Health: Concussion in Sport

Lord Moynihan Excerpts

Thursday 27th February 2014 Grand Committee

[Lord Moynihan (Con)]

My Lords, the Committee is indebted to my noble friend Lord Addington for securing this debate. It is both timely and important. It is timely because it comes on the eve of the screening next week at the Curzon cinema here in London of the world premiere of “Head Games: The Global Concussion Crisis”, which will spark nationwide comment and debate. From the acclaimed director Steve James, it is a revealing documentary featuring neurological findings related to rugby and soccer players that will serve as a wake-up call for those who think that the devastating and chronic effects of repetitive head trauma are found only in American football and boxing. The film is inspired by the book Head Games: Football’s Concussion Crisis, written by the former Ivy League football player and WWE wrestler Christopher Nowinski. I believe it will capture the attention of the sports world, and it is already causing a stir in the United States.

Concussion is increasingly recognised as a serious medical condition that is interesting legislators around the world. Indeed, it is the only medical condition whose treatment is currently mandated by legislation in the United States. This is the result of the Zackery Lystedt law, started in Washington state, home of the Seattle Seahawks, by the Seahawks’ doctor, Dr Stan Herring, after a terrible accident involving a teenager, Zackery Lystedt. There are now Zackery Lystedt laws in 49 of the 50 states of the union; Mississippi is the only one that does not have one.

The Zackery Lystedt law states, first, that concussion education must be delivered to parents, coaches and players in all sports, not just contact sports. Secondly, after a concussion the player must be removed from play and not allowed back on to the pitch. Thirdly, after a concussion the player cannot be allowed to return to sport until cleared to do so by a healthcare professional who has experience in concussion.

We have no legislation in the United Kingdom and, as my noble friend Lord Addington has highlighted, individual sports vary greatly in their attitude towards concussion management. That is the urgent issue that needs to be addressed. My noble friend mentioned horseracing, which is way ahead of the rest and started a management programme in 2004. The work that Dr Michael Turner, until recently chief medical officer of the Jockey Club, has done for jockeys has been world-leading and deserving of careful study and praise.

Rugby is still trialling new and appropriate codes; for example, the five-minute concussion timeout to allow doctors to assess and diagnose concussion. Speaking from a non-medical perspective, that seems a totally inadequate length of time and yet rugby has put many of the issues under consideration on the world stage. The highly controversial decision to allow Australia’s George Smith to return to action during his side’s third-test defeat to the British and Irish Lions last year, despite clearly having been concussed, has prompted one of a series of changes to the global trial of the pitch-side suspected concussion assessment, the PSCA protocol.

What is needed above all is education at the grass roots. At the moment there is nothing in this country that is structured for coaches, parents and clubs. That is a very serious state of affairs, which should concern all sports administrators and politicians. The South Africans have a great programme in this context called BokSmart, which should seriously be considered by all our governing bodies. The Canadians have Parachute and we have Headway.

The main source of information is the latest concussion consensus statement from Zurich 2012. It recently emphasised, once again, the need for education and in the United Kingdom all sports, not only contact sports, have faced the consequences of this. In soccer, there were changes to pitch-side assistance and medical requirements soon after the Reading-Chelsea match when Petr Cech sustained a depressed skull fracture and then the substitution goalie sustained a concussion, leaving John Terry in goal.

The Australians are probably the leaders internationally given the work being done in Aussie rules football in particular. Many sports are now caught up in the debate—NFL, ice hockey, FIFA, boxing, equestrian, rugby league and union. It is a global issue as well as a legal one.

What needs to be done? In this country we could create a national concussion and head injury research centre. This could address all of these issues, bring them together and ensure that what we are debating today is not a series of different practices across sports, clubs and schools but a centre capable of bringing together all research in this area and then disseminating it to all sports in this country. Above all, we need consistency in the approach of the national governing bodies of sport, both amateur and professional. Without it, and without such a voluntary approach working with the governing bodies of sport, there may be serious calls for legislation in the future, as there are at the moment in the United States.

Will the Minister, with his ministerial colleagues at the Department of Health, agree to a further meeting with interested members of the medical profession to discuss the establishment of a world-leading centre in the United Kingdom based on international co-operation, which I have called today the national concussion and head injury centre?

Perhaps I may set this in context. The current definition of concussion was first agreed in 2001 at the Vienna concussion consensus conference and has remained largely unchanged over the subsequent three meetings—the Prague concussion conference and then in 2008 at Zurich 1 and in 2012 at Zurich 2. It has been recognised that concussion is a complex neural process that does not involve any structural brain damage and does not produce any changes on conventional imaging—for example, an MRI scan. Normally it resolves spontaneously in seven to 10 days without medical intervention. However, it may linger on, and post-concussion syndrome may lead to long-term problems.

On the subject of long-term concerns, recent research published in the USA suggests that multiple concussions or sub-concussive impacts might lead to a serious brain condition called chronic traumatic encephalopathy. This has resulted in a number of law suits being initiated in North America against the governing bodies of professional sports, the NFL and the NHL, and unless we in the UK act, sports governing bodies must expect similar legal action in the future.

My noble friend focused his remarks on the sports with the highest incidence of concussion. We need to look at all sports. Dr Turner, to whom I have referred, recognised that if concussion does not involve any structural damage it is reasonable to suggest that a little more impact would lead to a few nerve fibres becoming damaged or dying. He refers to this as concussion plus. You cannot tell the difference between concussion and concussion plus. They are indistinguishable at present because the tools we have are not sensitive enough to pick up the microscopic structural and chemical changes involved.

This is the tip of a highly complex medical iceberg. It is vital that we bring together all the expertise available in order to ensure that, by setting up a national centre—which could be world-leading and could co-operate internationally with best practice—our athletes, our clubs and our governing bodies are best served. I repeat, I hope the Minister will accept that this kind of initiative is worthy of further study and that he will attend a meeting—I hope with his colleagues from the Department of Health—with medical experts in this field, including Dr Michael Turner, to see what can be done to ensure that we are world leaders in this context, above all because we will be protecting the interests of our athletes, both able-bodied and disabled, as our first priority.