Acquired Brain Injury

Siobhain McDonagh Excerpts

Thursday 6th February 2020 Westminster Hall

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

I thank the all-party parliamentary group on acquired brain injury for its continued determination to ensure that the issue is given the time and attention it deserves; I particularly thank my hon. Friend the Member for Rhondda (Chris Bryant), who has campaigned admirably. Politicians’ stock is low at the moment, but anyone who heard his contribution, with its passion, hard work, determination and sincerity, would feel a lot better about what we do.

As the right hon. Member for South Holland and The Deepings (Sir John Hayes) said, one person is admitted to hospital in the UK every 90 seconds as a result of brain injury, so it is imperative that the recommendations in the APPG’s report, “Time for Change”, are implemented without delay. I fully support the excellent report and endorse all its recommendations.

As hon. Members may know, I have a long-standing association with the brain injury charity Headway, mainly through its chief executive, Peter McCabe, who has been my friend and colleague in Mitcham for more years than I care to say. His charity does incredible work across the UK to support individuals and families affected by brain injury. The help provided by Headway is seen as a lifeline to those who receive it, whether through its helpline—inquiries to which have more than doubled in the past decade; through the provision of free, award-winning publications to help people understand and adapt to life after brain injury; or through grants distributed via its emergency fund.

Many hon. Members will also testify to the exceptional work done by Headway groups and branches in their own constituencies. The APPG report rightly calls for a national review of neurorehabilitation to ensure that service provision is adequate and consistent throughout the UK. This report must not confine itself to acute care settings. Headway groups and branches are under severe financial pressure as a result of cuts to local authority budgets. The fact that they continue to provide such vital support, through rehabilitative therapies and social interaction programmes, is a testament to their determination to support this vulnerable community.

Let us be clear: the pressure under which Headway groups operate must be eased, and they must be afforded the funding they need to continue to support people who may otherwise be cut adrift from society. “Time for Change” also calls for improvement to how the criminal justice system meets the needs of brain injury survivors. In a previous debate on acquired brain injury, I highlighted Headway’s brain injury identity card, which helps to identify brain injury survivors when they come into contact with the criminal justice system. To date, more than 7,000 such cards have been distributed to vulnerable adults in the UK.

The ID card is part of Headway’s Justice Project, which is helping to increase understanding of brain injury within the criminal justice system. That includes the provision of training to the police, liaison and diversion services, the Crown Prosecution Service, the Public Prosecution Service in Northern Ireland and other agencies. As highlighted in the report, this work is vital and charities such as Headway must be supported in delivering the training required.

I have also previously spoken of the Headway emergency fund, which provides grants to families to ensure that they can be by the bedside of a loved one in the acute stage of care following a brain injury. Since it was established, the fund has distributed more than £400,000 to almost 2,000 families with limited income or savings. About 82% of those grants are spent on travel, accommodation or parking at hospitals when no alternative transport is available—an issue I would like to focus on.

In December, the Government announced a new approach, giving access to free hospital car parking for thousands of NHS patients and visitors. I congratulate the Government on that announcement, which stated:

“From April, all 206 hospital trusts in England will be expected to provide free car parking to groups that may be frequent hospital visitors, or those disproportionately impacted by daily or hourly charges for parking”.

Each year, thousands of patients admitted with ABI will have sustained severe brain injuries, putting them at the greatest risk of a fatal outcome. If they survive, they face many weeks or months in acute care and rehabilitation. The development of major trauma centres and specialist brain injury units results in improved outcomes for patients. However, the emergence of such centres has meant patients being treated many miles from the family home, resulting in families facing financial hardship to be by the bedside of their loved ones.

If the patient is the main breadwinner or self-employed, the financial stress placed on the family can force them into impossible choices. The families of patients who have sustained potentially fatal acquired brain injuries will be desperate to be by the bedside of their loved ones at such a critical time, often for periods of several weeks or months. I am sure everyone agrees that they should be classified as “frequent hospital visitors” who are

“disproportionately impacted by daily or hourly charges for parking”.

Will the Minister confirm that that will be the case? It is vital that we receive confirmation today that it will, so that that vulnerable group receive the support they so clearly deserve.

--- Later in 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.

[Siobhain McDonagh]

I thank the Minister for giving way on this important issue. There are many terrible stories of people spending their life savings in an effort to keep being able to visit children and partners. Could the Minister specifically say, or could we have a response in writing to this effect, that that includes the families of people with acquired brain injury? I have been seeking some clarification from the Department, but all the responses have so far been obscure.

[Caroline Dinenage]

I will certainly seek to get that in writing for the hon. Lady.

My right hon. Friend the Member for Hemel Hempstead spoke about continuing healthcare. I know that that is a concern for many people, but what concerns me is that actually, CHC is needs-based, not diagnosis-based, so eligibility should be assessed by looking at all of an individual’s needs and considering their nature, complexity, intensity and unpredictability. If he wants to drop me a line about an individual case that he is concerned about, I will be more than happy to look at it.