Chris Bryant (Rhondda, Lab) and chair of the debate opened the session by outlining the obvious and more hidden forms of brain injury.

“Sometimes a brain injury is really obvious – where the skull has been fractured or penetrated—but often the sheer force of the soft tissue colliding at speed against the hard inside of the skull bruises the brain, leading to a contusion or a haemorrhage that is outwardly invisible.

“Injuries can also be caused by stroke, tumours, infection, carbon monoxide exposure and hypoxia—oxygen starvation. These are hidden injuries with complex and fluctuating life-changing effects that strike close to the heart of what it is to be human, to be conscious, to be alive and, in many cases, to want to be alive.”

Chris Byrant, MP for Rhonnda

Barry Sheerman (Huddersfield, Lab/Co-op) raised the issue of the long-term exposure to carbon monoxide and the effect that can have on the brain. Chris Bryant said it was a critical issue which involves an element of social justice.

“Children from poorer backgrounds are four times as likely to have a significant brain injury before the age of five as those from wealthier backgrounds. We do not fully understand why as yet, and we need to do more work on that.

“However, it is also true that elderly people, who maybe cannot afford to have their boiler checked as often as others or may have landlords who do not check their boilers as often as necessary, may be suffering low levels of carbon monoxide poisoning over such a long period that they are not even aware that they are being poisoned. The memory loss, the fatigue and the problems they are having may be associated with their boiler rather than with anything else. We need to look further at legislation in that area.”

Rushanara Ali (Bethnal Green and Bow, Lab) reiterated the need for wider specialisms in hospitals and for transition support to provide much-needed rehabilitation. Chris Bryant agreed, citing his own experience of cancer as giving him insight into the needs of patients.

“If there is one thing that I have learnt from my experience of melanoma this year, it is that I, as the patient, wanted to go to the real expert, and I would travel as far as I needed to do that. Sometimes in politics it is easy to join the bandwagon when people say, ‘no, everything’s got to be intensely local,’ but the decision on major trauma centres was a brave one taken by this Government.

“The Conservatives are not a party that I support, but it was the right decision for saving people’s lives. We can now save people’s quality of life as well.”

Luke Graham (Ochil and South Perthshire, Con) highlighted the need for trauma centres to be based throughout the UK, alongside outreach for subsequent rehabilitation, especially in rural areas.

Chris Bryant stressed the need for changes to the welfare system, using the example of Jordan Bell, who had a motorcycle accident six years ago, aged 17, which have left him with significant impairments. Jordan’s father described dealing with the welfare system as “the most demoralising and depressing experience for us all.” “I cannot emphasise enough the stress this process puts on people with ABI. One woman told me, ‘I know I should use all my energy to try and get my brain back together. But I end up spending all my energy on forms — filling in forms and fighting bureaucracy’.

“An unresponsive, intransigent welfare system is effectively preventing people from healing.

“I beg ministers to take this issue seriously and to make sure that all PIP advisers are trained in the fluctuating and unseeable nature of brain injury. After all, one common feature is that patients become over-keen to please people. Often, they will tell the assessor everything they think the assessor wants to hear, because that is part of the condition.” He also raised the issues of ABI in prisons and sport.

“In Leeds Prison, 47 per cent of inmates, both male and female, have an ABI with over 60 per cent in Exeter Prison having atraumatic brain injury.

“In both surveys, the majority of injuries occurred before the prisoner’s first offence, suggesting that the brain injury may be a key factor in why they offended in the first place. If we really want to tackle their reoffending, we will have to deal with their brain injury, too.

“If we really want to tackle reoffending, we must do a better job of recognising and treating  brain injury.

“That means screening all new prisoners, training prison staff, providing proper neurorehabilitation for all prisoners with a brain injury and making special provision for women that recognises the likely different causes of their injury—particularly domestic violence.”

“With regard to sport, he continued: “I make it clear that sport is good for people’s health, and I do not want to prevent anyone from taking part in sport. I do not want all our sportspeople and youngsters to be mollycoddled and wrapped in cotton wool, but the record on sports concussion is shockingly bad, particularly  in football.

“The last season has been especially bad. Mohamed Salah, Jan Vertonghen, David Ospina, Anthony Lopes and Fabian Schär have all been involved in high-profile, very dubious decisions by the on-pitch medics.

“Let me be very clear to the football authorities. Football is failing its players. It is giving a terrible message to youngsters, parents and amateur coaches. Those authorities are putting players’ lives at risk. If they do not get their house in order, they will face massive class actions in the courts and we will have to legislate to protect players from what is, frankly, an industrial injury.”

Sir John Hayes (South Holland and The Deepings, Con) spoke about the scale of ABI and the number of families affected.

“The patterns that families endure are similar, one to another. Initially, of course, there is shock – a sense of disbelief—and the question that most people pose in these circumstances: “Why me?” Then there is a gradual realisation of the depth and scale of the effects of acquired brain injury, and an
unhappy initial concentration on what the person can no longer do, followed eventually by a reconcentration on what they can do. Most families follow that pattern when they suffer this kind of event, and that is why all that is done beyond the treatment of the initial trauma is so critically important.

“Neurorehabilitation is vital because of the dynamic character of these conditions. Most people who acquire a brain injury will change. Many will recover fully and some will recover partly, but all that takes place over a long period and is particular to each case. There is an unpredictability about the effects of acquired brain injury; it can affect physical capacity of course, psychology and cerebral function, as well as personality. Families dealing with that must cope with those kinds of changes, which can be terribly frightening for the individuals concerned and those who love them. The point is that a difference can be made by the quality of care that they receive during that rather difficult journey.”

Steve Baker (Wycombe, Con) said that babies can also acquire brain injuries from contracting meningitis, or during childbirth, and urged the Government to consider this issue.

Dr Julian Lewis (New Forest East, Con) raised the issue of personnel in the armed forces who have been misdiagnosed with post-traumatic stress disorder, when they actually have a mild traumatic brain injury.

“I believe that only two scanners in the whole country are capable of identifying mild TBI. There is not yet an adequate programme to make sure that the condition is discovered before irreparable damage is done.”

Sir John Hayes: “Often, misdiagnosis is part of that problem. Because of the characteristics of acquired brain injury that I described earlier— the changes in personality and the effect on cerebral function—misdiagnosis is all too easy. Part of our mission in bringing the all-party group’s report to the House’s attention, and doing so again in today’s debate, is to get all of Government, including the Ministry of Defence, working together to understand the breadth and scale of the problem.”

Barry Sheerman shared his concerns at the apparent decrease in numbers of people wearing seatbelts, saying he is “obsessively concerned” about road deaths and injuries. He said cross-departmental working in Government is proving difficult.

Sir John Hayes: “It is really important that local government is involved in this work, too. It is therefore not only a lateral challenge but about connecting the local approach to the national one.”

Caroline Harris (Swansea East, Lab) said early diagnosis and better access to rehabilitation is needed, but it is essential the long-term complications of ABI and its associated problems are also tackled. She used the example of George, a 23-year-old who sustained a brain injury in an unprovoked attack outside a nightclub.

“As a result of the severity of his injuries and the complexity of his ongoing disabilities, George was eventually awarded significant compensation, but this only led him to further problems. A friend introduced George to online gambling, something he had no previous interest in, but he now had the time and the money. George very quickly became addicted, making frequent and significant deposits with a wide variety of online gambling platforms. The result is that George has lost all his compensation, as well as money obtained by taking out additional loans and credit cards. At one point, he gambled and lost—this is breathtaking—£67,000 in just 40 minutes. He is now at least £15,000 in debt and, with no income, has no hope of meeting these liabilities.

“George is not alone. Research has identified that brain injury survivors are 27 per cent more likely to develop problem gambling or addiction than the general population, and that risk is found particularly among people with frontal lobe damage.

“Brain injury survivors such as George have already suffered so much, with their bright futures indefinitely stolen from them because of the trauma or illness they have experienced. They continue to suffer daily from the lasting effects of their injury as well as the associated anxiety and emotional difficulties. From an early stage in George’s addiction, the gambling platforms were made aware of his vulnerability, but despite this knowledge they continued to allow him to gamble on their sites, robbing him of his much-needed compensation, which was intended to give him a stress-free existence after his injury. Brain injury survivors are vulnerable, and at the moment the gambling industry appears to be exploiting that vulnerability.

“It is not just about gambling. The consequences of brain injury affect so many people in so many ways, and we have to start looking more closely at this issue. We need better diagnosis, better care and  rehabilitation support.”

Bill Grant (Ayr, Carrick and Cumnock, Con) said after spending 31 years of his career in the fire service, he would welcome the introduction of compulsory helmet wearing for cyclists.

“I am sure that that would reduce brain trauma injuries in the future.

“Those people’s survival is to be welcomed, although regrettably some could have a degree of disability and might have a different persona, which can prove difficult for all to cope with. The individual and their families undoubtedly need an informed and readily available bespoke support package. The onus is on us to enable these individuals to regain their dignity, which they so richly deserve, and to have an active role in our society, which is their society as well.”

Liz Twist (Blaydon, Lab) reflected on the positive reaction to the landmark Time for Change report, but that work must now be done on its implementation.

“It becomes clearer and clearer the more we look at it that acquired brain injury and its impact spread into so many different areas of everyday life, but I will focus on education and children.

“Acquired brain injury should be included in the special educational needs and disability code of practice. All education professionals should have a minimum level of awareness and understanding about acquired brain injury and about the educational requirements of children and young people with this condition—for example, with the completion of a short online course for all school-based staff.

“Additional training should be provided for the named lead professional who supports the individual with acquired brain injury and for special educational needs coordinators. We recommended that the acquired brain injury card for under-18s produced by the Child Brain Injury Trust should be promoted in all schools, hospitals and local education authorities.

“Many children and young people with acquired brain injury require individually tailored, collaborative and integrated support for their return to school and throughout their education. As agreed, a return-to-school pathway is required—led and monitored by a named lead professional—to provide a consistent approach and support for the individual, their family and their teachers.”

Jim Shannon (Strangford, DUP) stressed the importance of more support being given to people living with ABI and their families, based on his own experience of an accident which left his brother brain damaged.

“Owing to the determination of my parents and family, who took the time to care for and look after him, we were able to give him some sort of an independent life, which is very important. He is happy and safe with his carers, friends and family.

“Intensive care packages are essential to rehabilitation, and funding must be available for them. It is so important to give people who have acquired brain injury a normal life, if at all possible.”

Siobhain McDonagh (Mitcham and Morden, Lab) praised the work of Headway, which is celebrating its 40th anniversary this year.

“The reality is that, aside from Headway, most people—particularly those who cannot afford private healthcare—will receive insufficient support or rehabilitation after leaving hospital. Unless action is taken to enable people to access the vital support needed to ensure that these services survive, more and more people will be cut out of society and taxpayers will be left footing the bill for the longer-term care of those without the means to care for themselves. Considering that another four people will have been struck by brain injury during my speech, there simply is no time to delay.”

Jamie Stone (Caithness, Sutherland and East Ross, Lib Dem) said he is a passionate campaigner on disability issues following his wife’s brain haemorrhage operation and subsequent recovery 20 years ago.

“At a time, whatever happens with Brexit, when we must play to all our strengths—we must play every card we hold—we have a lot of people who have been ill or are partially disabled who have great abilities that they could contribute to the functioning of the United Kingdom and to forging a new and better future for the United Kingdom. It remains a challenge for Governments of all colours to harness those people. If nothing else, it makes them feel that they are contributing to the country and it makes them feel useful and that they are important. Self-esteem and the esteem of your peers is incredibly important to happiness and to quality of life.”

Martyn Day (Linlithgow and East Falkirk, SNP) highlighted that ABI is the biggest cause of disablement of people of working age in Scotland – around 40 per cent of working age disabled adults are in employment, compared with more than 80 per cent of those without a disability, and called for action on welfare benefits.

“The disability employment gap compounds the problems for those with ABI when interacting with that complex service. I echo the report’s call for less frequent reassessments and for assessors to be trained to understand the problems faced by those with ABI.”

Julie Cooper (Burnley, Lab) raised the issue of misdiagnosis of ABI.

“It is estimated that 24 per cent of children have some sort of brain injury, compared with 1 per cent who have autism. ABI in children is often misdiagnosed as autism or attention deficit hyperactivity disorder. The point about misdiagnosis across the board was made effectively. A particularly good example was the misunderstanding of cases involving service people.

“The combined cost of brain injury, including health and social care costs, disability support, lost work contributions and premature death, is estimated to be £15bn a year, which equates to about 10 per cent of the NHS budget. This is an issue of such seriousness and magnitude that it cannot and should not ignored.”

Seema Kennedy (Parliamentary Under Secretary of State for Health and Social Care) addressed the topic of rehabilitation prescriptions (RP), drawing on the recommendations of the APPG report, which said all ABI patients should have one.

“The National Clinical Audit of Specialist Rehabilitation for Adults Patients with Complex Needs Following Major Injury, published in 2016, found that on average 81 per cent of patients had a record of a rehabilitation prescription. The audit recommended that major trauma centres 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 per cent 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.”

Sir John Hayes: “Sometimes a person may be deemed to have recovered completely and to have returned to normal—whatever normal is—but their manner, meter and mood might have changed and their sense of appropriateness might have altered, and that has effects in education and employment, in particular, as well as in personal relationships.”

Seema Kennedy responded to many points within the debate, and reiterated calls for more to be done to reduce risk of ABI in sport.

“The Department for Digital, Culture, Media and Sport [DDCMS] 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.”

Concluding the debate, Chris Bryant said there are some issues still to be tackled, including armed forces personnel, cost recovery caps for insurance companies, school exclusions, and training and recruitment to get more people working in the area. He thanked members for their speeches.

The question was put and agreed that members urge the Government to work through all its departments to ensure that those who have sustained brain injuries are guaranteed full neurorehabilitation as needed.

Legal view by Louise Jenkins, partner and head of the serious injury team in Irwin Mitchell’s Sheffield office.

The effects of ABI can be widespread and have a significant impact on all areas of life both for the individual concerned and the family unit.

Early intervention from appropriate services and agencies is key to achieving the best possible long-term outcome.

Where there is a potential personal injury claim, it is vital that lawyers work collaboratively with clinicians to provide a seamless, best interests focused approach, with the clinician retaining overall clinical responsibility, whilst ensuring the injured person is always at the centre of decision making and fully involved wherever possible.

Signposting to support services early can make a real difference in relieving financial pressures on the injured person and their family.

Support for the family unit is critical, particularly for those caring for the injured person and to give advice and support to children to help them to understand the impact of brain injury on all aspects of life and equip them to adjust and cope with any personality change.

Assisting the injured person to achieve the best possible recovery, using the claims process where possible, should be the focus of any compensation claim, the process being a platform for helping an injured person to rebuild their life positively and engage in meaningful activity, beginning with accessing early rehabilitation through interim payment funds and expert advice on future treatment.

The claims process is ultimately there to restore quality of life and provide long term protection for those with life changing injuries.

Working collaboratively between the statutory and private sectors will ensure a smoother recovery pathway for injured people and allow them to maximise their potential.

Collaboration is ever more important given the reduced resources in the NHS and in social care.

Compensation claims have a valuable role to play in providing financial protection for life for those who have sustained serious injuries and in taking the pressure off statutory services to enable resources to be used for those who do not have a viable claim.