Adult Cerebral Palsy: National Service Specification

Daniel Francis Excerpts

Tuesday 10th March 2026 Westminster Hall

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

I beg to move,

That this House has considered the national service specification for adult cerebral palsy in the NHS.

It is a pleasure to serve under your chairship, Ms Jardine. I am grateful to secure this debate. Approximately 130,000 adults in the UK have cerebral palsy. Although the NHS now officially categorises it as a lifelong condition, there is clear evidence that specialist support stops at the age of 18. A national service specification for adult cerebral palsy in the NHS would ensure that the transition from childhood to adulthood is supported by relevant healthcare services and the necessary support. It would ensure that support continues to be provided throughout adulthood. I pay tribute to Up—the Adult Cerebral Palsy Movement, and Action Cerebral Palsy, for their dedicated advocacy for people with cerebral palsy throughout the UK, their campaigning on this issue and their support in preparing for this debate.

I will start by talking about my experience. As hon. Members will be aware, one of my daughters has cerebral palsy. Although she is still a child, I remain concerned about the level of support that will be provided to her when she reaches adulthood—a concern that I am sure many parents of children with cerebral palsy will relate to. During childhood, layers of support are provided, ranging from paediatricians to services that often are supplied at school and through the NHS such as physiotherapy, speech and language support, and occupational therapy. Parents are rightly concerned about what the transition at 18 looks like and whether wraparound healthcare remains. Sadly, the reality for many people with cerebral palsy is that after the transition, they are left with little support for their health needs and to help them function in life, including for day-to-day activities such as work.

Throughout this debate I will refer to the 2022 report of the all-party parliamentary group on cerebral palsy, “Barriers for adults with Cerebral Palsy on achieving full life participation: access to healthcare services and progressing at work”. Although the APPG is now disbanded, the key recommendations remain relevant. I pay tribute to my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the former Member for Blackpool North and Cleveleys, Paul Maynard, for their work to commission the report.

For many adults with cerebral palsy, their experience is similar: they receive care and support through paediatric services before reaching adulthood, then find themselves facing a cliff edge. In essence, they are left without the support that they received for the first 18 years of their life. Cerebral palsy affects about one in every 400 children in the UK, but the severity of each child’s cerebral palsy varies greatly, and many have more complex issues, with one in two having a learning disability and one in four having a severe learning disability.

The first recommendation in the APPG report outlines that NHS England and social care, education and employment specialists must agree a national service specification for adult cerebral palsy, to be commissioned based on the needs of local populations within the 42 integrated care boards across England. Furthermore, in the 10-year health plan, the Government made the commitment that 95% of people with complex needs should have an agreed personal care plan by 2027. Many adults with cerebral palsy have complex needs and, with that, elevated health risks. They are 14 times more likely to die from respiratory disease and three times more likely to die from cardiovascular disease. In 2023, a review of 69 studies to assess the prevalence and incidence of chronic conditions among adults with cerebral palsy showed that 21% had depression, 21% had anxiety, 24% had asthma, 28% had epilepsy, 32%8 had incontinence and 38% had malnutrition.

I would welcome the Minister’s response outlining how the commitment in the 10-year health plan can be achieved for adults with cerebral palsy. I would also welcome the Minister considering how a national service specification for adult cerebral palsy could be implemented within the 42 ICBs, including by encouraging ICBs to implement the NHS framework for the commissioning of services for children and young people with cerebral palsy as a blueprint for adult cerebral palsy commissioning and provision.

In March 2021, the then APPG on cerebral palsy published its first report, entitled “Early identification, intervention and pathways of care of infants and young children with cerebral palsy: the case for reform and investment”. One of the report’s key recommendations was that all health authorities should be required to implement NICE—National Institute for Health and Care Excellence—guidelines. Dr Charlie Fairhurst, head of children’s neurosciences at the Evelina London children’s hospital and chair of the committee for NICE guidelines on cerebral palsy, accepted those recommendations, which have been implemented in the NICE guidelines for children. It is therefore disappointing that the recommendations for adults outlined in the 2022 report, including the full implementation of NICE guidelines, have not been implemented for adult cerebral palsy in the NHS.

In May 2025, NHS England published the commissioning framework for children and young people with cerebral palsy. The framework aims to simplify and summarise the existing guidance available. It also highlights best-practice care pathways that could be replicated by other systems and enables systems to identify population need through data. Over the past year, eight ICBs have been piloting that framework for children, which involves undertaking a baselining exercise to understand existing service provision and to identify service gaps for children with cerebral palsy. However, as we know—and as the 2022 APPG report highlighted—the needs of local populations differ across the country, and the results from just eight ICBs are not enough to provide an accurate representation of the effectiveness of the framework.

The existing postcode lottery of specialist support constrains the lives of adults with cerebral palsy and results in worse health outcomes, not to mention lower education and employment participation for individuals, with the subsequent substantial economic loss. Analysis from the Northern Ireland cerebral palsy register has shown that the prevalence of cerebral palsy in adults is comparable to that of multiple sclerosis or Parkinson’s disease.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman for securing this debate, and I thank him for sharing his personal story. That personal knowledge adds to the debate.

Studies by Queen’s University Belfast indicates that adults with cerebral palsy often struggle to navigate adult health and rehabilitation services after moving on from paediatric services. That can limit their access to physiotherapy, occupational therapy, speech and language therapy, orthopaedics and neurology. Does he agree that the best way to navigate this issue is to establish a clear, co-ordinated transition pathway from paediatric to adult services, with dedicated case management so that nobody is left behind when it comes to their care?

[Daniel Francis]

I absolutely agree. Between the APPG’s 2022 recommendations and the example the hon. Member gave of the analysis in Northern Ireland, it is clear that the evidence is there, and hopefully we will hear from the Minister about how we can continue to progress some of those matters.

I would welcome a commitment from ICBs across the country to implement the framework as a blueprint for adult cerebral palsy commissioning and provision, as the hon. Member outlined.

The 2022 report’s second recommendation highlighted the need to support GPs in identifying adults with cerebral palsy by extending the UK-wide quality and outcomes framework to incorporate the creation of general practice-level cerebral palsy registers along the lines of the expansion of the QOF to learning disabilities. That would make a profound difference in the health outcomes of children with cerebral palsy when they transition into adulthood care pathways. Would the Minister look to extend the quality and outcomes framework to incorporate the creation of general practice-level cerebral palsy registers, similar to the expansion of the quality and outcomes framework to learning disabilities?

The third recommendation aims to ease the transition into adult care pathways through a national service specification for adults with cerebral palsy in the NHS, which must include training covering adults with cerebral palsy for those working in general medicine, general practice and nursing from entry level. For many adults with cerebral palsy, their primary co-ordinator of care is their GP, who, despite their best efforts, often does not have the specialist knowledge or training to support their patients.

Written evidence submitted to the APPG as part of the report highlighted that medical undergraduate students do not receive training about cerebral palsy in adults. One way to support GPs in identifying adults with cerebral palsy is to extend the UK-wide quality and outcomes framework to incorporate the creation of general practice-level cerebral palsy registers along the lines of the expansion of the quality and outcomes framework to learning disabilities. That would make a profound difference in the health outcomes of children with cerebral palsy when they transition into adulthood care pathways. Would the Minister outline how the current NHS staffing guidelines could be amended to include the incorporation of training for those in general medicine, general practice and nursing from an entry level to cover adults with cerebral palsy?

The report’s fourth recommendation outlined that each ICB should be required to undertake a gap analysis of existing cerebral palsy services for adults against NICE guidance and use the results to inform and guide their local commissioning decisions. This must include investment in services to support and address associated conditions. The results should then be used to establish regional multidisciplinary cerebral palsy clinics for adults, providing access to a range of psychological, physical and complementary therapies. The recommendation highlights that disability access co-ordinators appointed in both acute and primary centres would be able to provide referrals to the clinics and ensure that reasonable adjustments are made.

The report also highlighted that the provision of a neurologist during the transition from childhood to adulthood is an essential component of adult cerebral palsy care to ensure that, when a patient is discharged from their paediatrician, they do not face that cliff edge in support. Will the Minister agree to investigate how ICBs can undertake a gap analysis of existing cerebral palsy services for adults against current NICE guidance, and how they can include adults with cerebral palsy in their integrated needs assessments?

The report’s fifth recommendation suggests that, to ensure the provision of specialist services, the Department of Health and Social Care should provide ringfenced funding to ICBs to enable them to develop the much-needed specialist services at a local level. Will the Minister agree to look at ringfencing funding for the 42 ICBs so that they can develop specialist cerebral palsy services?

Finally, I want to demonstrate why national service specification is so needed. Emma Livingstone, the co-founder and chief executive officer of UP, The Adult Cerebral Palsy Movement, is in the Public Gallery, and her lived experience perfectly encapsulates why national service specification for adults with cerebral palsy is needed. Emma was diagnosed with cerebral palsy at two years old. At 16, she was discharged from medical services after being told that she was the best that she would ever be.

Unfortunately, without any integrated care during Emma’s adulthood, she experienced a significant decline in mobility in her late 30s. That led to Emma having multiple surgeries, and unfortunately having to give up her work as a speech and language therapist. In Emma’s own words,

“In my late thirties, my mobility declined rapidly. I needed hip surgery, then more surgeries, and eventually had to give up work. What shocked me wasn’t the physical deterioration—it was the silence. The coordinated care I’d received as a child simply vanished when I turned 18.”

Emma is sadly not alone in experiencing that. The APPG report found that

“the transition into adolescence and adulthood is often accompanied by a decline in physical function,”

with up to 50%

“of people with Cerebral Palsy experiencing deterioration in walking function between 20 and 40 years of age.”

That statistic alone is reason enough to show why national service specification for adult cerebral palsy in the NHS is so greatly needed.

I would welcome the Minister’s response to the five recommendations from the APPG report that I have highlighted today.