Urgent action is needed by Government and sporting bodies to address a long-term failure to reduce the risks of brain injury in sport.
In football, MPs found a lack of engagement with the issue of concussion despite a coroner's court verdict nearly 20 years ago that dementia suffered by player Jeff Astle was entirely consistent with heading a ball.
The DCMS Committee’s inquiry into concussion in sport, which examined acquired brain injury, found broader failings including a lack of government action on previous safety recommendations, no UK-wide minimum standard definition of concussion, and an absence of employer responsibility expected through the Health and Safety Executive.
DCMS Committee Chair Julian Knight MP said: “We’ve been shocked by evidence from athletes who suffered head trauma, putting their future health on the line in the interests of achieving sporting success for the UK.
“What is astounding is that when it comes to reducing the risks of brain injury, sport has been allowed to mark its own homework.
“The Health and Safety Executive is responsible by law, however risk management appears to have been delegated to the National Governing Bodies, such as the FA.
That is a dereliction of duty which must change.
“The failure by these sporting organisations to address the issue of acquired brain injury is compounded by a lack of action by Government. Too often it has failed to take action on player welfare and instead relied on unaccountable sporting bodies.
“As concerning is grassroots sport with mass participation where we’ve found negligible effort to track brain injuries and monitor long-term impacts.”
Key findings and recommendations:
• No overall responsibility within sporting organisational structures to mandate minimum standards for concussion and head trauma or to assess whether protocols are followed
• Government should establish UK-wide minimum standard definition for concussion that all sports must use and adapt for their sport
• Health and Safety Executive should work with National Governing Bodies of all sports to establish a national framework for the reporting of sporting injuries
• UK Sport should take a governance role in assuring that all sports it funds raise awareness on the dangers of concussion effectively
• UK Sport should pay for a medical officer at every major sporting event with responsibility to ensure the safety of participants and the power to prevent athletes at risk from competing
Professional sport marking own homework
MPs conclude they were ‘astounded’ that sport should be left by the Health and Safety Executive to mark its own homework on risks involved. The Health and Safety at Work Act 1974 places a duty of care on employers to protect the health of workers which should apply equally to footballers and jockeys as well as miners or construction workers. The Report finds that statutory responsibilities for employees have effectively been delated to National Governing Bodies to manage.
Lack overall responsibility
The Report concludes there was ‘no overall responsibility’ to mandate minimum standards for concussion and head trauma, with each sport left to decide on correct protocols. The present system allows sports to be funded as long as their protocols look good on paper, with no effort put into assessing how they might work in practice. When funding depends on excellence and achievement, the focus of athletes, clubs and governing bodies on the safety of athletes can easily be lost.
Because concussion does not occur at high frequency within the elite sport community, little effort is made to drive numbers down even further with some preventable brain injuries occurring, carrying the potential for long-term consequences for individuals, say MPs.
Reporting of brain injuries
The inquiry heard evidence that the lack of any statutory requirements to report injuries could have led to under reporting. Sports Minister Nigel Huddlestone voiced concern to the inquiry that he was “not at all convinced” there was accurate recording of all concussion injuries at present.
Precautionary approach needed
The Report finds the absence of scientific certainty should not be a prerequisite for changing sporting rules to improve safety. It recommends a more precautionary approach with a greater proportion of the money spent on elite sport to be focussed on protecting the athletes who are at the core of UK success in sporting endeavours.
Though scientific research could not yet demonstrate a causal link between dementia and sporting activity, it was undeniable that a significant minority of people would face long-term neurological issues as a result of their participation in sport, say MPs. Notable cases include the 1966 World Cup winning squad, with five former players diagnosed with dementia. The FIELD research study, joint-funded by the Football Association and Professional Footballers' Association, established a strong correlation between a career in football and a significantly increased incidence of dementia in later life. Risks for former footballers were found to be 5 times greater for Alzheimer's disease, almost 4 times greater for motor neurone disease, and 2 times greater for Parkinson's disease.
The inquiry was told that a focus on the term concussion was potentially unhelpful because though one of the most obvious symptoms of brain injury, long-term impacts of acquired brain injury might occur in absence of historic concussions. Many sports injuries result in impacts sufficient enough to cause brain injury, but not severe enough to cause concussion.
The Report criticises the Football Association and the Professional Footballers' Association for failing to fight hard enough within the broader football community or publicly enough to address the issue of concussion. Instead, it had been left to campaigning by organisations like the Jeff Astle Foundation and former footballer Chris Sutton to keep the issue in the public eye.
Though a vast number of people participate in grassroots sport, there was evidence of a lack of awareness of concussion and its potential long-term consequences among participants and those facilitating sport. The inquiry heard repeatedly that the NHS was not properly equipped to deal with the issue. The Report makes recommendations to improve NHS knowledge and treatment, as well as data collection on concussion and concussion-related brain injury.
The Concussion in sport inquiry took evidence from scientists, former athletes, chief medical officers, players' unions, and National Governing Bodies for various sports, and received written evidence from a wide range of interested parties.
The Report does not address or comment on cases of head injuries and rugby which are the subject of current court proceedings.
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