House of Commons Library briefing on mental health policy in England.
1. Acquired brain injury
A debate will take place in Westminster Hall on Tuesday 2 July on acquired brain injury. The debate will be led by Chris Bryant MP.
A debate on a similar subject took place on 9 May 2019 and some of the key points are noted below, along with a recent question to the Prime Minister on the subject by Mr Bryant.
1.1 Earlier Debate
A debate on a similar subject took place on 9 May 2019. The motion for the debate was:
- 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.
During the debate, a wide range of issues were raised by Members. These included highlighting the importance of neurorehabilitation services for individuals affected by brain injury and calls for further investment into these, the screening of prisoners for brain injuries, benefits assessment for those with brain injury and including brain injury in the code of practice for special educational needs.
In responding to the debate, the Under-Secretary of State for Health and Social Care, Seema Kennedy, noted that activity on this issue crossed a number of Government Departments and these had all contributed to the Government’s response to the APPG on acute brain injury’s recent report.
On the issue of neurorehabilitation, the Minister set out the importance of timely and appropriate neuro-rehabilitation. She said that the majority of local rehabilitation services are locally provided, and that NHS England has produced guidance on rehabilitation provision. She went on to provide more information about neurorehabilitation in England and the importance of rehabilitation prescriptions (RPs):
[…] RPs reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient and are an important element of rehabilitation care. The APPG report was clear that all patients with ABI should benefit from an RP.
- NHS England’s major trauma service, where acute phase rehabilitation begins, sets out that patients should be reviewed by a rehabilitation consultant. The shadow Minister asked about this. The development of major trauma centres, which the hon. Member for Rhondda supported, has improved recruitment to this specialty, while the national clinical audit of specialist rehabilitation recommended that all trauma networks review access to rehabilitation consultants and make improvements. Patients should have either a rehabilitation consultant or an alternative clinician with skills and competencies in rehabilitation to provide an initial formulation and plan to complete and perform the initial RP. At discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialised or local rehab.
- The “National Clinical Audit of Specialist Rehabilitation for Adults Patients with Complex Needs Following Major Injury”, published in 2016, found that on average 81% of patients had a record of a rehabilitation prescription. The audit recommended that MTCs take action to improve compliance. The audit report appears to have had a significant impact. The latest data, from the last quarter of 2018, from the trauma and audit research network shows that the national average rose to a 95% completion rate for RPs. This is good news. NHS England has worked with patients, clinicians and charities to improve the RP design and set new standards for communication and involvement of patients, families and carers. It is hoped that the new RP will support the development of a rehabilitation dashboard to monitor the performance of the system. Audits play an important role in helping services to improve. The report also recommended that all organisations within a trauma network work together to review capacity.
1.2 Prime Minister’s Questions
The screening of prisoners for acquired brain injury was raised recently in a June 2019 Prime Minister’s Question. The Chair of the APPG on Acquired brain injury, Chris Bryant, invited the Prime Minister to co-sign a proposed amendment to the Domestic Abuse Bill to introduce screening of female prisoners for brain injury:
- When researchers recently screened all the women prisoners at Drake Hall prison in Staffordshire for brain injuries, they found that nearly two thirds had a serious brain injury before they committed their first offence and that, of those injuries, two thirds were the result of domestic violence. There is a real danger that we are criminalising the victims of domestic abuse. The Domestic Abuse Bill is going through pre-legislative scrutiny at the moment. Would not it be a good idea to change it by adding a clause to provide that all female prisoners will be screened for brain injury, and that all female prisoners who have had a brain injury will have proper neurorehabilitation, so that we can rescue their future and prevent crime? If the Prime Minister has some spare time, will she co-sign that amendment with me, perhaps as vice-chair of the all-party parliamentary group on acquired brain injury? 
- The Prime Minister
- We take the issue of prisoners’ brain injury very seriously and, indeed, action is being taken by the Ministry of Justice to look very carefully into the issue. Obviously, I look forward to the debate that will take place—[Interruption.] Well, I have had many invitations across the Chamber in the past. I have never quite had this invitation from the hon. Gentleman and I have to say, I think I will approach the invitation to work with him with caution given some of the arguments that we have had in the past, but I welcome the fact that I will be able to—or expect to be able to—contribute to the debate on that Bill when it goes through this House. It is a very important piece of legislation, which I want to see genuinely transforming what we can do to deal with domestic violence.
A debate pack was produced prior to the debate on acquired brain injury in May 2019. A link to this, and other sources is included below:
- Commons library debate pack, Acquired brain injury, 8 May 2019
- APPG on Acquired Brain Injury and the UK Acquired Brain Injury Forum (UKABIF), Acquired Brain Injury and Neurorehabilitation, Time for Change, September 2018
- Government response to the APPG report, February 2019
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