Concussion in sport: experts discuss science, spending and state intervention with MPs

The Digital Media Culture and Sports Select Committee (DMCSSC) opened its inquiry into “concussion in sport” in a hybrid meeting on 9 March, hearing from clinical experts and interested charities. In an informed discussion, topics of medical causation, informed choice, funding of research and state intervention in personal freedoms were considered and are touched on in the body of this piece. For those unable to watch the hearing live, the recording can be accessed here.

The witnesses at this first of two DMCSSC hearings are listed below.

  • Professor Craig Ritchie, Centre for Clinical Brain Sciences, University of Edinburgh;
  • Professor William Stewart, Consultant Neuropathologist, University of Glasgow;
  • Dr Michael Grey, Reader in Rehabilitation Neuroscience, UK Acquired Brain Injury Forum;
  • Peter McCabe, Chief Executive, Headway;
  • Richard Oakley, Head of Research, Alzheimer’s Society

Professors Ritchie and Stewart provided a neutral, straightforward account of the importance of research, and its current limitations.  Concerns were expressed without hyperbole for current participants (young and old) and retired players and whilst the interest of Parliament was welcomed, the clear message was that more needs to be done and without delay; a point echoed by the later witnesses.

Rugby and football – a primary focus

The inquiry intends to address concussion across all sports, but inevitably, the primary focus was on rugby and football.  Questioning was sometimes direct (“is rugby safe?”) but largely politely probative; perhaps doing no more than preparing the ground for the wider / further enquiries the Committee alluded to, and identifying those who they might expect to hear from in the future.

Although there was some legalese – the difference between beyond reasonable doubt and on the balance of probabilities – and passing reference to the US NFL litigation, there was no reference to the current civil claims by former players against the RFU, Wales and World Rugby.

Prevention better than cure

Professor Stewart raised the importance of framing concussion as brain injury, and the importance of “prevention is better than cure.”  His evidence dealt with high level rather than granular detail, concluding that more can be done (e.g. in rugby) to reduce the risk of brain injury in training and in competition and, combined with better post-concussion management, might ameliorate the long term issues and risks without having to hit the “big red button” – stopping a sport altogether where risk remains unacceptably high.

The observations of Professor Stewart that football’s attempted development around concussion safety are “a shambles” caught the attention of the Committee and of the press; criticism that football appeared to disregard the learnings from other sports (notably rugby) was simply not good enough.  The introduction of “concussion substitutions” did not deliver the tools needed for pitch side medics to ensure the safety of players.

The Committee was concerned to understand what national governing bodies (NGBs) were contributing to research, prevention and outcomes, with little positive offered in response from any of the attendees. 

The cost of neurodegenerative research

Modestly, Professor Stewart identified that huge strides had been made in research into neurodegenerative issues on a budget of c.£250,000 and that UK and Scotland were leading lights in that respect and oblique reference was made to the results of further research that might be available in the coming weeks.  Asked what he might do with a budget of £2.3 million, he identified that 10 times his current budget may not improve results by the same margin but more funding was (a) welcomed and (b) necessary.  In response, the Committee Chair rhetorically observed that Gordon Taylor, Chair of the Professional Football Association, enjoyed an annual salary of £2.3m.

Mr Oakley indicated the annual cost of dementia to UK PLC was c.£34.7 billion.  Reference was then made by the Committee to the deep pockets of (some) sports NGBs along with a passing reference to the funds generated by gambling. It may come as no surprise to see rather more searching questions being asked of those organisations as to what funding they are providing, and what further funding they might voluntarily commit to, before regulation or legislation compels them.

The Committee may be buoyed in that respect by the comments of Mr McCabe that, following his invitation to present to the inquiry, Headway had been approached by the FA to engage in discussion.  If the mere mention of the inquiry generates positive action from NGBs, then what focus might regulation bring?

In response to the direct question, Dr Michael Grey said he was aware of research commissioned by National Governing Bodies which had not been published.  He identified that, unlike government studies, NGBs were not required or obliged to publish.  Pointedly, it was an aspect the Chair wanted to address privately with Dr Grey in order that “further enquiries can be made”.

Education and Government intervention

Dr Grey, Mr McCabe and Mr Oakley also wanted steps to be taken to ensure discussion around brain injury and neurodegenerative disease remains high on the agenda for Government; in the education of the general public including those participating in sport, of GPs and A&E services where anecdotal evidence suggested continuing professional development around concussion diagnosis and treatment was lacking.

All the witnesses were also supportive of greater government involvement and, if needs be, intervention in NGBs. Such intervention might ideally ensure coordination amongst sports’ various NGBs and provide direction for those sports that have no NGB. It was also suggested that where existing NGBs don’t do enough, government should do more. That said, neither the Committee nor the witnesses identified where the bar of state intervention should be set.

A game of two halves?

With the focus on football and rugby, we did not get a sense of the other sports that might fall under the consideration of the Committee. Reference was made to the “elephant in the room” of boxing and ‘cage fighting’ which, in the unequivocal view of Peter McCabe, should be banned.

Mindful that the Committee intends to consider the “potential implications of successful legal action and what impact that could have on sport in the longer term” there was nothing in this hearing that would assist them with this limb of their terms of reference. 

With written submissions due by the end of this month, the Committee will likely have a great deal to mull over, and a great many loose ends to pull together before the second hearing. In that respect its work may be a game of two halves and it could well go into extra time.

David Spencer, Partner and Head of Sports Practice Group

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