Acquired Brain Injury

John Hayes Excerpts

Thursday 6th February 2020 Westminster Hall

[Sir John Hayes (South Holland and The Deepings) (Con)]

Today, like every other day, some 954 people will be admitted to hospital with an acquired brain injury. That is one person every 90 seconds. As the hon. Member for Rhondda (Chris Bryant), who has done such great work to highlight the issue, has already said, all kinds of events can be involved. It could be a brain tumour; I am president of the Lincolnshire brain tumour support group. Alternatively, it could be a traumatic event, such as a car accident or a blow to the head, or something else, such as a stroke. The effects are so varied that they are hard initially to diagnose, and then hard to rehabilitate—but that does not mean that we should not do so.

The initial NHS response to strokes, tumours and dramatic, traumatic events is invariably good, but the multitude and diversity of the effects of these events, as well as the difficulties faced by those with acquired brain injury, will often not be obvious until long after the patient has left hospital. Indeed, the unpredictability of the consequences, as described in the previous speech, is immensely distressing for both the person concerned and those around them. There can be inappropriate behaviour and changes of personality, as well as the obvious matter of decreased capacity.

Proust said:

“Happiness is beneficial for the body, but it is grief that develops the powers of the mind.”

Grief is, of course, for the departed, but it is also for any kind of loss. People grieve the loss of capability and capacity—the inability to do the things they once did or the lost chance to do the things they had hoped to.

I had a serious head injury in my youth, but I was able to do all that I had hoped to. As I have said before, I wanted to be a Conservative MP from the age of seven; when I say that, the hon. Member for Rhondda usually raises his eyebrows in disbelief—right on cue, Mr Robinson, he is doing it again. My head injury did not stop me from achieving that ambition, but it might have done if I had had other ambitions, if the treatment and care I received had been different, or if, to be frank, I had not enjoyed the same good luck.

We cannot be clear either about the pace of recovery, which is also immensely variable—not only is the severity of the effect unpredictable, but so is the speed at which people’s lives can change. Although there can sometimes be a deterioration, more often there is a gradual—sometimes very gradual—improvement. That means that although the adjustment they will have to make, at work and home, to go about their normal affairs will sometimes initially be very great, gradually they will be able to do more and more.

As an all-party group we produced an extremely good report, which was, though I say it myself, very well received. It was the result of a great deal of work, done not just by us—in fact, done rather less by us than by the many people to whom the hon. Gentleman has already paid tribute. The Government gave it a good hearing and we have had a good response from Ministers, but as has already been said repeatedly, the issue requires a cross-departmental approach; I have a long speech here that I am not going to make, but I will highlight some points before allowing others to contribute.

The impact on individuals, in respect of benefits, the education system and possible changes in personality and capability, may mean that they engage in activities, including malevolent activities, in which they would not otherwise have engaged. The criminal justice system has a part to play, as does, accordingly, the Ministry of Justice. There are other things too, beyond health: almost every Government Department has a part in addressing the issue of acquired brain injury.

However, Governments are extraordinarily bad at cross-departmental co-operation and collaboration, as I know having been a Minister in many Departments myself. Unless there is a real determination on the part of Ministers, and probably the Cabinet Office, to pull together the activities of Government Departments—for the most part, by the way, officials resist that; they do not like that kind of thing—things will not improve in the consistent way we want. Some Departments have already done good work, while others have been rather slower to respond to the recommendations in the report—it is available to colleagues and others, so I will not go through those recommendations in detail.

I want to amplify the call made by the hon. Member for Rhondda for a new emphasis on collaboration and for a mechanism to bring that about—probably through a Cabinet Office working party pulling together Ministers from different Government Departments. That can work, as I know from my own time in Government. I implore the Minister to set about the business of putting that in place, following this debate.

I have two other things to say, Mr Robertson. The hon. Gentleman drew attention to neurorehabilitation. A rehabilitation prescription should be made available to all individuals with acquired brain injury on discharge from acute care. It should be held by the individual, with copies made available to the general practitioner. A national review of neurorehabilitation is required to ensure that service provision is adequate. The Government should collate reliable statistics for the number of individuals presenting at A&E with acquired brain injury, and record the numbers that require and receive neuro-rehabilitation. There should be a significant increase in the number of beds, too. I am sure the Minister will want to comment on the whole subject of rehabilitation when she winds up the debate. Those are just a few of the things that we have argued for and to which I wanted to draw the House’s attention, on the back of the remarks made by the hon. Member for Rhondda.

I said I had two further points, and that will not have been lost on you, Mr Robertson. So, finally, I draw attention to the important work that has been done at universities. My own university, Nottingham, is doing important work on both the primary science of the subject and the psychological effects of injury. I hope that the all-party group will go to Nottingham to take a closer look—indeed, we were discussing that yesterday. When the Government work with the higher education sector, they can drive forward public policy changes resulting from important work on assessing the effectiveness of different approaches by public sector, private sector and charitable organisations, such as Headway, of which I am a patron.

Proust also said:

“A change in the weather is sufficient to recreate the world and ourselves.”

When the storm of head injury happens, the skies darken for individuals. Our job as parliamentarians is to bring change to those individuals, through brightening their prospects in all that we do.

--- Later in debate ---

[Caroline Dinenage]

The hon. Gentleman is absolutely right to raise that issue. NHS England has a veterans trauma network, which delivers comprehensive medical care to veterans, including those suffering from brain trauma. It does excellent work, but there are also many individual charities up and down the country that work to support veterans who may not have been diagnosed; they may have been diagnosed with post-traumatic stress disorder or something else, but never actually had the original head injury diagnosed.

Almost as if to highlight the fact that this is a hugely cross-Government issue and the inadequacy of Ministers working in their individual silos, I will today be able to focus massively only on the issues relevant to our health service, but I will try to come on to a lot of the questions that right hon. and hon. Members asked.

[Sir John Hayes]

I am extremely grateful to the Minister for giving way. We had meetings as an all-party group with the former Chancellor of the Duchy of Lancaster, the former right hon. Member for Aylesbury. I believe that at that point there were suggestions, at least, that a Cabinet Office piece of work would be initiated. Can we take it from the Minister’s assurances that she will write to the Cabinet Office colleagues who are now responsible for these matters and copy that letter to participants in this debate?

[Caroline Dinenage]

Yes, I am very happy to commit to doing that.

Before I go on to talk about the health implications of ABI, I want to deal with a couple of other things. They are not within my realm of expertise, but I want to touch on them.

The hon. Member for Mitcham and Morden spoke about the Headway brain injury identity cards—how important they are and how important it is that they are recognised across the criminal justice system. I wanted to mention how Headway has been integral in partnering NHS England’s health and justice liaison and diversion services programme team, to provide workshops in London and Leeds to raise the awareness of the prevalence of ABI within criminal justice populations. The objectives were designed in a “train the trainer” format, so that the attendees could return to their services and cascade the learning on how to identify people with brain injury, how to identify the brain injury cards that Headway has brought forward and how to understand the implications. I thought that was quite positive.

My right hon. Friend the Member for Hemel Hempstead was right to mention the positive progress that has been made in some sports. The Rugby Football Union’s Headcase campaign and the British Horseracing Authority have also made great strides in this area. However, he was also right to say that other sports have a long way to go.

The hon. Member for Rhondda spoke about trauma centres. As he knows, in 2012 22 regional trauma networks were developed across England to ensure that those with the most serious brain injuries received the best care. Two years after their introduction, an independent audit showed that patients had a 30% improved chance of surviving severe injuries. Since then, as he says, the network has saved literally hundreds of lives.

For people who have ABI, neurorehabilitation that is timely and appropriate to their circumstances is a massively important part of their care. Access to high-quality rehabilitation saves money and, more importantly, significantly improves outcomes for patients. NHS England commissions specialised rehabilitation services nationally for those patients with the most complex level of need. As we have already heard, trauma unit teams work to assess and develop a rehabilitation prescription for brain-injured patients. At the unit, patients can access care from specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription.

These rehabilitation prescriptions are an important component of rehabilitation care, because they reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient. The APPG argued that all patients should benefit from an RP; as I understand it, at discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialist or local rehabilitation, supported by the RP. However, I take on board what the hon. Gentleman says about ensuring that the letter and the prescription itself are written in language that people can understand, are easily accessible and are available to them and their family members.

The “National Clinical Audit of Specialist Rehabilitation for Patients with Complex Needs Following Major Injury”, published in 2016, found that, on average, 81% of patients had a record of a rehabilitation prescription. That audit appears to have had a significant impact, because the latest data shows a rise to an average 95% completion rate. In April 2019, the third and final report of the Audit Commission to NHS England’s audit programme was published, and it is encouraging to see that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

However, the audit report also suggests that much more work needs to be done to ensure that all patients who could benefit from specialist rehabilitation can access it. Using data provided from participating centres, the audit’s authors estimate that the current provision caters for about 40% of those who need the services. To address the capacity issues highlighted, the audit makes a range of recommendations.

It is important to recognise that these audits play a massively valuable role in helping services to improve. They shine a light on variation and help to support services to best meet the needs of patients. However, there will always be different models of improving access to specialist rehabilitation, depending on the set-up of the services around the country. Therefore, local service providers and commissioners should review capacity in the pathways for specialist rehabilitation in the light of this audit, taking action where they can.

The majority of rehabilitation care is commissioned and managed locally, and NHS England has produced some documentation and services plans to help with that. “The Principles and Expectations for Good Adult Rehabilitation” describes what good rehabilitation care looks like and offers a national consensus on the services that people should expect. The NHS long-term plan has also set out some key actions on this, designed to improve care, treatment and support for people with long-term conditions such as ABI.

Community services, which play a crucial role in helping people remain as independent and well supported as possible, are going to receive significant investment, with £4.5 billion of new investment in primary and community care. Furthermore, NHS England has set out plans to roll out the NHS comprehensive model of personalised care, which includes self-care care planning, personal health budgets and social prescribing. It will reach 2.5 million people by 2023-24 and is particularly relevant to people with acquired brain injury. The model is currently implemented across one third of England, but by September 2018, more than 200,000 people had already joined the personalised care programme.

The hon. Member for Mitcham and Morden asked about free car parking. From April, all hospital trusts will be expected to provide parking to groups who may be frequent visitors. I interpret that to mean families visiting people who are in hospital for a long period of time, which I think is what she was asking me.