Third Report - Concussion in sport

Despite the need for acquired brain injury to be taken seriously by sport, the detail of which we will come onto later in this Report, both written and oral evidence to this inquiry support the health benefits to people through mass participation in sporting activity. An active lifestyle promotes overall good health, including reducing the risk of dementia in later life. (Paragraph 9) Grassroots sport

The reality is that, for most people playing sport, there is no one to stop them except themselves, their friends, teammates, and family. That is how far down the knowledge and awareness of concussion and how to respond to it must reach to ensure people seek the necessary help and treatment rather than returning to the field to the detriment of their long-term health.

Doctors may not be able to rely on patients to remember previous concussions or head traumas, especially if these happened at different times playing different sports. They must instead be able to rely on robust information that should be collated on a patient’s records.

We recommend that NHS England reviews the way in which it collates data about concussion and concussion-related brain injury and ensures that doctors have a full history available to better inform patient treatments.

We are also concerned that the relative infrequency with which clinicians encounter this kind of condition suggests that many of them are likely to be out of date with regard to the best possible practice in treating these patients and getting them the necessary specialist treatments.

We recommend that NHS England, in collaboration with the Faculty of Exercise and Sport Medicine, within the next twelve months, prepares a learning module on the best practice for treating and advising those who present with concussive trauma and ensure that all General Practice and Accident & Emergency practitioners take this module within the next 2 years. The module, and the updating of practitioners, should be repeated every 2 years thereafter. (Paragraph 27) Elite sport

The current organisational structures in sport mean that there is no overall responsibility to mandate minimum standards for concussion and head trauma or to assess whether protocols are followed. The system allows sports to be funded as long as their protocols look good on paper with no effort put into assessing how those protocols work in practice. The fact that concussion does not occur at high frequency within the elite sport community means that little effort is made to drive numbers down even further. This means that, some preventable brain injuries are suffered, with the potential for long-term consequences for individuals. (Paragraph 37) Concussion in sport 31

It is no longer acceptable for concussion to be addressed in this fashion. We recommend that the Government mandate UK Sport to take a governance role in assuring that all sports it funds raise awareness on the dangers of concussion effectively. Those sports should not only have good protocols to mitigate the risks of such injury but proactively implement those protocols.

We are concerned that UK Sport, uniquely in our evidence base, considers the Consensus Statement by the Concussion in Sport Group as a satisfactory basis for concussion protocols. We recognise the value in the Consensus Statement that provides a baseline for what the science can say for certain and identifies a gold standard for science in this area of research. Scientific certainty is a worthy ambition, but it should not be a prerequisite for changing sporting rules to improve safety.

We recommend a more precautionary approach is taken and a greater proportion of the money spent on elite sport is focussed on protecting the athletes who are at the core of UK success in sporting endeavours. We also recommend that UK Sport fund a chief medical officer to attend events, like the Olympics, who will hold over-arching responsibility to assess the application of protocols and make decisions on who should be allowed to continue to compete in the event of injuries, including head trauma, sustained in practice and competition. (Paragraph 40) Professional sport

Football’s engagement with the issue of concussion, both in England and internationally, has taken too long and its current prominence is due to the campaigning of organisations like the Jeff Astle Foundation and prominent spokespersons like Chris Sutton. We would have expected the Football Association, as the National Governing Body, to have taken a stronger, sustained interest in the issue after the coroner’s verdict of Jeff Astle’s death. We would also have expected the Football Association to have been publicly hounded by the Professional Footballers’ Association, whose key concern should be player welfare. Over the past 20 years neither the Football Association nor the Professional Footballers’ Association have fought hard enough, or publicly enough, to address this issue within the broader football community. They are, however, only part of a broader failure to address the issue of acquired brain injury in sport.

The problems faced by both football and rugby are common to a multitude of other sports which do not have the same media attention or the same resources to apply to possible solutions. One of the biggest problems is the apparent lack of clarity on who is responsible for driving change. Change has not happened quickly enough and while the science currently available to us describes the problem it does not provide solutions.

The protections afforded by the state to workers apply as much to footballers and jockeys as they do to miners and construction workers. The Health and Safety at Work Act 1974 was a landmark piece of legislation to protect the health of workers and, along with subsequent Regulations, places a duty of care on employers. The 32 Concussion in sport extent of that duty has been established through numerous court cases in many other sectors. We are astounded that sport should be left by the Health and Safety Executive to mark its own homework.

Our inquiry into concussion has demonstrated that the long-term effects of acquired brain injury are not simply those events that lead to a diagnosis of concussion. Therefore, any impacts that impair clear thinking or involve a heavy impact could contribute to acquired brain injury.

We recommend that the Government immediately mandate the Health and Safety Executive to work with National Governing Bodies of all sports to establish, by July 2022, a national framework for the reporting of sporting injuries. Within a year of the framework being published, all organised sports should be required to report any event that might lead to acquired brain injury. (Paragraph 62) The need for a coherent approach

We recommend that the Government uses its power to convene interested parties and establish a single research fund that will co-ordinate and fund research. The allocation of funds should follow the model of the research councils to ensure it is seen to be independent and excellence-driven and to ensure that the available funding is coordinated to cover the research requirements most efficiently. All research funded in this way should be required to return all results and analysis to a central database that should be freely and publicly accessible. We also recommend that the Government incentivise sport and other groups to contribute to this fund by offering a degree of match-funding.

We also recommend that the Government convene its own specialist group on concussion, drawing on campaign groups, relevant scientific expertise and sporting institutes to assess, every four years, the emerging science on this issue. This group should take a broader view of the existing science than the Concussion in Sport Group, with its priority on taking a precautionary approach to safety.

We find it difficult to see any downside of a coherent UK-wide protocol for concussion and recommend that the Government look to the Scottish model and then work with the devolved governments in Scotland, Wales and Northern Ireland to develop, in the next 12 months, a UK protocol for concussion across all sport. This should be used by National Governing Bodies as the minimum standard in creating the rules for their sport and should take account of, and be consistent with, the national framework for the reporting of sporting injuries we recommended earlier in this Report. This protocol should be refreshed every two years.

Once this protocol is in place we recommend the Government deliver a comprehensive communications campaign to ensure that everyone involved in sport, from the athletes to coaches and doctors, is aware of best practice. This campaign should signpost where people can find the most current, well-evidenced advice on what action to take in the event of head trauma.

We are concerned that there is history of the Government looking into issues of sporting safety and failing to follow through with practical interventions that would Concussion in sport 33 make a difference to the safety and health of those participating. The reports of the 2002 Working Group and by Baroness Grey-Thompson in 2017 both suggested ways to address the issue of concussion in sport and yet the Government has not progressed these. We urge the Government to grasp the nettle this time, move past the concerns about how regulation may change sports, and take real and effective action.

It will never be possible to ensure that sport is one hundred percent safe. It should, however, be expected that participants are aware of the risks involved and that there is a precautionary approach to risk management. The Government cannot avoid taking a proactive role in ensuring that this occurs. (Paragraph 83) 34 Concussion in sport