Brain Injury Rehabilitation Services

Speech by Bob Russell MP delivered to Adjournment Debate - Hansard on Tue 21st Jan 2003

There is some justice in his misfortune, for such a clash would not have occurred under the previous sitting arrangements, which he campaigned to change. Next I must thank whoever it was in the Speaker's Office who drew my name to fill the vacated space. That was appreciated not only by me but by the all-party acquired brain injuries group, which I have the honour of chairing.

The group takes the view that more needs to be done to improve brain injury rehabilitation services not only in the interests of the individuals who have suffered brain injuries through accidents at home, at work or at play, in road crashes or owing to medical causes, but in the interests of those who care for them, be they NHS workers, other health providers, the voluntary and charitable sector or families.

I should like to offer my personal appreciation as well as that of the all-party group to each and every person and organisation who individually and collectively seeks to improve matters for brain injury victims. In particular, I mention Headway, the leading UK charity dedicated to providing help, support and services to people affected by brain injury. It also gives much-needed support to families and carers. There are more than 100 Headway groups around the UK. My thanks also go to the United Kingdom Acquired Brain Injury Forum for its valuable contribution, to Rehab UK whose aim is to enhance the social and economic independence of people with disabilities, and to the Brain Injury Rehabilitation Trust, which is a division of the Disabilities Trust.

The seriousness of today's debate stems from the stark fact that every year around 1 million people attend accident and emergency departments with some form of traumatic brain injury. It is estimated that for every 100,000 of the population as many as 15 will receive a serious head injury, up to 20 a moderate head injury and up to 300 a mild head injury. It is estimated that about 120,000 people in the UK live with the long-term effects of a severe traumatic brain injury.

I should declare my personal interest in the general subject of brain injuries. This coming July marks the 25th anniversary of the death of my first daughter. She died as a result of head injuries that she sustained when she fell from wall bars during a gym lesson at school. She was seven years old. Regrettably, despite the efforts of her teacher, who had recently qualified as a first aider, the ambulance personnel and medical teams at Essex County hospital and Oldchurch hospital, Romford, she did not survive. I dread to think what her condition would have been if she had lived. It was my daughter Joanne's tragedy that caused my wife and me to do what we could to help survivors.

We know that medical science has made advances over the past 25 years. More people appear to be surviving as a result of better and earlier diagnosis and the improved treatment that follows. However, that has not been matched by advances in rehabilitation-something that the Health Committee set out in its excellent report on the subject in March 2001. It is most regrettable that progress on the Select Committee recommendations has not materialised. I hope that today's debate will contribute towards ensuring that the improvements, which are both necessary and obtainable, can be provided.

I recognise that better rehabilitation services for those with brain injuries will cost money, but greater investment from the outset will cost the public purse less in the long run, which I assume appeals to the Treasury. In addition, of course, it will greatly improve the quality of life of those who have suffered brain injury and their families, who so often have their own lives torn apart by what has happened to their loved one. Perhaps the Minister will give an assurance this afternoon that all the Health Committee's recommendations will be put into action. Those with brain injuries and all who are associated with them would welcome such a declaration.

Headway has told me that the Select Committee's report entitled "Head Injury: Rehabilitation" is a seminal document. Its recommendations define an ideal brain injury service. However, Mr. Graham Nickson, Headway's policy and campaigns manager, told me:

"Whilst there were elements in the Government response (Command Paper 5226) which Headway welcomed, overall we were very disappointed at what we felt was a complacent approach.

Given that it is nearly two years since the publication of the report, Headway feels that it would be an opportune moment to ask what progress has been made in meeting the standards recommended by the Health Select Committee."

Let us hope that there will be real progress. I know that other hon. Members hope to participate in the debate. No doubt they will discuss some of the Committee's recommendations.

I am grateful to Professor Lindsay McLellan, Professor of Rehabilitation Medicine at Southampton university and chairman of the UK Acquired Brain Injury Forum, for his professional thoughts. He tells me that unless the management structures of the national health service are reformed at the same time as the national service framework is developed, any new resources for meeting NSF standards may be spent in areas other than rehabilitation. The Government already face that issue in respect of the money that they have provided for cancer care services. Professor McLellan suggests that a senior manager in each NHS trust be given responsibility for brain injury rehabilitation services, thus ensuring that the budget is spent correctly and progress is made.

I am sure that the Minister will readily confirm that the NSF will lay down what her Department believes that health and social care services in England need to do for those who have brain injuries. Unfortunately, when it comes to rehabilitation, it is clear that insufficient is being done to honour the spirit and letter of the NSF.

There are no pharmacological treatments for brain injury, which is the poor relation in medical research, even though each year, as I have already pointed out, some 1 million people in this country will seek treatment for a head injury. Road crashes are the biggest cause of injury. I am sure that everyone will welcome the moves that are being made across the board to reduce the number of road accidents so that there is less pressure on health services. However, this debate is about people who already have head injuries.

The Health Committee reported:

"Head injury is the foremost cause of death and disability in young people. In an age of increased motorisation and violence, head injury is a healthcare problem which is not going to go away. There is a growing population of head-injured people in this country, as improved medical techniques have led to many head-injured people now surviving their accident and living into old age, with a normal life expectancy."

The majority of brain injuries-40 to 50 per cent. of all cases-are sustained by young men aged between the ages of 15 and 29 who are involved in road crashes. Accidents at work and in the home account for 20 to 30 per cent., sports-related injuries 10 to 15 per cent., and violent assaults about 10 per cent. of brain injuries. Men are two to three times more likely to sustain a head injury than women.

Despite the widespread prevalence of brain injury, services to help and support the victims are woefully inadequate. The brain, with its 1 million million nerve cells, can be injured by illness, a physical blow to the head or internal neurological malfunction. Brain injuries can affect young and old, rich and poor, men and women and people from all cultures and ethnic backgrounds.

Greater importance must be attached to rehabilitation. Intensive rehabilitation must immediately follow acute care, which could last several weeks or many months. That should be followed by long-term rehabilitation. Given the importance of rehabilitation following brain injury, have the Government given serious consideration to the Health Committee's recommendation xix, which called for each NHS trust to identify a named manager with responsibility for rehabilitation services?

I would also draw the Minister's attention to recommendation xxi, which states:

"We recommend that the Department of Health should help charitable organisations, where they are providing core services, to develop these services further."

I very much regret that the inadequate funding for rehabilitation is likely to get worse if the example of my local branch of Headway is typical. Many Headway groups are struggling financially just to survive, although they are providing a vital service for those with brain injuries and saving the state a fortune. Such groups need more resources, not fewer.

Colchester Headway has been led to believe that the Colchester primary care trust will not be renewing its annual grant. A shortfall of £15,000 in the current financial year has not been paid. It gets even worse for the financial year due to start in April. The ongoing grant, which would be about £56,000, is in doubt.

Colchester Headway says:

"Should Colchester PCT decide to withdraw its support from Headway the repercussions will be immediate and very distressing for the people with brain injury and the families from the Colchester area who currently attend the day centre and receive our general support. The knock-on effect of this withdrawal, at a time when the world believes money is pouring into the Health Service, would not only be difficult for the public to understand, but would probably affect the viability of our organisation."

Will the Minister explain why money for rehabilitation for those with head injuries is being reduced? Perhaps my example is purely localised, and more financial support is being provided elsewhere. Either way, intervention by her in this funding crisis would be appreciated. Will the Minister point out to her Treasury colleagues the overall saving that will accrue to the public purse if proper resources are put into rehabilitation? Continuing the theme of joined-up government, I suggest that she involves the Department for Work and Pensions, from which I detect mixed messages.

Is the Minister aware of the views of Lord Morris of Manchester, the much-respected former Minister who did so much to help those with disabilities? In November, he attacked cuts in services to disabled people with acquired brain injuries, which are forcing the closure of centres specifically designed to help them. What is her response to that?

Rehab UK estimates that, for an average investment of £15,000, their 48-hour-a-week vocational rehabilitation programme saves the benefits system £300,000 over the lifetime of a person. The Brain Injury Rehabilitation Trust estimates that lifetime savings are in the range of £400,000 to £1 million per person, depending on the severity of the injury and the person's life expectancy. Those are huge savings for relatively little outlay.

The financial benefits are one thing. Of even greater importance is the improvement to quality of life for those with brain injuries and those who care for them.