Batten Disease

Chris Bryant Excerpts

Monday 22nd July 2019 Commons Chamber

[Seema Kennedy]

I pay tribute to my hon. Friend for all the work she has done as a clinician. I can only say again—I know this is very disappointing for the House—that we have to rely on the NICE process to be independent. I hear what the House is saying about some people having doubts about the process, but, again, it is under review. NICE is internationally respected, and it has been going for 20 years. Yes, these are exceptionally difficult cases, but this is why, as custodians of NHS funds, we have to be very careful, because every pound we spend on one drug is a pound we cannot spend on another. I hear what my hon. Friend says about this being a life-changing drug, and I hope that BioMarin, NHSE and NICE will, and we would urge them to, carry on with their negotiations.

[Chris Bryant (Rhondda) (Lab)]

There can be very few things as painful for a parent as knowing, once their child has been diagnosed, that there is potential treatment out there that may make a radical difference to their life, and it feels as though some bureaucrats—whether or not they are medical bureaucrats—are saying no. These little things in my hand, which would not have been prescribed for me if I had gone to the doctor a year ago, now cost £7,000 a month to the NHS, and I am delighted that I am able to receive them. However, I do want to make sure we have a proper system to ensure, for the most rare conditions, that there really is a possibility of making things available.

There may be only three dozen cases in the UK at the moment, which means there are probably about 900 in Europe, and if we include the Commonwealth, probably several thousand more. Why do we not have Governments in the world sitting round the table together with people from the pharmaceutical companies, who are not the baddies in this—these are the people, I think including the hon. Member for North East Somerset (Mr Rees-Mogg), whose investment made these pills available for me, in part; investment in these pharmaceutical companies is a good thing—to make sure that more of these rare—disease conditions can be treated?

[Seema Kennedy]

We are determined to improve treatments for people living with rare diseases. As the hon. Gentleman pointed out, they have to be treated differently because fewer people are affected by them. We have the rare diseases strategy, and we are trying to use genomics better to diagnose and treat diseases. We are trying to be the first health service to put genomics into day-to-day health delivery, which will enable us to diagnose and treat diseases such as Batten more quickly. We have care co-ordinators for patients with rare diseases and we are trying to ensure that those who live to adulthood are cared for better, but what the hon. Gentleman said about having an international approach is valid.

Non-invasive Precision Cancer Therapies

Chris Bryant Excerpts

Thursday 18th July 2019 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

I completely concur with what you just said, Madam Deputy Speaker. My hon. Friend the Member for Blackburn (Kate Hollern) made a very warm and touching speech, which only reinforces the point made by my hon. Friend the Member for Easington (Grahame Morris) that so many people have been touched, in many cases very painfully, by cancer.

My anxiety is that a growing crisis in cancer care is coming in this country. The worst of it is that we may not spot it, because our cancer survival rates are, of course, improving, which is brilliant. Doctors and scientists—pathologists and so on—have done an amazing job in recent years in managing to keep many more people alive, and in this country in particular we have done well, but frankly we started from a very low base compared with other countries in Europe and around the world. I am painfully conscious of that in relation to Wales.

I make no partisan point here, but I will criticise what we are doing in the Welsh NHS at the moment. I do so not out of partisan anger, but simply because we need to get this right. The truth is that cancer survival rates will improve, but not as well as they could do if we managed to get several things right. We have to persuade more people, particularly from poorer backgrounds, to go to the doctor when they have suspicions about their condition. We must also persuade more doctors, particularly those in poorer backgrounds, to refer people on when they think there might be a suspicion of cancer. It is still worrying that, in my patch in south Wales, we still do not refer on enough people, so that they end up being referred much later, when they are in the later stages of cancer. The most galling thing of all for anybody is when they hear, “Well, it’s just a little bit late. If only you had come six months, three months or even four weeks ago, you would have been at stage 2 or stage 1.”

The truth is that we are failing at the moment in the UK, and particularly in Wales. The diagnostic teams in Wales are in far worse nick than they are in Australia, Poland, Scotland, the best area in England, which is the north-east of England—ironically—and the worst area in England. Nine out of 10 consultant radiologist vacancies in Wales have been unfilled for more than a year. We need 105 more radiologists by 2023 if we are to meet the growing demand for CT and MRI scans, which has risen by a third in the past three years. Thirty six per cent. of Welsh consultant histopathologists are over 55 —that is much higher than in the rest of the UK—17% of whom are locums, which means that we are paying agency staff over the odds and therefore wasting NHS money.

UK-wide, only 3% of path labs believe that they are adequately staffed at the moment. This is not to attack the Government in any way, but simply to say that we have to recruit more people. In relation to radiotherapy, the Velindre Cancer Centre in South Wales, a wonderful centre, has a target of seeing and treating 98% with radical radiotherapy within 28 days, but that has not been met in any month in the past year. In January, the figure was just 63%. Why does all this matter? It is because time is of the essence when it comes to cancer. Long waits for biopsy results are absolutely terrifying for the individual, but they may also mean that the treatment is delayed, which makes it less effective than it might be. We could save more lives if we had more people working in these services.

--- Later in debate ---

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

I want to begin by thanking the hon. Member for Easington (Grahame Morris) for introducing the debate and all Members who have spoken today, particularly the hon. Member for Blackburn (Kate Hollern), who spoke movingly about her late partner, John. His example lives on through his two beautiful daughters—my beautiful cousins—who, too, have dedicated their lives to public service. I am happy to reassure all Members that I am very happy to meet the all-party group—fingers crossed—and if I fail to address any of the points made today, I will try to address them at that meeting.

Cancer is a priority for this Government, and we have got survival rates up over the last 10 years, but there is a lot more to do. In the long-term plan, we state our aim to have 55,000 more people surviving cancer for five years by 2028. Four in 10 NHS cancer patients are treated with radiotherapy, so clearly radiotherapy is a really important part of the mix. I did not know about that until I met members of the APPG. I want to thank them for the manifesto that they presented to me, which I have read with interest and am happy to respond to.

NHS England announced a £130 million fund, which the hon. Member for Easington mentioned, to start a programme of modernising LINACs and giving patients access to leading-edge technology, regardless of geography. I will come on to the specific point raised by the hon. Member for Westmorland and Lonsdale (Tim Farron), because we share Rosemere as a cancer centre.

Since 2016, we have seen more than 80 machines either upgraded or replaced, with the aim of giving cancer patients access to the latest technology, regardless of where they live. The long-term plan specifically promises

“Faster, smarter and effective radiotherapy”,

with an aim of providing curative treatment, with fewer side effects and shorter waiting times.

Members mentioned the facilities at the Christie Hospital. Some of my constituents go there as well. The good thing is that previously some people had to leave the country, but at least now people are able to be treated in this country. The first treatment was last December. Work continues on the University College London Hospitals proton beam therapy centre, which we hope will be opened next year.

[Chris Bryant]

I commend the Minister for everything she has said, but it is slightly easier to put new kit in and build new buildings than it is to develop new staff. The biggest difficulty is with the number of radiologists and the whole staffing element. I wonder whether she could co-operate with colleagues in Wales, because this is a UK-wide issue.

Acquired Brain Injury

Chris Bryant Excerpts

Tuesday 2nd July 2019 Westminster Hall

[Chris Bryant (Rhondda) (Lab)]

I beg to move,

That this House has considered acquired brain injury.

You might have noticed, Mr Rosindell, that we have considered this matter once or twice already over the past year or two, but today we are looking at some specific elements of acquired brain injury. As all right hon. and hon. Members will know, brain injury can relate to so many parts of Government: the Ministry of Defence, the Department for Work and Pensions, the Department for Education, the Ministry of Justice, the Home Office and so on. Today we have the Health Minister before us, so I am keen to focus on health-related issues.

I know that many right hon. and hon. Members will have been approached by the Headway charity, clinicians who work in their area, patients or carers of people who have suffered a brain injury, and will want to make a contribution, so I do not intend to speak at great length. I am passionately conscious of the fact that, since I first became involved in this issue in Parliament three years ago, I have met so many amazing people—not only clinicians and people who work in the charity sector, but patients who have had brain injuries and spoken about what that experience is like. It is so important to hear that experience directly from individuals.

One particularly poignant aspect of brain injury is that in the vast majority of cases it is completely invisible. Yesterday, I met Tom Hutton, who is here—I know we are not meant to refer to the Public Gallery, Mr Rosindell, but I have already and have got away with it. He was training on his bike for an Ironman a few years ago and had a collision with a small lorry. He was in an induced coma for a week. There is not a mark on his head. No one who saw him at work or in the street, including a Department for Work and Pensions assessor, would have the faintest idea that he had had a brain injury, or an injury of any kind.

The fascinating thing he spoke to me about is that he has to talk to himself all the time. One symptom of brain injury is phenomenal fatigue, and if the sufferer does not see the fatigue coming, they can experience phenomenal depression, or dysphoria, as it is called.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I warmly congratulate my hon. Friend not only on securing this debate, but on his fantastic campaigning work in this area. On the symptoms being invisible, Departments, particularly the Department for Work and Pensions, cannot pick up precisely how such injuries affect day-to-day life, and that needs to be improved.

[Chris Bryant]

Yes. The all-party parliamentary group on acquired brain injury—I see that two of the vice-chairs are in the Chamber—has been campaigning to ensure that everyone who does any kind of assessment for the Department for Work and Pensions, whether for personal independence payments, the employment and support allowance, or any other benefit, has a full training in acquired brain injury, so that they understand the variable nature of the condition.

One element of the personality change that may come about is that somebody with a brain injury might be desperate to please the person in front of them, so they might want to give what they think is the “correct answer” to the question being asked by the official. That can give a misleading idea of what that individual’s abilities are.

I have not asked Tom whether it is all right to say all this today—I see that he is nodding, so it is fine. When the Duracell battery inside someone’s head is running low, they talk to themselves to try to re-energise it, but that uses even more energy. That can lead to a vicious cycle: further depression and anxiety makes it more difficult to recharge the battery, in turn making it more difficult to get better.

There are others who have had much more dramatic and traumatic injuries, perhaps where something has penetrated the skull. However, in the vast majority of cases, the injury will be inside the brain. A fundamental part of what we have to address is how the mind and the personality sit inside the brain. Right hon. and hon. Members might have seen the television series “MotherFatherSon”, which deals with someone who has had a massive aneurysm and then a stroke. Lots of things in the programme are not entirely accurate, but many families and individuals have to cope with the very real element of personality change. I met a wonderful woman three months ago told me that she wished that her old self would come back. She could remember what her old self was like, but it is not the person she now is. She just does not know how to recreate that personality inside herself. Again, it is this thing of talking to yourself all the time.

If there has been impairment of the executive functions due to a brain injury to the frontal lobes, particularly in teenagers or as the young brain is still developing, it can lead to all sorts of other problems in terms of employability, and being able to engage with the wider world and their family. Sometimes people share far too much information; sometimes they are far too timid about being able to share information.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

On that point about sharing, as I told the Chamber in the debate on 9 May, my wife suffered from a meningioma. As I think the hon. Gentleman mentioned, a certain fretfulness can come into the character. On sharing, perhaps it is because I live in such a remote area, but I am surprised those who have come through the treatment are not encouraged more to share their pre-operative and post-operative experience with people who are suffering or are about to have a medical intervention, because it would give them great courage and help.

[Chris Bryant]

Yes, that is true. Because of the pattern of brain injuries across the country, it may be difficult for people to gather with people of a similar age and background. Lots of people with brain injuries arising from road traffic accidents are quite young—in their teens or early 20s. Sometimes they get put into support groups with people in their 60s or 70s. That is not an impossible combination, but sometimes it is not the most natural grouping for those with a much longer life expectancy.

The most difficult element for a lot of people is the significant impairment in their ability to speak and communicate. Speech therapists are an essential part of the mix in bringing people back to a degree of independent living after a significant event. One worry across the whole of the UK is the shortage of people working in this field, who sometimes do not feel as valued in the team as they might. We need to ensure that speech and language therapy is still available for some time after someone has had their immediate intervention.

One of the most common things that people tell me is that they are accused of being drunk, when in fact they have difficulty speaking properly because they have had a brain injury, not because they are a bad person. They feel the sense of stigma that attaches to not being able to speak as clearly as they might have been able to before their brain injury.

[Bill Esterson (Sefton Central) (Lab)]

My hon. Friend mentions that people can have the appearance of being drunk. My 15-year-old adopted son’s mum drank heavily while she was pregnant with him, which is where he acquired his brain injury. The most recent research suggests that every year tens of thousands of children are born in this country with foetal alcohol spectrum disorder; it is a spectrum, as the description implies. It is a massive problem, and it leads to the kind of emotional and behavioural difficulties that my hon. Friend will be familiar with from speaking to those who have had acquired brain injuries later in life. What are his thoughts on what is needed to address the numbers of people who have brain damage through their lives?

[Chris Bryant]

My mother was alcoholic. I do not know whether she drank during my pregnancy—[Laughter.] Was it my pregnancy? I mean before I was born. I am painfully conscious of how difficult it is for women who are alcoholic to stop drinking when they are pregnant. The message about the dangers of drinking during pregnancy has been out there for a long time, but we still have remarkably little in the toolkit for dealing with alcoholism in this country. Broadly speaking, it is still about the 12-step process, which has a very low success rate in comparison with other therapies and which relies on surrendering to a higher being, albeit not necessarily a religious one. It just does not work for an awful lot of people. The syndrome that my hon. Friend refers to is much more prevalent than we realised even 10 years ago. Further research is going on, and we need to ensure that it is fully understood across the whole educational spectrum, as well as the health spectrum.

[David Simpson (Upper Bann) (DUP)]

Does the hon. Gentleman believe that brain injury in children and young people requires a different approach from how we handle adult brain injury?

[Chris Bryant]

There are specific issues that affect children. It is a profound source of depression to me as a Labour Member and a socialist that a child from a poorer background is four times more likely to suffer a brain injury before the age of five than a child from a wealthy background. We need to look at all the elements that lead to that, because prevention is far better than cure. I have spoken in other debates about issues that relate particularly to education, including the importance of schools having as full an understanding as possible of how brain injury can affect a child. All the statistics now indicate that every primary school class in this country has at least one child who has had a significant brain injury, although many of them may be undiagnosed. That is an issue for every single school in the country, and I do not think that we have fully taken it on board yet.

The experience of having had a brain injury often includes the sense of being pushed from pillar to post in the health system and in the organisations that the state provides. An element of that is inevitable, because something fundamentally chaotic is being brought into an ordered system. That is how it feels to the individual, too: they knew what their life was, and then suddenly—nearly always completely out of the blue—something has happened to radically change their life and their family’s lives, perhaps permanently. All too often, however, families have to fight for every single bit of support from the national health service, the local authority, the education system or wherever.

If there is one thing that I hope will come out of all the work that we have done in the all-party group, it is that we can change that feeling of having to fight for every single element. So many patients have told me, “If I could devote all my energy to getting my brain better, rather than fighting for support, I would be a useful and fully functioning member of society. I would dearly love to be that person again.” If there were any way in which all the arms of the state could fully recognise that factor, that would be something that we should dearly hope for.

The charity Sue Ryder does an awful lot of work with people who have had brain injuries and other neurological conditions. It reckons that 15,000 people who have had acquired brain injuries are now in generalist older people’s care homes, which are probably not the places to get the right support, but are the only places available. Sue Ryder is aware of at least 515 people who are placed out of area, a long way from home, which means that all the support systems that they might have through family, friends and so on are simply not available or are extremely expensive because of the travel.

We really have to do far better. The Minister is very good on the subject—I have talked to her several times—but the tendency in the NHS and in Government circles is to put a positive gloss on everything and stress all the good things that have happened. I understand that, but we are still a long way from achieving what we all want, and what the people we are talking about deserve.

The national clinical audit of specialist rehabilitation produced a report earlier this year—it has not yet been discussed in Parliament—on all the specialist rehabilitation around the country. Somebody who has had a major traumatic brain injury, or a brain injury caused by factors such as carbon monoxide poisoning, may at first need four or five people to feed them, clothe them, wash them and provide all the basics of their daily life. However, effective neuro-rehabilitation over a sustained period can and often does mean that they need just one person—or, in an ideal world, it gives them back the independent life that they had before, in as large a measure as possible.

The good news from the report is that the rehabilitation prescription that the all-party group has discussed is being steadily rolled out across the whole country. That means that patients and their families can say, “This is what we know we should be getting—we want to make sure that we are getting it.”

[Lilian Greenwood (Nottingham South) (Lab)]

I congratulate my hon. Friend on securing the debate and on his speech. Does he share my concern that neuro-rehabilitation in the UK is particularly limited for children? There is just one option for in-patient neuro-rehabilitation and post-hospital discharge, which is run by the Children’s Trust in Surrey. Should not every region have a paediatric neuro-rehabilitation pathway, rather than the patchy and underfunded set of services that we have at the moment?

[Chris Bryant]

My hon. Friend is absolutely right. Indeed, I know of a case that makes that point extremely keenly, where a young lad ended up having to go from south Wales to Surrey. Obviously in south Wales we love visits to Surrey, but it is a phenomenal cost for the family to have to visit their child there every week because it is the only facility in England and Wales. There is also an emotional cost in being a long way away and not being able to see their child every day. We really need a string of these paediatric services across the whole country.

One of the great successes that the Government have introduced in the past few years is the major trauma centres, which are now saving many more lives—at least 800 more a year. People who would have died of brain injuries are now alive. However, the national clinical audit has found that only 40% of those who were assessed at the major trauma centres as needing in-patient rehabilitation actually got it. That means that across England and Wales we are probably about 330 beds short. We have to strive to get those beds and make sure that nobody fails to get the in-patient rehabilitation that they need, not least because rehabilitation works. According to the audit, 94% of those who got the rehabilitation that they needed ended up able to live far more independent lives.

The net saving to the public purse from rehabilitation is significant. Extrapolated over a patient’s lifetime—in many cases it is quite young people who have had brain injuries—the average net lifetime saving from rehabilitation amounted to just over £500,000 per patient. That means that the total savings that would be generated from just this one-year cohort of patients alone was £582 million.

Investing in the 330 beds that are needed, which might cost somewhere in the region of £50 million, would generate an enormous return for the public purse. Leaving aside the finances, there is also a moral imperative. If we can not only save people’s lives but give them back as much quality of life as is humanly possible—if we can do that medically—we should do that as a society.

The other thing that I want to say about finances concerns the injury cost recovery scheme, which is a little-known aspect of the national health service. We always say that the NHS is free, and that is true. However, under the injury cost recovery scheme, local hospitals and ambulance services can reclaim an element of the cost when an individual has had an insurance claim met. The scheme was last reviewed in 2003, but in 2018-19 the sum total brought in by all the hospitals and ambulance trusts in England, Wales and Northern Ireland was £200 million, which is not an insignificant amount of money. In April, the amount that hospitals and ambulance services can charge was increased by the annual health and community services inflation measure, which meant that for in-patient care they can now claim £891 a day and for out-patients £725 a day. However, these amounts are capped at £5,381 a week and £53,278 in total.

These amounts need to be reviewed. There is no reason why hospitals in the NHS should not be able to claim a significantly higher amount when there are significant insurance claims. The extra money would not come out of the money won by the individual; it would come out of the money paid in legal and other costs. The average cost for in-patient care for somebody who has had a brain injury runs to something like £16,000 a week, yet the maximum that the NHS can claim from insurance companies is just £5,381 a week.

A regulatory impact assessment in 2006—the last one conducted by the Government—said that the cost to the NHS then was £170 million to £190 million. I reckon that in this financial year the figure would be more like £440 million, so yet again we have another means to find additional resources to put into these services.

I want to end with the experience in south Wales. I recognise that the Minister is not responsible for that, but a large number of people in south Wales, including constituents of mine and of other south Wales MPs, end up using English health services because we do not yet have a major trauma centre in Wales; there will be one and I hope that it will be very successful. I hope that the Minister will accept that one thing that was slightly left out of the equation when the major trauma centres network was set up was how to integrate fully neuro-rehabilitation—good, strong rehabilitation—and the whole pathway from ultra-acute or hyper-acute services all the way through to care in the community and patients returning to their home. Such integration was slightly forgotten and left to one side, which is why a quarter of major trauma centres in England still do not have a neuro-rehabilitation consultant.

I say to my colleagues in Wales: let us not make the same mistake in Wales. When the major trauma centre opens in Wales, I want to make sure that we have a fully functioning neuro-rehabilitation centre alongside it, so that every single patient who is assessed as being in need of in-patient neuro-rehabilitation will receive it and will continue to receive it for as long as they need it, so that they can return to full health. That should also apply to children and teenagers.

I say that because in the end, although I am not as religious as I used to be, I always have this little thing running through my mind, and I apologise if it sounds too religious or pious for some. Jesus said something about his having come to give people “life in all its fullness”. The sadness for me is that we are managing to save people’s lives but are then unable to give them life back in all its fullness. That is what the NHS should be about in this regard, because otherwise there is a cruelty, if all we do is save somebody’s life but do not give them life in all its fullness.

--- Later in debate ---

[Seema Kennedy]

I thank the hon. Gentleman for raising that point. I was talking to another colleague who had a brain injury just last year, and she said exactly the same thing. That was not in A&E; it was at a GP practice. There are of course training modules for GPs to access, but debates such as this one and my conversations with NHS England can only help in raising awareness. I thank the hon. Gentleman for bringing that point to my attention.

To return to the audit, its authors estimate that current provision caters for 40% of those who need the services, so there is a lot more to do. On capacity, the audit made some recommendations, including that trauma centres should review their processes and ensure that standards for rehabilitation provision and availability are met, and that commissioners should consider opportunities for development of specialist rehab capacity, both for in-patient and community-based services—a point that hon. Members have raised. These are important points. Although we only had this debate two months ago, I am glad that the hon. Member for Rhondda has raised the subject again. I will discuss with NHS England what it is thinking, what it is doing on the audit and what the next steps are. We need to impress on it the importance of bed provision.

The majority of rehab care is commissioned and managed locally and there are guidelines produced by NHS England, such as the principles and expectations for good adult rehabilitation, which describe what good rehabilitation care looks like. There is additional guidance that covers both adults and children.

Many hon. Members mentioned neuro-rehabilitation for children, and I know that NHS England is aware that there is variability in the provision for children. Best practice guidance was published in 2016, but there is always more to be done. I will take the points away and speak to NHS England. We are looking at how we can educate people on foetal alcohol syndrome, and I am happy to report back to the House on that.

The hon. Member for Newport West raised a specific issue about speech and language therapists and physiotherapists. I very much agree that we need a joined-up approach to care and I am concerned to hear that there is a gap. Members can make representations to NHS England on that. I know the situation is different in Wales, but I would be very happy if the hon. Lady would keep me informed.

The hon. Member for Rhondda raised the injury cost recovery scheme. Again, that is a matter for the DWP and I will be pressing ministerial colleagues to respond on that point. That scheme allows for the recovery of costs for providing treatment to an injured person where that person has made a successful personal injury claim against a third party. It recovers funds from insurance companies and pays into the NHS or hospital ambulance services. The current cap is around £53,000, renewed annually in line with inflation. I will follow up with more detail—the hon. Gentleman looks slightly sceptical.

[Chris Bryant]

I do.

[Seema Kennedy]

I have found it is always good to be sceptical in this place.

The NHS long-term plan was announced in January this year. There are some key actions designed to improve the care, treatment and support of people with long-term conditions, such as ABI. Community services, which play a crucial role in helping people with long-term conditions such as brain injury, remain as independent and well supported as possible and are to receive significant investment. The long-term plan set out £4.5 billion of new investment in primary and community care, including for expanded community multidisciplinary teams, providing rapid targeted support to those identified as having the greatest risks, including those with long-term health conditions.

There is also the comprehensive model of personalised care, which includes self-care, care planning, personal health budgets and social prescribing, and which we hope will reach 2.5 million people by 2023-24.

--- Later in debate ---

[Chris Bryant]

This has been a good debate and I am grateful to all those who have taken part. I am grateful to the Minister for what is, I think, her bearing down on NHS England, although she is sounding too nice about the way she is going to approach it.

[Jenny Chapman]

Nice is good.

[Chris Bryant]

Nice is good, obviously, but a little bit of bearing down is important. I am grateful to the UK Acquired Brain Injury Forum, Headway, Sue Ryder, the National Star College near Cheltenham and so many other organisations, including the Child Brain Injury Trust and the Disabilities Trust, who have done so much work in the field to inform us about a subject that was completely unknown to many of us, in the same way that it is unknown to so many members of the public.

To correct one element, perhaps we have given the impression that all is gloom. I have met so many people who have had brain injuries and whose personality change has been marked, but sometimes they have developed a phenomenally savage wit that they did not have before. There are people who have said, “Yes, it has changed me, but I have become a new person and that person can play a full part in society and has discovered other ways of appreciating life.” So let us not turn all of this into gloom. I just want us to be able to do better—to make sure that there are enough rehabilitation beds for every single person to get the improved care from which they could benefit.

I have met the deputy Prime Minister several times and I think it is really important that the Government now decide, as a matter of priority, to set up some taskforce—probably of junior Ministers, probably with this Minister at the helm—to drive forward this issue in all the different Departments that it affects. We could get the health bit right and lose out on so many other bits and, in the end, we would have failed the people we are talking about.

Who knows what will happen to the Government? Anybody who says they know what is going to happen to the Government later on this year is lying, but I wonder whether there might not be a moment now to say, “We are going to make this a priority. It is going to be a three-year taskforce and we are going to make sure that every single Department pulls its weight to make sure that we truly deliver.” As I said earlier, it is almost cruel to save lives and not give people the quality of life that they deserve.

Question put and agreed to.

Resolved,

That this House has considered acquired brain injury.

NHS Long-Term Plan: Implementation

Chris Bryant Excerpts

Monday 1st July 2019 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

Having been diagnosed earlier this year with a stage 3B melanoma, I always get a bit sweaty when people start talking about how important it is to have early diagnosis to ensure survival rates, but of course they are absolutely right. The number of people, in particular men, with melanoma is rising and people are still dying. I have heard horrific tales of people going to GPs five, six or seven times before a GP was able to send them on to see a dermatologist. I have heard about dermatologists saying, “I’ll look at this mole here, but I’m not going to look at that one because you haven’t been referred for that one. That will have to be a separate referral.” I have heard of people waiting six or seven weeks for histopathology to come back. All those things delay the process. Do we not need to have a wholesale approach to melanoma to ensure that we save more people’s lives?

[Matt Hancock]

Yes, the hon. Gentleman is absolutely right. I agree with what he says. There is a need for the whole medical profession to be constantly up to date with the latest treatment and diagnostic science. I am determined that part of the drive for early diagnosis is about not just diagnosis once referred, but better referral. We all have a part to play in that—wider society, as well as primary care.

Tessa Jowell Brain Cancer Mission

Chris Bryant Excerpts

Monday 13th May 2019 Commons Chamber

[Matt Hancock]

The hon. Lady expresses the thoughts of the whole House. She, too, has done an awful lot. I should of course have mentioned my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire), who used his enforced sabbatical from the Cabinet due to cancer to push this agenda. I add his name to the tributes. It is absolutely true that campaigners on this subject who have had personal experience of brain cancer either themselves or in their loved ones and friends, as I have, feel very strongly about it, and this is absolutely not the end of the drive. I wanted to update the House on what we have done in a year, but there is still plenty more to do.

[Chris Bryant (Rhondda) (Lab)]

Melanoma is one of the cancers that can metastasise into the brain, because it can travel either through the blood or through the lymphatic system. We also know that, although it can kill, especially in the circumstances we are talking about, it is very preventable. I just wonder whether there is not considerably more that the Government could do to ensure that every child covers up in the sun and that more people use sunscreen, perhaps by taking VAT off sunscreen that is higher than SPF30 or SPF50. We must also ensure that we have enough dermatologists in this country to check moles and other growths that people might have on their bodies.

[Matt Hancock]

Yes, I agree with all that. Of course, protection from too much exposure to the sun is part of the prevention agenda in healthcare, as well as being an absolutely sensible thing to do.

Acquired Brain Injury

Chris Bryant Excerpts

Thursday 9th May 2019 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

I beg to move,

That this House notes the report of the All Party Parliamentary Group on acquired brain injury and supports its conclusions; and urges the Government to work through all of its departments to ensure that those who have sustained brain injuries are guaranteed full neuro-rehabilitation as needed.

I rise to speak in support of the motion in my name and those of my hon. Friends, including those on the other side of the House—I see the right hon. Member for South Holland and The Deepings (Sir John Hayes) taking his place now.

Sometimes a brain injury is really obvious—jagged bone where the skull has been fractured or penetrated—but often the sheer force of the soft tissue colliding at speed against the hard inside of the skull bruises the brain, leading to a contusion or a haemorrhage that is outwardly invisible. Likewise, blunt trauma, where the head smashes into a windscreen or the road, means that the brain is pulled away from the opposite side of the skull, leading to even worse damage. The same can happen on the rugby, football, or hockey field, in the boxing ring and on the racecourse. Repeated incidents, even minor ones, can lead to chronic traumatic encephalopathy or what is often known as “punch drunk syndrome”.

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

[Paula Sherriff (Dewsbury) (Lab)]

I am sorry that I cannot stay for the whole debate but, prompted by my hon. Friend’s excellent work in this area, I recently visited the Second Chance Headway Centre in Wakefield, which supports people with brain injuries. I was struck by the spectrum of conditions that the centre deals with and by the dedication of its wonderful staff and volunteers. I encourage all Members to visit a Headway centre in their constituency, and I want to make the House aware that it operates a free helpline, which is driven by nurses, that people can call for advice.

[Chris Bryant]

My hon. Friend is absolutely right. I know that many Members in the Chamber today and others, including Ministers who are unable to participate in the debate due to their ministerial responsibilities, have also visited Headway groups in their constituencies. I have been to the group in Cardiff, which does a magnificent job. This is also about those who work in the NHS and alongside many of the voluntary organisations that do magnificent work. For many people, the work is thoroughly rewarding, because somebody can be taken from complete dependency on others to needing much less frequent support through neuro-rehabilitation, enabling them to stand on their own two feet and have the quality of life that they had before.

[Mary Glindon (North Tyneside) (Lab)]

Will my hon. Friend commend the vocational rehabilitation provided to 10 of my constituents by Momentum Skills in Newcastle? The organisation asked me to pass on its massive support for the “Time for Change” report and its recommendations.

--- Later in debate ---

[Chris Bryant]

My hon. Friend has done a lot in this field herself. She has met with that group, which has been to see us here in Parliament, and I hope that they will be taking part in our lobbying event in a couple of weeks. Next week is Brain Injury Awareness Week, which is why this is such a timely debate. Tomorrow, I am going with the hon. Member for The Cotswolds (Sir Geoffrey Clifton-Brown) to visit the National Star College outside Cheltenham, which does an awful lot of work.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I am grateful to my hon. Friend for mentioning the damage that long-term exposure to carbon monoxide can have on the brain. He knows that I was one of those who organised the seatbelt legislation 25 years ago. One of the really worrying things that the Parliamentary Advisory Council for Transport Safety found last week is that we are getting relaxed and that people are beginning not to wear seatbelts and not to put their children in vehicle restraints. If that continues, people are in terrible danger of serious brain injury or death.

[Chris Bryant]

My hon. Friend is absolutely right. One reason why carbon monoxide exposure matters so much to me is because it involves an element of social justice. Children from poorer backgrounds are four times as likely to have a significant brain injury before the age of five as those from wealthier backgrounds. We do not fully understand why as yet, and we need to do more work on that. However, it is also true that elderly people, who maybe cannot afford to have their boiler checked as often as others or may have landlords who do not check their boilers as often as necessary, may be suffering low levels of carbon monoxide poisoning over such a long period that they are not even aware that they are being poisoned. The memory loss, the fatigue and the problems they are having may be associated with their boiler rather than with anything else. We need to look further at legislation in that area.

The thing about brain injury is that it is often internal and completely unseen. It can add a whole new layer of stigma because people can often misjudge a sufferer standing in a queue in front of them or coming to work with them as being drunk. However, the reason why the person is slurring is because they have had a brain injury. That is why I and others—I pay particular tribute to my hon. Friends the Members for Blaydon (Liz Twist) and for Swansea East (Carolyn Harris) and the right hon. Member for South Holland and The Deepings—wanted to set up an all-party parliamentary group on acquired brain injury to look at the issue, which is a hidden epidemic. Every 90 seconds, someone in this country is admitted to hospital with an acquired brain injury.

The APPG produced a report because we wanted to see more evidence. The Select Committee on Health produced a report in 2001, and some of its recommendations were implemented, but many were not. We wanted to go further, so we produced the “Time for Change” report, which calls for real investment in neuro-rehabilitation. We have major trauma centres that have saved so many lives—I pay tribute to the Government for the brave decision to take them forward—but it is depressing that a quarter of trauma centres still have no neuro-rehabilitation consultant. That means that people sometimes fall between two stools when they leave the acute setting and go back to their home and to their community.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

A great friend of mine suffered a brain aneurysm, and she may not have survived were it not for the Royal London Hospital and its support. My hon. Friend makes a good point about the need for that wider specialism in other hospitals and for transition support to provide much-needed rehabilitation.

[Chris Bryant]

My hon. Friend is absolutely right. If there is one thing that I have learnt from my experience of melanoma this year—incidentally, the thing on the back of my head is not a brain injury; I am still getting over the melanoma being cut out—it is that I, as the patient, wanted to go to the real expert, and I would travel as far as I needed to do that. Sometimes in politics it is easy to join the bandwagon when people say, “No, everything’s got to be intensely local,” but the decision on major trauma centres was a brave one taken by this Government. The Conservatives are not a party that I support, but it was the right decision for saving people’s lives. We can now save people’s quality of life as well.

The APPG also called for proper return-to-school plans for every child with acquired brain injury, training for teachers, prison officers and benefits assessors, and proper protocols shared across all sports for concussion in sport.

The effects of a brain injury can be profound. Some sufferers have severely impaired physical mobility, and there can be major behavioural challenges. I have heard of patients losing all sense of inhibition, suddenly becoming tactless, using crude and abusive language, divulging private information and becoming impulsive, irritable and aggressive; or, on the opposite side, completely passive, unresponsive and lacking initiative. Others become obsessive, repeatedly checking their possessions or becoming profoundly self-centred.

[Luke Graham (Ochil and South Perthshire) (Con)]

I thank the hon. Gentleman for securing this debate. I have experienced some of the characteristics he mentions within my family—my auntie experienced a riding accident and my cousin experienced a motorcycle accident, and they both suffered brain shears. I also understand it from the experience of constituents.

Does the hon. Gentleman agree that, although trauma centres are very successful in trying to get the right expertise in the right place, they are required throughout the UK? Outreach is also required for subsequent rehabilitation, especially in rural constituencies such as mine.

[Chris Bryant]

That is one of the key points that everyone on the all-party group wanted to make. It is all very well saving someone’s life but, because we have seen so many miracles done by good neuro-rehabilitation in the community, we need to make sure it is available where people live. Otherwise we are condemning people to a half-life existence when we could restore real quality of life—they might go back to work and be fully independent.

The hon. Gentleman is absolutely right to say it is a matter of getting social care to work with NHS and getting all the different organisations to work as a whole. That is why we hope that the Government—there are signs of this, but we would like to see more signs—will not work in silos of departmental and organisational thinking. We have to think across the whole, because this affects nearly every Government Department.

Many patients lose their executive functions, so they find it next to impossible to plan, make decisions, monitor what they are doing or control their emotions—that can make it difficult even to cook for themselves. In particular, a brain injury to the frontal lobes during the teenage years, when that part of the brain is still developing, can turn a charming, ambitious and able young person into an out-of-control youngster. All too often, if the brain injury is missed or misunderstood, they get into trouble, they are excluded from school and they fall into the criminal justice system. I read Edward Timpson’s report this week. It is an important piece of work, but it is a shame that it does not mention brain injury at any point. I will be writing to him about that to see whether it is another element that we need to address if we are to stop exclusions, which are currently so prevalent.

Even a minor brain injury can lead to headaches, dizziness, fatigue, depression, irritability and memory problems. Sometimes the effects last long after the injury, and sometimes they do not even appear until some time after the injury, which makes them particularly difficult to spot.

Partners and family members have a tough time, too. The hon. Member for Ochil and South Perthshire (Luke Graham) will know from his own family how complicated it is to make sure that people get the support they need. Loved ones have the terrible fear of the unknown. What is going on inside their loved one’s head? Will the anger and frustration they seem to be suffering get stronger, or will it ease off? How much will they be able to recover their former abilities and personality? And how hard will they have to struggle to get the support they need?

In too many instances, families and patients are being pushed from pillar to post when it comes to benefits. Listen to what happened to Jordan Bell, who had a motorcycle accident some six years ago, when he was 17. The accident left him in a coma for six weeks and in rehabilitation for six months before he went home. He had to learn to walk, talk, eat and socialise all over again. I am glad to say that he has made a remarkable recovery and is now a father, but he lives with significant, serious and completely unseeable impairments.

Jordan’s father describes dealing with the welfare system as

“the most demoralising and depressing experience for us all.”

This is a professional family. The initial application for personal independence payment took six months, with interventions from the family’s MP. David Bell writes:

“A year or so after our son’s condition had improved we contacted the relevant department to advise them that he was in our judgement no longer entitled to some elements of the PIP. We were ‘quietly’ advised not to inform them of the changes at all, but as we are honest people we felt duty bound to inform them of our son’s improvement. The advice given to us was correct; instead of adjusting the PIP in what would have been a sensible way the PIP was cut entirely. This then set in motion another six months of huge effort and stress and again the involvement of our MP to get the PIP reinstated. We eventually succeeded. But two years later it was reduced again to nothing.”

I cannot emphasise enough the stress this process puts on people with ABI.

One woman told me:

“I know I should use all my energy to try and get my brain back together. But I end up spending all my energy on forms”—

filling in forms and fighting bureaucracy. An unresponsive, intransigent welfare system is effectively preventing people from healing. I beg Ministers to take this issue seriously and to make sure that all PIP advisers are trained in the fluctuating and unseeable nature of brain injury. After all, one common feature is that patients become over-keen to please people. Often, they will tell the assessor everything they think the assessor wants to hear, because that is part of the condition.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Notwithstanding what I will say later, in casework I find that a surprisingly high number of disability living allowance claimants are having the mobility element carved away as they move to PIP, perhaps because, as the hon. Gentleman says, they have exaggerated their ability to get from A to B or to move into work.

[Chris Bryant]

That specific point has not been raised with me in relation to brain injury because it is one of the seeable bits. It is the unseeable bits that are particularly difficult for PIP assessors and other assessors to get right, which is why it is important that they all have proper experience and training in assessing brain injury.

I do not want to take too much time because I know that many others want to speak, but I will refer to a few more elements, the first of which is the prisons system. All the latest research shows that a very high percentage of inmates, both male and female, have had a brain injury. One survey shows that 47% of inmates at Leeds Prison have had an ABI, and Huw Williams’s work shows that more than 60% of prisoners at Exeter Prison have had a traumatic brain injury. In both surveys, the majority of injuries occurred before the prisoner’s first offence, suggesting that the brain injury may be a key factor in why they offended in the first place. If we really want to tackle their reoffending, we will have to deal with their brain injury, too.

Research at HMP Send and HMP Drake Hall also finds that the most common way for women inmates to acquire brain injuries is through domestic violence— 45% of injuries. Again, we may be criminalising people who are actually victims. We need to get this right. If we really want to tackle reoffending, we must do a better job of recognising and treating brain injury. That means screening all new prisoners, training prison staff, providing proper neuro-rehabilitation for all prisoners with a brain injury and making special provision for women that recognises the likely different causes of their injury—particularly domestic violence.

I will not say much about education, because I know other hon. Members will. The Government have been good in responding to our report in detail, but the section of their response with which I am most dissatisfied is on education. There is a hidden problem across our schools estate, and we will store up problems for the future if we do not take this issue seriously. In particular, I urge the Government to reconsider our recommendation that acquired brain injury should be included in the special educational needs and disability code of practice.

The final area is sport. I make it clear that sport is good for people’s health, and I do not want to prevent anyone from taking part in sport. I do not want all our sportspeople and youngsters to be mollycoddled and wrapped in cotton wool, but the record on sports concussion is shockingly bad, particularly in football. I am no football expert.

[Paula Sherriff]

You don’t say.

[Chris Bryant]

All right. I am no expert, but I know about concussion in football. The last season has been especially bad. Mohamed Salah, Jan Vertonghen, David Ospina, Anthony Lopes and Fabian Schär have all been involved in high-profile, very dubious decisions by the on-pitch medics. UEFA rules since 2014 seem clear:

“In the event of suspected concussion, the referee stops the game to allow the injured player to be assessed by the team doctor. In principle this should take no more than three minutes, unless a serious incident requires the player to be treated on the field of play or immobilised on the field for immediate transfer to hospital”.

Honestly, three minutes is nowhere near enough to be able to judge whether somebody has suffered a concussion or any other kind of brain injury. Moreover, FIFA, UEFA and the Football Association have different definitions of concussion and, unlike rugby—where it is now standard that a player should be off the pitch for 10 minutes and can be replaced—football allows no subs for concussion, so all the incentive is to get the player back on and playing as fast as possible and in less than three minutes.

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

I want to end by talking about my own patch. I am delighted that south Wales will soon have a new major trauma centre at the University Hospital of Wales, but it would be cruel in the extreme to save people’s lives without ensuring that we can guarantee their quality of life. So we must make sure that when the centre opens there are proper neuro-rehabilitation services in Wales and that there is continuity of care once people leave hospital.

There is another issue for us in south Wales. In 2009, Kyle Beere was a typical healthy, intelligent, active 12-year-old—a bit too interested in fishing for my liking, but none the less. That November, he suffered a massive brain haemorrhage that left him fighting for his life. With no paediatric rehabilitation service in Wales, Kyle had to travel to Surrey for treatment. He is grateful for his treatment and his family is working all God’s hours to ensure that he gets all the support he needs. But I would dearly love there to be paediatric rehabilitation services in Wales.

Many medical miracles have been performed over the years, and I pay tribute to the doctors, nurses, scientists, pharmaceutical companies and staff who have constantly experimented and reviewed their work to see whether they can do more. I pay tribute to Chloe Hayward and everybody involved in the UK Acquired Brain Injury Forum. But we need a political miracle now.

The Health Committee produced a great report in 2001, but many of its recommendations have never been implemented. That cannot happen this time—please. We need a champion in Government to instil a real sense of urgency into dealing with brain injury: someone who can bring together all the different Departments and make them work together to deliver a quality of life that is more than just a collection of vital functions. I dearly hope that that champion will be speaking from the Dispatch Box in a few minutes.

--- Later in debate ---

[Liz Twist (Blaydon) (Lab)]

I thank my hon. Friend the Member for Rhondda (Chris Bryant) for opening the debate in such an excellent manner and the right hon. Member for South Holland and The Deepings (Sir John Hayes) for helping to secure it.

Acquired brain injury is often a hidden disability. It is so hidden that, before this all-party parliamentary group inquiry, I had failed to recognise that people I know—family members, friends and colleagues—have an acquired brain injury. Some people may have outward, visible signs of the trauma that they have been through, but for many there are no outward clues. That can mean that, instead of people recognising the disability and responding in a helpful or understanding way, they may be impatient or downright rude, or try to rush those with acquired brain injury. This may not just be the case for people we bump into; it could be the officials of one Department or another who really do not get it. For example, assessors for personal independence payment or employment and support allowance may not have sufficient understanding of the effects of acquired brain injury and fail to recognise that what may appear as a reasonable response can actually hide the reality of the disability.

It has been a real privilege to be involved in the inquiry and the report, “Time for Change”, to reach so many people affected by acquired brain injury, to hear their personal stories, to hear about the positive impact of effective neuro-rehabilitation and, sadly, sometimes to learn where such rehabilitation has not gone so well and people are struggling to cope. At the presentation of our report last year, we watched a very moving film showing people suffering from acquired brain injury describing their experiences. I found it a very moving experience that really brought home the difficulties that people can face.

The practical effects of acquired brain injury affect many areas of life, and our evidence sessions covered neuro-rehabilitation, education, criminal justice and sport-related concussion and touched on the welfare benefits system. The launch of “Time for Change” was well received, and was attended by Ministers, the shadow Secretary of State for Health and many other Members of Parliament. Most importantly, some of those who have acquired brain injury told us their personal stories. Our report made a number of recommendations in each area that we studied and, most importantly, called for Departments to work together to improve services and join things up. It was clear to us, as I am sure it will be to the House, that this is not just a health issue to be left to the Department of Health—although neuro-rehabilitation and physiotherapy, along with many other health services, are of huge importance in recovery and development—but one that needs to be joined up across other Departments.

If we are to make the real change that we have called for, we have to link up what happens in health with what happens at school, in the Department for Work and Pensions and in so many more Departments. Since the report was launched, there have been meetings with a number of Ministers, including the Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office and the Economic Secretary to the Treasury, to name but two. The Government have now responded to our report, with the Department of Health pulling together responses to our recommendations from other Departments. I will refer to one of those Departments in particular—the Department for Education—and introduce a new area that was not covered in our report but that has been mentioned today.

It becomes clearer and clearer the more we look at it that acquired brain injury and its impact spread into so many different areas of everyday life, but I will focus on education and children. “Time for Change” called for some very specific measures. As we have heard from my hon. Friend the Member for Rhondda, this condition affects many more people in disadvantaged areas than elsewhere, so it is really important that we get to grips with it. Our recommendations were fairly straightforward. Acquired brain injury should be included in the special educational needs and disability code of practice. All education professionals should have a minimum level of awareness and understanding about acquired brain injury and about the educational requirements of children and young people with this condition—for example, with the completion of a short online course for all school-based staff.

Additional training should be provided for the named lead professional who supports the individual with acquired brain injury and for special educational needs co-ordinators. We recommended that the acquired brain injury card for under-18s produced by the Child Brain Injury Trust should be promoted in all schools, hospitals and local education authorities. Many children and young people with acquired brain injury require individually tailored, collaborative and integrated support for their return to school and throughout their education. As agreed return-to-school pathway is required—led and monitored by a named lead professional—to provide a consistent approach and support for the individual, their family and their teachers. An enhanced education campaign should be implemented in schools to improve awareness and understanding of sport-related concussion, with the support of Departments.

During filming for the launch of the report, I had the chance to talk to a young man from Scotland who had returned to school following an acquired brain injury and who told me about his experience of doing so. Simple things were not happening, like making sure that he had off-white paper because the white paper was far too bright for him to be able to take in. There was also the impact of noise affecting his concentration. They were all quite small things, in themselves, that were supposed to be planned for but actually did not happen. That brings it home to us that it is those small things that can make a big difference to children.

[Chris Bryant]

My hon. Friend is making a really important point. There are two other areas where we could do more in exactly the same way. One of those is in prisons, where toning down some of the sounds and noises makes it much easier for those with brain injury, and the other is in our supermarkets. It is great that Morrisons, certainly in my patch, has an hour at the beginning of the day when the lights are a bit dimmer. It would good if all supermarkets had a similar sort of event.

[Liz Twist]

I thank my hon. Friend for those remarks; I most certainly agree. As I say, we just do not think about these things sometimes, and they can have such a huge impact in improving things for people with acquired brain injury.

I am afraid that the Government’s response in this area was rather disappointing. As in earlier answers to parliamentary questions, the Department for Education seemed just to restate the current responsibilities of schools and governors for SEND—special educational needs and disability. Our inquiry showed that there needs to be a greater understanding, very specifically, of both the presence of an acquired brain injury in young children and the practical steps needed to help staff to support these children with what is often a hidden disability. We also need greater co-ordination between health and education professionals to support children returning to school after a brain injury.

We have recently had much discussion in this Chamber and in Westminster Hall about the funding pressures on schools and the impact that that is having, particularly on special educational needs. We really have to bear that in mind. It is not enough to restate the law and the theory—the thinking—behind special educational needs and education, health and care plans, and then leave it to staff and governors who are increasingly under pressure just to hold things together at school. I would have hoped for a more positive response in this area. I hope that Education Ministers will look at it again and address the need for more practical steps to ensure that pupils have what they need to develop and be supported at school.

--- Later in debate ---

[Chris Bryant]

I will be very brief, because the next debate is also very important. I was delighted with the speeches of all hon. Members; my only complaint is that my constituency is not “Rhonda”, but Rhondda—if everybody could practise that before our next debate on acquired brain injury, I would be very grateful. I am conscious that lots of people have been watching the debate, including clinicians at the clinical neuropsychology department in Oxford and at the Child Brain Injury Trust.

There are some issues still to be tackled, including armed forces personnel, cost recovery caps for insurance companies, school exclusions, and training and recruitment to get more people working in the area. I very much hope that the new champion, who did magnificently in this debate and will do even better in the next one, will ensure that we can have a cross-departmental meeting with all Ministers who have responsibilities in the area.

Question put and agreed to,

Resolved,

That this House notes the report of the All Party Parliamentary Group on acquired brain injury and supports its conclusions; and urges the Government to work through all of its departments to ensure that those who have sustained brain injuries are guaranteed full neuro-rehabilitation as needed.

Sunbed Use: Health Implications

Chris Bryant Excerpts

Wednesday 13th February 2019 Westminster Hall

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

I beg to move,

That this House has considered the health implications of sunbed use.

It is a delight to serve under your chairmanship for the first time, Mr Hosie, and I thank my good friend the Minister for responding to this important debate.

The motion asks the House to consider the health implications of using sunbeds, but I would go as far as calling for a ban. Who needs sunbeds? No one. Many people in the UK believe that they look healthier with a tan, but that could not be further from the truth. Bronzed skin was a trend first popularised by Coco Chanel in 1923, and it has never gone away. From St Tropez to Derbyshire, a suntan continues to be a desired accessory. Over time, people have sought to maintain their tan using artificial means, including the sunbed. In the ’60s, sunbeds were developed for the first time, and in the ’80s they began to be used in large numbers. The industry continued to grow throughout the 1990s and into the 2000s. Today, an estimated 3 million Britons use sunbeds to keep themselves tanned.

According to the World Health Organisation, sunbeds are as dangerous as smoking—many people do not realise that—and in 2009 it classified them as carcinogenic to humans. Worryingly, statistics show that people who have used a sunbed at least once, in any stage of their life, have a 20% higher risk of developing melanoma than those who have never used a sunbed. The first use of a sunbed before the age of 35 increases the risk of developing melanoma by 59%.

[Chris Bryant (Rhondda) (Lab)]

The hon. Lady is making an important speech. In all honesty, I think of sunbeds as pernicious death machines. They rely on people’s vanity, but we all have elements of vanity in our lives, so let us not decry that. We should be doing far more. One hundred thousand people get a melanoma every year; it is one of the most pernicious forms of cancer, and 10,000 people die. These are death machines, aren’t they?

[Mrs Latham]

Yes. The hon. Gentleman makes an important point, and we must emphasise the fact that sunbeds are killing machines that nobody needs to use. Nobody needs a tan, and as the hon. Gentleman says, this is purely about vanity. We know there is a lot of vanity in the world, but this is a deadly vanity and it is a waste of everybody’s time and money—sunbeds are also expensive.

Dr Andrew Birnie, a consultant dermatologist and dermatological surgeon, supports the World Health Organisation classification of sunbeds as carcinogenic. He notes that

“it has been shown that the biggest cause of melanoma is high-intensity bursts of ultraviolet light on skin not used to being exposed to UV.”

The World Health Organisations has recommended that countries either ban or limit the use of sunbeds. In reality, there is no such thing as a safe tan unless it comes from a bottle or a can. Indeed, one trainee beautician, Kimberley Platt, said:

“I’m a trainee beautician and part of the course is being taught to spray tan. Our course tutors tell us to steer clear of sunbeds, I wonder why. Has anyone ever looked on Instagram at sunbed burn photos? Horrific. It seems as if to burn, either artificially or in the sun, is somehow a funny thing to do. Dealing with skin cancer is not funny though. Think about the cost of treating skin cancer, not to mention the cost of a life.”

[Chris Bryant]

Is this particularly an issue in this country because so many people are genetically made for British weather? We have freckles, fair hair and fair skin, which is far more prone to some of the dangers that the hon. Lady mentions.

[Mrs Latham]

Again, the hon. Gentleman makes an important point. We are not built for the sun; otherwise we would be black. That is why people in Africa do not have the problems that we have. We tend to go on holiday for a couple of weeks, burn like mad, come back and think it is great, but it is damaging to the skin. One need only look at people who spend a long time either on sunbeds or in the sun. When they get older they look like dried-up prunes, and nobody wants to look like a dried-up prune. People think that they are making themselves look healthier, but they are not; they are deeply damaging their skin, and we must try to persuade the Minister that a ban on sunbed use is the only thing we can do.

Frighteningly, over the past 30 years cases of malignant melanoma have more than quadrupled in the UK, and the scary truth is that it is now the second most common form of cancer in those aged 15 to 34. A melanoma is not easy to treat unless caught early. There are around 15,400 new melanoma skin cancer cases in the UK every year—42 every single day. Every 24 hours in the UK, six people die from a melanoma, and in 2016, 2,285 people died of the condition.

In the United States of America, Europe and Australia, combined sunbed use is estimated to have been responsible for more than 450,000 non-melanoma skin cancer cases and more than 10,000 melanoma cases every year. It is no coincidence that the rise in that aggressive form of skin cancer aligns with the popular use of sunbeds. The current updated body of scientific evidence strongly suggests that indoor tanning significantly increases the risk of melanoma. A large amount of data from observational studies provides enough information to infer that sunbed use causes melanoma, using all the epidemiological criteria for causality.

Dr Nicole Chiang, a consultant dermatologist who treats skin cancer patients on a regular basis, has noted that the risk of melanoma more than doubles when sunbeds are used at a young age of below 35 years. Sunbeds cause three times more DNA damage than natural sunlight, and it has been estimated that 20 minutes on a sunbed could be equivalent to approximately four hours in the sun. Just one sunbed session can increase someone’s risk of developing squamous cell skin cancer by 67%, and basal cell skin cancer by 29%. Even more important is the increased risk of melanoma, which is the deadliest form of skin cancer.

I was concerned to learn that data from Cancer Research shows that more than 25% of the UK’s 3 million sunbed users are unconcerned about the dangers that sunbeds pose. Indeed, I was on the radio today and I heard some people talking about this issue. They said, “Well, so what? It doesn’t matter. It will be okay.” I believe it is important to dispel the fake news, often used in the marketing of sunbeds, that they provide a “controlled” way of getting a “safer” tan. Sunbeds are no safer than exposure to the sun.

A 2008 study published in the journal “Pigment Cell & Melanoma Research”—that sounds like something from “Have I Got News For You”—came to the conclusion that to achieve a tan, the skin must be exposed to ultraviolet radiation, and therefore “safe tanning” is a physical impossibility. It is also important to dispel the myths perpetrated by the sunbed industry about vitamin D benefits from sunbeds. Due to the carcinogenic risk associated with sunbeds, their use cannot be justified. We can take a tablet in the winter to ward off vitamin D deficiencies. A further myth is the idea of the base tan—the dangerous and fanciful assertion that getting an initial tan from a sunbed will protect the skin from the sun. Guidelines from the National Institute for Health and Care Excellence explain that getting a tan provides little protection against later exposure to sunlight, and the resulting skin damage outweighs any later protective effect.

Throughout my time in Parliament, I have focused on the prevention and treatment of skin cancer as a result of personal experience. I have had the privilege of working with a cancer charity, Melanoma UK, which I thank for its support in gathering evidence for this debate. I know only too well the devastating effect that that cancer can have on people’s lives. What is most insidious about melanoma in particular is that it is impossible to treat in its late stages, and it often results in a drawn-out, very painful death. Last year I had my own personal scare. I found a mole, which was malignant. After a tortured three weeks waiting for the results I found out that, luckily, the tumour had not spread—but it was malignant. The fear was magnified by the fact that my own brother died from a melanoma when he was only 54. I have therefore always taken a close interest in that type of cancer and its causes.

My brother went to his GP three times in a year before the GP eventually said, “There’s nothing wrong with you, but I will refer you”—just to get him out of his surgery, I think. By that time it was far too late, and my brother died from his melanoma a few years later; but he was never able to work again, because muscle and lymph glands had to be taken away, so he could not do his job. Neither I nor my brother used sunbeds, but given my experience of the awful disease of melanoma I cannot comprehend why anyone would want to increase their risk of contracting it. Research shows that many people who contract it probably would not have done, if they had never been able to use a sunbed.

I want to refer to some case studies highlighting the horrific effect that sunbed use can have on individuals and their loved ones. I thank the House of Commons outreach team for helping me to collate a vast and wide-ranging response, obtained thanks to the power of social media. I am so grateful to those who participated in the initiative. There were some interesting and informative discussions. I was taken aback by the significant number of responses from people who said they regularly used sunbeds in their youth and today have, or have had, a melanoma. One such lady, Jade Luelle Cope, said that she used sunbeds often between the ages of 15 and 32, and was diagnosed with malignant melanoma at 38. She stated that she does not think that it was a coincidence.

Beverley Chesters passionately advocated a ban. Describing her experience, she said,

“without a doubt these killing machines”—

as the hon. Member for Rhondda (Chris Bryant) called them earlier—

“need to be banned in a heartbeat!”

She used sunbeds in her late teens and early 20s, when

“it was the norm for everyone to walk about with the supposed ‘healthy glow’. How very naive was I. I cannot recall ever any health warnings regarding sunbeds, and yes a pair of goggles given for eye protection and that’s it! Now all these years later I have malignant melanoma, first diagnosed last August…since then I have 2 more separate melanomas, and also waiting for results of 2 further biopsies. I would not wish this horrible disease on anyone. If only I knew then what I know now I would never ever have put myself in that position of risking my life, all for a tan. My body looks like a patchwork quilt.”

Similarly, Vicki Brennan noted that she used sunbeds and now has a malignant melanoma. Tragically, she comments:

“If I knew the statistics back then I would have made an informed decision not to use them, it scares me to think how many people are putting themselves at risk. And as for banality...Tell this to the thousands enduring treatment and those who are dying. You don’t just cut skin cancer out and carry on as normal. Please ban sun beds.”

A lady who came to a meeting that I was chairing had four young children, and was only in her 30s. She knew she was not going to survive, because she had a melanoma. She was going to leave the four young children for her husband to bring up, and they would not know their mother at all because they were so young.

The heartbreaking consequences of melanoma, aligning with sunbed use, were highlighted by Elaine Broadhurst. She said she and her brother used sunbeds as teenagers.

“We had one in our own home. There was no legislation or advice on the dangers. My brother was diagnosed with melanoma and died from it two years ago aged 46, leaving a wife and two young children. I’m convinced that the sunbed use contributed to losing my brother to this deadly disease and that sunbeds should be banned.”

Hundreds of people wrote similar testimonials, which illustrate the huge personal impact that the condition has on people’s lives, and the regret that many feel, having used a sunbed repeatedly and contracted the condition as a consequence. I encourage Members to take the time to read through some of the comments on the House of Commons Facebook page.

It is important to stress that it is clear that the majority of people use sunbeds purely for cosmetic reasons and vanity. The significance and dangers of cosmetic tanning are supported by many case studies and scientific research. It is said that people feel more confident, and sometimes even slimmer, when they are bronzed. However, in reality, over time when people over-use sunbeds their skin can age prematurely, making it look coarse, leathery and wrinkled—prune-like. In the worst-case scenario sunbeds can cause burns, scars and ulcers known as basal cell carcinomas. Dr Birnie observed that there has been rising incidence of the condition in younger people, and especially in women who have used tanning beds in their teens and early 20s. I am sure that that is not the aesthetic that young people craving a tan are trying to achieve.

I am particularly concerned to learn of a trend towards sun tanning addiction, where people use the sunbed for a quick and lasting tan. Some research suggests that as many as one in 50 sunbed users are addicted to them. There are stories of people using a sunbed daily for a long period of time. I was on Radio Sussex this morning and a lady said she had for three years used a sunbed at home for an hour a day. She now has a melanoma. That is excessive use, but lower use is still deadly. Scientists from Germany and the US recently published a study showing that almost 20% of indoor tanning users have addictive symptoms.

I would like high street tanning salons that offer sunbeds to raise awareness of the potential health implications of using sunbeds, as happens with cigarette packets. I understand that the British Association of Dermatologists has explained that many tanning salons fail to provide adequate information. However, I should prefer an outright ban to the use of nasty pictures of people with burns.

There is work to be done outside the legislative reach of Parliament. I would encourage the fashion and beauty industry to take an active role in discouraging the use of sunbeds. I commend initiatives previously adopted by the fashion industry, such as when in 2012 Kate Moss and her then modelling agency, Storm, aimed to raise awareness of the dangers associated with sunbeds, to put heavy tans out of fashion. At the same time directors from 11 UK model agencies including Elite, Premier Model Management, Storm and Next signed up to a zero tolerance policy on sunbed use, to protect new and established models from the health and cosmetic effects of using ultraviolet tanning beds. It would be good to see such work continue and perhaps go further. Perhaps there should be more articles in girls’ and women’s magazines to explain the dangers of tanning in that way. We all know that models are generally young and thin—that is another issue—but they do not need a tan to look beautiful. Twiggy, in the 60s, was pretty beautiful, and she has continued to be. I doubt whether she uses a sunbed.

In 2003 the World Health Organisation responded to the serious public health challenge and published a guidance document on sunbed legislation. Since then, a number of organisations and individuals in the UK have called for an outright ban on the use of commercial sunbeds. We should also look at the practice of selling them privately, because there is then no control over how people use them. The Sunbeds (Regulation) Act 2010 banned the use of sunbeds by under-18s, but many people feel that the ban did not go far enough. It was a start, but only an all-out ban is acceptable. That idea is being explored by our European partners. France’s health watchdog says that the risk of cancer from sunlamps and sunbeds is proven and authorities should act to stop people being exposed to artificial ultraviolet rays. France is one of a number of countries that have already limited their use.

I know that many members of the public support the banning of sunbeds. I was very pleased that Melanoma UK’s recent petition to ban sunbeds in the UK received in excess of 15,000 signatures. While I received a mixture of responses on both sides of the argument from the parliamentary outreach exercise, I was struck by the support from some people in the beauty industry. I am pleased that some individuals in the industry have recognised the dangers of sunbeds and champion the safe alternative of a spray tan.

One such example is Tonina Healey, a beauty salon owner who took the decision to ban the use of tanning beds in her salon and instead has promoted a spray tan. She said:

“I have always been very uncomfortable at the use of sunbeds. I took the decision to stop the use of tanning beds in my salon, I think one of the things that should be of major concern to all salon owners, is the issue of control. I have seen articles relating to tanning addiction and of clients going from salon to salon in order to achieve ‘double’ sessions. No one in the beauty industry can legislate for that and I for one, do not want to invite a lawsuit my way—does anyone in this industry really need that kind of hassle? I do believe that that will come one day, a salon in the UK will be sued when someone develops melanoma. I don’t want that on my plate and I certainly don’t want the illness of a client on my conscience. We trained in beauty to make our clients feel good, not to watch them die horrific deaths. We support a ban.”

Brazil and Australia have already banned sunbeds commercially. Brazil was the first to ban sunbeds in 2009, the only exception being where doctors prescribed their use for health reasons. In the same year, the World Health Organisation classified exposure to UV sunlamps, sunbeds and tanning booths as carcinogenic to humans. Australia followed Brazil’s ban in 2013. Annual rates of malignant melanoma in Australia were 10 times the rate in Europe for women, and more than 20 times for men. Professor Grant McArthur stresses the success of the ban in Australia, saying:

“The Sunbed ban in Australia has been highly effective. We estimate that one unnecessary death per week has been prevented by the ban. The greatest burden of deaths from Sunbeds falls in people aged 20-40. I plead that the UK save their young people by banning sunbeds”.

To conclude, it is my view that there should be an outright ban on sunbeds, and I hope I will receive the support of colleagues in that. While the temptation to achieve that sun-kissed glow is understandable, risking contracting such a devastating disease is not. The unnecessary exposure to UV is nonsensical, and I implore anyone to get a fake tan through a bottle or can, not the sunbed. It seems wrong that people should have the option of damaging their health so greatly, purely in pursuit of cosmetic gratification.

The evidence is clear: for over three decades, deliberate sunbed exposure to UV for cosmetic purposes through sunbeds has been driving up the incidence of skin cancers and driving down the age of their first appearance. I stress again the shocking figures that people who have ever used a sunbed are 20% more likely to develop melanoma later in life than people who have never used one, and those who started using sunbeds before the age of 35 were 87% more likely to develop melanoma than people who have never used a sunbed.

I also believe that action needs to be taken to further raise awareness of melanomas and what causes them, including over-exposure to UV through sunbeds. That action should include providing stronger and clearer warnings about the consequences of sunbed usage. Being aware of the possible consequences of the sunbed should lead to a cultural and generational shift, with people avoiding exposing themselves to UV unnecessarily. It is vital that people are conscious of the impact that this awful condition can have on one’s health and personal life—something that I myself have experienced through my own personal circumstances. Please may we have a ban on sunbeds?

Mental Capacity (Amendment) Bill [Lords]

Chris Bryant Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

I beg to move amendment 1, page 5, line 10, at end insert—

“(3A) Before making any regulations under subsection (3)(b), the Secretary of State must lay before Parliament a report on—

(a) the likely effects of the provisions of this Act on persons undergoing rehabilitation for brain injuries, and

(b) the interaction between the provisions of this Act and the processes for prescribing for brain injury rehabilitation therapy.”

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

With this it will be convenient to discuss the following:

Government amendments 5 to 32.

Amendment 2, in schedule 1, page 15, line 24, at end insert—

“(d) the effects of any treatment undergone by the cared-for person, including prescription brain injury rehabilitation therapy.”

Government amendments 33 to 37.

Amendment 49, page 16, line, leave out from “out” to the end of line 16, and insert

“by the responsible body.”

This amendment would require the responsible body to carry out the consultation in all cases.

Government amendment 38.

Amendment 50, page 17, line 13, at end insert—

“(ca) the arrangements are being authorised under paragraph 16 of this Schedule, or”

This amendment would require an AMCP to review all cases where the responsible body is authorising arrangements based on a statement provided by a care home manager.

Government amendment 39.

Amendment 48, page 18, line 21, at end insert—

“Authorisation charges

24A No charges may be made in relation to the steps taken in determining whether the responsible body may authorise the arrangements for the cared-for person.”

Amendment 3, page 18, line 35, at end insert “or

(c) at the end of a period of prescription brain injury rehabilitation therapy undergone by the cared-for person.”

Amendment 4, page 20, line 4, after “met” insert

“taking into account any treatment to be undergone by the cared-for person, including prescription brain injury rehabilitation therapy.”

Government amendments 40 to 46.

Amendment 51, page 23, line 1, leave out paragraphs 39 and 40 and insert—

“39 (1) The responsible body must appoint an IMCA to represent and support the cared-for person if–

(a) one or more of sub-paragraphs (2), (3), (4) or (5) applies, and

(b) sub-paragraph (6) does not apply.

(2) The cared-for person makes a request to the responsible body for an IMCA to be appointed.

(3) The responsible body has not identified an ‘appropriate person’ to support and represent the cared-for person in matters connected with the authorisation.

(4) The responsible body has identified an ‘appropriate person’ to support and represent the cared for person in matters connected with the authorisation, and they have made a request to the responsible body for an IMCA to be appointed.

(5) The responsible body has reason to believe one or more of the following—

(a) that, without the help of an IMCA, the cared-for person and any appropriate person supporting and representing them would be unable to understand or exercise one or more of the relevant rights;

(b) that the cared-for person and any appropriate person supporting and representing them have each failed to exercise a relevant right when it would have been reasonable to exercise it;

(c) that the cared for person and any appropriate person supporting and representing them are each unlikely to exercise a relevant right when it would be reasonable to exercise it.

(6) The cared-for person objects to being represented and supported by an IMCA.

(7) A person is not to be regarded as an ‘appropriate person’ to represent and support the cared-for person in matters connected with this schedule unless—

(a) they consent to representing and supporting the cared-for person,

(b) they are not engaged in providing care or treatment for the cared-for person in a professional capacity,

(c) where the cared-for person is able to express a view about who they would like to represent and support them, the cared-for person agree to being represented and supported by that person,

(d) where the cared-for person is unable to express a view about who they would like to represent and support them, the responsible body has no reason to believe that the cared-for person would object to being represented and supported by that person,

(e) they are both willing and able to assist the cared-for person in understanding and exercising the relevant rights under this Schedule, including with the support of an IMCA if appropriate.

(8) The ‘relevant rights’ under this schedule include rights to request a review under Part III of this Schedule, and the right to make an application to the court to exercise its jurisdiction under section 21ZA of this Act.”

This amendment would broaden the provision of advocacy, ensuring that advocates are provided as a default unless the cared-for person does not want one.

Government amendment 47.

[Chris Bryant]

I will speak to amendment 1 and the three other amendments in my name and the names of several colleagues.

I want to start with enormous praise for the national health service, which in many cases makes the key decisions on everything that we will talk about today. Sometimes those are very difficult decisions, including for families, and they need to be managed with care and sensitivity. Ensuring that we have the right law in place to enable clinicians to make the right decisions is vital. I was on the Public Bill Committee for the Mental Health Act 2007 under the Labour Government, and I remember many of the rows and difficulties then. Ensuring that legislation fits the complicated circumstances of real life is not all that easy, and in particular, the definition of what might be proper treatment is not readily come by.

Often lobbyists get a really bad press. My experience of lobbyists in this field is entirely positive, including those working for the pharmaceutical industry, who do an amazing job in providing new drugs that can save people’s lives and manage their conditions much better, and the many charities in this field. When lobbyists are decried, I sometimes want to point out that they play an important part in ensuring that Members of Parliament know exactly what they are doing when it comes to legislation.

All the amendments that I have tabled relate to acquired brain injury. I am aware that several other colleagues who are members of the all-party parliamentary group on acquired brain injury are here today. I do not want to make an apology for that, but I want to explain why I have tabled these amendments. It is partly because I believe that acquired brain injury, though recognised and understood by some, is something of a hidden epidemic in Britain.

Something like 1.4 million people in this country are living with an acquired brain injury. A new person presents at accident and emergency with a brain injury every 90 seconds. Many of these injuries have lasting effects that are completely invisible to an ordinary member of the public. For instance, the person standing in front of us in a queue who is being difficult might look as if they are drunk or just being difficult, but they may have a brain injury. We would have no idea, and the person feels trapped and finds the situation as difficult as we do. The more we come to an understanding of acquired brain injury in this country, the better.

There are many different causes of brain injury, including road traffic accidents, accidents about the home and stroke. One cause that has been brought home to me recently is carbon monoxide poisoning. Not only the high level of carbon monoxide poisoning that follows an incident, but a sustained low level of carbon monoxide due to poor central heating systems or facilities or something like a Calor gas burner in a home, can end up causing a long-term brain injury. This particularly affects some of those who live in the worst housing in the land, and who are the poorest and least able to afford, for instance, to have their boiler mended or assessed every year.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Is my hon. Friend aware of the problem that some members of the armed forces face with acquired brain injury? It may be because they were involved in or close to the explosion of an improvised explosive device, or because they had a gunshot wound, when the head covering was hit but not penetrated, and the shock can lead to acquired brain injury.

[Chris Bryant]

My hon. Friend makes a very important point. I know the role she has played, in particular in the all-party group on the armed forces, and of course in the NATO Parliamentary Assembly. She is absolutely right, and there are sometimes coup and contrecoup elements of damage to the brain. There is also some evidence to suggest that some people diagnosed with post-traumatic stress disorder have actually been suffering from a brain injury.

Interestingly, the Ministry of Defence has done some of the most innovative work in relation to brain injuries—physical brain injuries, as it were—and it has been able to transfer some of the skills and research involved in that work to the wider population, which is all to the good. However, I think that the way in which the mind sits inside the brain and the brain sits inside the skull is one of the areas of research that is still underdeveloped, and we still need to do a great deal more about it.

Other causes include brain tumours and chronic traumatic encephalopathy, where somebody may have had a series of relatively minor concussions. There is a complete misunderstanding of what concussion actually involves, particularly in sport. This might be leading to some of the long-term sustained problems of, for example, people in my own constituency who played rugby for many years and had repeated concussions. They may suffer from dementia, depression and anxiety in later life, but have no understanding that that may relate to a brain injury, rather than to anything else.

[Mr Jim Cunningham (Coventry South) (Lab)]

While we are talking about sport, may I say that this does not involve only rugby players? There is now evidence that footballers, particularly those heading the ball, suffer sustained brain injuries. It used to be interpreted as dementia, but it is a lot more serious than that. Has my hon. Friend had any discussions with the Football League about that?

[Chris Bryant]

I have had lots of discussions, some of them more fruitful than others, with the Football Association.

It is wholly to be deprecated that FIFA still will not allow a full substitution for an assessment of brain injury during a match. Ten minutes are needed to do a proper assessment on the pitch, but at the moment only three minutes is available in a FIFA match. There can be no substitution, and it is not therefore in the team’s interests to take the person off the pitch. I think that this must change. If there is one thing that I hope Parliament will say to FIFA about this in the next few months, it is that this must change. People we talk of as heroes, such as Jeff Astle, have died because of heading the ball. If those who are heroes to our young people today end up suffering in later life because of what they sustained in their footballing career, we will have done them a terrible disservice.

[Catherine West (Hornsey and Wood Green) (Lab)]

Does my hon. Friend agree that this applies equally to those who play rugby league, and in fact perhaps more, given the impact that some tackles occasionally have?

[Chris Bryant]

My hon. Friend makes a very good point. One of the things about rugby league and about rugby union, which I know rather better, being from south Wales—[Interruption.] I do not think it is parliamentary to tut-tut from the Chair, Mr Deputy Speaker, if you don’t mind my saying so. The truth is that many of the players today are bigger, stronger and faster, so the impacts may be much more significant than they were in the past. Curiously, when we watch some of the commentary on Twitter and Facebook about matches, we see a kind of rejoicing in the physical pain that people are going through, and I think we really need to roll that back. We need to roll that back so that we are actually caring about the players. Quite often the players themselves will be desperate to go back on. It should not be the player who makes that decision; it should be an independent doctor who makes it. [Interruption.] I think you want to intervene on me, Mr Deputy Speaker.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

The tut-tut was to say that the hon. Gentleman would benefit from knowing both types of rugby. The only thing I would add, just to help his case, is that in rugby league a player is taken off for a full assessment by a doctor and not allowed back on. That is the benefit on which rugby league is leading the sport.

[Chris Bryant]

I am glad I took that intervention. It is unusual to get an intervention from the Chair, but I think we welcome this new style of chairing.

[Mr Deputy Speaker]

It was a clarification.

[Chris Bryant]

I am tempted to make a point of order! No—you are absolutely right, Mr Deputy Speaker.

The key thing is to have the same protocols for all sports, so that there is the same protection. A child might play rugby league one year and rugby union the next; if there are different protocols, that will undermine the whole system. Incidentally, the point also applies to a whole range of other sports—hockey and ice hockey, as well as American football, in which there is growing interest in the United Kingdom. We should not let the issue be led by litigation, which is what has happened in the United States of America: we should let it be led by the medical science, which is rapidly changing.

--- Later in debate ---

[Mrs Moon]

My hon. Friend is being generous in giving way. One of the things that concern me most is that it is easy to label someone with any form of brain injury—whether dementia, Parkinson’s or anything else—when they also have an infection. What can be seen as difficult behaviour can be misunderstood when it is caused by the infection rather than by any acquired injury or illness.

[Chris Bryant]

Yes. People will also attribute bad intention to the person when what is happening is that the short-term memory is simply not functioning properly. For instance, someone with very little short-term memory may find it difficult to turn up on time, as I mentioned earlier. That may be not because they are being lazy, truculent or difficult but simply because their brain does not work in that way. It may mean that their capacity is so diminished that, according to the Bill, they cannot make decisions. Alternatively, it might just be one of the elements that needs to be dealt with—they need to find tricks to circumvent the problem, and medical and clinical professionals can help.

This is why I tabled my amendments. Neurorehabilitation, when done well and on a sustained basis, can take an individual from being low functioning and high dependency, perhaps needing three or four people just to be able to wash themselves, clothe themselves and provide for themselves physically, to a much higher level of personal functionality and much greater independence. I have made that argument from a different place, in the sense that taking someone from needing four people to look after them to just one person coming in once a day for an hour or so could be an enormous financial saving to the taxpayer. That is why neurorehabilitation and the work that has been done in many cases can be so important.

Neurorehabilitation is really important in relation to the Bill. We might be able to take somebody from a place where they are not truly able to make a decision about what treatment they should be undergoing and, according the Bill, deprive them of their liberty, to a place where that would no longer be appropriate. My anxiety is that if there is no incentive in the system to ensure that neurorehabilitation is provided to people, there is a danger that we just discard them and leave them by the side, particularly as we are now talking about a three-year term rather than a one-year term. I think the clauses at the end of the Bill militate in favour of renewal, rather than providing a clear option not to renew at that point.

I have an anxiety that perhaps in some care homes and other places there just might be an incentive to think, “Well, this person isn’t going to get better so we’re not going to do anything to try to help them to get better.” I do not want to give up on so many people. Thanks to what the Government have done with the major trauma centres, we now save about 800 or 1,000 more lives every year following road traffic accidents and the like, but we need to give people quality of life. We do not have enough people working in this field. We need to recruit many more people. If 20 people were inspired by what we are talking about today to go and work in that field—there are so many high rewards for people working to take people from high dependency to low dependency—that would be a success in itself.

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that the all-party group inquiry heard some remarkable examples of people who have gone through the pathway with neurorehabilitation prescriptions and are increasingly able, with great work and support on everyone’s part, to carry out many functions?

[Chris Bryant]

Absolutely. One key thing that we saw repeatedly—this is an issue for the Bill, I think—was the fluctuating nature of some brain injuries. For instance, fatigue is a very common feature of many brain injuries. I do not mean just feeling tired because you are sitting at the back of a debate in the House of Commons and somebody is wittering on for far too long and you fall asleep, but real, genuine fatigue. I mean the kind of lassitude that leaves you unable to move from one side of the bed to the other. It is often misunderstood, because it might look like laziness to somebody with a judgmental eye. That lassitude can pass or go through phases and can sometimes be a bit difficult to explain or predict. I am therefore really keen that we ensure, in all the processes in the Bill, that anyone with an acquired brain injury is regularly and repeatedly reassessed so that they have an opportunity to escape. That is important.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The hon. Gentleman is making some good points. The only point I would make to him is that without a deprivation of liberty order—I agree that they should be open to review, and I am sure the Minister will go on to talk about how that can happen—some of the people he talks about may have to be put under the Mental Health Act 2007 due to the fluctuating nature of their capacity. That would be much more restrictive and could lead to them being sent to entirely the wrong places to be cared for. I would just give that caveat and that warning to him about the potential consequences of what he is saying.

[Chris Bryant]

I think the hon. Gentleman has just read, in some weird way, what I was about to say—he has a very special mental capacity of his own if he is able to read my notes from that distance. He is absolutely right, however, and I do not want to drive a coach and horses through the Bill at all. I fully accept that there is a requirement for some elements of it.

I have an anxiety about the pace at which the Bill is going. It is a shame that the code is not yet available, because it would significantly affect how we viewed some of the issues that we are talking about today. All the things in my amendments should probably be in the code, rather than on the face of the Bill—that is what the Minister said to me yesterday, and I should have given her a much harder time, by the way—but why do we not have the code now? We are not going to have it before the Bill receives its Third Reading, and I think that is a mistake. It is not as though we have lots of wonderful business to be getting through.

[Janet Daby (Lewisham East) (Lab)]

A young person in my constituency has contacted me—she has a disability and works for a disabled people’s organisation called Inclusion London—to raise concerns about the speed at which the Bill is going through Parliament. There is a sense of it being rushed through without adequate consultation, which it needs, and with little regard for the people who are likely to be affected by it. Does my hon. Friend agree?

[Chris Bryant]

Yes, I do have that anxiety. I want to be a bit critical of the Government on that, because this is a two-year Session of Parliament and there is no reason why this could not have been done in a proper way. I am slightly conscious that there is not a great deal of time left today, however, so I am keen to bring my remarks to a close.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Before my hon. Friend concludes, since the code is going to be so central to the operation of the Bill, and since none of us will have seen it before the Bill concludes its proceedings, does he think that it is vital for the Minister to say today that there will be proper and extensive consultation on the code before it is implemented?

[Chris Bryant]

Yes. The Government have effectively already said that, but to be really nasty, we should have had the code before today, in all honesty, even if it was only in draft form, so that we would be able to see what we are really talking about, and I would then not have been talking about these amendments.

I want to bring my remarks to a close as soon as I can. We need to build in an incentive to make sure that there is proper neurorehabilitation provision for people with acquired brain injuries. All too often, patients and carers in this field feel as though they are being processed. That is not because health clinicians are nastily minded, but because people sometimes end up having to deal with so many different departments that they feel as though they are being pushed from pillar to post. That is why it is really important that the Government strike the right note when it comes to the next stage of introducing the code.

Amendment 1 simply says that

“the Secretary of State must lay before Parliament a report on”

the “likely effects” of the Bill on ABI before it comes into effect. Amendment 2 requires the “relevant person”, who could be somebody managing a care home, to consider

“the effects of any treatment undergone by the cared-for person, including prescription brain injury rehabilitation therapy”

in addition to the length of time since the assessment was originally made. Amendment 3 would mean that an authorisation that was not renewed would lapse after 12 months, after a time specified in the original authorisation, or, as I would like it to be,

“at the end of a period of prescription brain injury rehabilitation therapy”.

I think that is key to making sure that there is an incentive to ensure that therapy is provided. Amendment 4 refers to the renewal of an authorisation and requires the responsible body to take into account

“any treatment to be undergone by the cared-for person, including prescription brain injury rehabilitation therapy”.

I do not think that any of those amendments would do the Bill any harm—no harm at all—and I am feeling a bit more grumpy with the Minister than I was yesterday when I met her, so who knows? We might end up voting on them.

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

It is good to see the hon. Gentleman on his feet, but I hate to see him grumpy. He will have my response to his all-party group next week. I promised him a recommendation by recommendation response to his report, the launch of which I attended, and he will have it next week.

[Chris Bryant]

I am very happy with this Minister, but the other Minister—

[Steve Brine]

She’s nicer than me.

[Chris Bryant]

That is true, but she has to prove her mettle on this. I do not mean that in a nasty way; I simply mean that we want some changes.

[Several hon. Members rose—]

--- Later in debate ---

[Alex Cunningham (Stockton North) (Lab)]

I had hoped to address several of the amendments signed by my hon. Friends and me, because this is a bad Bill with huge opposition across our society. It fails to protect people adequately, meaning they could be locked up without a proper process of assessment and without advocacy support—and that includes 16 and 17-year-old children. The protections for them are also inadequate, as they are for their parents. Time is against me, however, so I will turn straight to amendment 48, which stands in my name and that of my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams).

There is a genuine concern among organisations in the sector that vulnerable people, particularly those receiving private care, may be charged for an assessment or for assessments to be carried out. I know the Minister got a bit fed up with me banging on about funding and about the fact that local authorities such as mine in Stockton-on-Tees have lost millions of pounds in funding and that budget reductions are continuing across health. I have also addressed the tight margins on which care homes operate and the need to ensure the sector remains viable.

We know that the sector is strained financially and might feel it has no choice but to implement fees and charges for the assessment of clients’ mental capacity. The intention of the amendment is to ensure that this does not happen. Several written submissions to the Public Bill Committee raised concerns about the absence of any provision for a fee for medical professionals to provide medical evidence.

This is the right point to refer to the revised impact assessment published by the Government. I and other Opposition Members have been contacted by academics accusing the assessment of perpetuating a myth by saying that GPs will provide diagnostic evidence and conduct capacity assessments for the LPS and that this will have no resource implications. What total nonsense. How has this conclusion been reached? I have not heard from a single body or GP arguing it will have no resource implications—quite the opposite.

The experience of judicial DoLS applications to the Court of Protection seems to be that GPs are very reluctant to provide such evidence, either because they do not feel skilled enough to do so or because they require payment. This means that someone will have to pay a fee for the medical assessment, and there is nothing in the Bill or the NHS charging regulations to prevent it from being passed on to the person themselves.

Evidence shows that that is already happening. Southfield House, a care home in Stockport, was found to be charging residents £250 if they required a deprivation of liberty authorisation. A complaint was lodged with the Care Quality Commission by Edge Training, but it was told in response that that was allowed. What was that £250 for? “An application to the local authority requesting an assessment” appears to cover it—and after that, there was the £125 annual fee. Individuals who are going through what can only be an extremely emotionally difficult process are being charged hundreds of pounds for the luxury.

It is frustrating that the care home is well within its rights to make those charges. A spokesman put it best:

“The social care sector…is currently under huge financial pressure. All tasks from care to admin to facility carry a cost”.

Because the sector is underfunded, the Government consider it appropriate to take financial advantage of the most vulnerable people in society.

I do not intend to press the amendment to a vote, but I think that the Minister must take on board the whole issue of charges. At present, the law gives care home managers and others carte blanche to charge exactly what they want. There are no limitations whatsoever. I ask the Minister, perhaps at the regulations stage, to come back with specific ideas to restrict care home managers and others from exploiting those vulnerable people.

[Chris Bryant]

I was expecting my hon. Friend the Member for Stockton North (Alex Cunningham) to go on a bit longer, but now that I have the Floor, let me say this.

There is quite a bit of consensus, certainly among Labour Members, that there are elements of the Bill with which we are not happy, and I am sure that we will vote on those in a few moments. What the Minister said earlier makes me hopeful that she will do her level best to ensure that the way in which the needs of people with acquired brain injuries can be met will be clearly laid out in the code of conduct. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, some of the issues are very specific to them; they are different from those affecting other people in the same category.

The deprivation of liberty is one of the most important issues that Parliament ever has to consider. We all accept that, and it was referred to by both the Minister and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). I hope that we manage to get the code of conduct right, at the right time, and that the process we use ensures that as many as possible of the users, patients, carers and organisations that are involved in this matter on a daily basis have a real opportunity to feel that they can own that code. I think that that is the point at which the Minister might manage to assuage some of our concerns, although some Labour concerns are extremely strong.

As I told the Minister yesterday, I do not intend to press my amendment to a vote. She is smiling now. I therefore beg to ask leave to withdraw the amendment.

Question put and agreed to.

Amendment, by leave, withdrawn.

[Madam Deputy Speaker (Dame Eleanor Laing)]

With the leave of the House, I propose to put Government amendments 5 to 37 together.

Schedule 1

SCHEDULE TO BE INSERTED AS SCHEDULE AA1 TO THE MENTAL CAPACITY ACT 2005

Amendments made: 5, page 8, line 6, leave out from “Wales,” to end of line 10 and insert

“the person registered, or required to be registered, under Chapter 2 of Part 1 of the Regulation and Inspection of Social Care (Wales) Act 2016 (anaw 2) in respect of the provision of a care home service, in the care home;”.

This amendment amends the definition of “care home manager”, in Wales, so it will be the person who is the registered service provider. This mirrors the approach taken for England.

Amendment 6, page 8, line 13, at end insert—

““Education, Health and Care plan” means a plan within the meaning of section 37(2) of the Children and Families Act 2014;”

This amendment is consequential on Amendment 22.

Amendment 7, page 8, leave out line 16

This amendment is consequential on Amendment 13.

Amendment 8, page 8, line 17, at end insert—

““independent hospital” has the meaning given by paragraph 5;”

This amendment is consequential on Amendment 13.

Amendment 9, page 8, line 27, at end insert—

““NHS hospital” has the meaning given by paragraph 5;”

This amendment is consequential on Amendment 13.

Amendment 10, page 8, line 46, leave out “Hospital” and insert “NHS hospital and independent hospital”.

This amendment is consequential on Amendment 13.

Amendment 11, page 8, leave out line 47.

This amendment is consequential on Amendment 13.

Amendment 12, page 9, line 15, after “6” insert “(1)”.

This amendment is consequential on Amendment 18.

Amendment 13, page 9, line 16, leave out “a” and insert “an NHS”.

This amendment amends paragraph 6(a) so that where arrangements are carried out mainly in an independent hospital the responsible body for those arrangements will not be the hospital manager.

Amendment 14, page 9, line 17, at end insert—

(aa) if the arrangements are carried out mainly in an independent hospital in England, the responsible local authority determined in accordance with paragraph 8A;

(ab) if the arrangements are carried out mainly in an independent hospital in Wales, the Local Health Board for the area in which the hospital is situated;”

This amendment makes provision for who the responsible body will be for cases where arrangements are carried out mainly in an independent hospital in England or Wales.

Amendment 15, page 9, line 18, leave out “paragraph (a) does not apply” and insert “none of paragraphs (a) to (ab) applies”.

This amendment is consequential on Amendment 14.

Amendment 16, page 9, line 27, leave out “neither paragraph (a) nor paragraph (b)” and insert “none of paragraphs (a) to (b)”.

This amendment is consequential on Amendment 14.

Amendment 17, page 9, line 28, leave out “(see paragraph 9)” and insert

“determined in accordance with paragraph 9”.

This amendment is consequential on Amendment 14.

Amendment 18, page 9, line 28, at end insert—

‘(2) If an independent hospital is situated in the areas of two or more Local Health Boards, it is to be regarded for the purposes of sub-paragraph (1)(ab) as situated in whichever of the areas the greater (or greatest) part of the hospital is situated.”

This amendment provides that, for the purpose of determining who is the responsible body, if a hospital is situated in the areas of two or more Local Health Boards, it should be regarded as situated in whichever of the areas the greater (or greatest) part of the hospital is situated.

Amendment 19, page 9, line 29, after “manager” insert

“, in relation to an NHS hospital,”.

This amendment is consequential on Amendment 13.

Amendment 20, page 9, line 45, at end insert—

(ca) if the hospital is vested in a Local Health Board, that Board.”

This amendment makes provision that the hospital manager for an NHS hospital vested in a Local Health Board will be that Board.

Amendment 21, page 9, line 46, leave out from beginning to end of line 12 on page 10

This amendment is consequential on Amendment 13.

Amendment 22, page 10, line 20, at end insert—

8A (1) In paragraph 6(1)(aa), “responsible local authority”, in relation to a cared-for person aged 18 or over, means—

(a) if there is an Education, Health and Care plan for the cared-for person, the local authority responsible for maintaining that plan;

(b) if paragraph (a) does not apply and the cared-for person has needs for care and support which are being met under Part 1 of the Care Act 2014, the local authority meeting those needs;

(c) in any other case, the local authority determined in accordance with sub-paragraph (4).

(2) If more than one local authority is meeting the needs of a cared-for person for care and support under Part 1 of the Care Act 2014 the responsible local authority is the local authority for the area in which the cared-for person is ordinarily resident for the purposes of that Part of that Act.

(3) In paragraph 6(1)(aa), “responsible local authority”, in relation to a cared-for person aged 16 or 17, means—

(a) if there is an Education, Health and Care plan for the cared-for person, the local authority responsible for maintaining that plan;

(b) if paragraph (a) does not apply and the cared-for person is being provided with accommodation under section 20 of the Children Act 1989, the local authority providing that accommodation;

(c) if neither paragraph (a) nor paragraph (b) applies and the cared-for person is subject to a care order under section 31 of the Children Act 1989 or an interim care order under section 38 of that Act, and a local authority in England is responsible under the order for the care of the cared-for person, that local authority;

(d) if none of paragraphs (a) to (c) applies, the local authority determined in accordance with sub-paragraph (4).

(4) In the cases mentioned in sub-paragraphs (1)(c) and (3)(d), the “responsible local authority” is the local authority for the area in which the independent hospital mentioned in paragraph 6(1)(aa) is situated.

(5) If an independent hospital is situated in the areas of two or more local authorities, it is to be regarded for the purposes of sub-paragraph (4) as situated in whichever of the areas the greater (or greatest) part of the hospital is situated.”

This amendment makes provision as to who the responsible body will be in cases where arrangements are carried out mainly in an independent hospital in England.

Amendment 23, page 11, leave out lines 45 to 47.

This amendment is consequential on Amendment 22.

Amendment 24, page 12, line 19, at end insert—

12A (1) The following must publish information about authorisation of arrangements under this Schedule—

(a) the hospital manager of each NHS hospital;

(b) each clinical commissioning group;

(c) each Local Health Board;

(d) each local authority.

(2) The information must include information on the following matters in particular—

(a) the effect of an authorisation;

(b) the process for authorising arrangements, including making or carrying out—

(i) assessments and determinations required under paragraphs 18 and 19;

(ii) consultation under paragraph 20;

(iii) a pre-authorisation review (see paragraphs 21 to 23);

(c) the circumstances in which an independent mental capacity advocate should be appointed under paragraph 39 or 40;

(d) the role of a person within paragraph 39(5) (an “appropriate person”) in relation to a cared-for person and the effect of there being an appropriate person;

(e) the circumstances in which a pre-authorisation review is to be carried out by an Approved Mental Capacity Professional under paragraph 21;

(f) the right to make an application to the court to exercise its jurisdiction under section 21ZA;

(g) reviews under paragraph 35, including—

(i) when a review will be carried out;

(ii) the rights to request a review;

(iii) the circumstances in which a referral may or will be made to an Approved Mental Capacity Professional.

(3) The information must be accessible to, and appropriate to the needs of, cared-for persons and appropriate persons.

12B (1) Where arrangements are proposed, the responsible body must as soon as practicable take such steps as are practicable to ensure that—

(a) the cared-for person, and

(b) any appropriate person in relation to the cared-for person,

understands the matters mentioned in sub-paragraph (3).

(2) If, subsequently, at any time while the arrangements are being proposed the responsible body becomes satisfied under paragraph 39(5) that a person is an appropriate person in relation to the cared-for person, the responsible body must, as soon as practicable, take such steps as are practicable to ensure that the appropriate person understands the matters mentioned in sub-paragraph (3).

(3) Those matters are—

(a) the nature of the arrangements, and

(b) the matters mentioned in paragraph 12A(2) as they apply in relation to the cared-for person’s case.

(4) If it is not appropriate to take steps to ensure that the cared-for person or any appropriate person understands a particular matter then, to that extent, the duties in sub-paragraphs (1) and (2) do not apply.

(5) In this paragraph “appropriate person”, in relation to a cared-for person, means a person within paragraph 39(5).”

This amendment inserts new paragraphs 12A and 12B of the new Schedule AA1 to require responsible bodies to publish information about authorisation of arrangements under the Schedule and to take steps at the outset of the authorisation process to ensure that cared-for persons and appropriate persons understand the process.

Amendment 25, page 12, line 32, after “practicable” insert

“and appropriate, having regard to the steps taken under paragraph 12B and the length of time since they were taken,”.

This amendment amends the duty in paragraph 13(2) of the new Schedule AA1 for a responsible body to take steps, as soon as arrangements are authorised, to ensure that cared-for persons and appropriate persons understand matters relating to the authorisation, to reflect the fact the body may have already have done that very recently under new paragraph 12B (inserted by Amendment 24).

Amendment 26, page 12, line 33, leave out from “any” to “understands” in line 34 and insert “appropriate person”.

This amendment amends the duty in paragraph 13(2) so that the duty to ensure that cared-for persons and appropriate persons understand matters relating to an authorisation does not also apply to independent mental capacity advocates (who can be expected to understand those matters) in line with the new duty in paragraph 12B (inserted by Amendment 24).

Amendment 27, page 12, line 34, leave out from “understands” to end of line 5 on page 13 and insert

“the matters mentioned in paragraph 12A(2)(a), (c), (d), (f) and (g) as they apply in relation to the cared-for person’s case”.

This amendment aligns the description of matters that must be explained to the cared-for person and any appropriate person with the list of matters in new paragraph 12A (inserted by Amendment 24).

Amendment 28, page 14, line 46, at end insert—

‘(1A) The person who makes the determination need not be the same as the person who carries out the assessment.”

This amendment makes it clear that a determination need not be made by the same person who carries out an assessment. A person could, for example, make a determination based on an assessment carried out previously by a different person (paragraph 18(6) of the new Schedule AA1 allows for this).

Amendment 29, page 14, leave out lines 47 and 48 and insert—

‘(2) The appropriate authority may by regulations make provision for requirements which must be met by a person—

(a) making a determination, or

(b) carrying out an assessment,

under this paragraph.

(2A) Regulations under sub-paragraph (2) may make different provision—

(a) for determinations and assessments, and

(b) for determinations and assessments required under sub-paragraph (1)(a) and determinations and assessments required under sub-paragraph (1)(b).”

This amendment provides power to make regulations setting out requirements which must be met for a person to make a determination or carry out an assessment. The requirements will relate to matters such as knowledge and experience. Different requirements may be set out for a person making a determination than a person carrying out an assessment.

Amendment 30, page 15, line 12, after “the” insert “determination or”.

This amendment is consequential on Amendment 29.

Amendment 31, page 15, line 14, after “the” insert “determination or”.

This amendment is consequential on Amendment 29.

Amendment 32, page 15, line 16, leave out “The” and insert “An”.

This amendment is to make it clear that the assessment being referred to is an assessment on which a determination under the paragraph is made.

Amendment 33, page 15, line 32, leave out “made on an assessment” and insert

“by a person, who meets requirements prescribed by regulations made by the appropriate authority, made on an assessment by that person”.

This amendment is to make it clear that a determination required under paragraph 19 of the new Schedule AA1 must be made by the same person who carries out the assessment on which that determination is based and that person must meet requirements set out in regulations.

Amendment 34, page 15, leave out lines 38 to 44.

This amendment is consequential on Amendment 33.

Amendment 35, page 15, line 46, leave out from “16,” to “by” in line 1 on page 16 and insert

“a determination may not be made”.

This amendment is consequential on Amendment 33.

Amendment 36, page 16, line 7, leave out “assessment” and insert “determination”.

This amendment is consequential on Amendment 33.

Amendment 37, page 16, line 9, leave out “assessment” and insert “determination”.—(Caroline Dinenage.)

This amendment is consequential on Amendment 33.

Amendment proposed: 49, page 16, line 12, leave out from “out” to the end of line 16, and insert “by the responsible body.”—(Barbara Keeley.)

This amendment would require the responsible body to carry out the consultation in all cases.

Question put, That the amendment be made.

Oral Answers to Questions

Chris Bryant Excerpts

Tuesday 15th January 2019 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

What are the Government going to do about people who have suffered acquired brain injury? One in four major trauma centres have no neurorehabilitation consultant, meaning that such people all too often fall between the cracks and do not get proper support. Will the Government change that?

[Caroline Dinenage]

The hon. Gentleman chairs the all-party group on acquired brain injury, and we are working on the recommendations of his report. This is such an important issue, and we want to make sure that nobody falls through the gaps.

Budget Resolutions

Chris Bryant Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

Yes, I am going to come on to social care. Yesterday, we put a further £650 million into social care, and we are coming forward with reforms to social care to put it on a sustainable footing for the long term.

[Chris Bryant (Rhondda) (Lab)]

I want to ask the Secretary of State about acquired brain injury. We save so many lives now, but if we put in significant investment up front to ensure that everyone got the right neuro-rehabilitation, we could save vast amounts of money for the taxpayer. Is that not rather a good model for us to pursue?

[Matt Hancock]

Yes, and the constructive approach that the hon. Gentleman has taken on this subject with me over many months, and for years before that, shows the progress that we can make. We are putting £20.5 billion extra into the NHS, and making an uplift like that means that we can turn resources towards preventing ill health in exactly the way that he describes. I pay tribute to the work that he has done on this subject.