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UK Concussion Guidelines for Grassroots Sport

Volume 732: debated on Tuesday 2 May 2023

(Urgent Question): To ask the Secretary of State for Culture, Media and Sport if she will make a statement on UK concussion guidelines for grassroots sport.

The UK concussion guidelines for grassroots sport mark an important step in making sport safer for millions of people. Taking part in sport has many benefits. It is great for people’s physical and mental health, and it brings friends and communities together. We want to protect that and encourage more people to enjoy being active and play a sport.

As I set out in my written ministerial statement published today, the vast majority of people participate in sport safely, but head injuries do occur. We want to reduce the risks associated with concussion and make sport even safer for everyone. Research has shown the importance of fast, effective, tailored treatment, and we are issuing this expert guidance to help people spot and treat head injuries. Our guidance is a tool for the thousands of people who enjoy sport at the grassroots level. Whether it is used in a local leisure centre during a swimming lesson or in the second innings of a village cricket match, this landmark guidance has the chance to make a real difference to people across the UK.

The guidance was developed by a world-leading panel of medical experts, and I am grateful to the whole expert group for giving so freely of their time while drafting the guidance. I pay tribute to the efforts of the group and to the valuable input of the Sport and Recreation Alliance, which has worked tirelessly to produce this excellent guidance. All that builds on the world-leading work conducted in Scotland by raising UK-wide awareness of the issue of concussion and making sport safer for all who take part. Fundamental to the guidance is an overriding simple message:

“If in doubt, sit them out.”

Finally, this guidance is an essential but first step. The Government remain committed to working with the industry to help to make sport safe and enjoyable for everybody, including on technological solutions and the prevention of concussion.

Thank you, Mr Speaker, and thank you for granting this urgent question.

Sport is indeed good for us, but as we have seen from countless footballing legends and rugby league and union players, repeated sporting concussions and sub-concussive events can lead to depression, anxiety, suicide and early-onset dementia. I have seen tough men weep and heard from sporting stars with no memory of their victories and triumphs. I am therefore delighted that the Government have worked hard to produce these guidelines. I pay tribute to Professor James Calder and the team, to the Minister and to Dawn Astle, Alix Popham, Steve Thompson and Peter Robinson, who have campaigned for all this to happen.

However, I do have some concerns. These guidelines rightly say:

“If in doubt, sit them out.”

That is what to do after a brain injury on the pitch, but what are we going to do about preventing brain injuries in the first place? Should we not look at further limiting youngsters heading the ball in football and curtailing rugby training sessions that include tackling? Why is there no reference to multiple concussions? Surely a young person who suffers two or more concussions in a 12-month period must be referred to a specialist. Why is there no recommendation that medical approval be sought before a return to play? That is weaker than the Scottish guidance. How do the guidelines align with existing ones, such as in boxing and equestrianism?

What about elite sport? The sporting bodies have shown a shocking disregard for the health of their own professional players for far too many years. If they do not act, should we not legislate for a duty of brain injury care? How can we ensure we get reliable statistics on brain injury in sport when nearly one in five rugby league players say that they deliberately did not report a concussion last year lest they be not allowed to play?

How do we get schools to understand concussion and brain injury better? Would it not be better to say “brain injury” rather than “concussion” because that is what it actually is? How can we ensure far greater co-ordination of research into concussion in sport, for instance through saliva tests and new generations of mouthguards, and especially into concussion in women’s sport? Are we sure that we have enough rehabilitation services for those with more serious injuries?

Brain injury is a hidden epidemic. We cannot normally see it. Let us do everything we can to prevent brain injuries, spot them, understand them, treat them and give people back the best possible quality of life.

First of all, I congratulate the hon. Gentleman on all his work in this area. He has been a passionate advocate and campaigner, and I welcome all the further work that he is doing with those across Government. He is right to mention many campaigners who have been working hard in this area.

Prevention is important, which is why the guidelines will go out through all sports’ national governing bodies. We want them to go out to schools, so that teachers and medical professionals all have them. The advice in the guidance has been led by senior medical experts—I am not a medical expert so I am relying on their advice. I note the hon. Gentleman’s point that it perhaps looks weaker than Scotland’s guidance, but the professor involved with the Scottish guidelines has been instrumental in these, and has learned a lot of lessons from their publication.

The hon. Gentleman has raised with me the terminology of “brain injury” or “concussion”. The reason “concussion has been used is that it is more broadly understood among the grassroots organisations. We are trying to reach millions of people through the guidelines. I assure him that they are just the first step, as I said in my opening comments. I will continue to raise this issue with all the national governing bodies—I had a summit with them just last week to talk about it. We will ensure that sport is held to account to look after all players who take part.

I welcome the introduction of the guidelines, and I would add the Love of the Game campaign to the list of institutions that the Minister paid tribute to. It has done a lot of work to raise the profile of this important issue.

I urge the Minister to combine the guidelines and raising awareness of the dangers of concussion with a continuous education campaign from the Government and others to say that sport is good for people, particularly young people. There is a dangerous tendency among some parents to stop their children taking up sport because they are worried about concussion. Of course, we should be careful and do our best to prevent concussion, but will the Minister assure me and the House that the Government will do all they can to continue to encourage as many boys and girls as possible to take up sport?

I thank the acting Chair and the whole of the Select Committee for their input into this important area of work that we have announced today. I add my thanks to Love of the Game. He is right to raise continuous education. Sport and physical activity are incredibly important. We will release our sports strategy very soon, in which we will talk about how we want to raise activity levels among all age groups, particularly the young.

I congratulate my hon. Friend the Member for Rhondda (Sir Chris Bryant), who raised many important issues. We want everyone to safely enjoy the benefits of participating in grassroots sport. We agree on the pressing need to address concussion and brain injuries, so we welcome the guidance and the implementation of the action plan on concussion. However, we want to ensure that it is as robust as possible, so I have further questions for the Minister. Is he confident that the guidance makes the risks of sustaining a concussion clear enough? As my hon. Friend asked, why is the guidance limited to what happens once someone is concussed, rather than giving better advice on how to prevent concussions in the first place?

How does the Minister plan to monitor the adoption of the new guidelines and their impact? In the light of the possible gaps and points of contention in the guidance, and with new research and evidence emerging, what is the capacity to amend the guidance on an ongoing basis? Is the Minister aware of the ongoing inquiry into concussion by the Parliament of Australia—a nation that knows a thing or two about sport? Will he look at the outcomes of that inquiry?

Finally, guidance on dealing with a concussion can be effective only if the services that it signposts to can be accessed. Given the crisis in the NHS overseen by this Government, is the Minister confident that the current care and rehabilitation provision for people with a concussion is adequate? I do not think that he quite answered my hon. Friend’s question. Let us get this right and keep grassroots sport safe.

I thank the hon. Gentleman for welcoming the guidance. Prevention is important. It is up to each of the national governing bodies to draw up plans, and in every meeting I have with those bodies I will keep asking what they are doing in that area. We will ensure that we monitor the success of the guidance. Just last week, we were talking about how we will measure success and ensure the messaging is delivered effectively.

If research suggests that we need to amend the guidance, then we will amend it. We will keep up with the latest available medical research and take evidence from all over the world. Indeed, medical experts from around the world helped us to develop the guidance.

On the provision of health services, I know that my right hon. and hon. Friends at the Department of Health and Social Care are taking the issue seriously, as part of a wider brain injury strategy, and I am sure they will make announcements in due course.

Brain injury blights thousands of lives each year. The Minister is to be congratulated, as are his immediate predecessors, for taking the issue more seriously than it has been taken by Government for decades. Nevertheless, more needs to be done both on preventative measures of the kind that have been raised already and on aftercare. When concussion occurs, what happens 24 or 48 hours later, or later still, matters too. In developing the next stage of the strategy, will the Minister recognise that this is a matter of what happens before, during and after such an event?

I know that my right hon. Friend is vice chair of the all-party parliamentary group on acquired brain injury and takes a keen interest in this area. I hope that the publication of the guidelines shows how seriously we are taking the issue. We want to ensure that the best possible information is available, and we will liaise constantly with the research groups that have been established, so that the guidelines will be updated if needs be.

I pay tribute to all those who have campaigned tirelessly on this issue, particularly my hon. Friend the Member for Rhondda (Sir Chris Bryant). In order for the guidelines to be embedded in grassroots sport, the issue needs to be taken seriously at elite level, as that has an enormous influence on what happens in grassroots sport. Will the Minister say whether he is satisfied with how the governing bodies of elite sports, such as rugby union, rugby league and football, are treating the issue? What are the Government doing to ensure that they take the guidelines on board?

Obviously, the guidelines are a baseline that we would expect all the national governing bodies to use, but then to go even further. Many of them have professional medical support, but they should still take the issue very seriously because, as the hon. Gentleman rightly points out, they are role models for many organisations. In my meetings with each of them, I will ensure that I keep raising that point.

Nothing will instil confidence in the important message of “If in doubt, sit them out” more than for grassroots players, particularly youngsters, to see elite-level players adhering to the strictest head injury protocols. Sadly, we have seen too many coaches, referees, on-pitch medics and game administrators turning a blind eye, cutting corners and ignoring the protocols. Will the Minister say a bit more about what he is going to do with the governing bodies at professional level to ensure that there is consistency throughout sports, from amateur and grassroots levels right to the very top?

The very publication of the guidelines shows how seriously we are taking the issue. We felt that it was really important to get guidelines out to grassroots sports, given how many millions of people are taking part in them. My right hon. Friend is right that the elite levels of sports also need to lead the way. Good work is going on, but I accept that more needs to be done. I can assure him that I will take the messages from the House today to the governing bodies in my further meetings with them.

I welcome these changes, and I congratulate my hon. Friend the Member for Rhondda (Sir Chris Bryant) on the urgent question, but these changes relate to the grassroots. We know that elite rugby union players such as my constituent Ryan Jones, a former Lion, have early-onset dementia as a result of numerous subconcussions. Can the Minister update us on the work to develop technology that can help to mitigate concussions in sport—such as the player brain scan trials in rugby union clubs last summer —as promised in the concussion action plan?

We have established a research group that is looking into the technology that is available, and any information that we receive from its members will help us to develop this important work further. The safety of everyone taking part in sport is a priority for the Government. National governing bodies are independent bodies, but, as I said a moment ago, I will certainly continue to put the pressure on.

In the year that marks the 200th anniversary of a game that started in my constituency and is now played around the world, will the Minister welcome the input of the English rugby union authorities in setting the guidelines, and also their commitment to ensuring that improvements in the game’s protocols are implemented in time for the start of next season in September?

It was a pleasure to join my hon. Friend in his constituency to celebrate this important year for rugby, and yes, I do welcome the work that has been done. I shall be interested to hear how it is developing when I have my next meeting with the Rugby Football Union.

I am a gymnastics coach at a local club in Glasgow in whatever spare time I can manage. The message “If in doubt, sit them out” is very welcome—it is a good, strong message—but unfortunately there is still a lack of understanding among the public, parents, participants and coaches of the damage that concussion can cause. The Minister does not want to talk about brain injury, but may I gently suggest to him that there has to be a better link between the words “concussion” and “brain injury” if we are to take this issue more seriously?

Let me first thank the hon. Lady for all the work that she does with the gymnastics club. As she says, it is important for the guidelines to be available to grassroots sport throughout the country, and it has been good to work with the devolved Administrations in producing them. Of course, further work is being done across Government to examine brain injuries, which will be linked to much of the work that we have already done on the guidelines. We wanted the guidelines to be as effective as possible, given that there is so much grassroots sport, and ensuring that the information gets out there and is widely understood will be a priority for the Department.

I, too, warmly welcome the guidelines, which are an important step forward. I also pay tribute to those at the Headway charity in my constituency, who do fantastic work in supporting people with acquired brain injuries. They are always at pains to explain to me how the impacts of concussion can vary because everyone is different, and the way in which the side effects can fluctuate: they can come and go. What more can be done, moving forward from the guidelines, to ensure that the right training is in place for coaches and match officials so that the identification of concussion, and action on it, always take place very swiftly?

My hon. Friend is right, and that is the exact purpose of the guidelines: they are for coaches, referees and teachers. Our key priority will be ensuring that everyone has this information, so that everyone knows how to recognise the symptoms of concussion and how to deal with it. As my hon. Friend says, each person is different, so understanding how concussion should be treated to ensure a safe return to work and further sport is a priority.

I recently visited the Royal Hospital for Neuro-disability, which is in my constituency, with my hon. Friend the Member for Rhondda (Sir Chris Bryant). We heard about the shortage of beds for the rehabilitation of people who have had a brain injury, and about what is often too long a wait for the important early treatment, which is then a false economy. What assessment has the Minister made, along with Health Ministers, of the availability of rehabilitation beds and the need for more funding to meet the current requirement?

The Department and I work closely with colleagues in the Department of Health and Social Care. I understand the point that the hon. Lady is making. We are making this a priority in terms of safety in sport, and I will certainly raise the issue in my next meeting with that Department.

I welcome the work that is being done in Scotland and across the UK. I refer the House to my entry in the Register of Members’ Financial Interests as a football referee with the Scottish FA. On that subject, how does the Minister envisage this guidance and any updates being disseminated to the match officials, referees and umpires who officiate at all age groups and all levels, and who are often the closest to incidents that happen on the field of play or the pitch?

My hon. Friend is right to raise that issue. We are working incredibly hard on this. As I have said, we held a summit just last week with national governing bodies and all interested parties to ensure that this information gets out there. It is not just for one section of society; it is for everybody. We want everybody to understand and raise awareness of the issues that concussion can bring and, importantly, of how to treat it when it has been identified. We will continue to monitor the effectiveness of the distribution of that information, and if we need to look at another way of doing it, we will of course do so.

This new guidance is a welcome step in helping to make sport safer, but grassroots sports often do not have doctors or medics on hand to help players who have suffered concussion, so what steps is the Minister taking to ensure that the correct level of training is there for coaches and others to identify and advise on concussion?

That is precisely why we have published these guidelines. Professor Chris Whitty has said:

“These guidelines help players, referees, schools, parents and others balance the substantial health and social benefits and enjoyment from taking part in sport with minimising the rare but serious and potentially lifelong effects of concussion.”

We are providing easy-to-read guidance for all those people who are doing great work out there, so that they know exactly how to deal with the issue, should it occur.

I watch a lot of grassroots sport, particularly football and rugby, so I welcome the guidelines today. Does the Minister agree that, as risks vary between the sports, the sporting governing bodies are the best placed to regulate this, and also that as part of the review we need to look at the medical cover that is routinely available at these events?

As I say, this is a baseline of guidance and my hon. Friend is absolutely right to say that each sport will have its own individual needs. That is why it is right that the independent national governing bodies should take this guidance and build on it for the safety of all those involved.

I welcome the guidelines and compliment the Government on their thoughtful approach, including talking to the devolved Administrations, which is most welcome. There is, however, a bit of a problem. If there is a suspected case of concussion and some right-minded person calls NHS 111, there could be a very long delay before that call is answered. I understand that within the last 12 months, 3.6 million calls were abandoned. We have an issue here, so can the Minister assure me that there will be discussions with the Department of Health and Social Care about this particular aspect?

Yes, absolutely. This is obviously an important area of work. The running of NHS 111 is not within my remit, but that close working relationship with colleagues in the Department of Health and Social Care will be key to ensuring that the guidelines work effectively, so I will happily raise those issues.