from one side and hits it on the other, which leads to a significantly increased risk of dementia. It seems bizarre that that is not thought of as an industrial injury, which football needs to look at seriously. It also seems bizarre that, at the very highest level of football, a footballer who is taken off to be tested for concussion cannot be replaced, and that player gets only three minutes, which is nowhere near enough time for a proper analysis of whether somebody has suffered concussion.

Football still has some considerable way to go. The Department for Digital, Culture, Media and Sport must play a role in bringing all the sports bodies together round a table to analyse this problem. Otherwise, sports will end up facing massive court cases and very big fines, as has happened in the United States of America. I would prefer us not to go down that route.

There is a spectrum stretching from those who have suffered the worst traffic accidents or have had a severe stroke to those who have had a minor head injury and have lost consciousness for less than 15 minutes. Incidentally, there is a lot of misunderstanding about what losing consciousness and concussion means—I will not go into that, but there are different parts of the brain that might be affected.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend is making an excellent speech. Regarding road traffic accidents, there is a spectrum of vulnerability, and cyclists are some of the most vulnerable road users. There have been many studies about the efficacy of cycle helmets. The Cochrane review found that using a cycle helmet reduces the likelihood of brain injury by up to 88%. Should the Government not do more to encourage the use of cycle helmets for cycle safety?

[Chris Bryant]

I will not go beyond my area of expertise, so I hope my hon. Friend does not mind that I hesitate to respond. I have read the piece of work that he refers to, and he is right. Other work suggests that there are other things we must do to ensure that cyclists are safe. We need a mixture of all those measures because in future more people will cycle, and we do not want that to lead to a significant increase in road traffic accidents.

The one thing I must praise the Government for, though, is the development of the major trauma centres in England. Despite in many cases not being particularly popular, because it has felt like a service is being made less local and a more regional centre of excellence, the centres have undoubtedly led to at least 1,000 extra lives being saved every year. I praise the Government for their work on that, and I am glad that we will have something similar in south Wales soon. I will not go into the issues about the accident and emergency unit at the Royal Glamorgan hospital today.

The downside of saving lots of lives is that there is a duty of care to provide the neurorehabilitation needed to ensure that those people have a decent quality of life. It is perfectly possible to do that, but at the moment a quarter of major trauma centres do not have a neuro-rehabilitation consultant. There has been significant progress in relation to neurorehabilitation prescriptions. When I last raised that subject, the Government said that around 90% of people were receiving such prescriptions, but whether they are going to the individual and their families, to ensure that that can be pursued, or whether those prescriptions remain with the doctors only, I do not know.

If the Minister looks only at one specific issue, I am keen she looks at how patients get written to. Some doctors, such as consultants, always write to the patient’s GP or other doctor, sometimes in highly technical language. Some local health trusts copy that letter to the patient, but some doctors are now doing something far more effective—certainly far more effective in this area. They are writing not to the other doctor, but to the patient and copying that to the doctor. Of course, they have to use language that the patient can understand, but it is about empowering the patient. One message that I have heard more than any other from many patients and families I have talked to is that they feel completely powerless. Lots of other people are making decisions about them, but they do not understand how those decisions have been reached. They do not know whose door to knock on—or whose door to knock down for that matter—to ensure that their loved one gets the care and support they need. I wonder whether turning those letters on their heads so that the doctor writes to the patient, putting that information in their hands and empowering them, and similarly giving the prescription to the patient and family rather than to somebody else in the medical establishment, would not have a profound cultural effect.

I want to talk briefly about prejudice, because a degree of prejudice is another thing that sometimes comes with a brain injury. Perhaps the person in front of us in the queue in Morrisons or Sainsbury’s or wherever is slurring their words. It is all too easy to get judgmental and think, “Oh well, they’re drunk, and it’s only eight o’clock in the morning,” or whatever, but it might be because they have had a brain injury. It is great that work has been done on the London underground—it needs to be rolled out across the whole country—to explain that some disabilities are not visible, so we should suspend our tendency to be judgmental. We should probably suspend it more often in life generally, but we should do specifically in relation to potential disability.

In commenting on a story from earlier this week, I make absolutely no criticism of my hon. Friend the Member for Salford and Eccles (Rebecca Long Bailey), who I think mistakenly used the word “vegetable” when she meant to say “vegetative state.” Actually, I would like to get rid of the concept of vegetative state. It just sounds wrong. To any ordinary person, it sounds like vegetable, but these are people with all their humanity still in there, even if their personality may have changed in all sorts of ways because of the damage. The Minister will not do this, but I beg the medical establishment to come up with another term that is more sympathetic and genuinely expresses not just the downside of the condition, but hopefulness about the possibilities that may still be to come.

As I said, brain damage is not a pandemic and it is not catching, but it is in a lot of people’s brains. The damage has been done, and many people who have suffered that brain damage do not know that the reason why they find it terribly difficult to concentrate or to get up in the morning—they suffer from phenomenal fatigue that hits them like a sledgehammer—why they find it difficult not to lose their temper, or why they get frightened of loud noise or chaotic circumstances and so on is because they had a brain injury at some point. That is all out there and it affects so many Departments of Government. We have had many wonderful warm words from lots of Ministers—this is my fifth or sixth debate on the subject—but now I really do want the Cabinet Office or Downing Street to set up a cross-departmental body to look at the issue in the round, rather than in each of the different silos. I am serious about this, and I am not asking for lots of money. I hope that the Minister will take that back to the Cabinet Office and Government. At some point, I would like the Prime Minister to chair that body, because we could bring about real, positive societal changes if we get this right.

I will set out what specific Departments can do. In the Ministry of Justice, we should be screening all new prisoners coming in so that we can give them proper rehabilitation. We know there will be many people who have not had their needs met heretofore. That will make it easier to run prisons and much easier to rehabilitate those people not just physically, but back into society to lead fruitful lives. The Justice Committee produced a report in 2016 on youngsters in the criminal justice system, which made specific reference to brain injury. I really hope that all the recommendations in that report will be taken up by the MOJ.

I turn to the Department for Work and Pensions. All MPs have experience of the assessment process not being able to comprehend varying conditions. That is one of the problems with many brain injuries: someone might be all right today and, probably because of their brain injury, they want to please the person sitting in front of them, assessing them. They say, “Yes, I’m fine. I am absolutely fine. Honestly, I am fine,” but tomorrow they will not be able to get out of bed, not out of laziness, but because of completely debilitating fatigue. All assessors for personal independence payment, disability living allowance, universal credit DLA, universal credit, and employment and support allowance—everyone—must have a full understanding of brain injury and the way it works.

In the NHS, I know there are shortages in many categories of personnel. If I have one hope for something that might come out of a Government who have a significant majority, it is for more long-term personnel planning. Specific work needs to be done, because we are falling a long way short in the number of beds needed for neurorehabilitation and, in particular, in being able to take children out of hospital and into community services. I have already referred to the rehab prescription.

There are two other bodies that I want to thank as I end. The first is the United Kingdom Acquired Brain Injury Forum, run by Chloe Hayward. The all-party parliamentary group has worked extremely closely with it, and later this year we intend to do more roundtables to gather more evidence to take this work forward. I have discovered there are many spheres in medicine where all the organisations do not speak to one another or sit round the same table. I have been doing work on melanoma, and I would love to bring all the many melanoma charities together so that we have a co-ordinated approach. UKABIF provides that co-ordinated approach, I really want the Government to adopt that model. We could really crack something here if we manage to work on it not just with one Department at a time but with all of them co-ordinated together.

Finally, I am sure my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) will refer to this in a moment, but I want to thank Headway. I had an amazing day speaking to the Headway conference last year. I have referred to some of the professionals, but the most amazing people are probably those who have been through a version of hell that none of us would ever want to experience, having sometimes lost significant members of their family as well. I remember one woman said to me, “I know I have to use all the energy in my head to make my head better, but I am using all the energy in my head to try to work out this DWP form.” That is not what the state should be doing. That is when we really do want a nanny-state to help, to sustain and to support. All too often, of course, it is charities that provide exactly that, and I pay an enormous tribute to Headway for the work it has done.