NHS Specialised Services

Siobhain McDonagh Excerpts

Thursday 15th January 2015 Westminster Hall

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I too congratulate you on your knighthood, Sir David. I am not quite sure what it is about Essex MPs and knighthoods, but perhaps we could be let in on the secret. I congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on securing the debate. I would like to start with an apology, because it always seems a good thing to start with: I am sorry, but I will not be present for the wind-ups due to a long-standing agreement. However, I will be really interested to read the report of what everyone has to say.

I would like to concentrate my comments on brain injuries and the way in which any reconfiguration of commissioning might affect brain injury services. In addition to representing people in my constituency who have been affected by a brain injury, my interest is twofold. First, I was a member of the Health Committee when it conducted its inquiry into head injury rehabilitation. Our report was published in 2001, and our findings demonstrated the importance of good quality rehabilitation in improving patient outcomes. Rehabilitation can also save the NHS money by enabling people to move along the care pathway from acute care services, when appropriate, and, in the longer term, by reducing ongoing dependency and care costs. It is a shame that rehabilitation services remain under-funded all these years later. That must be addressed, regardless of commissioning arrangements.

My second interest is that my constituency contains the London office of Headway, the brain injury association, the estimable chief executive of which, Peter McCabe, has been my friend, colleague and constituent for longer than either of us would care to remember. The charity supports individuals and families affected by brain injury and, as such, is ideally placed to comment on the discussion on commissioning arrangements. As many of us know, brain injuries can leave people with a broad range of cognitive and physical issues, including communication, memory, emotional and mobility problems, each of which requires specialist yet integrated treatment and rehabilitation from the earliest possible stage to enable the best recovery.

In such a complex area of health care, the views of organisations such as Headway that provide services to people with brain injuries are of vital importance in discussions about how specialised commissioning might be reconfigured. Headway’s front-line services include a nurse-led helpline that takes thousands of calls each year, and acute trauma support nurses who provide valuable assistance to families of loved ones in the acute stage of care. It also has an emergency fund that provides vital financial support to families who are unable to afford to visit their loved ones in specialist brain injury units, which are often many miles from the family home, along with a network of more than 125 groups and branches across the UK that provide local support and services to brain injury survivors and their families.

Ahead of this debate, Headway reported to me that it has had discussions with experts in the field of acquired brain injury about the proposals, and that there are differing views as to whether changing the way in which brain injury services are commissioned would be beneficial or detrimental to brain injury patients. Some have questioned the wisdom of another reorganisation at this stage, yet most accept that encouraging those with commissioning responsibility at both a national and local level to co-operate and develop joined-up pathways of care for patients could provide real benefits. There is a great deal of concern, however, that the driving force may be to reduce expenditure. I seek assurances from the Minister that the potential reconfiguration of commissioning is about improving patient outcomes rather than cost-cutting.

The present level of detail on how brain injury commissioning changes may work in practice is also of concern. Without that, it is difficult for organisations representing patients to provide views as to what such changes might mean. Experts suggest that it could be helpful if it led to more investment in rehabilitation services. That is supported by an article in the Evening Standard this week quoting Robert Bentley, director of trauma at King’s College hospital, who explains that trauma units can struggle greatly to move patients back to local rehabilitation due to a lack of rehabilitation beds, and that that leads to a blockage in trauma units. Rehabilitation services must be invested in at a local level to encourage patient flow at a national, regional or tertiary level.

I ask that NHS England provides more detailed information on how any reconfiguration of commissioning may impact on survivors of a brain injury. I also ask that any move to restructure is subject to consultation with appropriate and relevant organisations; it is important that experts and patient groups are able to feed into the plans, so that the interests of patients are protected and consideration is given to the law of unintended consequences.

It is also important to state how imperative it is that CCGs, if they are to become more involved in the commissioning of specialist services, are supported to increase their expertise in these areas of health, so that they are able to make effective and well-informed decisions. That would also help to ensure a consistent quality in services across the country.

To pick up on the points made by my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), I note that the Neurological Alliance highlighted that only 26.2% of CCGs responded to its audit looking at what specialist levels of understanding they have in that area of care, and that just 20.4% had explored the number of people using local neurological services. If the approach to commissioning services for these conditions is to be changed, CCGs will need to increase their knowledge of the level of need in their areas and the types of provision required. That might benefit from input from experts and patient groups, and should brain injury services move to a different form of commissioning, organisations such as Headway and its local groups should be engaged as part of the process.

I conclude by saying that the detail of these plans and how they are executed if they are put in place are of vital importance—as is always the case, the devil will be in the detail. The reality is that any one of us may suffer a life-changing brain injury. Those facing such difficulties need the assurance that they will receive the best possible acute care and rehabilitation to maximise their recovery, regardless of who commissions or pays for it.