Health: Concussion in Sport

Lord Gardiner of Kimble Excerpts

Thursday 27th February 2014 Grand Committee

[Lord Gardiner of Kimble (Con)]

My Lords, I, too, congratulate my noble friend on securing this debate on such an important subject. I thank noble Lords for this illuminating debate. As the noble Baroness, Lady Grey-Thompson, and my noble friend Lord Storey acknowledged at the outset of their speeches, participating in sports greatly benefits individuals and society, but we must ensure that risks are minimised and that appropriate medical treatment is available to all.

Any head injury sustained on the sports field must be treated seriously. Instances of serious injury are, thankfully, low, with many patients recovering fully without special intervention. However, a minority experience complications that must be minimised or avoided with early detection and appropriate action. The noble Baroness, Lady Grey-Thompson, spoke movingly about the tragic death of Ben Robinson and about his brave parents.

Instances of concussion are undoubtedly of concern to governing bodies. From what I have seen, I believe that they take this matter increasingly seriously, and responsibly. The Football Association and other sports with experience of head injuries, such as rugby, American football and ice hockey, are working together to establish appropriate internal guidance. This point was raised by my noble friend Lord Addington. The equestrian community, to which my noble friends Lord Addington and Lord Moynihan referred, is very much at the forefront of this. We need to ensure that the experiences of the equestrian world are incorporated into what other sports are doing.

The FA rules on head injuries are extensive but, in essence, a player suffering a head injury must leave the field of play and may then return only if he is given medical clearance to do so. My noble friend Lord Addington referred to the amateur and community level of sport—what I would call the grass-roots end of the game—where a medic may not be present. There, the default guidance to all affiliated clubs in the FA is that the player cannot resume play, and the reintroduction of the player to football in the following weeks should be tightly controlled. The FA emergency aid certificate provides club representatives and volunteers with crucial skills and gives prominence to head injuries and concussion.

As the leading body on concussion management in sport, the Rugby Football Union works proactively with the International Rugby Board and independent experts to raise awareness, stay at the forefront of research and promote best practice, to which the noble Baroness, Lady Jones, referred. My noble friend Lord Moynihan mentioned the importance of global exchanges of experience. I have the leaflet produced in Scotland and supported by Scottish Rugby, the Scottish FA and sportscotland, to which the noble Baroness, Lady Grey-Thompson, referred, entitled, If In Doubt, Sit Them Out. Rugby has taken specific steps to reduce risk in the game and these messages are being cascaded to clubs.

My noble friend Lord Storey referred to the “Don’t be a HEADCASE” initiative, which educates players and coaches—it is very important to mention coaches as well—below professional level to recognise and remove players with concussion. Some 200,000 concussion awareness cards have been distributed, and posters have been sent to every member club and newsletters to every member school. The “HEADCASE” website has also been adopted by the Medical Officers of Schools Association. The RFU’s first-aid course for volunteers, coaches and officials also gives prominence to concussion. Its pitch-side immediate trauma care course for healthcare professionals also includes specific concussion training.

The noble Baroness, Lady Jones, rightly raised the important issue of safety within schools. Many young people engage in sport at school. Indeed, the Department for Education expects schools to provide a safe environment for their pupils and they must ensure that their training includes child safety and well-being. There is, of course, also the DfE advice on health and safety. Indeed, the Association for Physical Education and the Royal Society for the Prevention of Accidents provide professional advice to schools on how to manage activities safely and reduce the risk of injuries. My noble friends Lord Addington and Lord Storey mentioned that advice.

The noble Baroness, Lady Jones, rightly referred to the need for dialogue. DCMS Ministers meet DfE Ministers monthly as part of the ministerial board on PE and sport. The board also includes external partners, such as the Association for PE, that play a lead role in health and safety in PE lessons. The departments continue to work together to ensure that schools have the necessary resources to deliver high-quality PE and sport, including through professional external partners such as the Association for PE, and provide guidance and advice on ensuring the safety and well-being of their pupils when playing sport. The Association for PE guidance on safe practice in physical education and sport is available online through the Department for Education. This comprehensive guide provides examples of issues that schools should consider in risk management for school sport, and advice on managing and applying safe practice.

All sports governing bodies working with schools should ensure that participation takes place in a safe environment. All national governing body coaches working in schools should obtain the level 2 coaching standard, which includes basic first-aid skills as a minimum requirement. Indeed, as part of the school games initiative, in which around 17,000 schools take part, national governing bodies have developed competition formats designed to ensure that schools can provide safe, meaningful and appropriate competition to all pupils regardless of age, ability or disability. As to guidance on sports-related concussion, the national governing bodies and schools do good work in disseminating advice to prevent injury and improve pitch-side care. However, it is clear from the examples given today that undoubtedly more needs to be done.

At an international level, my noble friend Lord Moynihan and the noble Baroness, Lady Jones, referred to the Zurich consensus of 2012. I am pleased to acknowledge and endorse what the noble Baroness said about the welcome for this statement, which of course forms part of the learning that is increasingly being developed in the area of head injury. This outlines that when an individual shows any symptoms of concussion they must either be assessed on site by a licensed healthcare provider using standard emergency management principles or be safely removed from practise or play for urgent referral to a physician. The statement also highlights that a player with diagnosed concussion should not be allowed to return to play on the day of injury; that sufficient time and adequate facilities should be provided for the appropriate medical assessment, both on and off the field; and that the final determination regarding a diagnosis of fitness to play should be a medical decision.

Standards in sport and exercise medicine are set and maintained by the Faculty of Sport and Exercise Medicine, a faculty of the Royal College of Surgeons and the Royal College of Physicians. The faculty works to develop and promote the medical specialty of sport and exercise medicine, and oversees the training and assessment of doctors working in this discipline. In November last year, the faculty outlined key messages of concussion management in sport at all sporting events for athletes of all ages.

The noble Baroness, Lady Jones, asked about advice to health professionals. The National Institute for Health and Care Excellence, established by the Government to provide evidence-based clinical advice, issued updated guidance last month to support clinicians on the diagnosis and treatment of head injuries, including concussion. The faculty helped to develop this guidance.

The noble Baroness, Lady Jones, asked about the rules for children and adolescents in these matters. The recent clinical guidance, CG176, is on the Triage, assessment, investigation and early management of head injury in infants, children and adults. So the guidance refers to it all.

My noble friend Lord Moynihan raised the issue of a research centre. The Department of Health’s National Institute for Health Research is supporting a research project in Birmingham that is looking at the effects of repetitive concussion on athletes from sports such as rugby, football, cycling and gymnastics. The institute has awarded a research professorship to Peter Hutchinson at the University of Cambridge to study head injury. The institute at the moment has an annual budget of over £1 billion and I hope that this will be an important resource. I shall of course be pleased to have a meeting with my noble friend to discuss his proposal and see how best we can all help on these important matters.

There is so much more to say. The noble Baroness, Lady Jones, mentioned guidance. A lot of this further public awareness, which is so important, is on the NHS Choices website.

Concussion is one of the most complex injuries to assess, diagnose and manage. Clinicians will make a diagnosis on a case-by-case basis, using their training and clinical judgment, and take into account the individual circumstances of each case. Much has been said in this debate. If there are any outstanding points that I have not raised, I will write to your Lordships. It is important to say that I have consulted officials from all three departments in preparation for this debate. It is clear that all three are working together. UK Sport, as part of DCMS, is working with the governing bodies. The system is working, but I think we can always work better. It is important that individuals engaged in sport, which is such a force for good and benefits society so much, are safe and secure. We must make sure that participation is in the right environment and that, in the event of injuries, all steps are taken to secure a full recovery.