HC Deb 28 January 2004 vol 417 cc359-68

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ainger.]

3.17 pm
Mrs. Iris Robinson (Strangford) (DUP)

I welcome the opportunity to have the debate this afternoon—albeit a little earlier than I expected; indeed, I believe that the Minister too was caught unawares.

The most recent statistics available show that 7,826 individuals presented with head injuries at the accident and emergency department of one of our major hospitals in Northern Ireland in 12 months. In that total, 2,417 adults, of whom three quarters were male, and 871 children required admission. Fifty-two per cent. of their head injuries were from falls, another 21 per cent. were from road traffic accidents and 18 per cent. were from assaults. Annual figures are not available for the entire Province, but those from the Royal Victoria hospital in Belfast give us an indication of the large number of head injuries that occur.

Acquired brain injury is responsible for 30 per cent. of all trauma-related deaths. We tend not to consider traumatic injuries in the same way as viruses, cancer or cardiac deaths, for instance, yet acquired brain injury is the leading cause of death in young males in developed countries. Two thirds of those affected are aged between 14 and 39. When a brain injury occurs, it can change the way in which a person thinks, acts, feels and moves his or her body. Brain injury can also change the complex internal functions of the body, such as regulating body temperature, blood pressure and bile, and bladder control. Those changes can be temporary or permanent. They may cause impairment or a complete inability to perform a function.

An acquired brain injury occurs when an outside force impacts on the head hard enough to cause the brain to move in the skull, or when the brain is hurt directly if the force causes the skull to break. That type of injury can be caused by motor vehicle crashes, firearms, falls, sports and physical violence, such as being struck with an object. A rapid acceleration and deceleration of the head can force the brain to move back and forth across the inside of the skull. The stress from those rapid movements pulls apart nerve fibres and causes damage to brain tissue. Acquired brain injury takes place at cellular level in the brain, so it can affect cells throughout the entire brain, instead of just in specific areas.

An acquired brain injury cannot be hereditary, congenital, degenerative or induced by brain trauma. It has occurred after birth and causes can include trauma to the head or neck, heart attack, stroke, intracranial surgery, airway obstruction, crush injuries, choking, strangulation, near-drowning, electrical shock, lightning strike, infectious disease, intracranial tumours, metabolic disorders, meningitis, certain venereal diseases, AIDS, insect-borne diseases, seizures, or toxic exposure to chemicals or gases, such as carbon monoxide poisoning.

Reconnect is an organisation in Northern Ireland that provides training for those with complex neurological disability resulting from acquired brain injury. It aims to provide access of opportunity for that group of people. Reconnect's mission is to enable people with an acquired brain injury to realise their maximum potential for social and vocational reintegration, through structured training programmes based on the needs of the individual. I have had personal involvement in the case of one young man who suffered a severe head injury and benefited from the input of Reconnect. He was a civil servant in his 20s living my constituency, who suffered a head injury at a football match that led to him spending three weeks in a coma. He spent some time at the Joss Cardwell rehabilitation unit on Holywood road in Belfast. My office assisted him in securing benefits. His subsequent experience at Reconnect proved invaluable not just for himself, but for his young wife and their very young children. He continues to experience some difficulties, but manages to function at a reasonably high level today. If he had not had access to Reconnect at that time, his quality of life would have deteriorated owing to lack of stimulation.

Reconnect came into existence under the name Garden Reach in 1991. Based on the Ormeau embankment in Belfast, it operated in modest surroundings and provided training and rehabilitation for those with acquired brain injury from two simple glasshouses and another two portakabins. That was the extent of its facilities.

The original idea came from a physiotherapist who recognised that when patients in Northern Ireland left hospital after a traumatic head injury, no service was available to help them to piece their lives back together again. Sufferers from complex neurological disability therefore became socially excluded and lacking in confidence. As a result, they could not gain access to any of the limited services available and tended simply to sit in the house all day. Those who did gain access to services were likely to attend a day centre, where they had only limited interaction with elderly individuals. One important consequence of a lack of stimulation is regression from what has been achieved through the good work carried out by dedicated hospital rehab teams.

Rev. Martin Smyth (Belfast, South) (UUP)

I am grateful to the hon. Lady for giving way on that point, because Garden Reach operated in my constituency until redevelopment meant that it had to move. Does she agree—indeed, this is the very point that she is making—that it is vital that after the acute sector has done its immediate work, we should not leave people without the back-up that is needed to give them the quality of life that the rest of us would like to have, and also that what is done should be done at minimum expense to the state?

Mrs. Robinson

I thank the hon. Gentleman for his comments and totally concur with them. I shall deal with that point later in my speech.

We could consider the victims of road traffic accidents as examples. They will probably be admitted to intensive care after assessment in accident and emergency. Their gradual recovery will continue in one of the general hospital wards, and then the new regional brain injury unit at Musgrave Park hospital, where they will re-learn how to walk, talk and swallow. They will be attended by a rehab team of physiotherapists and speech and language therapists, and I pay tribute to the work undertaken by staff at the hospital However, after patients are discharged home, Reconnect represents the final stage for those with head injuries to get their lives back together again. Reconnect assists patients to return to work, or simply to function to the maximum as a normal human beings again through structured training programmes.

With head injuries, a person's life can change dramatically in an instant. With a severe brain injury, an individual goes from being independent to being totally dependent, and from being capable to being incapable; everything about their lives becomes different. During the recovery period, there is a need not only to reconnect neurological paths, but at a deeper level, for people to reconnect socially and emotionally with their friends, families, therapists and society at large.

Training and rehabilitation focus on reconnecting lost skills and learning ways to compensate for abilities that have been permanently changed because of a brain injury. The brain is a dynamic organ, and as long as it receives repeated stimulation, chemical and physical changes occur to ensure that cells will react to that same stimulation in the future. Following a brain injury, the remaining tissue may set up new connections and pathways. The surrounding tissues in the brain try to take over the functions that were lost in the area of injury, so the brain tries to reconnect to the old pathways. That can occur only if a person is active. The brain does not adapt or try to recover if it is inactive—it must be stimulated. Rehabilitation involves stimulation, and that happens at Reconnect using information technology, office skills, horticulture and many other essential social skills.

Reconnect is a voluntary organisation that has been supported since 1995 by the European social fund. In 2002 the ESF doubled its funding, which allowed it to embark on plans to move away from its dilapidated premises on the Ormeau embankment and source new land to build the first purpose-built training facility for people with acquired brain injury in. Northern Ireland. As a result of heavy capital investment from the European regional development fund, the European capital programme, a brand-new £750,000 training facility sits in the Castlereagh hills overlooking the city of Belfast. The new facility is greatly expanded from the old premises and can accommodate up to 15 staff and more than 60 trainees at any one time. On any day, it is likely to hold the highest concentration of people with an acquired brain injury under any one roof in the Province.

The facility is unique because it can train brain injury sufferers on site in areas as diverse as catering, in the kitchen and preparation areas; information technology, media and communications, in the computer suite: office and administration work, in the large, specially designed secretarial areas; and horticulture, in its specifically designed climate-controlled glasshouses, seeding area and polytunnels. It has numerous other training facilities in the large boardroom, the therapy room and additional offices.

In September 2003 staff numbers increased to 15, and in November the organisation was officially relaunched as Reconnect, bringing with it new corporate branding and a strategic vision for the future. The strategic plan was a realistic achievable vision that would enable the organisation to become a centre of excellence in the provision of community-based training and the rehabilitation of people with acquired brain injury. Through a commitment to person-centred planning and an ethos of "whatever it takes", Reconnect set out to provide each trainee with their own training package based on their skills and desires, which is essential to attaining a positive outcome for someone with an acquired brain injury.

Unfortunately, in December 2003 Reconnect received a letter stating that its application for core funding from the European social fund programme "Building Sustainable Prosperity", administered by the Department for Employment and Learning, had been unsuccessful. That occurred despite the fact that the organisation had surpassed the ESF's criteria for a quality organisation, thereby reaching the threshold for acceptance for funding. The decision to stop funding was taken by two civil servants and an independent member, and was based on information identical to that in previous successful applications. As the ESF provided more than 65 per cent. of Reconnect's core costs, which was match funded by other organisations, such as the disablement advisory service in the Department for Employment and Learning, Reconnect now faces closure on 30 March 2004. Up to 48 trainees will be denied access to training, 15 experienced and highly specialised staff face redundancy, and a brand new £750,000 ESF-supported purpose-built facility will be left derelict and unused.

One reason given for the failure of the application, apart from an overall reduction in European funding, is that Reconnect's services cut across the remit of several Government Departments. It appears that it has fallen between two stools. No service equivalent to Reconnect is currently provided by the statutory sector in Northern Ireland. In current circumstances, Reconnect simply does not have the finances to continue. It is ludicrous to end funding at this critical phase in its development, as it has received extensive support thus far. I therefore urge the Under-Secretary of State for Northern Ireland, the hon. Member for Basildon (Angela Smith), to intervene and support Reconnect in its appeal against the decision. I also encourage her to consider mainstreaming the organisation to allow its services to continue. Co-operation between Ministers with responsibilities for health and for employment and learning may be required.

Anecdotal evidence suggests that across the Province, 500 people a year sustain a head injury and would benefit from a service such as Reconnect. I trust that the Minister agrees that the organisation fulfils an important role and offers an invaluable service to many people across Northern Ireland. For that reason, I decided to seek this Adjournment debate, and I hope for her support in maintaining and optimising this critical service.

3.33 pm
Rev. Martin Smyth (Belfast, South) (UUP)

Circumstances are fortuitous, because the hon. Member for Strangford (Mrs. Robinson) and the Minister would originally have had to wait until 7 o'clock for a half-hour debate. We could now have a debate lasting until 7 o'clock—although I have no intention of making my speech last until then. None the less, I shall take the opportunity to say a few things in support of the hon. Lady's request.

We hoped to have a meeting with the Minister to argue the case for supporting Reconnect. It is unfortunate that it has not been arranged yet, because there are time pressures and a decision could be made by the end of the week. However, this is a timely occasion for an Adjournment debate on the subject, and I congratulate the hon. Lady on securing it. She mentioned the work that is done and said that the figures would not tell us how many were injured in other parts of the Province. That is partly because the Royal Victoria hospital is the major trauma centre in Northern Ireland, and the Musgrave Park hospital in my constituency is the rehabilitation centre, which does a great deal of work for people throughout the Province.

Now we must deal with onward development. Even in speech therapy, there have been changes in recent years with growing recognition of the importance of stimulating people who have had strokes and lost the power of communication. It is fantastic to see some of the work being done.

One of the saddest statements that the hon. Lady made was about the concept of prosperity. So often that concept is used only in relation to finance, and takes no account of the physical, mental and social prosperity of people who have been so handicapped. There is a case to be made. I pay tribute to the work done at Musgrave Park and to the work of Reconnect. I hope the Minister will take the matter on board. Even though she spells her surname differently from mine, I believe we have a similar understanding of human nature.

We are talking about the seamless robe of Government and the fact that Government Departments have been reconnected. I hope that money can be found in the Department to keep that excellent work going on. It is strange that two civil servants and an external person acknowledged that money was needed in the past, but they say that there is no money now. There must be some way to find extra money, because the need still exists. The facilities are better than in the past and it would be tragic to lose them. I plead with the Minister to use her influence with her colleagues. If we can help her to put pressure on them, we shall be glad to do so.

3.37 pm
The Parliamentary Under-Secretary of State for Northern Ireland (Angela Smith)

I congratulate the hon. Member for Strangford (Mrs. Robinson) on securing the debate. The subject is obviously close to her heart and I commend her for the way she made her case; it is one with which I have considerable sympathy. I welcome the support of the hon. Member for Belfast, South (Rev. Martin Smyth).

In the time remaining this afternoon, it may be helpful if I explain the background. I understand the hon. Lady's concerns for her constituents, and I am very much aware of the pressures on individuals and families when a member of the family suffers an injury that leads to acquired brain injury. The hon. Lady outlined the random nature of such an event and the traumatic effect that it can have on the life of the person with the injury and on friends and families, who often bear the brunt of dealing with a very different person, in some cases, and caring responsibilities.

Brain injury is a complex and difficult area of medicine. The Government recognise the seriousness of the issue and the need to find ways to combat the effects of such injury on victims. As the hon. Lady said, brain injury can arise through traumatic events such as accidents, or be acquired through brain damage as a result of tumours or chronic illnesses. Initial treatment usually takes place in hospital neurosurgery or neurology departments. Following hospitalisation, a patient may recover sufficiently to return home, although some may require considerable support.

Investment in the health service in Northern Ireland is central to our Government's policies and is bringing improvement to Northern Ireland for the benefit of patients and their families. This commitment is reflected in the fact that almost 41.5 per cent. of the Northern Ireland departmental expenditure limit for 2003–04 is devoted to health issues. The figure will rise by 7.8 per cent. in the next financial year, amounting to more than £3 billion.

The Department for Employment and Learning, not my Department, is responsible for administering the European social fund for projects such as Reconnect which, as she described, provides rehabilitation for people with head injuries. Eligible projects are those that provide training and skills development for people seeking employment or advancement in employment. Some supported projects seek to meet the employment and training needs of those with health problems or disabilities, as in the case of Reconnect.

The primary focus of the European social fund is to provide individuals with the necessary skills to gain employment. The general rehabilitation of those with health problems or other disabilities is not the primary objective of the European social fund, but, of course, the building of confidence and of the skills required to enter employment are an important contribution to rehabilitation.

There are some misconceptions about the reasons for Reconnect not succeeding this time. There is a substantial but finite amount in the European social fund available to projects for the two years from 1 April 2004 to 31 March 2006. That amount is £22 million. I understand that that is not a reduction, but the reasons for the application's failure have nothing to do with it crossing two Departments. Each application is considered on its merits.

One problem is that there is extensive competition for the funds: 95 applicants sought a total of £36 million, which the fund could not meet. The result was that there were more deserving projects than could be dealt with by the funds available That is one reason why, on this occasion, Reconnect was not successful.

I understand that Reconnect was supported previously by the European social fund, but that in itself is not a criterion for future support. I am told that that would be unfair to new applicants, which is understandable. However, that causes a problem for organisations on the ground of sustainability, so perhaps we ought to work across Departments and with the organisations that might be involved to see whether more can be done to help to develop exit strategies or alternative funding streams.

Unfortunately, the timing is difficult, because often when organisations are notified that they are to lose their funding there is not always enough time to put other funding in place. However, the Department for Employment and Learning, as well as my own Department, the Department of Health, Social Services and Public Safety, very much recognise the seriousness of brain injury and its effects on the victims.

I understand the disappointment felt by Reconnect at its recent unsuccessful application. It has decided to appeal against that decision—I am told that the review panel is meeting on 4 February—but the difficulty is that Reconnect was not the next organisation on the list for gaining funding. Other organisations, which are also extremely worthy and extremely important, were ahead of it. We await the outcome of that appeal. In the meantime, I can assure the hon. Members for Strangford and for Belfast, South that the discussions are ongoing between the organisation, the South and East Belfast trust and the Eastern board to see whether any interim measures can be taken. I will say more about that later.

In a moment, I will come to the discussions that are taking place and what steps we are considering to see how the Department of Health, Social Services and Public Safety can help. First, I want to talk about the Department's work in this area of health.

Rev. Martin Smyth

I may be coming in too soon on this one and the Minister may be about to answer my question. I understand her reference to the South and East Belfast trust and the Eastern board, but are no folk in other board areas benefiting from Reconnect's work? Has the Department taken that point into consideration?

Angela Smith

Unfortunately, Reconnects work takes place only in the Eastern board area, not in others. Therefore, it would be difficult to ask other boards to assist in funding activities that do not take place in their areas. There is a problem here—my Department would fund work that happens across all four boards, but this organisation's work does not do that.

Mr. Roy Beggs (East Antrim) (UUP)

The point made by my hon. Friend the Member for Belfast, South (Rev. Martin Smyth) is that we have only one centre in Northern Ireland that does not deal exclusively with those who require assistance in the Belfast area. Obviously, others who require support must travel to that centre.

Angela Smith

Perhaps the hon. Gentleman will be patient for a moment. He is not correct because, as I will explain, considerable other work is going on across Northern Ireland to assist people with acquired brain injury. I shall outline some of what my Department is doing.

The Department recognises that people with a brain injury require a continuum of care—this was also acknowledged by the hon. Members for Strangford and for Belfast, South—in respect of acute care, which is followed by community care and support. As a result, we are establishing a new regional acquired brain injury unit on the Musgrave Park hospital site. That will provide state-of-the-art in-patient rehabilitation services, and is due to open in 2006. I am sure that that will be welcomed across Northern Ireland and by all in the Chamber. The £8.5 million cost of that represents a considerable investment in brain injury rehabilitation services.

The development of community brain injury services to complement the new unit is also essential. These will provide rehabilitation and support for those with brain injury already living in the community and provide a "step down" service for the new unit, the importance of which both hon. Members specified. It is envisaged that community services will be provided by teams comprising psychiatry, psychology, therapy, nursing and social work input. In 2004–05, an additional £500,000 will be provided for that purpose.

The third aspect of support for people with brain injuries and their carers is also provided by voluntary organisations. Currently, my Department provides funds amounting to £120,000 to the Cedar Foundation, which provides rehabilitation and vocational training. Cedar provides socio-vocational brain injury services at six centres across Northern Ireland—Belfast, Ballymena, Lisburn, Londonderry, Newry and Enniskillen. The Cedar Foundation was successful in its recent application for funding from the European social fund, and it plans to expand its brain injury services. Headway also provides support and services for people with brain injury and their families. That organisation received project funding until March 2003.

A new organisation, the Northern Ireland traumatic brain injury forum, was established in 2002 to bring together people with a brain injury, their carers and professionals in the field to lobby for better services. My Department provided funding for the organisation's inaugural conference in 2002 and an application for recurrent funding is currently being considered. The forum also organised a seminar in November 2002 on the needs of children with a head injury, which my Department funded. A report of the recommendations of the seminar is awaited, and that will assist in planning for future service development. In addition, an inspection of services for disabled children is being undertaken by the social services inspectorate, which will advise my Department of any current gaps in service provision.

Work is also being undertaken by the Department for Employment and Learning through its disablement advisory service, which provides advice, guidance, training and a placing service for people with disabilities and health issues. The service is available for those who wish to obtain or retain employment and can be accessed through a specialist team of disablement employment advisers across Northern Ireland.

The disablement advisory service also offers a range of practical and financial support to employers recruiting and retaining disabled employees, as well as a professional assessment system. The disablement advisory service administers four main employment programmes to help people with disabilities enter or remain in work: the job introduction scheme, access to work, employment support and the new deal for disabled people. The job introduction scheme is a job trial facility, which offers both the employer and the disabled jobseeker an excellent opportunity to find out if the job and the person match. The disablement advisory service helps the employer with a contribution towards employment costs for the first few weeks, and the trial period usually lasts for about six weeks. Employment support gives people with more severe disabilities the opportunity of working alongside non-disabled employees in a wide variety of jobs. That enables people who cannot reach standard output levels, because of their disability, to work in real jobs and earn the full rate of pay for the job that they are doing. I have mentioned the work of the new deal for disabled people.

Projects such as Reconnect, which were already receiving European social fund assistance, were aware that further assistance, as previously, is subject to competition with other organisations. That, however, does not lessen the threat to Reconnect's services. Clearly, health is a priority for Northern Ireland and is central to Government policies. As I indicated earlier, the priority is reflected in the high proportion of expenditure devoted to health issues in Northern Ireland, and I have outlined some of the important work that is going on to assist people who have disabilities and acquired brain injuries. We do as much of that work as we can, as this is a very complex and distressing area of medicine, and patients, carers and their families need support, as I outlined at the beginning of my speech. However, I have to recognise that, within the budget limits that apply, we cannot meet every need in medicine.

I want to comment on the specific action that we are taking to try to help Reconnect. I apologise to the hon. Member for Belfast, South if he has not had a response about meeting me. I understand that my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy) is the Minister with responsibility for employment and learning. If the funding falls under that Department, the request would not have come to me at this stage.

I understand that 33 people are currently using Reconnect services and I am most concerned that they continue to receive the care and support that they need. I am sure that the hon. Lady appreciates that it is quite difficult for the Health Department and health boards to pick up the drop in expenditure from the Department for Employment and Learning. I can say that the trusts that use Reconnect services have advised the board that they have contingency plans to absorb current users into alternative provision if the need arises. For those currently accessing the services of Reconnect, every effort has been made to ensure that there is no lack of provision of service for them.

The Eastern health and social services board and the four community trusts are working together to find a means of supporting Reconnect beyond 31 March 2004. What we would like to do then is collectively to review the longer-term funding of the organisation to establish how it can be supported. I am pretty confident that we will be able to achieve that. There will be further formal discussions with Reconnect in the very near future, but its longer-term future must be viewed in the context of other services being provided across Northern Ireland for people with brain injury. The commitment to building community services for people is also important.

I assure the hon. Lady that I take a personal interest in this matter and I have asked to be kept informed of what happens in future. I hope that I have dealt with the points that she raised and I thank her for the way in which she raised them today. I hope that we can find a way to continue these services, which are so important.

Question put and agreed to.

Adjourned accordingly at nine minutes to Four o'clock.