Acquired Brain Injury

Neil Gray Excerpts

Thursday 6th February 2020 Westminster Hall

[Chris Bryant]

Perhaps we have thought, “Well, a little blow to the head is okay; we don’t mind and we’re not going to worry about that.” The right hon. Gentleman is right; perhaps we have been a bit blasé about it, and perhaps even more so in the armed forces, where people want to show that they are tough and can carry on.

Incidentally, the appearance of symptoms some time later is equally an issue in education. A child might come back to school wearing a bandage, at which point everybody is warm, friendly, loving, caring and supportive. Nine months later, when the bandage is gone and everyone presumes that the child is getting on with their life, the child may start becoming difficult in class, finding it difficult to concentrate and falling asleep in lessons. They may be less in control of their inhibitions, and all the rest of it. The teacher may not recognise that as part of what happened nine months before.

Unless teachers and the whole education system are trained to understand fully the concept of neurocognitive stall, there is a real danger that the child will end up becoming increasingly difficult because they do not know anything else; they get shouted at, which sends them into panic rather than making them say, “Please, Miss or Sir, I need some support and help.” Then the child ends up getting excluded and falling into the criminal justice system. If the support had been sustained from day one for at least a year, and if we had made sure that all the teachers in the school understood those issues, we might have been able to save that person’s education.

[Neil Gray (Airdrie and Shotts) (SNP)]

I commend the hon. Member on bringing this debate to the House, and on the work he has done in this area for some time. He is right to point to some obvious potential ABIs and the lack of knowledge and response. Will he reflect on some areas where there are changes in social norms and ideas about how brain injury can be acquired, such as in the heading of footballs? The Scottish Football Association has considered banning children from heading footballs.

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[Sir Mike Penning (Hemel Hempstead) (Con)]

It is a pleasure to take part in this debate. I campaigned for free car parking with my right hon. Friend the Member for Harlow (Robert Halfon), and I completely agree with what the hon. Member for Mitcham and Morden (Siobhain McDonagh) said about it. Perhaps the Minister cannot commit now to abolishing car parking charges, but I am sure that the Government will do so because we campaigned for that all the way through. No distinction should be made between one type of case and another; people who need to be by their loved one’s bedside should not be paying car parking charges. The NHS was designed to be free at the point of delivery, and that includes car parking for people in that position.

The hon. Member for Rhondda (Chris Bryant) is right in most, if not all, of what he said. His personal experience has given him an outlook that someone like me could not possibly have. Interdepartmental work is the only way to take this forward. Like my right hon. Friend the Member for South Holland and The Deepings, I have been a Minister—in my case, in seven Departments, before I managed to upset the last one and came to the Back Benches. This will only work if the Prime Minister says that there will be an interdepartmental group that will meet regularly and will be chaired by so-and-so—probably the Deputy Prime Minister, as it was then, or the Cabinet Office—and that they will report back what each Department is doing.

As we have heard, nearly every Department will be affected, from the Department for Digital, Culture, Media and Sport—the hon. Member for Airdrie and Shotts (Neil Gray) has alluded to football, and I will declare an interest about rugby and boxing in a moment—to the Department for Work and Pensions, which deals with how personal independence payment is assessed, and where I used to be a Minister. As I said earlier, because of the nature of the injury, it is not always visible; very often, it is inside.

I will touch on some other points. I understand exactly where the Scottish Football Association is going in looking at the issue of younger people and heading, but if those young people go on to play professional football later, they will head the ball. The rest of the world of football must take a leaf out of rugby’s book—particularly rugby union. I declare an interest: I stupidly started playing rugby when I was 11, and I am still playing now. I will be playing against the Welsh Assembly at Richmond in a couple of weeks’ time; that game might be slightly more interesting than the England-France one was.

Perhaps because we have seen some shocking injuries and we know what is going on, the game has changed, not just in that we now pull people off the pitch to be assessed, but in how we tackle. To be fair, a lot of that has to do with American football, where they used to lead with their head because they had the protection of the helmet, and because of machismo. Women’s rugby is the fastest-growing female contact sport in the country, and it has been for years; quite right, because it is brilliant to watch. However, in women’s rugby as well as men’s rugby, the game had to change to protect the players—those going into the tackles as much as those coming out of them.

[Neil Gray]

Like the right hon. Gentleman, I declare an interest in view of my past, rather diminished career as a rugby player. Football certainly has a lot to learn from rugby, not least when it comes to what he is saying about the contact area. The enforced absence of a player from the pitch for a period of time following a concussion diagnosis is also important, and it is something that football needs to learn from.

[Sir Mike Penning]

I could not agree more, and I was just coming on to that point. The Football Association and FIFA do not need to reinvent the wheel. We need to take time to assess whether a person has been concussed and, if so, they should not play the following week or the week after that. Those assessments have to be done by professionals, away from the pitch, and sometimes with scans.

Rugby has led the way. I watched a rugby league match this weekend—I have a rugby league team in my constituency, even though I am deeply in the south. Some of the tackles just would not be allowed in rugby union any more. As far as I could work out, they were old-fashioned spear tackles—the player is allegedly going for the ball, but they catch their opponent around the top of the neck, and that causes damage to the brain, which rattles around inside the piece of bone that protects the brain. It is plainly obvious that we needed to change, and it has taken time—probably too long—but it has happened.

Boxing also has to change for the better. I declare an interest, in that I boxed for many years. I am talking not just about the terrible things have gone on in the ring, as a result of which people have died for a sport that they love and want to be involved in, but about what happens to people years later. I will not name names, but I know several former world boxing champions who now suffer the consequences of the brain damage that they incurred. They can be read about in the papers. I do not need to name them, and it would be improper to do so.

This is not just about concussion. People in this situation have gone through clinical depression, and their injuries affect them and their loved ones for the rest of their lives. We must support more awareness and encourage the sport to do all it can to open up. We do not need to reinvent the wheel, but we must learn from other sports. I wish the hon. Member for Airdrie and Shotts luck in Scotland on Saturday, and I hope that England play somewhat better than they did against France. Let us hope that there are no injuries like some of the ones we have seen in the last couple of weeks. There was a neck and spinal injury at the Saracens-Worcester game the other week, and it was spine-chillingly horrible. People want to play the sport and it is their passion—stupidly, I still play—but we have to make sure that we protect them.

I want to touch on long-term care and the assessments that are carried out when people with a pre-existing brain injury of some description get dementia. Continuing healthcare is an absolute minefield. I have heard about this from too many of my constituents, and from colleagues in the House over the years. Even though someone who is going into care has a medical condition—a brain injury—before dementia comes on, that seems to be put to one side when the panel look at continuing health provision for them. That is fundamentally wrong.

Just because someone develops dementia or Alzheimer’s, it does not mean that their other medical conditions have vanished off the face of the earth. They have not. But time after time, I have had to help individuals and their families to go to appeals and tribunals to get something that they would probably have got if the individual had not got dementia, but that that they do not get because they have dementia alongside the pre-existing injury. It sounds very complicated, but it is actually very simple. If someone has a medical condition, such as a brain injury, that brings on dementia—we do not really understand that, and I was reading some research last night on the reasons for it—surely, the medical and nursing care that they needed for that brain injury should not be put to one side when they go for an assessment if they have Alzheimer’s or dementia.

I give praise where praise is due. I was a shadow Health Minister for four and a half years when the last Labour Government were in power, and they started the major trauma centres. The debate started with them, and they progressed it. The issues with major trauma centres are about where they should be, how quickly people can get to them and whether enough people are using them to make them viable, given the required expertise. To be honest, it is the same old story as with A&Es. Major trauma centres are not A&Es; they are specialist units for people who need specialist care. People who need to go to A&E should go to A&E, and people who need to go to a minor injuries unit should go to a minor injuries unit. It is about making sure that people go to the right place.

With major trauma, the decision is made for people. All the major trauma centres have helipads now. I truly hope that as they develop as centres of expertise, we will recognise that people need travel to the right place to see the specific consultant specialist who can save their life. That may not be the centre that is just down the road or the one in London—for my constituents, such things often involve coming into London—but it might be one that is 20 minutes away by helicopter ride. That is absolutely right, if that is where the expertise is. The time when people need to be closer to home, and to the support of their loved ones, is when they come out of major trauma centres and into rehabilitation.

Public understanding about major injuries is better these days. I was a fireman for many years and, sadly, I went to too many road traffic incidents. People are increasingly surviving major road traffic incidents or collisions. We tend not to call them accidents these days, because they are not accidents—they are preventable—and victims feel very strongly that we should not call them accidents. I understand that view. I made a big booboo as road traffic Minister when I talked about road traffic accidents. I did so because that is what firefighters did, but I respect the point: every accident is preventable, and these are collisions in which people’s loved ones are involved.

Today’s survival rate has a lot to do with the manufacture of the vehicles, airbags and how crush plates work inside vehicles. Those things mean that more people are surviving, but with very serious injuries. As I alluded to in my intervention, some of those injuries are physical and show themselves there and then, but a lot do not show signs until much later—sometimes nine weeks or nine months, or sometimes many years later.

That brings me to my final point, which is about our armed forces. We send our armed forces around the world. They work in a very dangerous occupation, and we try to make it as safe as possible. Sometimes, there are injuries in training. We sadly lost one of our Royal Marines only the other day; he was doing the job he loved and training to do something he was passionate about. Our thoughts and prayers are with his family, friends and loved ones.

We must look after our armed forces personnel after they are injured. I can remember so many incidents around head injuries when I was a squaddie, and there was no way that I would have gone down to the medical officer the day after a head injury with a headache. The barrack room humour would have been all about, “Get on with it. You are supposed to be robust.” I have been the Minister for the Armed Forces, and I think we are getting there, but the way forward is to improve public awareness. That involves debates such as this, and perhaps an overall Government body that can look at the issue in general terms. I hope we do not need too many of these debates—I have been around a long time—before we get to a better position in Government.

[Neil Gray (Airdrie and Shotts) (SNP)]

It is a pleasure to contribute to this debate on behalf of the SNP with you in the Chair, Mr Robertson. I strongly commend the hon. Member for Rhondda (Chris Bryant) for bringing the debate to the House, for his contribution over many years and for the erudite and informed way he goes about his business on this subject. I hope it means that ears are open to what he has to say, not least today. He has certainly earned respect for his erudite contribution in the debate today. I am only sorry that the debate is happening on a Thursday—normally a day when colleagues take time in their constituencies to carry out constituency business, which is why so few are here with us today.

The speeches today have been consensual in nature and informed and have added a very real quality to the debate, which I am sure the Minister will reflect on as she comes to sum up. The contribution of the hon. Member for Rhondda was very personal. He rightly mentioned the report of the all-party parliamentary group that he chairs, whose publication my party welcomed. He drew on examples of people he has worked with who require and deserve specialist provision as close to their home as possible. All Governments in these isles need to reflect on that, and on the wider societal impacts of ABI, which require earlier and greater intervention to prevent them from happening at all. The hon. Gentleman was also right to raise the issue of language in this context; he himself cited an unfortunate example and I hope that we will all reflect on it in the future.

The right hon. Member for South Holland and The Deepings (Sir John Hayes) too made a very erudite contribution, which was also informed by his personal experience, and I commend him for the work that he has done with the all-party parliamentary group, too. And he was right about the need for cross-departmental and cross-Government co-ordination, which I will come on to later in my speech.

I commend the hon. Member for Mitcham and Morden (Siobhain McDonagh) for her work with Headway. The point about a brain injury ID card was a very interesting focus of her speech. The benefits of such a card, which she articulated, are quite clear.

Like other colleagues, not least the right hon. Member for Hemel Hempstead (Sir Mike Penning), who have campaigned strongly on hospital parking charges, I am sure that the hon. Lady will be aware that in Scotland we have already got rid of them. I encourage them to keep pressing the Government in that regard, because of the very obvious benefits that such a change would provide for people using hospitals.

The right hon. Gentleman was right to focus on sport; our exchange on that subject is on the record. I entirely agree with him that sport undoubtedly has a role to play and can do immeasurable good for society, not only in terms of physical health but in terms of mental health. However, a lot of work needs to be done, especially in the particular sports that he mentioned but also in sport generally. The hon. Member for Rhondda rightly highlighted that issue as well.

As for myself, I will relate the Scottish experience. Be it in relation to ABI or any other issue, disabled people—regardless of their condition—deserve the right to live as independently as possible, and they should have freedom, dignity, choice and control over their lives. Accessibility is at the foundation of the approach that the Scottish Government are taking in providing disability support. I point Members towards “A Fairer Scotland for Disabled People”, which is the Scottish Government’s plan in response to the UN convention on the rights of persons with disabilities. It aims to make equality of opportunity, access to services and independent living a reality for all disabled people, as well as being a national plan for accessible travel, an awareness-raising campaign about the barriers that disabled people face, and a review of the legislation regarding adults with incapacity. It also aims to increase the uptake of modern apprenticeships by disabled people, to provide a new social security system that treats people with these conditions with dignity and respect, and to call for more work to tackle disability hate crime and violence against disabled women and girls. The Scottish party’s vision is that children and adults in Scotland with acquired brain injury should have equal access to the highest quality brain injury care, regardless of where they live.

The Scottish Acquired Brain Injury Network was established in 2007, with the key objective of enabling improvements in access to and the quality of services in Scotland. SABIN comprises service user representatives, healthcare professionals, service providers and voluntary sector groups, and it has published the traumatic brain injury and adult standards. Those standards have ensured that there is a joined-up approach to immediate and long-term care for people with an acquired brain injury. The right hon. Member for South Holland and The Deepings raised that earlier, and the Government here in Westminster should look at.

The Scottish Government have also made significant investment in the health service to provide the care that is required, including opening two major trauma centres in Dundee and Aberdeen, with further centres due in Glasgow and Edinburgh soon. I hope that all these centres will be adequately staffed with neurorehabilitation consultants, as the hon. Member for Rhondda suggested.

Clearly, there is work to do, not just in Scotland but elsewhere in the UK. Nevertheless, I hope that colleagues will recognise that Scotland is working hard on this issue. I thank the hon. Gentleman once again for bringing this debate to the House. I hope that his demands are taken seriously, and that that is reflected in the Minister’s response to this debate.

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[Caroline Dinenage]

Thank you; that is a very generous offer. People can see what an inspiring group Headway is.

We have heard a lot about the excellent and wide-ranging APPG report from 2018. As the hon. Member for Rhondda said, the Department of Health and Social Care co-ordinated with officials from across Whitehall to deliver the response, which was a truly cross-Government response, but I certainly feel his frustration at how silo working across Whitehall can be an impediment to getting the change that he wants. A number of right hon. and hon. Members have mentioned that today, and I will certainly take forward the idea of a real, collaborative cross-Whitehall group to discuss this. Even from the issues raised today, the Department of Health and Social Care, the Department for Work and Pensions, the Department for Digital, Culture, Media and Sport, the Department for Transport, the Department for Education, the Ministry of Defence and the Cabinet Office—I am sure there will be others—all need to be involved in the conversation.

[Neil Gray]

I thank the Minister for her contribution thus far. It was remiss of me, not just as someone who comes from an armed forces family but as a constituency MP with cases involving constituents who have been medically discharged from the armed forces, not to highlight and focus on the contribution from the right hon. Member for Hemel Hempstead (Sir Mike Penning) on the greater work that needs to be done within the MOD and across Government to ensure that we are treating our armed forces personnel, particularly when they leave service, with greater respect, and to ensure that we are providing for them, given the level of service that they have provided to all of us.

[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.