Westminster Hall

Thursday 4th December 2025 Westminster Hall

Thursday 4 December 2025

[Dame Siobhain McDonagh in the Chair]

Backbench Business

Acquired Brain Injury Action Plan

Thursday 4th December 2025 Westminster Hall

13:30

[Sir John Hayes (South Holland and The Deepings) (Con) [R]]

I beg to move,

That this House has considered the potential merits of a comprehensive acquired brain injury action plan.

Dickens wrote,

“Reflect upon your present blessings—of which every man has many—not on your past misfortunes, of which all men have some.”

There are few greater misfortunes than an acquired disability. Among those, a brain injury can challenge every aspect of life, whether people can walk, talk or think—or at least think straight. The effects are various: they can be mild or severe, and recovery will often take not just weeks or months, although the initial trauma can be treated in that timeframe, but many years. However, an improvement can be made over the long term.

Most of us think, “This will never happen to me.” I guess that is true of most misfortunes, including ones of this severity. Brain injury is the leading cause of disability and death among people under 40 in the UK. It can happen at any time, in any place. The causes, again, are various. One thinks of sporting injuries, or perhaps an attack—a violent incident. Of course, the principal causes are things like road traffic accidents, motorcycle and car accidents. Acquired brain injury, for the reasons I have given, has long warranted more attention than it has received, both publicly and among policymakers.

While the Department of Health and Social Care plays a central role in dealing with the immediate trauma caused by the sorts of accidents I have described, many other Government Departments have a relationship with the effects of brain injury. That is well illustrated by the work done by the all-party parliamentary group for acquired brain injury, which I am now proud to chair, and published in a report to which I will refer later in my speech.

We made the case that a cross-departmental approach to brain injury is required, for exactly the reasons I have set out. Of course, it affects the Department of Health, but it also affects the Department for Culture, Media and Sport—I spoke about sporting injuries a moment or two ago. It affects the Ministry of Justice, because such a high proportion of the incarcerated have brain injuries. It affects almost all aspects of Government, on which I know other contributors to this debate will focus, so a lateral approach to the way that public policymakers consider brain injury and its effects is critical.

As you will know, Dame Siobhain, as an extremely experienced and very wise Member of this House, might I say—

[Dame Siobhain McDonagh (in the Chair)]

Flattery will get you nowhere.

[Sir John Hayes]

I was hoping it might. Lateral policymaking is not easy in Government, because of the way Government works and ministerial responsibilities are exercised. It is a challenge, therefore, to get that sort of approach adopted by a Government of any colour or persuasion.

[Mr James Frith (Bury North) (Lab)]

The right hon. Gentleman is making a typically thoughtful contribution, and I congratulate him on securing this debate. I also thank Clare Harrison, a constituent of mine, from the Brain Injury Group for bringing this important matter to my attention.

The right hon. Gentleman makes a point about the Government’s role, and as he mentioned, sporting injuries populate such issues. Among those affected are former professional footballers, who are four times more likely to develop a neurodegenerative disease, support for which is patchy. For female former professional footballers, that support is non-existent. Will he join me in encouraging the Minister to consider the creation of an independent, football-funded body, alongside any wider action plan that his APPG is advocating for?

[Sir John Hayes]

I am grateful for the hon. Gentleman’s contribution. He makes a valuable point and an interesting suggestion that I will reflect on. He is certainly right that more can be done to affect brain injury in the first place. I have spoken a bit about its effects, but he is right to speak at greater length than I did about its causes. In the area of sport, of course, he is right that we now know that heading a football does all kinds of damage that no one imagined a generation or two ago. His suggestion is well made and worthy of further consideration.

Around 350,000 people a year are admitted to hospital with acquired brain injury—that is one every 90 seconds. About 125,000 of those are admitted following a traumatic brain injury, around 43,000 with brain tumours and others following strokes. I pay tribute to Lincolnshire brain tumour support group, of which I am president, and to Headway, which I will say more about in due course. The end result of those admissions is that about 1.3 million people are living with the consequences of acquired brain injury every day. They and their families, loved ones and friends, and the communities of which they are part, are dealing with the effects.

According to our all-party group’s latest report, the cost to the UK economy through healthcare, social care, lost productivity and wider public services is £43 billion annually, which equates to 1.3% of GDP. Of that, £20 billion is accounted for within the NHS and social care budget for acute long-term care, £21.5 billion is attributed to lost productivity, £1.5 billion is spent in the criminal justice system and the Department for Education—yet another Government Department that needs to be involved in the consideration of this issue in the lateral way I mentioned—and about £1.9 billion is spent on benefits. Leaving aside the human cost and the visceral effects brain injury can have on affected individuals and those who care for them, this has a considerable effect on Government, the Exchequer and the public purse.

Those ramifications only scratch the surface of the wider social cost. The real cost is in lives disrupted, plans abandoned and ambitions jettisoned as a result of brain injury; in parents seeing a child’s personality change overnight and carers stretched to their limits, with little or no respite, because symptoms are dismissed as being mild or imperceptible or attributed to some other cause entirely. Although less obvious, those effects are just as devastating. When those costs are added to the ones I have described, the all-party group estimates that the real cost of acquired brain injury is £91.5 billion. That is about half of what the NHS spends every year. It is extraordinary that this issue is not given greater consideration. I am delighted that this debate gives us a chance to do so, at least for this short time. I thank all colleagues across the House who have been part of these efforts.

We have argued for what we call a right to rehab. Putting aside the substantial financial cost, the physical and emotional costs are still higher. The estimates do not include many of the costs associated with homelessness, addiction, mental health services and psychiatric stays. The cost to the NHS and welfare of lengthy treatment and recovery is huge and rises quickly during spells in hospital before one even receives community support and longer-term social care provision. Much of this could be prevented, and many of the costs could be reduced, if we had the right to rehab.

Much work has been done on this subject, including by Headway, which I mentioned earlier, and the United Kingdom Acquired Brain Injury Forum. A report from earlier this year, commissioned by the APPG, urged the Government to invest in specialist neuro-rehabilitation to save long-term societal costs. The report called for brain injury to be treated on a par with cancer and dementia. A statutory right to rehab in every region means that specialist neuro-rehabilitation services after an acquired brain injury would be put in place.

None of the failures that we see today in response to brain injuries is inevitable. The Ministry of Defence already guarantees the right to rehabilitation for military personnel, so we have a precedent. We want to build on that precedent, across Government, for those affected by brain injury.

We know from the MOD the results of having that right for rehabilitation—shorter recovery times, better outcomes, restored lives and improved prospects. The same approach is being piloted by the National Rehabilitation Centre, where every £43,000 invested in rehab yields savings of up to £680,000. That is a remarkable 16:1 return on investment.

Now is the time to extend the entitlement adopted by the MOD much more widely. We must establish a national neuro-rehabilitation framework that guarantees that access to specialist care is not a lottery, but a certain path to recovery. In doing so, money would certainly be saved, but life chances would be improved immeasurably, too. High-quality rehabilitation reduces the risk of homelessness, addiction and a drift into lawlessness. It allows people to contribute, return to work and rebuild lives and relationships—to begin to stand tall again.

Now is the time for the Government to act. I have every confidence that the Minister will rise to her feet at the summation of this debate and tell us that she has not only thoroughly studied the all-party group’s report—daily, perhaps—but that she is ready to respond in the way that we invite.

I pay tribute to the hon. Member for Rhondda and Ogmore (Chris Bryant), who chaired the APPG before I did—I was his vice-chairman for many years. He drove the original version of the report, which was republished more recently. It is an outstanding piece of work. We all know that APPGs vary, but this one is focused on the subject for which it is responsible and is determined to make its voice heard, because of the all-party support it attracts and because of the salience and significance of this subject.

Given the number of people affected by brain injury, the comparatively low cost of effective interventions, such as rehabilitation and community support, and the ongoing lack of support services, there continues to be a strong need for a proper strategy to be put in place.

I spoke earlier about a lateral approach. We are calling for a national strategy on brain injury. Around 60% of prisoners report having an acquired brain injury. We discussed that at a recent APPG meeting, where we heard from experts in the field. I have served as a Minister in multiple Departments—I will not list them all—and I know that cross-departmental working is tough, and the Minister will know that too, but it can be done. It requires structures to be created that facilitate Ministers to come together. The Cabinet Office might be able to play a part. I served in the Cabinet Office and its purpose, in a sense, is to deal with those issues that could otherwise fall between the cracks and departmental silos. However it is done, we need a national strategy.

As far back as 2001, the Health Committee published a report on head injury, issuing 28 recommendations that included, as a matter of urgency, finding ways of improving methods of data collection on incidence, prevalence and severity. In 2005, the national service framework for long-term neurological conditions was launched; it contained many good ideas, but had no mandate and no funding. In 2010, the National Audit Office published a report, “Major Trauma Care in England”, which highlighted the need for improvement in major trauma care. That led to the establishment—you may remember it, Dame Siobhain—of trauma networks, with a centralised and specialised approach to trauma care and service across the country.

The excellent work of the APPG for acquired brain injury, which was reformed in 2017, showed that there was a strong case for a cross-party commitment to action. I have already spoken about the 2018 report, which called for a national reconsideration of rehabilitation and the collation of reliable statistics, given the problems with data collection and analysis that prevail.

To be fair to the previous Government, our report was well received by Ministers. Indeed, they responded to what we had called for by committing to publish a strategy on acquired head injury in 2021. The following year, there was a call for evidence to inform the development of such a strategy. The previous Government said that they were going to do it, committed to the principle and welcomed the work that we were doing. However, we then, of course, had the inconvenience of an election—one of the aspects of democracy that sometimes gets in the way of these sorts of things. Therefore, the work was not brought to a conclusion.

Earlier this year, the current Government announced their intention to develop an “action-oriented, and accountable” ABI action plan

“with input from NHS England and other Government departments”.

It was due to be published “this year”—well, the year is running out, Minister. However, there are still a couple of sitting weeks left: a statement could be brought to the House and perhaps a document could be published that responds to the calls that we have made. We have the work that the previous Government and this Government have done. There has been no party politics; over time, Ministers have recognised the challenge—the scale of the problem—and the reasons for addressing it, which I have set out.

We can hope that this Minister, who I know is dutiful and diligent, will rise to exactly that challenge. I do not know whether I am flattering her, Dame Siobhain—I am doing my best.

[Dame Siobhain McDonagh (in the Chair)]

I think that may be your modus operandi.

[Sir John Hayes]

Following representations from myself and others, the Minister, who has responsibility for public health and prevention, kindly responded to say that the Government will publish an action plan in 2026. I hope that it will be published as early as possible—if not before Christmas, perhaps as an early new year’s resolution.

After years of campaigning by charities and MPs, the excellent news is that there now seems to be momentum on this issue, which is what sufferers and their families deserve; it is what they warrant and certainly what they need. The plan needs to include a focus on better community rehabilitation and on how that will help to achieve real change for people with ABI. It could also include national training for local authority and integrated care board commissioners, and for social workers, on the complexities of ABI. I have talked about the subtlety of the effects that ABI can have, including the changed personality that many people experience as a result of a brain injury. Addressing such subtle changes requires a level of understanding and expertise, so national training could be really important and of immense value.

I hope that the plan will also include funding for community-based specialist brain injury services. Staggeringly, the vital research by Dr Alyson Norman found that a third of serious case reviews in social services involved someone with a brain injury. Dr Norman lost her own brother to suicide after he suffered a lifetime of untreated brain injuries sustained in childhood.

Given that brain injury is no less than a hidden epidemic, it is imperative that the Government take further action to collect statistics about it, so that we can accurately ascertain the numbers impacted. We need a UK-wide consensus on which conditions are classified and coded as brain injury, and to make that data freely available. Access to hospital admission data on brain injuries must be free; currently, charities face significant costs.

The charity Headway, which has done so much in this field, is not an immensely wealthy organisation and so those costs are significant to it. I hope that we get some reassurance on that point. Research by Headway has shown that over three quarters of brain injury survivors encounter daily challenges due to the hidden nature of their injury, and that nine out of 10 people affected by a brain injury cite societal misunderstanding as a major obstacle in navigating life with a hidden disability. Collecting those facts and figures is important because of the nature of acquired brain injury.

I will not say too much more about the costs to the sector, except that over the past three years several local Headway charities have permanently closed, including one in the last month. Three local volunteer branches have also shut down. That is because of rising costs of all kinds, which I do not need to list here. Closures really do risk brain injury survivors feeling lost. This is an area of work and a need that can go unrecognised and unseen. The feeling of isolation and loneliness—this is, as I described, a hidden epidemic—can place immense strain on families as survivors are no longer able to access, for example, the specialist daycare centres that they might otherwise enjoy.

We need to find a way of granting exemptions for charities from things such as the employer national insurance charges. I hope that the Minister will look at that, or even speak about it in this debate. Some 57% of Headway charities say that they have experienced delays in receiving payments from local authorities and integrated care boards. Some charities have even had to employ additional staff members purely to chase the debts that they were owed. These are small organisations with limited budgets; they just need help.

I know that other hon. Members want to contribute to the debate and can see their eagerness to do so, so I will draw my remarks to a close. For survivors, a head injury is just the beginning; the real challenge after survival lies in the days, months and years that follow. Individuals and their families struggle to navigate, with minimal support, a fragmented and underfunded system of rehabilitation. I know that because more than 40 years ago, like so many other young people, I suffered a serious head injury. But the key for me is that it did not stop me from doing what I wanted or being what I became. That is fundamental for anyone with an acquired disability.

It is a matter of record that I decided to become a Conservative MP when I was seven—I was probably six, actually. That did not alter as a result of my head injury, but it might have done. I have seen those much more seriously affected by the traumatic injury they endured. As I looked at them I thought, “There but for the grace of God go I”, so I was determined thereafter to do all I could to fight for people with serious head injuries who struggle with their effects. I have been determined to champion their cause and to turn my hopes on their behalf, and their hopes too, into reality.

I started with Dickens, one of our greatest writers, and I will end with Tolstoy, the great Russian writer. He wrote:

“As long as there is life, there is happiness. There is a great deal, a great deal before us.”

For everyone, regardless of what they suffer, to be able to glean that happiness, through the care and support that they receive, should be the ambition of every Government Minister and every Member of this House.

[Several hon. Members rose—]

[Dame Siobhain McDonagh (in the Chair)]

I ask that Members consider a four or five-minute time limit on their speeches so that everybody can be heard this afternoon, although I do not want to do that on a forced basis.

13:54

[Mr Jonathan Brash (Hartlepool) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Siobhain. I pay tribute to the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing this debate and for all his ongoing work leading on this issue.

One of the most remarkable features of the human brain is its ability to change. Neuroscience tells us that the brain has what is known as plasticity: the ability to rebuild, adapt and form new connections after injury. But that is not automatic; as with any muscle, recovery happens only when the brain is exercised, challenged and supported.

If someone breaks a leg, we do not simply discharge them and hope that they walk again; we provide structured rehabilitation, physiotherapy and ongoing care. Yet for many people with brain injuries, that is exactly what we do not do. Too often, rehabilitation is determined by postcode rather than need. Some parts of our country offer specialist support; others offer little or nothing at all. Patients are discharged from hospital and sent home often not because they are ready, but because the hospital bed is needed. Families suddenly become care co-ordinators. People struggle with memory, fatigue, speech and personality change without professional help.

Let us be clear about the scale of the issue. As has already been mentioned by the right hon. Member for South Holland and The Deepings, acquired brain injury is the leading cause of death and disability among people under 40 years old. Every year, around 900,000 people experience a brain injury and over 160,000 of them are hospitalised. Around 350,000 hospital admissions involve an acquired brain injury.

As has already been mentioned, the cost is enormous. Analysis shows the real cost is over £43 billion, with wider wellbeing costs exceeding £91 billion. We also know that every £1 spent on neuro-rehabilitation saves £16 for the state. Yet community services are underfunded and overstretched, and voluntary organisations warn that systems are close to collapse. This is not just moral failure; it is also economic failure.

Behind every statistic is a life, and one of those lives belongs to my constituent, Jonathan Purnell. While playing rugby 34 years ago, Jonathan suffered a massive brain haemorrhage—he was 27 years old. He spent three years under neurosurgical care, and when discharge day finally came, he believed he was starting again, but then the reality hit him, as he describes it, “like a steam train.” There were no services, no pathway and no road map to recovery, so he built his own. Out of his experience, determination and quiet defiance, Jonathan created the 1492 Group, not as a charity in theory, but a lifeline in practice—a place for people with brain injuries to come together, share, rebuild and be heard. I am so proud that it operates today in my constituency of Hartlepool.

Jonathan did not wait for the system to change; he began the change. Today, he is not only a survivor, but a force—a campaigner, an advocate and a builder of hope for others still trying to understand their new reality. He should not have to do this alone, and no one else should either. The case for reform is overwhelming. The Government have committed to their acquired brain injury action plan—a process, I have to say, that started as a strategy in December 2021. How long does it take to get this done? It started in December 2021, and here we are in December 2025.

What matters now is delivery. We need a statutory right to rehabilitation, consistent national provision, proper data collection and sustainable funding for community services. Above all, we must ensure that people with brain injuries are not written off because recovery is complex. Brain injuries change lives, but failure to act destroys them. Jonathan Purnell shows what is possible, and the Government must now do what is responsible. I urge the Minister to set out a clear timescale for that action plan, the necessary funding commitments and the accountability mechanisms. When it comes to acquired brain injury, warm words are no longer enough: people need support, and they need it now.

13:59

[Wera Hobhouse (Bath) (LD)]

It is a pleasure to serve with you in the Chair, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on securing this important debate. Every 90 seconds, someone in the UK is admitted to hospital with an acquired brain injury. Participation in sport carries some of the highest risks. This is most evident in children, adolescents and young adults.

The University of Bath was recently named sports university of the year, and we are all very proud in my constituency. It is a national leader in making sports such as rugby safer while preserving the hugely positive health and community benefits of participation. Rugby is at the forefront of developing ways to identify and manage brain injuries and, crucially, to prevent these injuries in the first place.

It is about improving safety without losing what makes sports so valuable, exciting and enjoyable for players and communities. The University of Bath works directly with teams and governing bodies to research, trial and refine new safety protocols, ensuring that evidence rapidly translates into safer play at all levels. One such example is the Activate exercise programme, an evidence-based strategy to cut youth concussions by up to 60%, which has now been adopted internationally.

The University of Bath is also partnering with schools, including Beechen Cliff school in my constituency, to use instrumented mouthguards to monitor head impacts and guide approaches to preventing injuries in young players. I pay special tribute to Headway Bath, which provides specialist relief, cognitive rehabilitation and support to adults who have suffered an acquired brain injury and their families and carers.

[Wendy Chamberlain (North East Fife) (LD)]

My hon. Friend is right to congratulate Headway Bath. These local groups are so important in providing support within our constituencies and are sometimes used by us to signpost people on. I highlight Graham Geddes, who set up Headway North East Fife in my constituency and has been nominated as volunteer of the year. Does my hon. Friend agree that we need to support this vital charity?

[Wera Hobhouse]

I could not agree more with my hon. Friend. I congratulate her branch of Headway on its wonderful work and the award it is about to receive. What would we do without local charities leading the way and, often, guiding us?

In Bath, North East Fife and other constituencies across the country, Headway provides day services throughout the week, online groups and bespoke one-to-one outreach rehabilitation support. That vital support makes a real difference to the lives of sufferers of acquired brain injuries, but I am sure many hon. Members will echo the fact that local Headway charities are under severe financial strain. Seven have closed in the last three years and others are struggling to meet rising demand with shrinking resources.

This debate is a crucial opportunity to ensure that the ABI action plan tackles these challenges. The 2024 report of the Lancet commission on dementia prevention, intervention and care estimates that almost half of dementia cases worldwide could be prevented or delayed if we act on 14 modifiable risk factors. Among them is traumatic brain injury, which alone is estimated to contribute to around 3% of global dementia cases.

As we have mentioned, some high-contact sports, such as rugby and boxing, carry a higher risk of traumatic brain injury, but we must not forget that regular physical activity is one of the most powerful tools we have to protect brain health. Exercise improves memory, supports thinking skills and lowers the risk of dementia through its wider benefits to cardiovascular and metabolic health.

Addressing the full range of modifiable risks such as high blood pressure, smoking, physical inactivity and obesity, alongside reducing exposure to head injury, means we could lower dementia risk for an estimated 27 million people worldwide. Our task now is not to pit exercise against safety, but to balance the risks of head injury with the overwhelming health benefits of sport. Protecting athletes of all ages from avoidable head injury must sit at the heart of that effort.

I echo the call from Alzheimer’s Research UK for dedicated funding from national Government, sport governing bodies and research councils to advance research into the complex relationship between sport, traumatic brain injury and dementia prevention. I hope that the Government listen.

14:04

[Liz Twist (Blaydon and Consett) (Lab)]

It is a pleasure to serve with you in the Chair, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on his opening remarks. We have served together on the all-party parliamentary group for acquired brain injury for a number of years. He gave a very effective summary of the impact of brain injury. I thank Chloe Hayward and everyone at the United Kingdom Acquired Brain Injury Forum and its constituent organisations for all the work and campaigning they do to improve services for people with acquired brain injuries.

There are so many aspects of this issue, including sport, other conditions and the justice system, but I will focus on children. I thank the Child Brain Injury Trust for its long-standing support in my constituency. A few weeks ago, its representatives accompanied me on a visit to Chopwell primary school, as they have come to other schools in past years, during GloWeek, which is always a big hit with children in Blaydon and Consett. It turns out that road safety is even more memorable if there are high-vis armbands and a visiting police car and fire engine. The purpose is not just entertainment; it is to say to children, “Be seen and be safe,” because so many acquired brain injuries in children are from road traffic accidents. It is entertaining, but it has a very serious message: “Let’s avoid those brain injuries in the first place.”

UKABIF and N-ABLES—the National ABI in Learning and Education Syndicate, a young people’s group—point out that acquired brain injury is an under-recognised and often hidden condition that can affect every aspect of a person’s life. About 40,000 children and young people report to hospital with an acquired brain injury every year, but it is likely that many thousands more have an undetected mild brain injury.

UKABIF and N-ABLES also say, however, that even mild injuries can be associated with a range of cognitive, behavioural and emotional symptoms, which can inevitably have an impact on a child’s education and health—indeed, on every aspect of their life, as we have heard. For those with moderate and severe injuries, the effect on all aspects of their life is often profound. The UK’s major trauma centres and advances in healthcare are saving more children’s lives than ever—thank goodness—but investment is needed in the quality of those lives after a brain injury. We hope those children will have a long life, but the support remains desperately poor. It is actually left to families and schools to provide much of that support.

Brain injuries are common, but the symptoms often go unrecognised or are mistakenly attributed to conditions such as autism or attention deficit hyperactivity disorder. Even with a diagnosis, there is no special educational needs category for acquired brain injury, which forces schools to record affected children under more generic categories. Many teachers say that they have never taught a child with a brain injury, but the evidence suggests that one child in every class will have sustained one by the time they leave school. It is vital that clinicians, teachers and carers consider the question, “Could this be a brain injury?” If that question is not asked, too many will miss out on the specialist support that they need. That is true not just at school but throughout their lives.

Rates of brain injury are alarmingly high in our mental health system, in prisons, and among those accessing domestic abuse support services. The risk of suicide is two to three times higher following a brain injury. One in four people report suicidal thoughts within a year of diagnosis, and that risk persists throughout life. Despite that, more than half of people with neurological conditions have not been asked about their mental health in the past three years.

Many people experiencing suicidal thoughts might not even be aware that they have a brain injury, particularly survivors of domestic abuse who might have experienced repeated mild injuries rather than one significant event. Research suggests that up to half of survivors have experienced brain injury, yet frontline support workers are rarely aware of that link. This matters because people experiencing mental health issues as a result of their brain injury require specialist neuro-psychiatric support. Often they are excluded from mental health services or told that the services they need do not exist.

With fewer than 20 full-time neuro-psychiatrists in the UK, there is a postcode lottery in accessing support, so those most likely to experience high rates of traumatic brain injury and mental illness also face the most significant barriers to accessing healthcare. That includes those who are homeless, those who struggle with substance abuse or those in prison. Some 60% of offenders are thought to have a brain injury, and yet there are no secure services in the UK for women with an acquired brain injury. Given the links between domestic abuse, offending, brain injuries and suicidality, that is particularly concerning.

What steps is the Minister taking to improve the integration of mental health and neurological care, and to ensure that clinicians are trained to recognise and respond to the needs of patients with brain injuries? The national service framework for long-term neurological conditions emphasises the need for provision at all levels, delivered through co-ordinated networks of specialist hospital and community rehab services. Having met local professionals in the north-east—in Newcastle and south of the River Tyne—I know that community provision varies significantly by postcode, some receiving none at all and others receiving great support. Without support, patients go on to have poorer outcomes, relying more heavily on other parts of our NHS and the care system.

What steps is the Minister taking to ensure that we develop the care pathways we need to give patients the best chance of recovery? I welcome the Government’s commitment to a more focused action plan, and I look forward to hearing the Minister’s thoughts on what steps will be taken to achieve it. If we get this right, we can transform outcomes for thousands of people and build a system that supports them throughout their lives.

14:12

[Charlotte Cane (Ely and East Cambridgeshire) (LD)]

It is a pleasure to serve under your chairship, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on securing this debate and thank him for his hard work as chair of the APPG.

I want to pay tribute to Brainkind Fen House in my constituency of Ely and East Cambridgeshire for its incredible work to support people with acquired brain injuries. It provides a safe and secure space for patients, with rehabilitation and support so that people can thrive after brain injury. In preparing for this debate, it shared with me the story of my constituent Florence, which I want to share today.

Florence gave birth to twins, which should have been a very special time in her life. Unfortunately, just two weeks later, she suffered a stroke resulting in a brain injury. Her ability to speak became severely impaired. She found it difficult to walk or use her hands. Let us imagine being a new mother and suddenly finding that our body will not let us care for our babies. Florence went to Brainkind Fen House and after just five months of rehabilitation with its clinicians, she regained the use of her hands so she can now change and bathe her babies. Her speech recovered and she is able to walk again. I cannot do her story justice on my own, so I will quote her directly:

“I felt helpless. My whole world had crumbled. But Brainkind offered so much support. They made me realise I’m not alone. The staff rallied round, organising donations of toys and clothes for my children so we could spend time together. Then, as I began to recover, they took me shopping so I could buy things for my children for the first time.”

Florence’s story is a special one, showing us the vital role that specialists play in ensuring that an acquired brain injury is not the end, and that there can be light at the end of the tunnel.

I was also privileged to meet an individual at an event at Parliament this week; the event was on a different subject, but she wanted to talk about acquired brain injuries because, at the age of 16, her brother suffered an injury and was almost a completely different person afterwards—something we have heard from others. Two things she said stood out. She said it was almost as though he had gone through a “factory reset,” and she had to mourn the brother she once knew and bond with the brother she now had, because they were two different people. She said, “His smile is different”. Everyone she spoke to did not notice any difference, but she did. His facial muscles moved differently, and as someone who had known him all his life, she could spot that when others could not.

That story shows the pain these injuries can cause to a person’s loved ones. In this case, it caused a sense of grief; her brother had not passed away, but the brother she knew was gone, and she now had someone else to bond with.

Brainkind Fen House gives strong support to brain-damaged people and a range of therapies to help them recover. There are strict criteria for continued NHS funding after the first few months, which means that small improvements are not always sufficient to secure funding for ongoing rehabilitation. The person is then moved into long-term care, with little, if any, further support.

I have another case in which the person was responding to rehab, but the funding was coming to an end. After significant advocacy from their parents and the staff at Fen House, the funding was extended. That person is now waiting for a suitable flat, and his parents are fighting for a care package to support him in independent living.

People should not have to fight for this support, and it should not need an MP’s intervention. We need a clearer, fairer process to ensure that people get the rehab support they need, and then the appropriate housing and care support as they move back into the community. I ask the Government to publish the acquired brain injury action plan as soon as possible, and to include in it the right for those who have suffered to have access to a named GP. That must go hand in hand with better social care for disabled people and free personal care.

The stories I have shared highlight that more needs to be done, not only to help patients but to understand the impact on their friends and family. I hope this debate highlights the need for urgent action, so we can do more to support patients and their loved ones.

14:17

[Apsana Begum (Poplar and Limehouse) (Lab)]

It is a pleasure to serve under your chairship, Dame Siobhain. I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing this debate and for the work he is doing as chair of the APPG for acquired brain injury; I worked with his predecessor, my hon. Friend the Member for Rhondda and Ogmore (Chris Bryant), on these issues.

I want to speak about the case of Imran Douglas, the deceased son of my constituent Amy, to illustrate why an acquired brain injury strategy and action plan should no longer be a matter of if but when. Imran was born in 1995 and suffered a brain injury as a result of a road accident when he was just 17. He was in a coma, and when he woke up he was found to have significant personality changes. Imran was taken into care, having never previously needed psychiatric assessments or had any run-ins with the authorities or the criminal justice system.

While in care, Imran committed a horrific act of murder—something which his mother, my constituent, has always maintained was a brutal and undeserved attack for which Imran was responsible—of an elderly person who was completely innocent. Imran was then transferred to hospital, and in 2013 pleaded guilty to murder and was sentenced to life imprisonment. Imran was the first 18-year-old to be sent to Belmarsh prison following his sentencing. He lasted less than a week, because he killed himself.

A subsequent inquest into Imran’s death found a lack of planning and a failure of care by some of those responsible for his welfare while he was in custody, who were aware of Imran’s condition. It spoke to

“a systemic lack of communication between, and within, almost all the agencies involved most notably within Feltham Young Offenders Institution.”

In other words, he should not have been transferred to Belmarsh prison. Since his suicide, Imran’s mother Amy and his father Masum have been fighting for a serious case review. They have been fighting for several years but have never been granted one.

Over the years, Imran’s parents have worked with the Acquired Brain Injury Forum and various other campaign groups for changes in the law to identify brain injury at much earlier stages, and ensure that people in this country have the right to support in that regard. I pay tribute to them for their efforts over the years to deal with the pain of that loss and the tragic circumstances around it, and to use their energy and time to campaign for change. They know, as I do, that any action plan must be wide-ranging, comprehensive and multifaceted, because the prevalence of acquired brain injury among those with contact with the criminal justice system is reported to be around the 46% to 60% overall, between 50% to 87% among children, and 78% among women.

I have supported the work of Brainkind, an organisation that has evidenced the impact of brain injury on domestic abuse survivors. Its report, “Too Many to Count”, found that one in two survivors of domestic abuse may have sustained a brain injury, often through blows to the head or through non-fatal strangulation. As chair of the domestic violence and abuse all-party parliamentary group, I know that our membership is well aware of the correlation between women in prison and undiagnosed conditions such as acquired brain injury.

What is important for a revised or shorter action plan is to ensure that Departments and services speak to one another—that should be worked into the action plan itself—and that there are duties placed on national bodies, Government services and social services to collect and analyse data, and to share it with each other. Ultimately, if we look at the case of Imran, even just data collection and sharing between services could have perhaps prevented his death.

It is also important to ensure that the action plan invests in awareness training and support. Brainkind is doing some work around that, and has developed a new free tool—not a diagnostic tool, but a tool that professionals can use for support when working with survivors of acquired brain injury. Those are the areas that we need to look at if we want not just to present, but to deliver an action plan that can be passed through as soon as possible.

My constituent Amy has shown incredible resilience and fortitude; she is someone who reflects on what happened to her son and commits herself to trying to change things in society. While she continues to advocate for changes to the way in which serious case reviews are conducted, and to the difficult, onerous processes around them, she knows that the picture is much larger. It is a nationwide issue and it needs a national framework.

I mention Amy again because there is a need for serious case reviews, and I saw what she and Imran’s father Masum went through in trying to secure one. From my engagement with the all-party parliamentary group for acquired brain injury, and with other survivors and families that I have met, I can say that the thresholds that need to be met for a serious case review are applied inconsistently by local government and social services across the country. That is why there are not that many serious case reviews—I appreciate that they are reviews of serious cases, but the threshold seems incredibly high, even when a situation presents itself where it is probably better to have one than not.

I raise that issue because some of these matters could be addressed through a strategy and a more focused, shortened, action-oriented plan for the issue. A number of campaigners have called for data collection, analysis, awareness, training, data sharing and collaboration. I started engaging on these issues and matters as a result of my constituents’ case. As my hon. Friend the Member for Hartlepool (Mr Brash) mentioned, since about 2020 we have had lots of discussions, meetings and engagement. Progress was made under the previous Government to present a strategy, but we need to deliver it now. It has been five years since I started engaging on these issues. We need a society where no one loses their life to murder or suicide. I hope that the Minister can relay to us some form of timeline for when action plans and strategies can be delivered.

14:25

[Alison Bennett (Mid Sussex) (LD)]

It is a pleasure to serve with you in the Chair this afternoon, Dame Siobhain. I sincerely thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing this debate, for his thoughtful remarks and for his advocacy on this subject over many years.

As we have heard, an acquired brain injury is an injury to the brain occurring after birth, often caused by a car accident, a fall or, as hon. Members have said, a sports incident. The consequences can be profound. Acquired brain injuries can alter movement, senses, memory, reasoning, personality and emotions. In other words, they can change the entire direction of a person’s life and the lives of their families and carers.

Although the injury itself may often be sudden, the struggle that follows is not. For better or worse, it is shaped by the systems meant to support recovery. At present, those systems are failing far too many people. For years we have seen the same problems persisting: too little access to specialist rehabilitation, chronic workforce shortages, incomplete data, fragmented commissioning and Departments that do not work together. Those failings translate directly into poorer recoveries, greater long-term disability and immense emotional and financial strain on families and the economy.

The NHS 10-year health plan committed to delivering effective rehabilitation in the community—a promise that was warmly welcomed, but it is frustratingly vague. We know that access to rehabilitation is central to enabling people with an ABI to live fulfilling, independent lives, and that rehabilitation works best when delivered by a skilled multidisciplinary team. Despite that, rehabilitation remains underfunded, understaffed and inconsistent across the country. Earlier this year, the UK Acquired Brain Injury Forum published a report that laid bare the scale of the challenge and the opportunities to tackle it. It is estimated that acquired brain injuries directly cost the UK economy £43 billion every year, while ABI-related wellbeing costs amount to £91.5 billion. Crucially, as the hon. Member for Hartlepool (Mr Brash) said, neuro-rehabilitation yields a remarkable 16:1 return on investment.

The message is clear: investing in rehabilitation is not only the right thing to do morally, but one of the smartest decisions economically. Yet local capacity is shrinking when it should be expanding. Headway UK recently revealed that delays in receiving payments from local authorities and ICBs have had severe impacts on local brain injury services. My constituents in Mid Sussex are lucky enough to have Headway Sussex, which partners with brilliant local organisations such as Carers Support West Sussex. However, in the past two years alone, almost 10% of local Headway groups have been forced to close their doors. Each closure represents a community losing vital expertise and support.

There has been some progress. In October 2025, the National Institute for Health and Care Excellence published new guidance on rehabilitation for chronic neurological disorders, including ABI. The evidence underpinning that guidance showed what people with ABI have known for a long time: that many do not feel empowered to share feedback, that often rehabilitation is considered only once symptoms already affect daily life, and that people with acquired brain injuries typically need cycles of intensive treatment followed by lighter ongoing support. The new NICE standards set out clear minimum expectations across all health, mental health and social care settings, but they are just that—expectations.

In July, in response to a written question from my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour), the Government confirmed their intention to publish an acquired brain injury action plan in autumn 2025. As the right hon. Member for South Holland and The Deepings noted in his opening remarks, we are yet to see that plan. This follows years of long overdue commitments from the previous Conservative Government, who, having consulted in 2022, promised an ABI strategy back in 2024. People with an acquired brain injury should not have to wait any longer. My Liberal Democrat colleagues and I believe the Government must publish that action plan without delay, and it must include a commitment that every person with an acquired brain injury has access to a named GP.

Continuity of care is essential and at the heart of Liberal Democrat policy, but our vision goes further. We are fighting for better social care for disabled people, including free personal care, more support for family carers, more respite breaks and paid carer’s leave. That would offer desperately needed stability to families who have been carrying the burden alone for too long. We would extend the right to flexible working to everyone and give every disabled person the right to work from home, unless there are compelling business reasons not to.

We want people with an acquired brain injury to live not only independently, but with dignity and opportunity. To make that a reality, we would adopt new accessibility standards for public spaces, modernise the blue badge system and incorporate the UN convention on the rights of persons with disabilities into UK law. We would also introduce adjustment passports, ensuring that support and equipment stay with the person, not the employer, when someone changes jobs. Those are practical reforms, grounded in common sense.

However, we simply cannot talk about acquired brain injuries without talking about the crisis in social care. People with long-term conditions such as an acquired brain injury often have the most complex needs, yet they are among those suffering the most from the failings of the system. Hundreds of thousands of people are waiting for care, and many are stranded in hospital beds because the support they need simply does not exist in the community. In my time since being elected, I have heard that from constituents in Mid Sussex. The situation is bad not only for those individuals, but for the NHS, and it is disastrous for the taxpayer.

The Liberal Democrats would fix the back door of the NHS by introducing free personal care based on the successful Scottish model, creating a social care workforce plan, establishing a college of care workers, raising the carers’ minimum wage and ensuring that unpaid carers get the respite breaks and financial support they deserve and need. The Liberal Democrats would reverse the increase in national insurance contributions and invest directly in community nursing. We would create an independent pay review body, implement a 10-year retention plan and expand access to flexible working and childcare. We would reduce reliance on expensive agency staffing by rebuilding a flexible and sustainable NHS workforce.

People with acquired brain injuries and their families and carers deserve better. Our country, which bears the enormous economic and social cost of inaction, deserves better too. It is time for the Government to act, so I look forward to hearing what the Minister has to say today.

14:33

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Dame Siobhain. I congratulate my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) on securing a debate on a subject that I know is important to him, to many of our constituents and to the whole House. The brain is so important. It is responsible for moving and thinking, homeostasis, consciousness, our senses and how we interpret the world—essentially, it makes us the people that we are. Acquired brain injuries are therefore an important issue.

As other hon. Members have said, acquired brain injuries are the leading cause of death and disability in those aged between one and 40. Every 90 seconds, someone somewhere in this country—over 330,000 people per year—is admitted to hospital with acquired brain injury. They can have difficulties with walking, with talking, with moving, with thinking skills, with tiredness and fatigue, and with changes in personality. People can have one large brain injury with devastating effects, but they can also have multiple, small, almost unnoticed brain injuries, the cumulative effect of which can be quite severe, and the long-term effects of which can lead to dementia.

The previous Government began work on an acquired brain injury plan and made a public call for evidence in 2022. Unfortunately, that work was interrupted somewhat by the general election. It has been picked up by the current Government, who say they will publish such a plan; it is nearly the end of the year, and I hope they are not going to break that promise, and add to the list of the many other plans that they have delayed. Will the Minister tell us when the plan is going to be published? When it is published, will it include the evidence given in response to the 2022 public call for evidence by so many stakeholders, charities and other relevant organisations?

What should that plan contain? I will look at it from the perspective of this Government, who are looking for the three shifts in healthcare. First, they want to move toward prevention. It seems sensible to prevent brain injury in the first place, if we can, and we know some things that we can do. When I was a teenager, horse-riding and skiing were usually done without helmets; that would be very unusual now. We have not been so successful with cycling: people know that wearing a helmet is wise, to prevent brain injury, but if we looked outside into Parliament Square, we would see lots of cyclists, many of whom are not wearing a helmet that could protect them from brain injury. What are the Government doing to make people more aware of ways that they can protect themselves from brain injury? Concussion management guidance for those taking part in elite, amateur and school sport is important, as others have said today.

Stroke is a form of acquired brain injury and I spoke to representatives of the Stroke Association earlier this term. They talked about two things that can help to prevent or limit brain injury from stroke: first, blood pressure checks and identifying previously undiagnosed hypertension, and secondly, mechanical thrombectomy, which limits the injury that occurs.

The previous Government rolled out blood pressure checks to thousands of pharmacies across the country. Will the Minister update us on what further steps have been taken to identify undiagnosed hypertension since she came into office? The previous Government also began to roll out mechanical thrombectomy. I understand that this Government intend to ensure that a universal service for that technique is available by Easter next year. Essentially, mechanical thrombectomy is when an interventional neuroradiologist takes a wire into the vessels, floats it up into the brain and mechanically removes a clot. It is particularly helpful for people who have had a large stroke where the damage is not yet complete in the brain. Damage can be limited significantly by the use of that very clever procedure.

Earlier this week, I was kindly invited to visit the mechanical thrombectomy service in Romford and see the work done there. I was told about the delay that can occur due to inter-hospital transfer. The Minister, in response to written parliamentary questions, has talked about what constitutes a universal service: it is being able to access a service within four hours. One limit to that ability, as I understand it, is that when someone who has had a stroke attends a hospital that does not offer a mechanical thrombectomy service, the time it takes to transfer them to a hospital that does, after acceptance for the process, affects people’s ability to have that lifesaving in some cases, and certainly disability-saving, treatment.

When I was a junior doctor, I was lucky enough to care for people taking part in the total body hypothermia for neonatal encephalopathy trial—the TOBY trial. Essentially, we took babies who had suffered a brain injury around the time of birth and cooled their whole body to reduce the brain injury that they suffered. That was very effective, and became standard practice. What is the Minister doing to help people who want to do research into other ways of reducing brain injury? How is she helping with research, and what is she doing to sponsor it?

What work is the Minister doing with the social care teams at the Department for Education? One of the sad things that I have seen during my time as a consultant paediatrician is children with inflicted injury—particularly babies. In many cases their injuries should have been preventable because those families were known to social care before the injury occurred. What is being done to protect those extremely vulnerable children? There are other causes of acquired brain injury too. Could the Minister talk about what she thinks the most important causes are and what she and the Government are doing to reduce their incidence?

The other shift that the Government want is from hospital into the community. I was lucky to meet Headway Lincolnshire this week, which told me that there were only 12 in-patient beds available for acute brain injury rehab across Lincolnshire. That is not sufficient. When the charity provides counselling services, it has to do so online from outside the county because there is no one available in the county to provide them. What is the Minister doing to ensure that there is good neuro-rehab across the country, including in rural areas? Also, what is the Minister doing to make sure that rehab is long term? Neuro-recovery takes a long time. It is not just a case of a couple of appointments on leaving hospital; it needs to be over a more sustained period.

For people suffering complex injury, there are many professionals involved. Some people will have a physio, an occupational therapist, a speech and language therapist, nurses, doctors, carers and many others. NICE’s new neuro-rehab guidelines, published in October, talk about how it is difficult for patients to negotiate that, and they recommend a single point of contact. Does the Minister plan to ensure that that NICE recommendation is delivered? If so, how and when?

I would like to pay particular tribute to a young lady I met recently who is one of my constituents. She experienced a traumatic brain injury as a child, but with her determination, great family and community support and rehab, she has made a good recovery and is training as a nurse so that she can help others who suffer as she has. She is an incredibly impressive young woman. She highlighted to me the need for better rehab and school support. I urge the Minister to ensure that they are delivered.

The final shift that the Minister has talked about is from analogue to digital. Digital offers us huge capacity in rehabilitation from acquired brain injury. I talked to a gentleman who had had a stroke and was admitted to a rehab unit where he got involved in Wii Fit—a Nintendo game from some time ago. He was using it along with another person who was recovering from a stroke at the same time, and they became very competitive at these balance and movement games. That really helped them to recover. What is being done to make rehab more fun or competitive? Some of the exercises that people are asked to do can be quite difficult. How can we make them more enjoyable? There are apps available to improve communication, memory and fine motor skills, and virtual reality can help with cognitive rehab. How is the Minister ensuring that those are available to all who would benefit from them?

In summary, we need a detailed plan looking at prevention, acute treatment and rehabilitation. I hope it will not be delayed in the same way as all the other Government plans seem to be. I also hope that it will contain a delivery chapter that sets out not just what the Government want to do, but how they want to do it and when they want to do it by. Will the Minister confirm whether the relevant workforce will be included in the plan, or whether we will have to wait for the long-delayed workforce plan? Neuro-rehabilitation is really difficult, but many people show huge courage and determination in their work to rehabilitate. We need to support them in every way that we can.

14:43

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on securing this important debate on an issue that touches many thousands of lives across the country. I acknowledge and thank all hon. Members for the stories of their constituents that they have shared today.

I begin by paying tribute to the right hon. Gentleman and the all-party parliamentary group for acquired brain injury for shining a light on what has too often been an invisible issue. Through its recent report, “Right to Rehab: The Cost of Acquired Brain Injury to the UK Economy”, the all-party group, ably supported by the UK Acquired Brain Injury Forum, has demonstrated both the human and the economic imperative for action. That report reveals the staggering £43 billion annual cost of ABI to our economy. It makes a compelling case for improved rehabilitation, cross-Government co-ordination and investment in specialist services. That work has helped to drive vital conversations across health, justice, education and beyond to ensure that people living with ABI are no longer overlooked.

Recently, I was delighted to be able to attend and speak at the UKABIF annual ABI summit last month, where I met key stakeholders, including people with lived experience, for a panel discussion on the stage and at a separate meeting afterwards. I have taken away some important calls for action from those discussions. The Government have also listened to the calls of the all-party group and others for a dedicated plan. I reassure the right hon. Member for South Holland and The Deepings and others that we remain committed to delivering on that promise.

In the coming months, in the first half of next year, I confirm that we will publish the acquired brain injury action plan, a landmark step in delivering the joined-up approach that people with ABI deserve. I also confirm that when we publish it, that plan will draw on a wide range of evidence, including the evidence that was submitted in the 2022 call for evidence. The plan will set out clear priorities across health, social care, education, justice and beyond in a bid to move towards rehabilitation and long-term support being better embedded throughout public services. It will reflect continuing engagement with clinicians, charities and people with lived experience. It will provide the blueprint for improving outcomes, reducing inequalities and supporting independence.

[Sir John Hayes]

All the Minister has said so far is incredibly welcome. On ministerial engagement, given what she said about the cross-departmental working, which I called for earlier, is she engaged with the Ministers in those Departments in drawing up the plan and, if so, how?

[Ashley Dalton]

I am just coming to that, so the right hon. Member’s intervention was very timely. As has been highlighted, the plan matters, because ABI is not just a health issue; it touches education, employment, justice, work, benefits, housing, homelessness and many other areas of life. Without co-ordinated action, too many people will continue to fall through the gaps.

In the first instance, therefore, I have started conversations with ministerial colleagues who have responsibility for education at the DFE, for the criminal justice system at the MOJ, for housing and homelessness at the Ministry of Housing, Communities and Local Government, and for work and benefits at the Department for Work and Pensions. The Department also reached out to those working on transport, sport and defence, among others, asking them to commit to tangible actions in the ABI plan. I note the suggestion of my hon. Friend the Member for Bury North (Mr Frith)—he is no longer in his place—and we will give that consideration.

The plan will build on already excellent work that is going on across Whitehall, helping to tackle the impacts of ABI directly or indirectly. That includes the Ministry of Justice’s update to its new neurodiversity action plan; working with the Department for Transport on its road safety strategy; the Department for Education’s planned consultation on an updated version of supporting pupils with medical conditions at school; and the Home Office-led work to tackle domestic abuse.

I also confirm, as was raised by the hon. Member for Bath (Wera Hobhouse), that the Government are committed to advancing research into ABI in sport. We recognise the significant impact of sports-related head injuries on long-term health outcomes. Through the National Institute for Health and Care Research, we are co-funding a major initiative, the UK traumatic brain injury platform. In addition, the Department for Culture, Media and Sport established the concussion in sport research forum, in which we are working alongside them.

We recognise that developing the plan is taking slightly longer than we had originally wished, but I reassure right hon. and hon. Members that that is not because of a lack of commitment; it is because we want to get it right. We want to take ABI stakeholders with us and to set the plan against the new health and social care landscape described in this summer’s 10-year health plan. In Manchester last month, I had the opportunity, as I said, to hear directly about potential solutions and opportunities from those at the coalface.

ABI affects every facet of life, and creating a plan that truly delivers requires co-ordination across multiple Departments and extensive stakeholder engagement, as well as alignment with wider reforms and developments such as the 10-year health plan, neighbourhood health services, new NICE guidance on rehabilitation and NHS England’s recently refreshed service specification for adult neurology services. That will mean that, although the report may be slightly delayed, it will have a comprehensive cross-Government approach to drive real change by improving rehabilitation, reducing inequalities and supporting people with ABI to live independent and fulfilling lives.

I know that the all-party group, the right hon. Member for South Holland and The Deepings, my hon. Friend the Member for Hartlepool (Mr Brash), and the Lib Dem spokesperson, the hon. Member for Mid Sussex (Alison Bennett), all recognise that rehabilitation is the cornerstone of recovery and independence. Reports from the APPG and UKABIF have made it clear that timely, specialist rehabilitation can transform lives. Rehabilitation is what turns survival into quality of life, enabling people to return to work, education and their communities. The APPG has consistently championed a statutory right to rehabilitation because it knows that too many people face fragmented services and missed opportunities, and as a result their health deteriorates once they are back in the community.

What the final action plan will say on community rehabilitation will be worked through carefully with stakeholders and with NHS England to ensure that we get it right. We must ensure that our proposals are feasible and viable. However, at the absolute minimum, it will highlight the new NICE guidelines on rehabilitation, setting the expectation that the NHS should take these into account, as well as showcasing the best practice that already exists.

Many hon. and right hon. Members raised data sharing. I am keen to pursue better data sharing on ABI across Departments and the NHS to ensure that our response is joined up and that it improves patient identification, care and support. Rehabilitation is a central focus of our 10-year health plan, which recognises that timely, high-quality rehabilitation reduces long-term disability, improves quality of life and saves significant costs for both health and social care. By embedding rehabilitation into integrated care pathways, expanding community-based services and investing in specialist multidisciplinary teams, the 10-year health plan will ensure that support is available when and where it is needed, including for people who have experienced ABI. That commitment reflects a shift towards person-centred care, helping people to regain skills, to return to work or education, and to live fulfilling lives after serious illness or injury.

Through the 10-year health plan, we are introducing neighbourhood health centres and deploying multi- disciplinary teams to provide holistic support to people with conditions like ABI. We know that every ABI journey is different, and recovery depends on care that reflects individual needs, goals and circumstances. That is why the plan promises to expand personalised care approaches, giving people a say in their care. We commit, therefore, to providing 95% of people with complex needs with a personalised care plan by 2027. That means that people with ABI will benefit from structured and co-ordinated support that is tailored to their needs. The expansion of personal health budgets outlined in the health plan will give people greater flexibility, choice and control over their care.

Our digital transformation commitments will make a real difference too. By improving data sharing between health, social care and rehabilitation services, we can ensure continuity of care and avoid delays. Digital care plans will allow patients and professionals to track progress and adjust goals in real time. Those innovations mean more personalised and co-ordinated care. I am really keen to explore better data collection and sharing between the NHS, patient groups, researchers and those with lived experience across my long-term conditions portfolio, which includes ABI. There are ongoing discussions within the Department on how we might be able to improve the quality of, and access to, health data. I know that there is some great data out there, but too often access to it is too restricted.

The Government will publish the 10-year workforce plan in spring 2026. This will set out action to create a workforce that is ready to deliver the transformed service set out in the 10-year health plan.

My hon. Friend the Member for Blaydon and Consett (Liz Twist) mentioned mental health. NHS talking therapies have a specific pathway for people with long-term physical health conditions, including ABI, and all ICBs are expected to expand services locally by commissioning NHS talking therapies services integrated into physical healthcare pathways, including those for ABI.

Together with the ABI action plan, the 10-year health plan and the 10-year workforce plan will represent a step change in how we support people with ABI. The action plan will deliver a joined-up approach across health, social care, education, justice and beyond, ensuring that rehabilitation and long-term support are no longer fragmented. The 10-year health plan complements this by embedding personalised care planning, expanding community rehabilitation and harnessing digital innovation. These commitments will mean better access to timely, tailored services, improved continuity of care, and a focus on independence and quality of life. By working collaboratively across Government, the NHS and stakeholders will turn these plans into action and deliver the outcomes that people with ABI deserve.

I have covered as many issues as possible. There are some that I do not have immediate information about, but I will write after the debate to the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), about her question on mechanical thrombectomy. By working together right across Government and making sure we have joined-up data and joined-up thinking, we will bring forward the action plan on ABI in the first half of 2026 to deliver the outcomes that people with ABI deserve and need.

14:56

[Sir John Hayes]

This has been an extremely good debate. Contributions from across the Chamber have illustrated how strongly Members feel about the need for exactly the kind of strategy that the Minister has confirmed the Government will introduce. It is welcome that the Minister has recommitted to that plan. I offer thanks and a warning. The thanks are because she clearly understands and takes this seriously. The warning is that if we do not see the plan, we will be back, and next time we will be altogether more fierce.

While we have been debating these matters, tens of people, scores of people, have been admitted to hospital with an acquired brain injury—extraordinary. I can tell from all the contributions, including from my great friend on the Front Bench of my party, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), and from Members across the House that the plight of those with ABI is our cause and their needs are our mission. Let us do all we can to ease their plight and meet their needs.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a comprehensive acquired brain injury action plan.

Seafarers’ Welfare

Thursday 4th December 2025 Westminster Hall

[Sir Christopher Chope in the Chair]

13:30

[Jen Craft (Thurrock) (Lab)]

I beg to move,

That this House has considered seafarers’ welfare.

It is a pleasure to serve under your chairship, Sir Christopher. The UK is an island nation. Our history and economy have been defined by maritime trade. That is certainly true in my constituency of Thurrock. Part of our local identity is shaped by our position as a key port in the Thames estuary—from the instrumental role Thurrock played in the D-day preparations to the arrival of the Empire Windrush at Tilbury to help to rebuild the nation in the post-war period.

The shipping industry has driven economic growth. The port of Tilbury in my constituency, and the nearby London Gateway, act as key links in the supply chain that keeps our country moving, bringing significant investment and economic opportunity into the region. Some 95% of this country’s goods and services arrive by sea, with Thurrock’s ports receiving more than 65 million tonnes of cargo a year to quite literally keep our country moving.

It is easy to forget the people at the heart of the industry: the seafarers who staff the ships to bring goods to our shores. Their impact in Thurrock and the country as a whole is profound. More than 160,000 seafarers work in the UK shipping industry. Without them, and international seafarers, our supermarket shelves would be empty within seven days. As we enter the run-up to Christmas, the busiest time of the year for the shipping industry, many of us will be opening presents brought here on ships.

Yet the workforce are often overlooked. Seafarer charities call this phenomenon sea blindness—out of sight, out of mind. They remind us that welfare standards slip when no one is watching, particularly aboard deep-sea vessels. Many workers live in cramped conditions, performing physical roles with limited opportunities for rest. When crews are small, long shifts mean that sleep deprivation and chronic fatigue are common. This can be incredibly dangerous, especially when staff are handling complex machinery. It also drives poor mental health among crews. Loneliness and isolation are common, as they are separated from their families for often months at a time.

[Apsana Begum (Poplar and Limehouse) (Lab)]

The Queen Victoria Seafarers Rest, established in 1843, has a long history of serving those in need, both on land and at sea, including through its accommodation centre in my constituency, which is a safe haven for many hundreds of active and retired seafarers, including from the Somali community, who are in need of a home. Will my hon. Friend join me in paying tribute to Alexander Campbell, who is in the Public Gallery and who leads a fantastic team? Does she agree that although charities are central to meeting the statutory obligations to seafarers, they are underfunded, and that we need to address the deep inequalities in the provision of seafarer welfare at UK ports?

[Jen Craft]

I thank my hon. Friend for her intervention. I will come on to talk at length about the charitable contribution made by organisations such as the Queen Victoria Seafarers Rest. I am familiar with its work in her constituency and in mine. I do not think we can overstate the contribution that organisation makes to the welfare of seafarers, and to maintaining the shipping industry as a whole.

Mental health among crews is at a low and, tragically, suicide rates are higher among seafarers than among the wider population. We must do a much better job of supporting seafarers and ensure that they receive the same support as our domestic workforce. The Government have a key role to play in that.

The Employment Rights Bill is a critical step, paving the way for a legally binding seafarers’ charter that will help to root out poor practice in the industry. It aims to limit maximum periods of work at sea, improve safety training and strengthen laws around mandatory rest. Importantly, the Bill also combats unacceptable fire-and-rehire cycles. Trade unions such as the RMT have shone a light on these issues and stood up for British workers when they have been at the sharp end of the practice in the past.

The challenge now is to ensure that our interventions make a real difference for workers. If international partners are able to sidestep their obligations, UK nationals will lose out. We must not allow a situation in which the welfare and pay protections afforded to British seafarers put them at a competitive disadvantage.

It is encouraging to see our Government working to combat the issues, teaming up with signatories to the international maritime convention to drive up standards together. Tackling abuse and malpractice in the seafarer sector will, however, require a co-ordinated international approach. I would welcome any update from the Minister on engagement with our international partners to that effect.

Next year, new amendments to the international maritime convention come into force, including measures to strengthen repatriation rights. They will be critical for seafarers. Across the world, ship owners who face legal disputes or financial challenges are abandoning vessels in ports. Crew are left without pay, food or access to vital medical equipment. The issue has grown increasingly severe, and 2024 was the worst year on record, with more than 2,000 seafarers left to fend for themselves. Many have family at home who rely on their income. When a ship is abandoned, whole communities suffer.

The issue is more common abroad, but the UK has been affected on several occasions. Even when vessels are not abandoned, seafarers may find themselves stuck for weeks following ship arrests. This has happened several times in my constituency, with a notable incident at Purfleet-on-Thames last year that also highlighted why port-side support services are so important.

Several charities do excellent work in this space, including the Queen Victoria Seafarers Rest and the Merchant Navy Welfare Board. I offer my thanks for their tireless efforts, and for the tireless work of their volunteers—especially those who serve in my constituency at the Queen Victoria Seafarers Rest in Tilbury. I am incredibly impressed by their support for seafarers who come into port. They offer a brilliant service, including port transport, free wi-fi and fresh food. They also run a bar, host social events and assist with safeguarding concerns when necessary.

The latest Seafarers Rest project, wrapping 3,000 Christmas presents for seafarers, is well under way. I was pleased to lend a hand last month. Every seafarer receives either a hat, scarf or pair of mittens; SIM cards so that they can contact their family; a little bit extra and a chocolate bar. Importantly, they all receive a handwritten card thanking them for their efforts, on behalf of the people who are on the receiving end of all their hard work. For many people, this is the only Christmas present they will get.

While I was at the Seafarers Rest, one of the volunteers shared the story of a sea captain who came to visit. He was 17 the first time he went to sea, and he spent Christmas away from home. He was Norwegian, and he went to a similar set-up—not in this country but abroad—and was given a Christmas present. He still remembers it and still has the woolly hat that someone, somewhere knitted for him. He said it meant the world and lifted his spirits. So the efforts the volunteers put in do not go unnoticed, and we should all be grateful for what they do.

Unfortunately, such support is not in place across the country. Facilities like the Queen Victoria Seafarers Rest in my patch exist at only about 40% of all UK ports. Where services are available, many face financial uncertainty. Meeting their running costs can be a challenge, with most sites needing £170 a day to keep the doors open. Their funding comes from a variety of sources: funds from the Government, donations from shipping companies or port authorities, and fundraising efforts by the centres themselves. Some welfare centres have strong partnerships with the local port, but that is not the case across the board. In practice, voluntary organisations bear most of the financial burden for welfare support, relying on fundraising efforts to fill the financial shortfall and subsidise the costs that should fall to shipping companies to care for their own workforce.

There are long-term solutions that could be explored. A small opt-out levy charged to vessels entering UK ports could be a game changer. Just £50 per visit would make a significant difference. To put it in perspective, the cost of bringing a large ship into port often exceeds £100,000, so a small £50 donation would represent only a fraction of that cost.

Throughout the country, 25 ports have already implemented similar schemes, with varying levels of success. Levies have been most effective where port owners communicate with shipping companies, emphasising the importance of independent welfare support. Humber port, for example, raised over £72,000 last year by being proactive with its levy system. However, in ports where intervention is more limited, ships that often pay £100,000 or more in fees will regularly refuse to make a £25 donation. Currently, the total income generated from levies represents only 3% to 4% of the funds that UK charities require. I urge the Government to look into the idea and to work with ports and shipping companies to explore how to scale up schemes across the country.

Several other countries, including France, Germany and New Zealand, already have successful models in place. I encourage Members with significant ports in their constituencies to contact the local port authority to ask whether they would consider implementing an opt-out levy. For many vehicles, £50 represents less than 0.03% of docking costs. A levy would create a reliable, long-term funding stream for seafarers’ welfare. It would make a huge difference and give the organisations that work tirelessly to support them financial security into the future.

The Government are making historic progress on seafarers’ welfare, but it is vital that we continue to build on that momentum in ports and at sea. I look forward to the implementation of the mandatory seafarers’ charter and the Employment Rights Bill, which will deliver significant change, but we can go further in supporting the seafaring community, whose needs are often overlooked. The Government have a key role to play, working with ports, shipping companies, trade unions and international partners to drive better employment standards and improve welfare support. We must all remember what seafarers do for our country: their contribution is invaluable and cannot be overlooked.

15:11

[John Cooper (Dumfries and Galloway) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Thurrock (Jen Craft) on securing this important debate, because we are indeed a maritime nation.

Sir Christopher,

“I must go down to the seas again, for the call of the running tide

Is a wild call and a clear call that may not be denied”—

John Masefield’s poem “Sea-Fever” brilliantly captures the magnetic draw of the ocean which, as an island nation, we feel acutely. Yet to be a sailor is not for everyone. My father was a sailor all his working life—a marine engineer who qualified on steam power and ended up on jet engines. His career spanned deep-sea tankers and roll-on, roll-off ferries, and he visited much of the world—or at least sailed past it. However, the salt water in his veins was not passed down to me, for I get seasick in a bath. That does not mean that I cannot appreciate what it is to be a sailor, and I want to express how important maritime traffic is to this country.

My Dumfries and Galloway constituency has the ferry port of Cairnryan, which is a vital link with our friends in Northern Ireland. Our stunning coastline is studded with harbours—Kirkcudbright, Garlieston, the Isle of Whithorn, Port William and Portpatrick—which are used for leisure craft while the working boats win a valuable harvest of seafood from our pristine waters. Yet for all its romance, the sea is a tough place to make a living and, like all coastal communities, Dumfries and Galloway knows just how steep a price it can exact. The motor vessel Princess Victoria left my hometown of Stranraer—ironically with the motto “Safe harbour”—on 31 January 1953, but it never reached Larne. The more recent losses of the trawler Mhari-L and the scallop dredger Solway Harvester, with all 12 hands, are still raw.

Happily, support for our sailors comes from many sources, including the Mission to Seafarers Scotland and the Scottish Nautical Welfare Society, but I want to highlight the charity Combat Stress. As well as reaching out to veterans of the Royal Navy, it also helps with the mental health issues of former members of the merchant navy, which was Britain’s lifeline in wartime, and is very much the same today. As a journalist, I worked closely with the late Colonel Clive Fairweather, who was second in command of 22 SAS and commanding officer of the King’s Own Scottish Borderers. This tough infantryman was clear that Combat Stress’ outreach to the merchant navy was key. He would say:

“Worse things do happen at sea”,

acknowledging the strain that a life on the ocean waves can exert.

We all, in our comfortable lives, owe a debt of gratitude to the men and, increasingly, women who sail the planet’s one great ocean for us all. They are the ones who answer the call of the sea that was captured so well by Masefield:

“I must go down to the seas again, to the vagrant gypsy life,

To the gull’s way and the whale’s way where the wind’s like a whetted knife”.

15:14

[John McDonnell (Hayes and Harlington) (Lab)]

I genuinely congratulate my hon. Friend the Member for Thurrock (Jen Craft) on securing the debate, which she introduced eloquently. I refer to my entry in the Register of Members’ Financial Interests: I am the convenor of the RMT parliamentary group.

I want to start by referring to the loss of life in the Royal Fleet Auxiliary. A few weeks ago, we lost a crew member. The Royal Fleet Auxiliary has civilian crew; they are not Royal Navy, but they work alongside it. During a debate a few weeks ago, we were passed a note saying that one of our RMT members had lost his life overboard. I can now say that his name was James Elliott. On behalf of us all, I want to repeat our condolences to his family. I also pay tribute to the RFA for the essential role it plays alongside our Royal Navy and the work it does in protecting our shores. These are civilian crew. There was some confusion on the day, because the BBC reported that it was a member of the Royal Navy. It is important that we improve communication, because that caused some distress among a number of families who were trying to find out what had happened.

I met some RFA-RMT representatives today, who asked me to raise the fact that in the defence review there is a reference to the Royal Fleet Auxiliary that is causing some confusion about the role it will play and what investment there will be. I ask the Minister to pass on to his colleagues in the Ministry of Defence the message that the RMT would welcome a meeting with the Secretary of State or a Minister as soon as possible to discuss the defence review.

As my hon. Friend the Member for Thurrock said, one of the issues is that seafarers’ welfare is directly related to the conditions of their employment, which are governed by the International Labour Organisation’s maritime labour convention. That is the primary legislation that sets out legal standards for seafarers. In this country, the UK Maritime and Coastguard Agency is the competent authority for ensuring that every UK vessel, or vessel entering our ports, complies with that legislation. There are specific legal responsibilities under the convention on welfare standards.

As my hon. Friend said, we have 160,000 seafarers—unfortunately, fewer and fewer are British, but that is the overall number. They work on UK and internationally flagged ships in UK ports. At the moment, there are 120 Maritime and Coastguard Agency staff who undertake surveys and inspections. Last year, they undertook about 2,800 inspections and 3,000 surveys on UK-flagged ships, and 1,500 port state control inspections on international ships. There are 100,000 vessels calling into UK ports every year, and there is a real concern that, with so few staff, the ratio of inspections for the ships is insubstantial. For some time now, there have been calls for an increase in resources for the Maritime and Coastguard Agency.

My hon. Friend raised our concern that, for the last 40 years at least, there has been a tendency for shipowners to flag elsewhere, rather than the UK, with the aim of reducing labour costs. They do that, as my hon. Friend said, by putting pressure on the workforce. The number of ships registered elsewhere is startling. The practice of registering under a flag of convenience has begun to dominate the industry. Ships are registered in places such as Panama, the Marshall Islands, Liberia, Cyprus, the Bahamas and Malta, and that undermines the ability to maintain standards of basic welfare for seafarers. Huge numbers of ships are registered in the Philippines, Indonesia, China, India, Ukraine and Russia. Some of those countries undertake no inspection of their vessels whatsoever. They fail to manage welfare standards, which has resulted in a reduction in those standards and even, as my hon. Friend said, in tragedies, because of the pressure the workforce are under.

Like my hon. Friend, I welcome the fact the Government are seeking to address a range of these issues. The mandatory seafarers’ charter that has been introduced in the Employment Rights Bill is a huge step forward for us, and I congratulate the Government on it. The charter arose, as my hon. Friend said, partly out of the P&O scandal, whereby P&O just sacked its entire workforce. That was a scandal recognised across the House, and it should not have happened. P&O sacked its entire workforce, introduced agency staff on lower wages with no holiday or sick pay, and paid the minimum amount that it could possibly get away with. Exactly as my hon. Friend said, that means that those agency staff are working under intense pressure, which inevitably has consequences for safety.

Safety is one of our main worries, which is why the mandatory seafarers’ charter is so important. It was introduced to protect seafarers in the short-sea ferries sector, regardless of their nationality or the flag of the vessel they work on. It will cover standards of pay, roster patterns and other employment conditions through collectively bargained standards in the industry. It will also set out maximum periods of work at sea and minimum periods of rest, which is absolutely critical. There will be robust requirements to manage seafarer fatigue, which is an issue that my hon. Friend raised so forcefully. It will reinforce training requirements for operators, such as familiarisation with the vessel, to support safety and skills, so that the seafarers have the time to understand and appreciate what is needed on a particular vessel. There will also be strong standards of sick pay, holiday pay and pension rights, which is vital.

This charter is a major breakthrough, and the unions really welcomed it. Progress is being made and at the RMT union executive meeting this morning we discussed that. The RMT welcomes the detailed consultation that will take place in the coming months and the roll-out of the charter itself.

However, I will now raise the issue of discrimination within the sector. I have been involved in this campaign for nearly 30 years, but the issue has gone on for 50 years. It remains legal to practise nationality-based pay discrimination against non-EU nationals working as seafarers on UK-flagged ships. That is a discriminatory practice. It originates in part 9 of the Race Relations Act 1976, which explicitly permits racial discrimination against seafarers recruited overseas to work on UK-flagged ships for lower pay and longer periods than UK nationals.

Way back in 2009, I was involved in the fight against this discrimination. Gordon Brown’s Labour Government initiated the Carter review to make recommendations on ending discriminatory seafarer pay differentials. Susan Carter, who led the review, recommended in 2010 that nationality-based seafarer pay differentials should be prohibited on all UK ships. The proposal was supported by the union, but unfortunately it was rejected by the Conservative and Liberal Democrat Government who came into office in 2010.

The estimate emerging from surveys by the union is that tens of thousands of seafarers working today in the UK shipping industry are paid less than UK seafarers, simply because of their nationality and the flag of the ship that they work on. This situation impedes progress to improve seafarer welfare overall, both at the national level and the international level. The UK Government introduced secondary regulations in 2011 to do the bare minimum to avoid legal action by the European Commission over the continued practice of nationality-based pay discrimination among seafarers. I attended the Committee that agreed those regulations. They have been subject to two reviews that have never been concluded, which contravenes the post-implementation review regulations for a review to be carried out every five years.

Another consultation was held just before the 2024 general election, and the current Government are now seeking to reconsult. With one action—one effective piece of regulation—we as a Government could end nationality-based pay discrimination on UK-flagged ships. It would raise welfare standards in shipping and reinforce our country’s reputation as the gold standard in seafarer welfare and maritime safety provision. I urge the Government to act on this swiftly.

My hon. Friend the Member for Thurrock mentioned support for charitable organisations and others in supporting seafarer welfare and the potential of a levy. Levies operate very successfully in many other countries. The Maritime and Coastguard Agency and the Merchant Navy Welfare Board have recommitted themselves to joint working on seafarer welfare and met last month to do that, which we welcome. However, without the resources, effective action will be very limited.

We have looked at what has happened elsewhere. Levy systems, including mandatory payments, are used by other maritime nations. They fund seafarer port facilities. We have heard some fantastic examples of those today. In New Zealand, the then Labour Government introduced a mandatory levy to fund shore-side facilities in 2022, which influenced the thinking in Australia as well. In Europe, France has operated a mandatory seafarer welfare levy system since 2016, and there are levy systems in Germany, Spain and Romania. It is critical that we introduce such a system.

One example of the issues that we are increasingly dealing with at the moment is the abandonment of seafarers. They are recruited in one country, reach our country and then abandoned by the ship owners. That is happening more frequently across the globe. Yes, we can legislate for protections as best we can, but we need the wherewithal—the resources going into the charities and agencies that can help those seafarers, who are lost in a foreign country and bereft of support. Overall, a real programme of reform is needed.

Raising the issue of mental health has been one of the strong concerns within the seafaring unions. There has been report after report across the movement about mental health issues and the stress placed upon people, and the increased number of suicides taking place as a result, and it does relate to the person’s employment. If we get the seafarers’ charter operating effectively, it could transform people’s lives and take that pressure off them, as well as save people from harm and save people’s lives.

15:28

[Dr Lauren Sullivan (Gravesham) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate my hon. Friend the Member for Thurrock (Jen Craft) on securing this incredibly important debate and raising awareness of the plight of seafarers. She spoke with heart about the unseen strain and pressure on seafarers. I hope that, in some small way, this debate can help to shine a light on those issues.

The UK’s history can be viewed through the lens of the river and the sea. A main artery of the lifeblood of this island nation flows through my constituency of Gravesham: the Thames. Trade, travel, tourism and troops have flowed up and down the Thames since pre-Roman times and the river still shapes Gravesham today. Many of us have personal connections with the sea, and my household is no different. My late father-in-law worked for long periods of time on the sea laying underwater cables, which put a strain on his family.

Aside from the River Thames’s history, and all the people who have sailed and worked on it, it provides job opportunities for local businesses, employment, leisure and tourism. The Port of London Authority in Gravesham works safely around the clock so that one of the UK’s busiest ports flows without becoming gridlocked. It has a vision of the future where a trading Thames is the key commercial hub for the UK; of a destination that people can enjoy and where they can play and live; and of a natural Thames. All those things require the support of seafarers—those highly skilled professional men and women. I have also seen the immense work that goes on, day in, day out, to keep the river moving and keep it safe.

At this point I wish to pause and pay tribute to the Royal National Lifeboat Institution. My local branch in Gravesham, despite some recent criticisms, is essential and has helped so many who have fallen into the water. The RNLI’s mission is simple: to save lives at sea. My heartfelt thanks go to it.

This debate is for all those who work, sail and live on the sea and the river. I am hopeful for the future of the Thames and for the agenda to modernise it, invest in it and prepare it. We must ensure that the people working to deliver the growth that our country desperately needs are supported. I recently met a group of young apprentices who have started their working-age life with the sea and the river. There is pressure to ensure that the seafarer job is well protected so that as the ambitions of those apprentices grow, our country matches that ambition with the job that they look to flow into. Our country desperately needs that. My plea to the Minister is to hear the concerns that have been raised. I hope that we can help protect and support seafarers in the future.

15:31

[Alison Bennett (Mid Sussex) (LD)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Thurrock (Jen Craft) for securing this important debate, and for setting out why this issue matters.

Three years ago, the country watched in disbelief as P&O Ferries carried out one of the most disgraceful attacks on workers’ rights in recent memory: 800 loyal seafarers, men and women who had given years of dedicated service, were summarily dismissed over video call—no consultation, no notice and no dignity. It was a scandal that shocked the maritime sector. It shocked people across the country and it shocked people in Sussex communities, given that at Newhaven we have our much-treasured ferry service to Dieppe—thankfully not operated by P&O.

From the moment that outrage unfolded, the Liberal Democrats were clear and principled. We demanded urgent answers from the Conservatives’ then Transport Secretary, Grant Shapps; we demanded justice for the workers and families whose lives had been thrown into turmoil; and we demanded a fundamental change to ensure that nothing like that could ever be allowed to happen again. Hard-working seafarers and their families should never suffer because of corporate neglect or corporate greed.

In the months that followed, we pressed the Government to tighten the rules around how ships that are registered to operate in the UK treat their workers. We supported the Seafarers Wages Act 2023 as a necessary first step. It requires ships that make frequent calls at UK ports to pay at least the UK national minimum wage for time spent in our waters, but we also made it clear that the Act did not go far enough.

We have championed the calls of maritime unions and the UK Chamber of Shipping for stronger safeguards: measures to stop companies engaging in port-hopping to dodge basic obligations; collectively agreed standards on roster patterns, pensions, crewing levels and training; and tougher enforcement so that operators cannot simply ignore the law with impunity. After all, laws mean very little if bad employers know that they can bend or dodge them entirely, and we now know exactly how determined some operators have been to do just that.

In 2024, it was revealed that P&O’s replacement agency workers were being paid just £4.87 an hour—a shocking, exploitative wage that made a mockery of the protections that Parliament had tried to strengthen. Later, when the then Transport Secretary, the right hon. Member for Sheffield Heeley (Louise Haigh), rightly described P&O Ferries as a “rogue operator”, the Prime Minister dismissed her concerns to protect a £1 billion investment by P&O Ferries’ Dubai-based parent company. Once again, workers’ rights were treated as secondary.

Of course, public outrage did have consequences. In August 2025, Peter Hebblethwaite, the chief executive officer, who admitted to breaking consultation law, finally resigned. But accountability for one individual is not enough; we need systemic change. No worker, whether on land or at sea, should be discarded at the convenience of their employer.

That brings me to the Employment Rights Bill, and in particular the provisions on fire and rehire. The Liberal Democrats welcome the parts of the Bill that strengthen protections for workers and curb the disgraceful practice of firing staff, only to rehire them on worse terms. Under the Bill’s provisions, dismissals will be deemed automatically unfair unless an employer can provide clear evidence of financial difficulty and show that changes were truly unavoidable.

The Bill represents progress and it moves us in the right direction, but large parts of it are unfinished and critical details have been left to secondary legislation or promised consultations, including a long-awaited seafarers’ charter. That does not give workers or responsible employers the stability and certainty that they deserve. People whose livelihoods depend on those reforms should not have to cross their fingers and hope that the details are sorted out later.

Unions are rightly concerned about carve-outs that may allow companies on the verge of collapse to bypass protections. We accept that businesses face genuine existential threats, and sometimes they need flexibility, but we must ensure that exceptions are not exploited by those who simply want to trim costs at the expense of their staff. Workers must not be treated as disposable.

As the Bill gives Ministers new powers to implement international maritime conventions and a seafarers’ charter through secondary legislation, we must insist on ambitious and enforceable standards, including on maximum periods of work at sea and minimum periods of rest, as well as measures to manage fatigue, strong training requirements and protections that cover every seafarer who works in our waters. We need not just vague promises but real rules with real enforcement and consequences for those who break them.

[John McDonnell]

I welcome the hon. Lady’s engagement on this matter and the list of issues. Those issues will be subject to consultation, which will be part of the negotiation. I want to reassure her that the RMT strategy is usually not just crossing its fingers.

[Alison Bennett]

I thank the right hon. Gentleman for that reassurance.

An issue too often overlooked while talking about seafarers is their mental health, as the right hon. Gentleman drew to our attention in his contribution. We know that life at sea can be tough, isolating, demanding and physically and psychologically draining: long stretches away from family, stress, exhaustion and the unique pressure of maritime work all take a heavy toll. Seafarers rely on the NHS for mental health support, just like anyone else, but our NHS is in crisis after years of Conservative neglect. Mental health waiting lists have spiralled, and thousands of people are waiting months, and sometimes years, for the care they urgently need. That includes the people who keep our essential maritime supply chain moving.

Liberal Democrats believe that mental health must be treated with the same seriousness and urgency as physical health. That is why we are campaigning for regular mental health check-ups at key life points, just like blood pressure or eyesight checks. We are also calling for prescriptions for people with chronic mental health conditions to be free on the NHS, because we believe that no one should have to choose between treatment and financial strain. We will also create a statutory, independent mental health commissioner to advocate for patients and their families and carers. Those reforms matter for everyone, but are especially vital for communities such as seafarers, who often face some of the toughest working conditions.

The P&O Ferries scandal was a turning point. It exposed deep flaws in our system—in employment law, in enforcement, and in the way that successive Governments have allowed bad employers to exploit loopholes at the expense of ordinary workers. It also presented us with a choice: to accept this broken system or to build something better. The Liberal Democrats would choose to build something better. We choose fair pay, safe working conditions and dignity at work. We choose an NHS that supports people’s mental health properly, not one that is forced to ration treatment. We choose an economy where responsibility, fairness and respect guide the way businesses operate. Britain can be better than P&O Ferries’ behaviour—and Britain must be better. I look forward to hearing from the Minister on how the Government aim to chart a course towards that destination.

15:39

[Greg Smith (Mid Buckinghamshire) (Con)]

It is always a pleasure to serve under your chairmanship, Sir Christopher. As an island nation, Britain has always been reliant on our sailors, as other Members have said. For centuries, we have depended on them to protect our nation, to transport goods around the world and to deliver the products of our national endeavours across the seas to other countries.

The continued significance of maritime trade to our economy cannot be overstated. Of all international freight traded with the United Kingdom, around 85% by weight and 55% by value is moved by sea. Our seafarers also play a vital role in connecting communities across the United Kingdom, whether that is in our Scottish islands or the Isle of Wight, where my hon. Friend the Member for Isle of Wight East (Joe Robertson) has introduced proposals around fares on ferries, demonstrating that those services remain essential to our national fabric.

Even for those of us representing constituencies that could not be further away from the sea—Mid Buckinghamshire proudly holds the title of the second-most landlocked constituency in the country—the importance of the maritime sector to the UK’s past, present and future prosperity is abundantly clear. I therefore thank the hon. Member for Thurrock (Jen Craft) for securing this debate. It is right that we recognise the work of the estimated 23,700 UK seafarers active at sea, according to data from 2024, whose skill and dedication power this indispensable industry.

Understandably, the debate has referenced the actions of P&O Ferries in 2022. For all who observed that situation, the conclusion was unmistakeable: P&O’s decision was wrong. That is why the then Secretary of State for Transport, Grant Shapps, condemned it in the strongest possible terms. Indeed, during my time on the Transport Committee in the last Parliament, we heard very detailed evidence—often difficult to listen to—about the scandalous and wholly inappropriate behaviour of P&O. As the Minister will know from his briefings, the last Government acted swiftly in response. It is worth briefly reflecting on those steps, as they represented meaningful progress in protecting seafarers’ rights and, therefore, as the right hon. Member for Hayes and Harlington (John McDonnell) said, their welfare.

First, the Seafarers Wages Act 2023 ensures that those working on ships that provide a regular international service from the United Kingdom are paid at least the equivalent of the national minimum wage while operating in UK waters. This reduces the incentive for operators to employ overseas labour on worse terms and conditions—although I heard the arguments put forward by the right hon. Gentleman and the discrimination that he highlighted, which is still a wrong to be righted.

[John McDonnell]

I was elated at first to attend a Statutory Instrument Committee dealing with these matters, until I discovered that the Government had redefined the nature of British waters. Restricting the measure to UK waters was even less effective.

[Greg Smith]

The point of my comments on the actions of the previous Government is not to say that they were wholly conclusive and the end of the matter. But I believe the steps that were taken by the previous Government did demonstrate a step forward, as I think the right hon. Gentleman acknowledged in the debate—perhaps not the entire length of step that he would have preferred.

[John McDonnell]

It was like pulling teeth.

[Greg Smith]

I heard the reference that the right hon. Gentleman just made.

Secondly, the last Government introduced a statutory code of practice on fire and rehire that was intended to ensure that employees are properly consulted and treated fairly. Importantly, it included powers for employment tribunals to increase compensation by 25% where an employer unreasonably fails to comply. Thirdly, the start of the seafarers’ charter was launched, with operators including Brittany Ferries, Condor Ferries, DFDS, Stena Line and, at the time, even P&O was committing to work towards meeting the requirements of that charter. The charter placed seafarers at its heart, from ensuring they are paid equivalent to the national minimum wage throughout their engagement, to establishing two weeks on, two weeks off tour of duty baselines on high-intensity routes, and providing appropriate training and development opportunities.

Crucially, the charter also committed to providing social security benefits, such as sickness benefits, family benefits and medical care, and adopting roster patterns that properly account for fatigue, mental health and safety. That demonstrated a clear commitment to ensuring that seafarers’ welfare is not an afterthought but a priority. The framework further made it clear that, where provisions differed from those mandated in the maritime labour convention 2006 or any other standard, the higher standard would apply. I acknowledge that progress. Many Members rightly believe that more remains to be done. It is therefore appropriate to turn to the measures set out in the Employment Rights Bill that returns to the House of Commons next Monday.

Some hon. Members will know that I had the good fortune to sit through the 21 Committee sittings on that Bill as a shadow Business and Trade Minister, speaking for the Opposition on its many and varied proposals. During that process, we saw the ever-expanding scope of Government intervention illustrated vividly, with the Bill growing from an initial 149 pages when first introduced to 320 pages the last time it left the House of Lords.

Some Members may ask why that matters. As I said on Report, although the Bill contains many good and well-intentioned measures, the Government have struggled to get the balance right between the rights of employees and the needs of the employers who create the jobs in the first place. When it came to provisions relating specifically to seafarers, such as changing collective redundancy notification requirements for ship crews, the Opposition did not oppose them. Indeed, I explicitly recognised their relevance in preventing the sort of unacceptable conduct we have seen in the past. However, we also flagged concerns. For example, the Bill grants the Secretary of State broad powers to detain a ship without clearly defining how long the detention could last. That is a perfect illustration of the need for balance. We must uphold the highest standards of seafarer protection while avoiding measures that may deter responsible businesses from operating in the United Kingdom.

That links to a broader point recently emphasised by my party. One of the most important ways to protect workers’ rights is to ensure that people remain in work. We can and should tackle fire-and-rehire practices, but if we overburden the economy with excessive taxation and growth-suppressing regulation, the outcome will be the worst of all worlds—fewer jobs and weaker protections.

With UK unemployment having risen by 0.9 percentage points since the election and reached an estimated 5% by September 2025, we cannot ignore the reality that the welfare of workers, including seafarers, depends on the Government restoring economic stability. We owe it to seafarers to create an economy in which their livelihoods are secure and not vulnerable to the Chancellor’s mismanagement. Ultimately, I welcome all sensible and proportionate measures that prevent scandalous behaviour and advance the welfare of seafarers, because our maritime workers deserve nothing less.

15:48

[The Parliamentary Under-Secretary of State for Transport (Keir Mather)]

It is a pleasure to serve under your chairmanship, Sir Christopher. Before I thank my hon. Friend the Member for Thurrock (Jen Craft), I pay tribute to Lord Prescott, whose unfortunate passing was just over a year ago. Beginning with his career as a trade union official in the National Union of Seamen, and then as Deputy Prime Minister and in his work on transport, he was a defiant champion of the rights of seafarers right across the country. He was—how shall I put it?—a salty sea dog to the end and passionately defended workers’ rights in a sector that he cared about so dearly.

I thank my hon. Friend the Member for Thurrock for bringing forward this important debate. I commend her for her thoughtful remarks and her continued advocacy on behalf of her constituents, seafarers and those who support them.

Growth is this Government’s No. 1 priority. The maritime sector not only powers that mission, but is critical in delivering the goods and materials that people across the UK rely on in their everyday lives. As we approach Christmas, I hope we can take the time to appreciate our maritime workforce—their skill and hard work will mean that our tables and our stockings have everything we need for a very merry Christmas—while also recognising that lots of merchant seafarers will not be home themselves this Christmas, and the toll that takes on their families and their mental health. My grandfather on my mother’s side served in the merchant navy for 50 years, so my family is extremely cognisant of that.

I am delighted to hear about the incredible work of the Queen Victoria Seamen’s Rest in Tilbury in supporting those men and women. I again thank my hon. Friend the Member for Thurrock for supporting the Queen Victoria Seamen’s Rest and for highlighting its important work here in Parliament. The Seamen’s Rest has a long and fascinating history. It has always been there—for more than 180 years, I believe—to support seafarers and provide them with accommodation and welfare. I have not yet had the opportunity to visit the centre at Tilbury, but I am aware of the work that the Seamen’s Rest has done through its centres to ensure that hard-working seafarers have well-deserved facilities and support when visiting ports across the UK.

[Jen Craft]

I extend an invitation to the Minister to visit the Queen Victoria Seafarers Rest at Tilbury with me in the near future, if possible.

[Keir Mather]

In the Christmas spirit that we are experiencing in Westminster Hall today, how could I refuse? It would be wonderful to visit. I look forward to continuing to learn about the work of the Seamen’s Rest, not only in Tilbury but at its centres in Immingham, Felixstowe, Bristol and other places.

I thank my hon. Friend the Member for Poplar and Limehouse (Apsana Begum) for inviting those from the Queen Victoria Seamen’s Rest to join us in the Public Gallery, because it gives me an opportunity to place on the record my thanks and gratitude to its chief executive, Alexander Campbell, for all his hard work to pilot his organisation. I thank him for the enormous difference he will make to seafarers’ welfare across the UK, not only at this time of year, but year round.

The Government are undertaking wide-ranging work to enhance the support that we give to seafarers’ welfare charities. We have grants that provide a scheme called MiFi, which is about giving wi-fi access to seafarers in the United Kingdom. We have a vehicle replacement programme for the Merchant Navy Welfare Board to ensure that seafarers can get to where they need to receive support, and the Maritime and Coastguard Agency sits on the board of the Merchant Navy Welfare Board to provide a crucial link between these charities and Government.

I will go into more detail on the remarks of my hon. Friend the Member for Thurrock, but I want to acknowledge that we have more progress to make in the space of levies being paid when ships make port in the United Kingdom to contribute towards seafarers’ welfare. It is extremely encouraging to see how many ports have adopted that on a voluntary basis, but we always want to push to go further. She made an important point about international co-operation, and I was pleased—as I am sure was my right hon. Friend the Member for Hayes and Harlington (John McDonnell)—to meet Nautilus and the RMT only yesterday to discuss some of the obligations through the International Labour Organisation. I will come to that in greater detail in a moment.

The hon. Member for Dumfries and Galloway (John Cooper) spoke of the tragedies that have affected his constituency and reminded us of our obligation and duty to improve the welfare and safety of our seafarers—that is a duty for every generation lucky enough to have the privilege to serve in government. Being a native son of Hull, it would be remiss of me not to mention that we approach the anniversary, in January and February, of the triple trawler tragedy in 1968, when we lost three Hull trawlers, the St Romanus, the Kingston Peridot and the Ross Cleveland, with an enormous loss of life. That started a campaign in Hull for improved safety at sea, with dedicated radio equipment on every ship, which was pioneered by Lillian Bilocca, a pioneer in seafarers’ rights. She pushed Harold Wilson’s Labour Government to make those important changes for seafarers’ welfare, and we carry that legacy forward today.

Turning to the remarks of my right hon. Friend the Member for Hayes and Harlington, as I said, it was a pleasure to meet the RMT yesterday. We have an urgent need to protect life at sea, and I join him in sending condolences to James Elliott’s family. I thank everyone in the Royal Fleet Auxiliary; they work so hard to keep our nation safe. I will be certain to pass on to the relevant Minister my right hon. Friend’s request for a meeting with the Ministry of Defence.

My right hon. Friend also made an important point about nationality-based pay. In June 2025, the Government published a post-implementation review that recommended an amendment to the regulations, which currently allow nationality-based differential pay. Officials are progressing this work and aim to publish a consultation in spring next year, and we look forward to the RMT’s contribution.

My hon. Friend the Member for Gravesham (Dr Sullivan) pointed to the incredible work of the RNLI, and I too will take the opportunity to champion its work. I also place on the record my thanks to the Port of London Authority for the work it does to encourage safety on the River Thames in the areas where it has a footprint. Robin Mortimer and Jonson Cox do a lot of work in that space. When I visited, they made important points about pilot safety and about minimising the health impacts of the strain on pilots as they go out to make sure the largest ships can dock in our country.

The Opposition spokesperson, the hon. Member for Mid Buckinghamshire (Greg Smith), despite having the second most landlocked constituency in the country—I think Selby might be somewhere on that list as well—raised some very important points. He spoke about having a competitive tax regime to encourage foreign direct investment and to encourage shipping operators to use the United Kingdom. The tonnage tax regime that we have in the United Kingdom is seen as competitive in attracting that investment.

I am glad that the shadow Minister recognised the wrongs that were committed during the P&O saga, but he also highlighted the positive work that there is to do in relation to people and skills. I believe that enshrining in the Employment Rights Bill the rest and fatigue management provisions he spoke of is integral. I hope that his passion for maritime allows him to overcome some of his other doubts and to support the Bill as it makes further progress through Parliament.

I now turn to the points made by the hon. Member for Mid Sussex (Alison Bennett). We are expanding the scope of the Seafarers Wages Act through the Employment Rights Bill, which will include additional powers to regulate safety, including through roster patterns, fatigue management and training, as well as remuneration beyond just pay in UK waters. That will deliver on our promise to create a mandatory seafarers’ charter. We will be consulting on the use of those powers in 2026. In the light of the hon. Lady’s remarks and those of my right hon. Friend the Member for Hayes and Harlington, I am certain not to be remiss in ensuring that the consultation is as robust as possible and that our trade union colleagues are able to play their full part in it.

The Queen Victoria Seamen’s Rest is one of the many charities that support seafarers both domestically and internationally, but that work is spearheaded by the Merchant Navy Welfare Board. Raising the standards of seafarer welfare is a priority for the Government. That is why earlier this year the Maritime and Coastguard Agency launched The Seafarers’ Charities Forum, which aims to boost welfare through the exchange of information between the MCA and seafarers’ charities. We hope that will enhance mutual understanding of current initiatives, regulatory developments and welfare programmes, as well as identify opportunities for strategic alignment and joint action to improve seafarers’ living and working conditions. I commend all who are involved in that important initiative.

The Government are committed to growth, but none of the growth opportunities that we have will be realised without high standards of welfare for seafarers, in the UK and internationally, which is why we are ambitious about strengthening their rights. As I said, the Employment Rights Bill will improve employment protections for seafarers with a close connection to the UK, and protect the pay and working conditions of those working on services calling frequently at UK ports. That will build on the voluntary seafarers’ charter that was launched in 2023, under the previous Government, and we are working with a number of major operators to roll it out across their services. That will really help to raise standards, but it is voluntary, which is why we want to seek powers in the Employment Rights Bill to have a mandatory charter.

On international engagements, we are proud to have supported the amendments to the maritime labour convention that were agreed in April, but there is more work to be done in that space, and we can do it.

I want to pause at this point to record the thanks of the House and, more importantly, of seafarers around the country and far beyond for an organisation whose work is pivotal to the welfare of seafarers: the Marine Accident Investigation Branch. The MAIB continues to provide an essential service to seafarers. Its reports, which are of the highest quality, have saved countless lives over the years and ensure that the sector learns the lessons of the regrettable incidents that do still occur.

The MAIB is a vital component in the constellation of organisations that support the sector and one to which I am proud to put my name, but I am equally proud of the other ways that my Department supports the sector. One example, which I have alluded to, is our continued support for the MiFi project, which enables seafarers visiting UK ports to connect to the internet so that they can remain in contact with friends and family in their home countries. I am also pleased that we continue to fund the Merchant Navy Welfare Board’s vehicle replacement programme to make sure that seafarers can get to where they need to go.

I thank my hon. Friend the Member for Thurrock and other colleagues for drawing the House’s attention to the important but oft-neglected issue of seafarer welfare. Since becoming maritime Minister, I have been struck by the dedication and skill of those who work in the sector, and I believe that, working together with parliamentarians, colleagues across Government, industry partners and our wider social partners, we can make a positive impact on the lives of those who serve at sea. I again thank my hon. Friend for raising this issue and I commend everyone who has taken the time to take part in this debate.

16:00

[Jen Craft]

I thank everyone who has taken part in the debate. The 3 pm shift on a Thursday is not a great one, especially when we are low on numbers, so I am grateful to Members for being here.

I offer my thanks to all those who go to sea. The hon. Member for Dumfries and Galloway (John Cooper) spoke eloquently about the call of the sea, but also its inherent dangers. My right hon. Friend the Member for Hayes and Harlington (John McDonnell) highlighted a specific example. The loss of James Elliott brings home the real dangers for those who make their living at sea and the debt of gratitude that we all owe them. My right hon. Friend also spoke about flags of convenience, which is a real problem and an issue when it comes to investigating crimes at sea. For example, sexual assault against female seafarers is on the increase, but women often fail to find the justice they need. Perhaps that is something we can pursue.

I thank my neighbouring MP, my hon. Friend the Member for Gravesham (Dr Sullivan)—we are separated by only a body of water—for raising the work of the RNLI. I am incredibly grateful for the work that it does saving lives at sea. Without its vital voluntary contribution, I am sure the lives of many more who make their living at sea would have been lost. I welcome what the Minister said about looking at how we can promote the levy system and take it further. That is one thing that would make a real difference to onshore welfare provision for seafarers.

The Minister also updated us on some of the work he has been doing internationally, particularly in looking at reducing the pay differential between UK-based seafarers and others. I look forward to working with him and colleagues to make sure that those who make their living on the sea, to whom we all owe a debt of gratitude, receive proper remuneration and thanks from the nation.

Question put and agreed to.

Resolved,

That this House has considered seafarers’ welfare.

16:02

Sitting adjourned.