Acquired Brain Injury

Barry Sheerman Excerpts

Thursday 9th May 2019 Commons Chamber

[Chris Bryant]

My hon. Friend has done a lot in this field herself. She has met with that group, which has been to see us here in Parliament, and I hope that they will be taking part in our lobbying event in a couple of weeks. Next week is Brain Injury Awareness Week, which is why this is such a timely debate. Tomorrow, I am going with the hon. Member for The Cotswolds (Sir Geoffrey Clifton-Brown) to visit the National Star College outside Cheltenham, which does an awful lot of work.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I am grateful to my hon. Friend for mentioning the damage that long-term exposure to carbon monoxide can have on the brain. He knows that I was one of those who organised the seatbelt legislation 25 years ago. One of the really worrying things that the Parliamentary Advisory Council for Transport Safety found last week is that we are getting relaxed and that people are beginning not to wear seatbelts and not to put their children in vehicle restraints. If that continues, people are in terrible danger of serious brain injury or death.

[Chris Bryant]

My hon. Friend is absolutely right. One reason why carbon monoxide exposure matters so much to me is because it involves an element of social justice. Children from poorer backgrounds are four times as likely to have a significant brain injury before the age of five as those from wealthier backgrounds. We do not fully understand why as yet, and we need to do more work on that. However, it is also true that elderly people, who maybe cannot afford to have their boiler checked as often as others or may have landlords who do not check their boilers as often as necessary, may be suffering low levels of carbon monoxide poisoning over such a long period that they are not even aware that they are being poisoned. The memory loss, the fatigue and the problems they are having may be associated with their boiler rather than with anything else. We need to look further at legislation in that area.

The thing about brain injury is that it is often internal and completely unseen. It can add a whole new layer of stigma because people can often misjudge a sufferer standing in a queue in front of them or coming to work with them as being drunk. However, the reason why the person is slurring is because they have had a brain injury. That is why I and others—I pay particular tribute to my hon. Friends the Members for Blaydon (Liz Twist) and for Swansea East (Carolyn Harris) and the right hon. Member for South Holland and The Deepings—wanted to set up an all-party parliamentary group on acquired brain injury to look at the issue, which is a hidden epidemic. Every 90 seconds, someone in this country is admitted to hospital with an acquired brain injury.

The APPG produced a report because we wanted to see more evidence. The Select Committee on Health produced a report in 2001, and some of its recommendations were implemented, but many were not. We wanted to go further, so we produced the “Time for Change” report, which calls for real investment in neuro-rehabilitation. We have major trauma centres that have saved so many lives—I pay tribute to the Government for the brave decision to take them forward—but it is depressing that a quarter of trauma centres still have no neuro-rehabilitation consultant. That means that people sometimes fall between two stools when they leave the acute setting and go back to their home and to their community.

--- Later in debate ---

[Sir John Hayes]

I am grateful to my right hon. Friend for making that point. The hon. Member for Rhondda talked about the understanding that we need in the welfare system and the expertise that we need to acquire in dealing with the repercussions of a traumatic event. Often, misdiagnosis is part of that problem. Because of the characteristics of acquired brain injury that I described earlier—the changes in personality and the effect on cerebral function—misdiagnosis is all too easy. Part of our mission in bringing the all-party group’s report to the House’s attention, and doing so again in today’s debate, is to get all of Government, including the Ministry of Defence, working together to understand the breadth and scale of the problem. That kind of intergovernmental approach is essential to the recommendations of our report, and I shall say more about it in my concluding remarks.

Before I do that, I wish to say a little about the difference between the initial responses to acquired brain injury, whether acquired through a traumatic event such as a road traffic accident—indeed, many are acquired that way, which is why so many young men are affected—or through the kind of illness that the hon. Member for Rhondda spoke about, such as a brain tumour, meningitis or some other disease. By and large, the initial response is, as is so often the case in the NHS, routinely excellent. People are treated quickly and highly effectively. It is what happens afterwards that is more variable in its effectiveness.

When people leave hospital, invariably having been treated extremely well by our superb NHS, whether their subsequent treatment is effective is a matter of some uncertainty. It can be, and often is; indeed I pay tribute to the good work of Headway—I am a patron of Headway Cambridgeshire and have been for many years—and the other organisations that play a part in supporting families, spreading understanding and sharing good practice, but it is to some degree a lottery. It is partly about where someone lives and how effective the local agencies are; it is partly about how well Government Departments and local government work together and how meaningfully they address some of the challenges that are the inevitable consequences of these kinds of injuries. The all-party group’s report deals with them and the hon. Member for Rhondda highlighted some of them. There are educational effects and effects in the workplace and in socialisation; perhaps there is even the risk of criminality as a result of the consequences of a brain injury. It is the business of neuro-rehabilitation, which we emphasise so strongly in the report, that lies at the heart of what we believe the Government need to do to improve the outcomes for the people and families concerned.

When I was a Minister, which I was for a long time but not for long enough, many people in the House tell me—it is not for me to say, of course—I found that perhaps the greatest challenge Ministers face is in dealing with matters that cut across Departments. It has become almost routine to talk about Departments working in silos, but it is certainly true that the character of the vertical structure of the way we run Government and organise ministerial responsibilities makes it quite difficult for Departments to interact, or sometimes even to interface. On this subject, perhaps as much as on any subject that I know of, it is critical that Departments do just that. We speak in our report of the Departments concerned, and my right hon. Friend the Member for New Forest East (Dr Lewis) mentioned another, the Ministry of Defence. I urge the Government to continue to explore how we can take a cross-departmental approach. We have had strong support from the Cabinet Office, but I hope that the Minister will take that further forward.

[Mr Sheerman]

The right hon. Gentleman is absolutely right about cross-departmental working. I am obsessively concerned with road deaths and road injuries; does he accept that getting the Department of Health and Social Care, the Department for Education and the Department for Transport together to push for proper head and brain protection for cyclists, motorcyclists and people who drive cars is very difficult?

[Sir John Hayes]

Not for the first time, the hon. Gentleman is absolutely right. The hon. Member for Rhondda spoke of, for example, sports injuries. The response we have had from Departments has been mixed. It is certainly true that they have all responded, but it is fair to say that some have done so with greater enthusiasm and clarity than others. The convivial and collaborative nature of this debate forbids me from being more critical than that, but the Minister will want to look at those responses, as we have, and at how those Departments that have been rather slower to take their responsibilities seriously can be brought up to speed.

The hon. Member for Huddersfield (Mr Sheerman) is right that cross-departmental working is vital. It is important that we also look at local government and other Government agencies and organisations. Given the breadth of local government responsibilities, of which housing is a good example as well as education, which the hon. Member for Rhondda spoke about and which is critical to our report, it is really important that local government is involved in this work, too. It is therefore not only a lateral challenge but about connecting the local approach to the national one.

Furthermore, it is important that we recognise the dynamic character of individual needs. Governments are quite good at disabilities that are fixed. People have dreadful things happen to them and either acquire disabilities or perhaps start life with disabilities, and the Government can be quite effective and the national health service is highly effective in dealing with those kinds of challenges, but dynamic disabilities are different again, because of course by its nature that dynamism means changing needs and that requires changing provision. It might be in respect of benefits—the hon. Member for Rhondda mentioned support for benefits—or simply a matter of providing additional resource to an individual to allow them to get back to work or to return to education. It might be a matter of ensuring that the teachers, employers and others associated with an individual are well equipped with an understanding of what that dynamic disability might mean and might lead to. It is vital that the Government appreciate that many people have changing circumstances that require a changed approach.

Others wish to contribute, so I shall end by highlighting some of the things we said in the report and to which we would like the Government to respond. First, simply raising awareness is vital, and I hope that the report and this debate have done that. Secondly, I have spoken about neuro-rehabilitation and the need for a joined-up approach across Government. Thirdly, I wish to amplify an excellent point made by the hon. Member for Rhondda about education: it is really important that acquired brain injury is included in the special educational needs and disability code of practice. Fourthly, in the justice system, it is vital that all agencies that work with young people—including schools, psychologists, psychiatrists, general practitioners and youth offending teams—should ensure that the needs of the brain injured are individually and carefully assessed.

I could highlight many other things—our recommendations are broad, and I hope deep, too—but I shall end by quoting G. K. Chesterton, who said:

“How you think when you lose determines how long it will be until you win.”

When someone loses as a result of an acquired brain injury perhaps some cerebral function or the ability to mix and work with other people, or has some permanent disability, how long it is before they again see themselves as someone with a chance to win can be determined by what we here do, and on how the Government allocate their time, energy and resources to fight for, care for and campaign for people so affected.