Acquired Brain Injury

Debate between Julian Lewis and Seema Kennedy

Thursday 9th May 2019 Commons Chamber

[Seema Kennedy]

My right hon. Friend makes an extremely important point, showing that this is an issue not only for the health system and my Department but for others across Government.

While the majority of rehabilitation care is locally provided, NHS England commissions specialised services for patients with the most complex levels of need. For people who have ABI, neuro-rehabilitation that is timely and appropriate is an important part of their care. Access to high-quality rehabilitation improves outcomes for patients and can save money. The shadow Minister mentioned rehabilitation prescriptions. RPs reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient and are an important element of rehabilitation care. The APPG report was clear that all patients with ABI should benefit from an RP.

NHS England’s major trauma service, where acute phase rehabilitation begins, sets out that patients should be reviewed by a rehabilitation consultant. The shadow Minister asked about this. The development of major trauma centres, which the hon. Member for Rhondda supported, has improved recruitment to this specialty, while the national clinical audit of specialist rehabilitation recommended that all trauma networks review access to rehabilitation consultants and make improvements. Patients should have either a rehabilitation consultant or an alternative clinician with skills and competencies in rehabilitation to provide an initial formulation and plan to complete and perform the initial RP. At discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialised or local rehab.

The “National Clinical Audit of Specialist Rehabilitation for Adults Patients with Complex Needs Following Major Injury”, published in 2016, found that on average 81% of patients had a record of a rehabilitation prescription. The audit recommended that MTCs take action to improve compliance. The audit report appears to have had a significant impact. The latest data, from the last quarter of 2018, from the trauma and audit research network shows that the national average rose to a 95% completion rate for RPs. This is good news. NHS England has worked with patients, clinicians and charities to improve the RP design and set new standards for communication and involvement of patients, families and carers. It is hoped that the new RP will support the development of a rehabilitation dashboard to monitor the performance of the system. Audits play an important role in helping services to improve. The report also recommended that all organisations within a trauma network work together to review capacity.

The majority of rehabilitation care is commissioned and managed locally. To support commissioners to plan services for local populations, NHS England has produced a document, “Principles and Expectations for Good Adult Rehabilitation”, that describes what good rehabilitation looks like. Additional guidance covering adults and children sets out a commissioning model and the evidence base for delivering high-quality rehabilitation services.

The hon. Member for Rhondda mentioned that ABI spans many Departments, and I shall take away all the comments that concern my ministerial colleagues and will ask them to respond. On support for children with ABI in school, the special educational needs and disabilities system is designed to support all children and young people with additional needs. The arrangements for SEND are intended to support joint working between health, social care and education; multi-professional assessment of a child or young person’s needs involving relevant experts; and the development of an individual education, health and care plan to meet those needs. This should provide a basis for the sharing of information and expertise to ensure the needs of children and young people with ABI are supported in school.

The hon. Member for Blaydon mentioned the ABI card. The Department for Education has said that promotion of the card is a matter for individual schools, but as far as my Department is concerned, Professor Chris Moran, a national trauma director, said that he would be happy to promote the card in trauma networks, working with the Brain Injury Trust. The statutory guidance on supporting children with medical conditions at school covers a range of areas, including the preparation and implementation of school policies for supporting pupils, the use of individual healthcare plans, consulting with parents, collaborative working with healthcare professionals and staff training. The Department for Education continues to work with organisations such as the Health Conditions in Schools Alliance to help to raise further awareness of the duty on schools.

On prisons, there is an increasing body of evidence linking ABI to offending behaviour. NHS England’s liaison and diversion service has collaborated with Headway to develop workshops to improve awareness and identification of ABI in vulnerable offenders and the support available. The “train the trainer” workshops were designed so that attendees could return to their services and cascade workshop learning to their colleagues. Representatives of all NHS England-commissioned liaison and diversion services attended. Over the past two years, the Ministry of Justice has also piloted approaches to improve screening and support for prisoners through new link worker roles at six sites on the male secure estate. I take the point about female offenders and will speak to the relevant Minister. There was a pilot at a female prison between 2016 and 2018, but I will take away the point about the female estate.

I want briefly to touch on the point raised by my right hon. Friend the Member for New Forest East (Dr Lewis), the Chair of the Defence Select Committee. The veterans trauma network delivers comprehensive medical care to veterans, including those suffering from brain tumours, and, as he knows, the Prime Minister opened the successor Defence centre to Headley Court last year. We do not recognise his statistic that there are only two machines, but I will take that away and report back to him.

[Dr Julian Lewis]

I was not talking about tumours; I was talking about traumatic injury caused in explosions. My understanding is that only Nottingham and Aston Universities have the special types of scanners that can detect that particular injury. Will the Minister check that point and consider a screening programme for such people?

[Seema Kennedy]

I will happily take away that challenge from my right hon. Friend and will write to him.

The hon. Member for Rhondda spoke passionately about sport, although he claims not to be a sportsman. It is important that we do more to reduce the risk of ABI in sport. The Department for Digital, Culture, Media and Sport asked Baroness Grey-Thompson to carry out an independent review of the duty of care that sport owes to its participants; her report dedicated a chapter to safety, injury and medical issues. National governing bodies are responsible for the regulation of their sport and for ensuring that appropriate measures are in place to protect participants from harm. The DDCMS expects everyone in the sports sector to think carefully about the recommendations in Baroness Grey-Thompson’s report and in the all-party group’s report. Progress has been made over the years, for example through the Rugby Football Union’s Headcase campaign and action by other groups.

It is important that the welfare system appropriately supports people with ABI. Work capability assessments for the employment and support allowance are conducted by healthcare professionals for the Centre for Health and Disability Assessments. Case discussions about claimants with ABI form part of new entrant training for all healthcare professionals who undertake such assessments. They should all have access to a self-directed learning module on ABI, which was updated in 2018 and quality-assured by Headway.

Since September 2017, those who are placed in the ESA support group and the universal credit equivalent, who have the most severe and lifelong health conditions or disabilities and are unlikely ever to be able to move into work, will no longer be reassessed. Changes have been introduced so that existing claimants with the most severe lifetime disabilities whose functional ability has remained the same are more likely to have their evidence reviewed by a Department for Work and Pensions decision maker, and not need a face-to-face assessment with a healthcare professional.

I hope that this debate demonstrates how seriously the Government take the issue and the devastating impact that it can have on people’s lives. We are committed to ensuring that people are better protected. I look forward to responding to further debates.