Health: Concussion in Sport

Baroness Jones of Whitchurch Excerpts

Thursday 27th February 2014 Grand Committee

[Baroness Jones of Whitchurch (Lab)]

My Lords, I am extremely grateful to the noble Lord, Lord Addington, for tabling the debate today. As a couple of other noble Lords have admitted, I also have to admit that this is not an issue that I knew a great deal about prior to this debate but, now that I have looked into it, I agree with him that this is a serious problem. I very much look forward to hearing from the Minister about how the Government are acting to address the issue.

As the noble Lord has pointed out, growing awareness has occurred because of very sad deaths, particularly among several young people. It is particularly sad when that happens on a school playing field, where pupils ought to be properly supervised and protected by the highest standards of safety protocols. Parents should be able to feel assured that their children are being looked after in that context.

However, there is also growing awareness of the more insidious and widespread threat of longer-term damage for those who play sports, particularly professional sports on a regular basis. It is becoming increasingly clear that a number of sports players who have suffered concussion on a repeated basis are suffering from dementia and other longer-term brain issues. That is obviously a particular cause for concern. While it might not be possible to eradicate the danger completely, we owe it to amateur and professional sports men and women to invest in research to understand the dangers better; to provide rules for safe play; to ensure that staff are educated in diagnosis and response; and to ensure that there are strict regulations regarding return to play.

What does this mean in practice? First, we should welcome the latest Zurich consensus statement on concussion, mentioned by the noble Lord, Lord Moynihan, which provides a well informed and practical set of recommendations for those involved in the healthcare of sports men and women. Their advice provides diagnostic tools about what should happen should concussion be suspected, and emphasises the importance of standard emergency management procedures to ascertain the extent of the injury.

Importantly, the advice recommends that it should never be permitted for a player to return to play on a day where concussion is suspected, not least because, even if they get up and say, “I feel all right”, or if their mum and dad say, “Come along, pull yourself together and get back on the field”, there may be post-injury damage that is not immediately apparent. This is a particular challenge in high-level high-contact games such as rugby and football, where both the player and the medical team may be keen to downplay the injury and allow the player back on the field. However, as evidence grows of the longer-term health risks, it becomes more apparent that we need strict enforcement of the rules on the principle about returning to play.

The guidance that I have just referred to also makes it clear that any return to play should be on a graduated basis—over a period of a week is recommended—while tests continue. Again we need to ensure that this approach becomes standard practice. I would be grateful if the Minister would confirm whether his department is taking on board the Zurich conference recommendations and what discussions are being held with the Department of Health to ensure that health professionals are more aware of the dangers of this type of sporting injury and understand the signs that they should look for.

Secondly, we need a clear set of rules specific to children and adolescents, recognising the particular health dangers for this group whose brains can swell uncontrollably after a single bang on the head. All schools need to be aware of the dangers and the steps that need to be followed immediately an injury is suspected. Every PE teacher should be trained in the assessment procedures, and should be expected to carry a card that lists the nine red-flag symptoms that warrant urgent action. Parents and governors should be expected to check that the necessary staff training and awareness has taken place and should have a system for monitoring the responses to sporting accidents, as well as rules for rest, rehabilitation, and return to play. I agree with many of the points about the improvements in school procedures made by the noble Baroness, Lady Grey-Thompson. Will the Minister give details of any discussions held between his department and the Department for Education about the need to raise standards of care in sporting accidents, specifically on school premises?

Thirdly, at the professional end of sports, all players and coaches should be trained to understand the dangers of concussion and its diagnosis. This should follow the initiative already taken by the rugby union, to which the noble Lord, Lord Addington, referred, and should extend to other sports. This is increasingly necessary in the light of the rising number of concussions that have been recorded per 1,000 hours of play since 2011. Andy Hazell, who was forced to retire from England rugby after failing to recover from a concussion injury, rightly made this point, which was echoed by the noble Lord:

“Players are getting bigger and faster, and the collisions are getting a lot bigger”,

so the challenges in this particular sport remain high. It is not just rugby union, though; concussion remains the most common injury in premiership football. Training and awareness for both players and coaches across all sports have to be key to improving safety, so will the Minister give details of discussions held with the governing bodies to roll out a programme of training for players and coaches across the spectrum for all sports?

Lastly, there needs to be a review of what further preventive measures can be undertaken. It is not good enough to say that these games are inherently dangerous and that this is the nature of the sport. Where changes can be made to the rules to protect players from dangerous practices, they should be introduced. Most sporting rules are not set in stone; they are constantly being reviewed and updated by their governing bodies. For example, rugby union rules have been regularly updated to provide greater protection for individual players without taking away any excitement of the game, and that can be done across the board in other sports. We should be asking all sports bodies to review their rules to see what further steps can be taken to limit impact on the head, and what penalties should be introduced against those who flout the rules.

We should also be encouraging more research into helmets and other head protection to ensure that the best possible guards are available and permitted in the games. Will the Minister reassure us that dialogue is continuing with sports bodies to encourage research into safety equipment and to develop safer rules of play? Will he give serious consideration to the proposal of the noble Lord, Lord Moynihan, for a meeting to discuss the establishment of a national research centre? I thought that he made the case very well in his contribution.

The solution to many of the problems that we debate in this House is better liaison between departments and more joint working, and that is certainly true in this debate. The solutions lie in better education, better awareness among heath professionals and more responsible sports governing bodies. I hope that the Minister is able to persuade us that he is taking all these issues on board, and I look forward to hearing what the department is doing to liaise effectively and improve performance on this important issue.