Acquired Brain Injury Action Plan

Siobhain McDonagh Excerpts

Thursday 4th December 2025 Westminster Hall

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

I beg to move,

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

Dickens wrote,

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

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

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

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

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

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

[Dame Siobhain McDonagh (in the Chair)]

Flattery will get you nowhere.

--- Later in debate ---

[Sir John Hayes]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Dame Siobhain McDonagh (in the Chair)]

I think that may be your modus operandi.

[Sir John Hayes]

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

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

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

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

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

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

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

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

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

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

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

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

[Several hon. Members rose—]

[Dame Siobhain McDonagh (in the Chair)]

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