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Concussion in Sport

Volume 690: debated on Thursday 11 March 2021

Motion made, and Question proposed, That this House do now adjourn.—(David Duguid.)

I am good at clearing the Chamber, Madam Deputy Speaker.

Let me start with a couple of quotations:

“I felt like there was a rage inside me boiling up and I just needed to get it out. On one occasion, I lit the grill and forgot about it, even though my young child was in the kitchen. When the burning started, it was only when my wife turned up that I realised. When I went out on my bike, I got completely lost, even though it was a journey I have done many times.”

Somebody else said about her father:

“He started to ask: ‘When am I going to get this sorted? When is someone going to fix my head?’”.

The truth is that brain injury is a hidden epidemic in this country. We are used to talking about a pandemic at the moment, but there is a hidden epidemic. It is hidden because lots of people have a brain injury and we would never know. In some cases, yes, there is an evident scar from an operation or road traffic accident, but in many cases the damage is inside the brain and is not visible to anybody. Sometimes, the person in front of us in the queue who is slurring is not actually drunk at all, but has had a brain injury. Our judgmentalism may make that moment even worse for them.

Attitudes have changed considerably in recent years. I remember watching rugby matches in which the commentators used to sort of celebrate the big clashes, when head hit head or boot hit head. I was so proud when in the Six Nations rugby matches this year every single commentator was saying, “I’m sorry, but that tackle is too high”, or, “That’s a really dangerous injury. I hope somebody is looking at that. Isn’t it great that the player’s being taken off the field?”

In the past, there used to be so much: “Play up, play up, play on—play the game!” Or it was: “You’ve got to stay on the pitch whatever, because you’ve been selected and you want to show that you’re a man”—I will talk about the issues facing women in a few moments. There was almost a celebration of that concept of being punch-drunk in rugby, and people would laugh at players who were clearly groggy and unsteady on their feet on the rugby pitch or the football pitch. Thank goodness that a lot of that has changed. The honest truth is that it has changed in very recent years—it is only three or four years ago that commentators were sort of relishing these big fights.

I am really proud that the Digital, Culture, Media and Sport Committee started an inquiry into concussion in sport. It feels like some of us have been making these arguments in the House for a long time. This week, Dr Willie Stewart laid bare some of the problems. He said of rugby that one player in every match suffers a brain injury. In every single match that we watch, somebody suffers a brain injury, and the effects of that may last for many years of their life.

“Chronic traumatic encephalopathy” is one of the ways they describe it. This is a horrible image, but it was given to me by Willie Stewart originally: basically, we can imagine the brain as being like a wet sponge in a hard bucket, and when it is smashed against something else, the sponge moves with it, of course, and all the parts of the sponge get stretched, and sometimes they get stretched out so much that they never get back to normal.

Willie Stewart also said that

“the only thing that connects football to American football to boxing to rugby to wrestling…is head impact and head-injury exposure.”

He said that neurodegenerative disease and dementia

“was recorded on the death certificate in about 20% of our former footballers”,

compared with 6% of the population control: 20% versus 6%. I am not sure how much more evidence we need that concussion in sport is doing immense damage to players. In other words, the beautiful game is damaging brains and killing players. Nobby Stiles, Jack Charlton, Sir Bobby Charlton—I think five members of the 1966 team have now been diagnosed with early onset dementia of one kind or another.

This is not just about dementia. Post-concussion syndrome comes in many different forms. Some individuals have diminutive cognitive functioning. They have difficulty remembering things and do not understand why. Others have diminished inhibition, and a sense of rage—I referred to that earlier—or sexual inappropriateness. Those different elements of diminished inhibition also come with diminished executive function, such as an inability to turn up on time, or sometimes chronic fatigue. I do not mean just feeling tired or lazy. Some people call it brain-drain, when every ounce of energy that should be in someone’s Duracell battery has gone. There is nothing left; they are completely running on empty and cannot get themselves out of bed.

Others suffer from depression, anxiety, or horrific mood swings that have a terrible effect on their relationships with loved ones, family members and children. People start to fear what they might do to their children, and there is the horrible effect that that has on someone’s relationship with a wife, husband or partner. It causes terrible family distress.

I have spoken to players and their partners who are desperate to support the person through this, but they do not know how. They do not have the skills. Indeed, they never thought they would need them, as the person involved was so fit—the epitome of health—and to see them in that condition is terribly depressing. Dementia and many of these conditions affect many families, regardless of sports, but they are strongly felt in the sporting community. There is also second impact syndrome, perhaps the most notable instance of which was Ben Robinson in 2013. A young Irish lad, 14 years of age, had a second concussion having gone back on to play. He died later that day.

This is not just about men, although a lot of the research done so far is about elite players who are men. That needs to change. We need to do far more research into the effects of concussion on women, not least because in the United States of America more work has been done because of legal cases. If we consider the incidence of these problems per 1,000 athlete exposures—stick with me—as they call it, for women in soccer the rate is 0.54, whereas for men it is 0.26. In other words, it is 100% higher for women. Similarly, for lacrosse the figure is 0.3 per 1,000 athlete exposures for men, and 0.45 for women, which is 50% greater.

I suspect we would find all those figures writ large across football in the UK and for women’s sports, and we need to do that work. For instance, lots of work has been done on men’s boxing, and one reason why people changed the rules on wearing headguards is that they discovered that there tended to be more concussions with headguards than without, which was counterintuitive. That research was done on men, but there is still no data for women at all. It is shameful.

It is not just about adults, either. Figures I saw today show that 40,000 children go to hospital every year with a brain injury. That is significantly more children than present in hospital with autism, yet we know far more about autism in children than about brain injury in children.

The sporting bodies have repeatedly failed the people they should be there, as employers, to protect. Jeff Astle died in 2002 and the coroner decided that he had died of an industrial disease. He was 59—my age. On 15 October 2020, the coroner decided exactly the same in the case of Alan Jarvis; another footballer and the same verdict—death by industrial disease. What has happened in between? To be honest, from the football authorities, next to nothing: a lot of hand wringing, moaning and saying, “Yes, we’ll do more research; we’re committed to funding more research”, but there has been precious little action.

In UEFA matches, there is still only three minutes for an assessment. A proper brain injury assessment cannot be done in three minutes; 10 minutes would be far more sensible. A team doctor still does the assessment. It should not be the team doctor but an independent medic who does it. Of course, the team doctor wants the player to go back on. The Minister will rightly say that the UK is trialling substitution, but only five countries out of 211 have decided to trial it—five out of 211. Not even all the sports organisations in Europe are doing it. That is a disgrace. By now, substitution should not be a trial, but fully in place.

There is no independent medic sitting on the side of the pitch, watching the match and deciding, “Sorry, that person’s had a brain injury. Ref, you probably didn’t spot it, Coach, you probably didn’t spot it, but I did. That person’s coming off because we’ve got to do an assessment.” It is just basic if we really want to protect the players.

How many times must I hear, “Oh, but the ball is much lighter these days”? Actually, the ball is exactly the same weight as a leather ball. The leather balls gathered more water, so they got a bit heavier, but if we do the physics, the real issue is the speed of the ball. The ball probably travels faster than it did in the past, which means that we probably have more of a problem with heading the ball than we had in the past. We should listen to the research that has been done and implement its recommendations.

Far too much has been left to charities such as Headway and Head for Change, which has just started up and has as ambassadors James Haskell, Geraint Thomas, Inoke Afeaki, Lewis Moody and me; I do not look quite as good in the pictures on the website. There comes a point when if people constantly obfuscate, delay, refuse to act and demand more evidence before acting, they are complicit in the harm that is being done. I have come to the conclusion that football is simply a disgrace.

It is great to see the Minister here today, not least because I know he has been taking some action recently. He has covered several roundtables online. I think I know everybody who has been on his calls. It is great to see that work happening. I was a bit irritated with Leader of the House when I asked him about the matter a few weeks ago because he said that action was for the sporting bodies to take. I know that the Government, through the Chancellor of the Duchy of Lancaster, have co-ordinated work between different Departments, which is good. I had a meeting with the Under-Secretary of State for Education, the hon. Member for Chelmsford (Vicky Ford) earlier today, which was really positive.

As I have argued for many years, I want the Government to deal with the matter not in little silos, but through one whole co-ordinated effort because it affects the Ministry of Defence, the Treasury, the Department for Work and Pensions, the Department of Health and Social Care, the Department for Education, the Department for Digital, Culture, Media and Sport—indeed, there is hardly a Department it does not affect. We must therefore tackle it in a co-ordinated way. I am grateful that the Government are doing that. I hope the Minister will be able to say that they will be reporting back to the House at some point on those joint ministerial meetings, because I think they would receive a very strong welcome across the House.

However, I think the Government will still have to go further. If we really want shared protocols on concussion in sport that are shared across all sports at elite, junior and grassroots level for both men and women, that will only really happen with real pushing from the Government —and that means the Minister himself and his Secretary of State. We have to have shared protocols. I know sports are different, with elements that might play out differently, but rugby, football, cycling, hockey, ice hockey, boxing and wrestling all need shared protocols. Quite often, a child in particular will play several sports. They will not understand why there is one set of rules when they play netball and a completely different set of rules when they play baseball, basketball, soccer or whatever. There has to be a shared set of protocols with the same language used in all sports, and that will only happen if it comes from the Government.

I am a Welsh MP. The Minister sent me a text—I hope I am not breaking a confidence—to say that I have to remember that some of this is devolved. I am fully aware of that, but because Wales plays England at rugby in particular—the Minister may not want to remember that fact—it is important that we share the protocols across the whole of the UK. I want a UK-wide approach if we can possibly achieve that. If the Minister were to knock on that door in Wales, I believe he would receive a socially distanced welcome.

Physical education staff in schools and coaches really need a full understanding of concussion. There are still far too many people who simply do not understand it. They think it is only a concussion if you have been knocked out. Actually, being knocked out is a particular form of concussion where a particular part of the brain is affected. However, you might have several concussions without being out at all. That is why it is really important that a better understanding is shared across all PE teachers and coaches.

On legislation, I am always very reluctant to suggest that we need to legislate, but I just note that in the United States of America between 2009 and 2015, all 50 States and the District of Columbia introduced legislation on concussion in sport primarily, but on brain injury in general. The United States of America has a traumatic brain injury Act—we still do not—which lays down all sorts of different elements. It may be that if sporting bodies are not prepared to act, we will have to consider legislation in this field.

There are arguments for legislation in other aspects. There is a Bill going through the House of Lords at the moment to which Lord Ramsbotham, I think, has been tabling amendments this week that insist women who have been subject to a brain injury as part of domestic abuse will be guaranteed a proper test and be screened for brain injury. Women who go to prison will, when they first arrive in prison, all be screened for brain injury as well. I suspect we also need legislation on the treatment of veterans to provide for proper research programmes and for the protection of prisoners.

I warmly welcome the fact that the Select Committee is doing its work and the Government are doing their work, but I suspect that it is still woefully under-resourced. I do not know whether the Select Committee will produce a report or whether it is having another day of evidence, but I think the time is long past when we need a royal commission on brain injury as a whole and concussion in sport in particular, so that all the evidence can be presented, analysed and considered in a quasi-judicial way and we end up protecting people.

I end with this. Sport is good for us. I have no desire to stop people taking part in sport. I want more people to take part in sport. I would like myself to take part in more sport. Sport often involves risks, of course it does, but one player said this to me—I apologise for the language, which is not my language:

“I knew it would bugger up my body. I had no idea it would bugger up my brain.”

That is the bit here that matters and that we have to change. I am not interested in cotton wool—I do not want to mollycoddle anybody—but this is what Hayley McQueen, the sports presenter, said about her dad, Gordon McQueen, the ex-Man United player:

“I can’t believe football, the thing that gave him so much love, has cruelly taken a lot away from us.”

We do not have to lose the good. We can do the good.

I thank the hon. Member for Rhondda (Chris Bryant) for securing this important debate. I know—he has just illustrated this—how deeply he is concerned about the welfare of sportspeople and this issue. I greatly appreciate the care and commitment he has shown in regard to concussion and brain injury in the sporting sector and beyond over many, many years. He has spoken eloquently yet again today, showing great empathy and emotion. I have indeed interacted with many people he has interacted with over a much longer period than I have, and the stories I hear are absolutely heart-rending.

The fact that this debate is taking place is testament to the hon. Gentleman’s energy in chairing the all- party parliamentary group for acquired brain injury. The subject is getting increasing attention across the House and beyond, and I genuinely give him and the APPG credit for highlighting it.

Sports national governing bodies are rightly responsible for the regulation of their sports, and for ensuring that appropriate measures are in place to protect participants from serious injuries. We look to individual sports to take primary responsibility for the safety of their participants, but the hon. Gentleman is right to point out that it must go beyond that, and that the Government have a responsibility too.

I am pleased to acknowledge that positive progress has been made in recent years on this issue, and I am sure it will continue to be made. The Rugby Football Union has been researching head injury in the UK for the last 20 years. Its extensive Headcase education programme, which the hon. Gentleman mentioned, has helped increase understanding of concussion prevention and management. The British Horseracing Authority has also made extensive efforts to improve its concussion management protocols.

In football, although there is clearly more to do, I welcome the Football Association’s introduction of two concussion substitutes per FA cup match earlier this year. I am also glad to see that the Premier League started trailing the use of concussion substitutes last month, as the hon. Gentleman also highlighted—we should have shared a speech. Indeed, England is one of only five out of more than 200 countries to trial the new International Football Association Board concussion protocols. I am hopeful that far more countries will follow our lead. We can be proud that we are leading, but there are clearly many more countries to follow.

The FA also issued guidelines last year to help prevent children aged 11 and under from being taught to head footballs during training in England, Scotland and Northern Ireland. It is not just national governing bodies contributing to improvements in player safety. Last November, the Professional Footballers’ Association announced that it would set up a dedicated taskforce to investigate further the issue of brain injury diseases in football, and two independently led research studies supported by the FA are currently examining former professional players for early signs of deteriorating cognitive function. Those are demonstrably good steps across sports, but there is clearly more to do. That will be a familiar theme.

Concussions are notoriously difficult to identify. It is important to note that about 10%—but only about 10%—of reported concussions involve a loss of consciousness, so they are not always readily apparent and the player’s injuries may be far more serious than they appear at the time. Player safety is the No. 1 concern for sport. Much more work is needed to ensure that robust measures are in place to reduce risk and improve the diagnosis and management of sport-related concussion at all levels of sport.

That is why the Secretary of State and I hosted two roundtables on concussion in sport last month. I am grateful to the current and former sportspeople who attended the first roundtable. There were many heartfelt contributions to the discussion, which gave valuable insight into the experience of those who have suffered the consequences of brain injury directly or via loved ones. Attendees acknowledged that sports were now taking concussion far more seriously and players were now more likely to admit to being concussed, but there are still concerns about culture, promoting safety for children, differences between the amateur and professional levels and levels of education among players, whether that is advanced education or education and awareness on the pitch when an injury happens and, indeed, all the way to A&E and so on. There are many areas to investigate.

The second roundtable we had involved mainly national governing bodies and academics who focus on this area. The Secretary of State and I wanted to further understand what work is under way, what research is being undertaken and what more can be done. Chief executives and medical officers from various contact sports attended, along with academics. We also had in attendance representatives from the Department for Education and NHS England, and I am grateful again for those contributions.

We are in the early stages of these discussions, and it is clear that the Government have an important convening role to play here, and perhaps more. Collaboration on best practice, research and concussion protocols must be a priority for sports governing bodies, because one of the things that struck me is that while a lot of work is being done and a lot of research is being undertaken, I was not necessarily convinced there was a lot of sharing of that information and research. As the hon. Gentleman mentioned, collaboration is key to moving forward here. We must also ensure that players are not in a position to overrule doctors on medical issues.

One of my anxieties is that some sports are nervous about sharing because they think that there are legal cases coming, and they do not want to reveal their hand. We need to create a space in which they can do that with safe harbour.

I thank the hon. Gentleman for that comment. He may well be right. Of course, as soon as we get into the area of litigation, I am not really able to say much more. But on the principle of encouraging the sharing of information and data wherever possible, he is absolutely right, and we will look at what role we can play in encouraging that. That is a really important point.

The hon. Gentleman also mentioned the fact that there is lots of research on men but very little on women. We brought that up in the roundtable. We were proactively saying, “Do you have any research? Is there anything more on women?” I think there was a recognition that there is far more work to be done there, but, of course, women suffer injuries as much as men do. In fact, the physiology is perhaps not as well understood, and I therefore appeal to all stakeholders to particularly focus on that area.

We are currently reflecting on the ways that we can move forward on the issues raised in these discussions, and we plan further work and further discussions. The hon. Gentleman is right to sound slightly frustrated—there are lots of discussions, but we do intend to act. I do not know what the conclusions of the work we are doing will be, but I do want to see action. I do not want this to just be a talking shop and ongoing discussions. I also welcome, as he did, the Digital, Culture, Media and Sport Committee’s inquiry, which I hope will add valuable evidence to this debate.

I know that sports want to make progress in this area. It is in their best interests to improve safety for players and, indeed, everybody involved in sport as much as possible. As I said, we want tangible actions. The hon. Gentleman is aware of the further work that is happening across Government on the issue of brain injury. I was delighted to attend a meeting convened by the Chancellor of the Duchy of Lancaster and the Minister for Care. We will continue that work across Government, and I am sure that the hon. Gentleman will be involved. I invite ongoing discussions with him; in fact, I am due to meet him and the APPG shortly.

Last week I met a non-governmental organisation, Podium Analytics, which is starting to carry out more important research in this area, particularly focused on under-18s, alongside work and collaboration with the Department for Education. That is important, and that work will continue. Collaboration between sports, player associations, NGOs and others is clearly important, and we want to ensure that it continues and progresses.

The importance of sport has come even more into focus in the last year. We want to redouble our efforts to ensure that progress is made, and I am determined to play my part. I firmly believe that we need to continue to work together in driving forward research and continuing to improve player safety and welfare at all levels of sport. Everyone involved has a love for their sport, and good work has already been done, but there is more to do. We will do everything we can to ensure that all reasonable steps are being taken on safety and to protect British sport from concerns both now and in the future.

Question put and agreed to.

House adjourned.