Digital, Culture, Media and Sport Committee
Oral evidence: Concussion in sport, HC 46
Tuesday 25 May 2021
Ordered by the House of Commons to be published on 25 May 2021.
Members present: Julian Knight (Chair); Kevin Brennan; Alex Davies-Jones; Clive Efford; Julie Elliott; Damian Green; Damian Hinds; John Nicolson; Giles Watling.
Questions 430 - 503
I: Nigel Huddleston MP, Minister for Sport and Tourism, Department for Digital, Culture, Media and Sport; and Ben Dean, Director, Sport, Gambling and Ceremonials, Department for Digital, Culture, Media and Sport.
Witnesses: Nigel Huddleston MP and Ben Dean.
Q430 Chair: This is the Digital, Culture, Media and Sport Select Committee. Today we have two hearings. The first one is concussion in sport, which should take approximately an hour, and the second one is sport in our communities. They are the final hearings in both inquiries. We are joined for both hearings by Nigel Huddleston MP, Minister for Sport and Tourism at the Department for Digital, Culture, Media and Sport, and Ben Dean, Director, Sport, Gambling and Ceremonials at the Department for Digital, Culture, Media and Sport. Nigel and Ben, good morning and thank you for joining us.
Before I start with the questioning, I will ask members if they have any interests to declare about sport in our communities or concussion in sport.
Clive Efford: I declare that I am the chair of trustees of Samuel Montagu youth club.
Giles Watling: I would like to declare that I am a patron of the Clacton football club.
Chair: We will kick off, so to speak. Thank you for joining us today. We have heard some pretty powerful evidence on concussion in sport. It has been a very high profile inquiry for the Committee and no doubt you have seen some of the evidence. One of the things that I think many members of the Committee have been struck by is that there seems to be very little ownership, taking this matter across the piece. From sports through the NHS through different health bodies and different community bodies, there does not seem to be a great deal of ownership here. We have often heard the refrain, “We are waiting for the evidence.” Do you think it is right that these bodies are waiting for the evidence and that maybe now is the time to act?
Nigel Huddleston: It is definitely time to act. I have seen some of the evidence that has come before you and some of the really heartrending stories we have heard from individuals. From my side, we have had roundtables as well as receiving evidence from some of the same individuals and many others. I think there is a lot of information and research out there. One of the things that has struck me from the roundtables is that there is a lot of work being done. It is probably fair to say that it is not necessarily as co-ordinated as it could be, best practices probably are not shared and there is certainly more work to do.
I think there is an increasing realisation that there is a problem and something needs to be done but, quite frankly, we are all struggling with finding out exactly what needs to be done and how. I have been struck by the governing bodies’ sense of ownership and responsibility, at both professional and amateur level, and also there is work going on across Government. It is not just DCMS that is working on ABI, but there is an initiative across Government.
Q431 Chair: Forgive me, Minister, but we had a health professional who was working on winter sports and boxing—working one day a week on each—and we heard people from those sports giving evidence in this respect, and it is 19 years since Jeff Astle died. How much evidence do you think the sports community actually needs?
Nigel Huddleston: We definitely need more evidence, and that is one of the emerging findings and conclusions that I am coming to as well. Remember, we are similar to yourselves and I am looking forward to seeing your report. It will be important for the Government’s findings in helping us make decisions, but we are still at a relatively early stage of our review. I will say that there has been action. If you look at changes within sport, various actions have been taken but I would not deny at all that more action is needed. More research is needed, particularly with women, for example. There is a lot of research out there about concussion in men’s sport but very little on women’s sport. Some sports are taking more immediate action, whether it is on the field or guidance and so on. We have seen that in football, cricket and a few other areas, but more action probably is required.
I am with you on the frustration that we should not be waiting for perfect information to come through before taking action. I have been very clear with the governing bodies of sport that the responsibility primarily sits with them, but if we do not believe—and your report and findings will be pivotal to the Government’s—that sufficient action is taken we are more than happy to intervene in whatever area is necessary.
There are two or three key areas: there is research, there is some emerging technology where interesting things are happening—and I know you have heard about that—and there is education and the role that we have with schools, for example. I am not going to pretend for one minute that I am happy with the current situation. There is probably more awareness than we give sports credit for. I have been somewhat comforted by their response and the research investment, for example, but more can definitely be done and we do have a role there. Sports have a role, but Government have a role as well.
Q432 Chair: We will turn to research investment in a second. I was struck by the word “co-ordinated”. How much co-ordination do you think there is across sports, not just understanding the effects of concussion but also after-treatment, very crucially? We have heard evidence that sufficient after-treatment can mitigate some of the worst long-term aspects of concussion.
Nigel Huddleston: This is one of the areas, post-concussion guidance and experience, where some sports have certain guidance and others have different guidance. We have been looking—as I think you have as well—at what is happening in other countries. In Australia, Canada, the US and even Scotland there is more consistent guidance across multiple sports, and that is one of the things we are considering.
One of the suggestions that has come up in my roundtables is to try to co-ordinate this on the pitch and in the post-pitch treatment and acknowledgement, and also just the gathering of the data, understanding how big this problem is. Is there accurate gathering of the number of concussions? Even the NHS is now improving on that—and I think you have heard some evidence—and is gathering data on concussions in a more forensic way.
Q433 Chair: To the contrary, actually. The evidence we had was that it is very non-specific, which is a real problem. Would you like to see changes in that respect?
Nigel Huddleston: Yes, I would. I think there have been moves forward in all these areas but more can be done, and I think we are all in agreement on that. I am not going to come here and pretend for one minute that I am happy with the status quo. Far from it. We also need to take meaningful action, not just action for the sake of making it look like we are taking action. I put that onus of responsibility very clearly on the governing bodies of sport. I want them to take this—
Q434 Chair: Why do you think we are so far behind the United States in many aspects of this?
Nigel Huddleston: I am not sure whether we are completely behind the US and other areas.
Q435 Chair: Why are they funding our research then?
Nigel Huddleston: Often it is sport by sport. The sports are putting pretty significant investment into research, but my concern is that they are not necessarily sharing it. Learnings from one sport could be very relevant for learnings from others. Unfortunately we are in a somewhat litigious environment, certainly in the US as well, that adds a quite challenging dimension to this debate. As soon as you get into that arena you are talking about proven connections, not just correlations and links. It needs to be proven that one thing led to another. That is quite difficult in these areas, but that also speaks to the need for more research.
Q436 Chair: You have just hit the nail on the head when it comes to the litigious aspects of this. There is a certain amount of, let’s say, trepidation in the sporting community about what may be coming down the pipeline with the potential for claims over the long term. We find that is the case particularly in football. Some of the calls that we have heard, which successive people who have investigated this area have also heard, about needing more evidence strikes me as an excuse to bury their head in the sand. They want to avoid this as long as possible so that they don’t have to face up to the litigious issues that may come downstream.
Nigel Huddleston: I have had roundtable discussions with sportspeople who are impacted, and also with the CEOs of many of the major sporting organisations and their CMOs. I will say that their sincerity is considerable here. They recognise it as a problem and they want to take action. I think you are right and, as I have alluded to, the background fog of consideration of legal disputes causes some challenges here, but they are investing. We want them to invest more, and action is being taken.
We need to make sure that we have a convening role in Government to co-ordinate this in a more effective way, and sharing learnings and best practice is a route out of that. It is not in the best interests of any sport to deliberately and consciously continue with activities if they know that they are dangerous. I don’t believe that is the case, but where we are here—and this is the biggest challenge—is that concussion absolutely is a problem. We want to put pressure on sports to ensure that anybody participating in those activities does so in full knowledge of the risks, to ensure that they make informed decisions about participating in those sports and to enable those sports to go ahead in as safe a way as possible, minimising unnecessary risks without undermining the very thing that makes sport exciting. Of course, it is a physical activity requiring interaction that can sometimes be somewhat risky.
It is a matter of balance, but most of the sports I have spoken to recognise that they need to do more to ensure that everybody participates in an informed way and in a way that minimises unnecessary risk. The tricky area is what we consider unnecessary risk.
Ben Dean: It is important to recognise—and I hope you have seen it through your investigations—the difference between evidence that this is an issue and then how best to deal with it. I hope what you have seen from the sports, and we certainly have when we have conversations with them, is that every sport recognises the importance of concussion and that there is clearly enough evidence that it needs to be taken extremely seriously. Where we have to recognise that the evidence will continue to evolve is the medical evidence about the actual impact of different types of concussion and how best to treat it. There has been medical evidence that will continue to improve.
Q437 Chair: Why do you think, therefore, that Professor Willie Stewart described football’s concussion protocols as a farce?
Ben Dean: It is for him to draw his opinion. I think what football—
Q438 Chair: He is a very well-known scientist in the area and probably one of the most prestigious in the country. That is the reason he was before the Select Committee. You have stated, effectively, that these sports are taking the actions that they are taking, that they are very mindful of this, but at the same time here is a leading doctor saying that our national sport’s concussion protocols are a farce. That is deeply concerning, is it not, Minister?
Nigel Huddleston: Yes, it is. There is anecdotal evidence and certainly, in the first roundtable I had, I heard heartrending stories of real life-changing impacts on individuals’ lives, sportsmen and women whose careers have been ended, families who have been impacted. And the strong belief and understanding is that that has been caused by sporting injuries and concussion. We want to minimise those or hopefully eradicate them. Therefore, I think accusations of there being a farce or whatever—I am not surprised we are hearing that. Your role and my role is to make sure that we put pressure on sporting governing bodies and then consider what action Government can take to make sure that those kinds of accusations don’t happen again in the future.
As I say, I think co-ordination is key. Education before participating in sport, how to act if there is an injury on the sportsground, on the pitch, is really important. Post-trauma, post-impact assessment and treatment, and all the other considerations, are part of the mix here. I will repeat again: as far as the Government and this review are concerned, we are at the beginning of the process and I am open to listening to all ideas and suggestions here. We have not yet concluded the Government’s recommendations on this.
Q439 Chair: I am going to ask about football and then rugby in a second, but you mentioned the roundtables a few times and your engagement with them in this respect. I believe you had an NHS consultant in your roundtable, but you had no representative from the NHS. Is there any reason for that?
Nigel Huddleston: Well, there was an NHS—we are at the beginning of the process rather than the end, so if you ask us that in a few months’ time. There is also ongoing discussion—
Q440 Chair: Do you think that was an oversight?
Nigel Huddleston: No, because the first roundtable was specifically meant to be with sportsmen and women who have been impacted. The second roundtable was specifically with the CEOs of governing bodies, the chief medical officers and a few other advisers, but also representation from the NHS and the Department for Education. There have been further discussions with the officials, and further roundtables and discussions will take place. I think you are making an accusation as if we have concluded the process. We haven’t. We have had a couple of roundtables and we will be having more, and certainly the NHS involvement will continue. But you are right, we did have NHS representation and he made valuable contributions because he also had experience in the military.
Q441 Chair: Do you personally believe that heading a ball 72,000 times is dangerous, yes or no?
Nigel Huddleston: I think that number, yes. The difficulty is, when does it become dangerous? At what point does it become dangerous, at what age does it become dangerous? I am not a medical expert, and I cannot make those conclusions. Certainly, there is an alarming number of pieces of research and I have been impacted by the personal stories and the evidence I have heard, so this is a priority for me. I am concerned, as I am sure all the Committee members are.
Q442 Chair: Minister, you said before how sports are spending money on this. You said substantial sums. We suspect that football has not been spending substantial sums, and we tried to get to the bottom of that by asking the person who represents the FA, a medical doctor, head doctor. She was not able to tell us precisely how much money they spent on researching this, how much they contributed towards researching it.
The PFA spent £125,000 last year, I believe, which is equivalent to about six weeks’ wage for Gordon Taylor, the PFA chief. You cannot really say with a straight face that football has done anywhere near enough to fund the research and, crucially, to ensure that those who may face damage through concussive head injury get the proper support and long-term care that they need. You cannot honestly say that football has done a good job in this respect.
Nigel Huddleston: No, I could not, which is why I would not say that. I completely agree with you. As I said, I think more research is probably being conducted than most people recognise. Simply to say, “There has been nothing done. They are ignoring it. They are trying to kick the problem into the long grass,” I do not believe that is the case. As to whether they are putting enough money and research into it, my answer would be: absolutely, no, they are not. I would like to see them put more into research.
Q443 Chair: How much more do you think?
Nigel Huddleston: Again, I think you have the same issue as I have at the moment. I don’t know how much. One of the purposes of our review is to work out what research is taking place, how much is being conducted and by whom, and where there are gaps. Already one thing that is very clear to me is that there are huge gaps in research on women’s sport—absolutely massive gaps in women’s sport—and we probably need more at the amateur and school level as well. I am sure that one of the recommendations coming out of our review will be that this is an area where there is a gap that needs to be filled, and we will be discussing who needs to fill that.
I think you are right that there is absolutely an obligation on sports. We all know sports have had an incredibly difficult time during Covid, but some are quite wealthy and have skin in the game so they need to put their money into this area as well. They recognise this because it is not in their best interests if that sport has a reputation for being dangerous. That is not good for the pipeline of talent or for their sport’s reputation with young people and others thinking of taking it up.
Q444 Chair: Do you think some sports could struggle to survive if they were to face the sort of litigious action that you discussed earlier? I am thinking particularly of rugby, which I have to say in the evidence that we saw impressed us with how they were across a lot of the science. Also, unlike football, they actually knew how much they were spending on it, which was helpful. I have heard from several people in the game that, because of the impact nature of rugby, the fact that since the professionalisation of the game people have bulked up to such an extent that there is massive impact, there is real potential there for long-term damage. We heard evidence of a rugby player who couldn’t remember the key code to get into his own apartment block. As Minister for Sport, do you think the sports could really struggle to pay for the amount of legal action that may be coming down the line?
Nigel Huddleston: Who knows where the legal action will go? I cannot say, but I know it is something that the sports themselves are concerned about. I cannot talk about any individual sport at the moment, precisely because there is litigation going on, as you will be aware. I have to be somewhat careful about what I say here. However, should sports be concerned? Yes. Could huge litigation undermine the financial viability of sports? Of course, absolutely.
The issue then is, could they mitigate potential harms and concussion by changing the nature and the guidance of how those sports are conducted? I think in some cases, yes, and there are measures being looked at. There is a lot of research going on at the moment into helmets, mouthguards and a whole bunch of other areas, and protections are being developed. But would that then undermine the sport’s attractiveness and make it effectively quite a boring game and, therefore, not attractive anymore? That is a potential, so it is about the balance.
I think we all need to gather as much information as we can, without kicking it into the long grass and delaying things, to make sure that we focus on mitigation so that the sport can continue. Some of them probably will have to adapt even further than they have so far in changing the nature and types of interaction. That is probably likely, but I would be very wary of an individual case or anecdotal evidence potentially undermining an entire sport.
It is going back to: where is the volume? Where is the evidence? We are not in a position yet where it is 100% conclusive, but we never will be. We have to make a judgment call at some point to take further action about individual sports in the absence of perfect information.
Q445 Damian Green: Good morning, both. We had a very moving session with two athletes who had to retire because of head trauma. It appears to many of us that one of the most concerning things is that they said there is very little awareness among the sportspeople themselves or their coaches of the whole issue of concussion and head trauma. Do you find that concerning, and what are you doing about it?
Nigel Huddleston: Yes, I do find it concerning. I have heard similar things, individual stories of people saying that they were concussed on the pitch or on the ground somewhere. They were then sent back on and cannot remember the rest of the game or the rest of the day or the week. Clearly, that is concerning and should not be happening. I think things have moved on, because most of the cases you and I have heard along those lines were quite a few years ago, as opposed to yesterday or this year, although there are a few instances but not anywhere near the same volume.
The level of awareness and the culture of many sports seems to have changed. The previous culture not so long ago, probably just over a decade ago, the “Just get on with it. Get back on. Stop being a baby” kind of attitude was prevalent in some sports. Quite a lot of sportspeople admit that and say that it was the case. There is now an expectation and obligation on sports’ governing bodies to take concussion more seriously. Having independent doctors and medical advisers who can intervene is quite important, and just the basic level of awareness. Rugby has done a pretty good job with its Headcase campaign and so on. Coaches are now carrying advice cards with them on the pitch.
A few small steps are being made but, you are right, there are some really alarming incidents. Somewhat comforting is that most of the incidents I have heard have been historical ones from a few years ago as opposed to current, but we need to track that.
Q446 Damian Green: Do you know if that is also true particularly in school sport? I remember playing half a game of rugby with a dislocated finger, so it was not very serious in the long term, but that was absolutely the attitude of, “Get on with it, boy. Stop whingeing. It might hurt a bit but who cares?” Do you think this new enlightenment has penetrated school sport yet?
Nigel Huddleston: I think the duty of care responsibility is something that schools take seriously. I am with you. I remember my school taking a similar attitude, but I think things have moved on and changed. I am interested to hear the former Education Secretary’s views on this in a moment but, absolutely, there is a duty of care responsibility. I think you are all aware of the work that Tanni Grey-Thompson did on the duty of care in sport. Her recommendation included getting advice on concussion out to schools, and we did that. That has now gone out. There is increasing awareness. It begs the question of whether it is sufficient, whether it is enough, whether it is pervasive, but there is now far greater awareness and recognition of responsibility. We have all seen—this year and previously—that schools take their responsibility for the health and wellbeing of their pupils incredibly seriously, and that extends to sport.
Q447 Damian Green: Returning to adult sport, do you think we need a national mechanism for removing athletes if they suffer head injuries? Do you think there should be a very clear protocol covering all sports?
Nigel Huddleston: This is an area where, sport by sport, I think there has been considerable improvement and clarity of guidelines over the last few years at both elite and amateur levels. If you look at the websites of most of the governing bodies and their training of coaches, this is now absolutely part of the mix but it is not necessarily consistent. Maybe because of the nature of sport it does not need to be exactly consistent. I am sure John will raise this. This is an area that Sportscotland has tried to bring together to set national frameworks for this kind of guidance—and I think that is an interesting model—as have other countries, including Australia. These are exactly the kinds of recommendations that I have been hearing from sports and at my roundtables. I suspect similar recommendations are likely to come from this Committee’s report as well.
Q448 Damian Green: Given the flow of information and concern that we are now getting, it seems to me quite likely that in a few years’ time heading will be banned in football. Do you see that as a possibility?
Nigel Huddleston: Already there is enough concern that, for under-11s, heading in training is discouraged. That is FA guidance and we are seeing similar guidance evolving and developing around the world. The guidance is extended to minimising it, reducing it for the under-18s as well. That is an area where I think we will see further changes, but again it is difficult for me. I am not medically trained—and research is continuing in this area—to say, “Yes, it definitely will happen,” but we are going in that direction. Again, how would that change the nature of the sport and the game, and would any of the kind of actions of banning completely be a proportionate response to the danger? I don’t know whether we can conclusively decide on that at the moment.
Q449 Giles Watling: Before I cover something on the UK Sport side of things, I ran into a rugby player the other day who told us the story—just like Damian Green did—that it was, “Get on with it, boy. Get up and move on.” He said he had been concussed multiple times. He had had many injuries, but he does not regret a thing. It was all part of the game to him and he would not want to change anything. Is that sort of macho, “get on with it” attitude something that we should be addressing in some sort of PR way? Is it a lack of comms? Are we not getting the story over properly?
Nigel Huddleston: As we were saying, I think the culture of sport is definitely changing and we are going in the right direction. There is still a long way to go with educational awareness of the potential dangers. Rugby has recognised that and made quite considerable efforts with the Headcase initiative and so on, but I think you are right that there is a culture change.
It is very difficult for any of us in Government, or indeed for the governing bodies, to decide how to impact or change culture, but there are levers we can pull: education, training, awareness, coaches and so on. We can work on all of those areas, which will help slowly change the culture. You are right, it is a difficult one to change, but I think it is more historical than current and the awareness of concussion is far greater than it was a few years ago.
One of the dangers—and it goes back to something I said at the beginning—is that I don’t think any sport wants to deliberately and consciously encourage activities or behaviours that they know to be deliberately harmful. That was not necessarily known 20 or 30 years ago, but the dangers of concussion are increasingly known. It is difficult to judge the history of sports with what is known now, but also at the same time there is an onus and responsibility on those sports, now that we are more aware and informed, to take even more action.
Q450 Giles Watling: There is a balance to be struck here, surely. It is the inalienable right of anyone to take up any sport and get on with it. We just have to make sure that they are clear on their guidance. For instance, I am involved with yachting, which any sensible person would not do. Getting on the water is probably one of the most dangerous things you can do, but we take all the necessary precautions we can while we are there and take the right training. Are we doing the right thing for concussion in sport? Should people be wearing more protective gear? Is there a role for Government interference, or should the Government step back and let the regulatory bodies, the sports bodies, take the lead?
Nigel Huddleston: You raise some important points of principle. One is that the mitigations need to be proportionate to the danger, not to the point where they necessarily destroy the sport completely, but mitigations are required. Then where does the responsibility lie? First and foremost, the responsibility lies with the sports themselves. They know the dangers intimately, and they have a responsibility to set guidelines, guidance and protocols. It sits with them first and foremost, but there is a role for Government here as well, particularly in learning, sharing, making sure that all are moving in the right direction.
I would be somewhat reluctant to say that Government need to do everything in this area because, as we all know, Government sometimes get things wrong. The level of detail and the information primarily sits with the sports, who know the sports intimately and should take on those responsibilities, but if they are not doing enough we will absolutely intervene.
You are right, we are talking a lot here about organised and managed sports, so elite sports or sports that are organised at a grassroots level or at schools, but there is a lot of sporting activity at an individual level or in a knockabout with people in an unorganised way. That is where the information and the culture is really important, because a knockabout on a field or with your neighbours in the street can potentially be dangerous, but there is no organisation and support mechanisms there if there is an injury. The awareness of the information overall among the public is also something we have to tackle.
Q451 Giles Watling: I want to move very briefly on to sporting federations. UK Sport said it was not a regulator, it only hands out money. Should we be relying on international sporting federations to do the right thing?
Nigel Huddleston: You are probably getting at something, but I am not quite sure what it is. Sporting federations absolutely should do the right thing. I sat on this Select Committee previously, and we had many investigations into the ethical behaviours or otherwise of major sports.
Q452 Giles Watling: Sorry, Minister, if I may clarify what I am trying to get on to. Is it a level playing field?
Nigel Huddleston: If you are talking about whether, if we put measures in place, other countries might come in with something slightly looser, you are absolutely right that there is a danger of that. That should never stop us from doing the right thing, though.
Q453 Alex Davies-Jones: Thank you to the Minister for joining us this morning. We have talked a lot about elite sport and what the governing bodies are doing to try to raise awareness, but we have heard evidence in this Committee that there needs to be a key factor for addressing the issue at grassroots level to make sure that there is awareness of participants, coaches, teachers and parents. Do you agree, Minister, and what should the priority be in raising awareness at this level?
Nigel Huddleston: You are absolutely right. The governing bodies usually still have a responsibility at grassroots level. Different sports are structured in slightly different ways. Some of them have absolute clarity about governing bodies’ responsibilities and their resources and the way that they interact with sports. Some are incredibly well organised and do a pretty good job. You are right that the awareness of concussion—I think we are all in vehement agreement here—is something that needs more action. Some other sports have multiple governing bodies, potentially giving slightly different advice. It might not be clear who is taking responsibility, or they might give contradictory advice.
We have talked about a few sports in the past where the clarity in the structure of the governing bodies is not always clear. They worry me, because we need to make sure there is clear messaging coming out for each and every sport where there is a potential danger of concussion. Those are the kinds of things that we will be identifying in the review, looking at where the gaps are and probably making recommendations in those areas as well.
Q454 Alex Davies-Jones: You mentioned sports where there is confusion and there are no governing bodies, and you have alluded to sports that I have raised with you in the past. I should declare that I am co-chair of the All-Party Parliamentary Group on Wrestling, as I have mentioned previously throughout this inquiry. You mentioned the review to try to remove some of the confusion. When can we expect this review? Is there a timetable, because obviously this cannot wait any longer?
Nigel Huddleston: I genuinely applaud this Select Committee because the very fact that you are holding these hearings is itself helping raise awareness and important concerns. The Government are conducting their activities and reviews, and we are holding roundtables and discussions and taking evidence and information. Your report will be pivotal to that. The Government will be required and expected to respond to that report, which we will do and, depending on when you send the report into Government, we will obviously respond to that. My hope and expectation is that the activities that we are conducting will write out some kind of report as well, probably in the autumn. Depending on the timing of your report into us, whether I wrap them up into one or do two slightly different reports, I don’t know, but certainly we are looking towards the autumn for coming up with findings and recommendations from the work we are doing. Your report genuinely will feed into that.
Q455 Alex Davies-Jones: That is really pleasing to know. On raising awareness at the grassroots level, how do you plan on ensuring that progress is measured so that it is actually making a difference to people?
Nigel Huddleston: That is a really good point, and one of the things that concerns me is trying to get the numbers on this. Sport by sport, how many concussions are there? How are they being reported? How serious are they? Did they result in hospitalisations? Were they all recorded accurately? What happens in various sports? What happens at schools and so on? I think this is an area where we need more information and data, and the responsibility for gathering it is not always clear at the moment. It is not an area where I will say that we have absolute clarity on what needs to be done, but it is an area of concern for me. I don’t think we are making decisions based on full and accurate information at the moment.
The NHS has improved in this area, and I think you had evidence earlier in the year from the NHS. I think 1 million people go to A&E with concussions each year, and about 7,500 of those get hospitalised. Of those, about 8.5% were sport-related and that itself is important. We are talking about sport today. There are bigger issues with head injuries, concussions and ABIs that go well beyond sport that we need to consider as well, but my responsibility is to look at the sport element.
Ben Dean: Sports learning from each other leads to a good example about horse racing, where they have some very good procedures with detailed online records of any fall that a jockey has and then recording what happened to that jockey, how long they took to recover, what treatment they were given. That is an example where we would like to see sports learning from each other and copying that good practice where it happens.
Nigel Huddleston: I met the boxing governing bodies yesterday and they are moving in that direction. What I am hearing is that a lot of sports are starting to do this, whereas even a few years ago it was non-existent.
Q456 Alex Davies-Jones: On that point, you are right where sports have to make their own concussion protocols for themselves. One of the points of evidence that this Committee has heard is that few of these sports can afford a full-time chief medical officer. Is there a need for more funding to be applied to medical oversight, even if that means that fewer athletes are funded?
Nigel Huddleston: On funding and sport—I am sure we will come on to this later—there is never enough money in sport, and there is never enough money in Government for the research and funding that is required. This is an important area where we need to make sure that research is taking place. As I said, the onus of responsibility primarily sits with the sports and I expect and require them to put their hands in their pockets and fund research into concussion seriously and then share those results.
Where there are gaps—and in some areas it goes beyond sport relating to concussion; we are in conversations, we are conducting our review, I am talking to the Department of Health and the NHS—we will consider what the role of Government could be. I am not making a decision on behalf of the Treasury here today, of course; I could never do that. We will certainly put bids in if required, but I don’t think we should need to because there is enough money in sport to be able to do this.
Also, it is a long-term issue. We are not talking about a one-off here. We need ongoing research and ongoing work in this area. I would not want Government to do something that is purely tokenistic. We need to make sure there is serious long-term investment in this area from sport.
Q457 Alex Davies-Jones: I agree that it should not be tokenistic. If sport is serious about introducing concussion protocols and treating and protecting their athletes seriously, one of the recommendations we have heard is that there should be a requirement that, to qualify for elite funding, a sport should be able to fund a full-time chief medical officer. Is that something that you would potentially support, to ensure that athletes are protected?
Nigel Huddleston: That is a fair point. Some sports have multiple medical officers and they are incredibly well funded. Others are not, and there is not necessarily a correlation between the money and the potential danger of the sport either. You are making a fair point. I am open to all these creative ideas, and we are looking at what other countries do as well. Yes, I am definitely happy to consider that.
UK Sport funding has been alluded to a couple of times. Remember, it is not its responsibility to spend money on medical research. They do some research, but that is not their remit, so I think we have to be careful about considering what the remit is of various organisations. If we come to the conclusion that nobody is doing things that we know somebody needs to do, that is what we need to think about carefully.
Q458 Alex Davies-Jones: Whose responsibility should it be, Minister? Would the collection, for example, of chief medical officers for elite sport be the right body to develop and maintain a working protocol for concussion in sport? Should that responsibility sit with them?
Nigel Huddleston: Potentially. The chief medical officers that we had at the roundtable were all individually doing lots of things, quite impressive things. I think they all learned interesting things that are happening in other sports at that meeting, which in and of itself shows that there is a failure because that co-ordination and sharing is not going on. I think there is a convening role required. That may be a role for Government, or it may be a role for an alternative. There are other bodies and groups, including some NGOs, who do some of this co-ordinating activity. It is not true to say none of it happens, and various medical groups and professionals of their own volition gather together to do some of this learning and sharing, but it can be improved upon. Maybe we need to look at some structures.
Q459 Chair: I was a little confused by certain aspects of your answer, Minister. You were very quick to say it is not the Government’s job to specify that these organisations, these bodies, should be spending money on research, but Alex’s question was not related to that. Alex’s question was probably due to the fact that we heard evidence from a witness that she had banged her head as a skeleton bob-sleigher. She was on a flight a matter of hours later, and she basically didn’t know who she was for three weeks after. It was clear to this Committee that there was a lack of medical support on site but also in the hotel, on the flight home and then after that as well. I think Alex’s point is: should it not be beholden on a sport to look after its athletes and to ensure that, if they want money to support their sport, this should be one of hurdles they have to jump over?
Nigel Huddleston: Sorry if I was not clear, Chair. I said I am completely open to creative ideas like that. I think that is a fair point to make.
Chair: It does not seem like a creative idea. It seems basically a bit of morality.
Nigel Huddleston: I heard that hearing. It was Eleanor and she had to repair her own helmet and so on. That is an alarming incident to hear about, and I have had players tell me that they literally cannot remember the game. That is very concerning. If we need to force them to spend money in this area, we will do just that.
Q460 Julie Elliott: Good morning. I want to go back to something you said to the Chair a little earlier. You said that sports need to bring in mitigation, and you also said that you met with boxing people yesterday. You may have heard the evidence in our first session where there was a very strong call that boxing should be banned, that there is no way to make it safe. How do you make those three comments line up?
Nigel Huddleston: The challenge is that we need to try to keep sports going, but with people making informed decisions about participating and by minimising the dangers. Boxing, along with quite a few other high impact sports, is inherently dangerous. As Giles said earlier, we have a consideration and I have heard views and opinions of, “We should ban this, we should ban that, we should stop this, we should stop that.” If there are unnecessary activities that could be mitigated but we are choosing not to—
Q461 Julie Elliott: In boxing the whole purpose is to try to knock somebody out. How do you mitigate that activity?
Nigel Huddleston: I am sure you heard the boxing professionals say that it is not necessarily the intent to knock somebody out, but they are putting various measures in place to try to mitigate dangerous activities. We all know of high-profile incidents in boxing, but it is such things as making sure that they are the same age, weight and experience levels. They would not put you in the mix with Tyson Fury, so there are mitigations, although I don’t know who would win on that one. There are measures in place, and they are conducting quite a lot of research with mouthguards, looking at the impact and seeing where the dangers are.
Q462 Julie Elliott: Do you think that boxing can be made safe?
Nigel Huddleston: Can it be made safe? Can it be made 100% completely safe? No, because that is not in the nature of boxing. It is there to cause some physical impact on your opponent. That is the nature of the sport, but could risk be further minimised? Potentially, and they are looking at those activities. I completely understand that there is a school of thought saying that it should be banned, in the same way there is a school of thought saying that all heading should be banned, full stop, in football. I do understand that. If there is evidence that it is inherently of such danger that there is clear cause and effect, those things come into the mix. I would probably rather continue the sport but do everything we can to make informed decisions for the participants and then mitigate as much as possible.
Q463 Julie Elliott: On that point, before moving on to something completely different, do you have an open mind on whether boxing can be made safe or not?
Nigel Huddleston: I think further measures can be taken to make it safe.
Q464 Julie Elliott: Do you have an open mind?
Nigel Huddleston: I do have an open mind, yes.
Q465 Julie Elliott: On something completely different. You have also said that it is not Government’s role to fund this research, but is it right that most if not all research in this area is funded by professional sports?
Nigel Huddleston: Let me be clear, it is the Government’s role to conduct some research. However, we should not conduct research if all we are doing is replicating what has already been done and reinventing the wheel, or if it can be undertaken by the sports with private sector money. Where there are gaps, we either need to get the entities to put money in themselves, and there are mechanisms we could potentially use to do that, or there is a role for Government funding as well. What I cannot say is that I am going to promise X million into research here today.
Q466 Julie Elliott: Do you think funnelling money through research councils might provide a better perception of which scientists and what proposals get funding?
Nigel Huddleston: Potentially, but also a lot of the research that is conducted is done jointly with universities, which have a fair degree of independence. I do understand what you are getting at here. There is some suspicion that the sports are marking their own homework and, therefore, doing research that potentially is not leading to completely open conclusions. I don’t think that is the case, because often the research that they are reporting leads to changes and suggests that there are dangers that they are acting on, but we need more.
Q467 Julie Elliott: But some of the conclusions of the research are not freely available to people. Do you think it should be a requirement that conclusions of research should be made freely available?
Nigel Huddleston: It is interesting that you use the word “requirement,” because how exactly would we do that? That is a consideration for Government. Is there a weakness in sharing information? Absolutely. The primary conclusion from my second roundtable is that there is tonnes of research going on but it is not being shared enough.
Q468 Julie Elliott: If you look back to examples—asbestos, smoking, all those things—there was lots of research many years ago that was not in the public domain that proved how dangerous both those things were. This is not exactly the same, but do you not think that if information is there that shows any causal links or any problems, it should be freely available to people? If it were made freely available, how would that material be archived to be publicly accessible?
Nigel Huddleston: You are raising a really important point about the obligations of sharing information, but I don’t think I could be any clearer. I have said this to the sports and I will say it here today: I would be absolutely aghast if a sport was sitting on information about the dangers of concussion and not sharing it. It would be absolutely, completely and utterly irresponsible of a sport to knowingly allow behaviours and activities to continue that it knew were dangerous. That should not be happening. That should not be what sports do within the realms of—
Q469 Julie Elliott: It happens at the moment, and there is no comeback on that.
Nigel Huddleston: Again, it is a matter of balance here. The nature of sport means that there are some dangers. I don’t want to see sports doing a level of danger that is irresponsible. I don’t think any of us do. I don’t believe the sports themselves want to do that either, and I would like to believe that they are not.
Q470 Kevin Brennan: Good morning, Mr Dean and Minister. I apologise, Mr Dean, we tend to want to talk to the Minister. It is nothing personal if you are feeling a little bit lonely at times.
Minister, what is unusual about professional sport as a job, an industry and a career is that in most jobs you would expect to go to work and that health and safety would be a priority to make sure you did not get injured or sick at work. One of the reasons why the smoking ban was introduced in bars is that, ultimately, people might freely want to smoke but you could not really say to someone, “You have to go to work and inhale a noxious substance that could kill you in the future,” as a philosophical justification for that action. That is the difference in professional sport, that people are going to work, this is an industry, these are employees. What is stopping concussion-related dementia being classed as an industrial disease?
Nigel Huddleston: I think you are making a fair point. There are lots of jobs that are dangerous or potentially dangerous, and you are right that the health and safety regulations in the workplace highlight those. Sport should not be completely different, but it is different.
Kevin Brennan: It is, isn’t it?
Nigel Huddleston: It is because of the nature, the physical impact thing.
Q471 Kevin Brennan: It is also because it isn’t classed as an industrial disease. Let’s accept for a moment that there is risk involved in many sports and that we are all going into this with our eyes open, that there is a risk of injury every time you play football and so on. It is a given that you are going to get injured in a tackle or playing rugby and so on. The point is that this particular injury is not classed as industrial injury. Why is that?
Nigel Huddleston: It goes back to one of the themes that is coming out of your hearings and mine, that until recently I genuinely don’t think there was an awareness of the direct correlation but there is increasing awareness.
Q472 Kevin Brennan: That is not entirely true, is it? After the Jeff Astle case, the Industrial Injuries Advisory Council looked at this and they concluded—this was given to us in evidence by the PFA—that dementia in boxers was not classed as an industrial injury even though dementia pugilistica was identified in the 1920s. That is 100 years ago, and still the Industrial Injuries Advisory Council does not class dementia related to concussion in sport as an industry injury. Do you think it is setting the bar too high?
Nigel Huddleston: Potentially. I think that is exactly what we need to consider as part of our review in Government and your review in this Committee. Dawn Astle gave evidence to our roundtable and she told a heartrending story. The challenge—and this is where we get into the legal dispute area—is drawing the direct correlation. Did the sportsperson end up getting the injury because of concussion on the field, or did they get it from a bar brawl? It is very difficult.
Q473 Kevin Brennan: Does anybody seriously believe that, for punch-drunk professional boxers—and I not commenting on whether boxing should be made illegal or not—their condition has not been caused by boxing?
Nigel Huddleston: I think this is the danger or the challenge. There is an ethical consideration to this, and the preponderance of the evidence versus the legal dispute side where the bar is often considerably higher. Maybe I am sounding more in disagreement with you than I am. I vehemently agree with you that all these things should be considered in the classification of injuries and how we treat them and take them seriously, but I am very wary about moving into the area of legal dispute.
Q474 Kevin Brennan: In that agreement, are you agreeing with the assertion that the bar has been set too high by the Industrial Injuries Advisory Council in recognising dementia caused by concussion in sport as an industrial injury?
Nigel Huddleston: You may be correct, but I don’t have enough information to be able to say yes or no to that.
Q475 Kevin Brennan: Were you serious earlier when you said to Julie Elliott that you knew boxers who told you that the object of the sport was not to knock out the other boxer?
Nigel Huddleston: It is not the No. 1 goal, yes.
Q476 Kevin Brennan: Have you met many professional boxers and talked to them about boxing? I put it to you that it is the No. 1 goal of professional boxers to knock out their opponents. Yes, they win the bout but—
Nigel Huddleston: It is to win the game and, en route, maybe knock them out.
Q477 Kevin Brennan: For some boxers, their only chance in the ring is to knock out the other guy because they are not going to win on points. Anyway, I will leave that.
Are you surprised that the Health and Safety Executive does not provide oversight on injury in sport?
Nigel Huddleston: We are looking at all these things, yes.
Q478 Kevin Brennan: Does it surprise you is what I asked, rather than whether you are looking at it.
Nigel Huddleston: Does it surprise me? Not necessarily. We need to learn from where we are. Despite all the awareness we have in this room because we have been hearing evidence, the awareness of concussion, the danger of concussion, the potential links to dementia and all the causes, despite your saying it has been known since the 1920s, the general level of awareness has not been particularly high until very recently, so it doesn’t completely surprise me.
Q479 Kevin Brennan: I accept that there is greater awareness now, but don’t you think it is the duty of the Government to ensure that there is greater oversight of sport to help to reduce the incidence of concussions and injuries to those who are employed to play sport? You have a key role in trying to encourage and, in fact, require that to happen.
Nigel Huddleston: That might well be the case. One of the purposes of our conducting the review is to see what levers could be pulled and where those levers sit. If there is a role for Government with various institutions, bodies or other routes, we will consider them all.
Q480 Kevin Brennan: Should professional sports clubs have to report injuries, including head injuries, under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations?
Nigel Huddleston: I think I mentioned earlier that that is one of the areas of concern for me. I am not at all convinced that there is accurate recording of all concussion injuries at the moment.
Q481 Kevin Brennan: Is it right that the NHS and player unions should fund the health consequences of a career in sport?
Nigel Huddleston: This is a difficult area of what the NHS should or should not pay for. In the absence of anyone else paying for it, yes, but is there an obligation on the sports in this area as well? Absolutely.
Q482 Kevin Brennan: In the work you are doing in Government—I am not going to ask you to say what your conclusions are now—one of the possible things that you could look at is a requirement for the sports themselves to take on more responsibility for paying for the consequences of injury in sport. In this case we are talking about dementia related to concussion.
Nigel Huddleston: I think that is one of the things that we are all looking at. We know there are consequences here, and it is a matter then of what those consequences are and how they were caused. As I said, some of these incidents go back to the point where there probably wasn’t the level of awareness of what the implications were or what the dangers were.
Q483 Kevin Brennan: That is true, but the same is true for pneumoconiosis and asbestosis. What we are looking at here is what should happen for those people. Do you think ex-professionals should receive more money for respite and treatment from their sports?
Nigel Huddleston: Potentially, and I think we have been hearing similar evidence from similar people, and lots of suggestions have come forward. I will repeat what I said at the beginning. We are at the beginning of our review, not the end of it, and I am not going to say no to virtually any recommendation or suggestion that anybody comes up with.
Q484 Kevin Brennan: If the suggestion was to legislate to that end, is that something you would consider?
Nigel Huddleston: I am wary of legislating if legislation is not required but, as I said at the beginning, we don’t rule out legislation in this area.
Q485 Kevin Brennan: I don’t think anyone wants you to legislate if it is not required.
Nigel Huddleston: I don’t know. I think some people do.
Kevin Brennan: If there are no legal means that would require ex-professionals to be given more support for respite and treatment from their sport, if there is no other means to achieve that, that is the purpose of legislation, isn’t it?
Nigel Huddleston: I think that is the purpose of the NHS and other services. The Government are putting in more money into the whole area of dementia care and more broadly. There are more personal and direct individual services being provided. You are raising a perfectly valid point that if we know this was caused by that activity, should the obligation also be on the institutions, bodies or groups that caused that damage in the first place? As a point of principle, that is a fair point to raise.
Q486 Kevin Brennan: In finishing, I will return to my original point. I know there will be further reports on this—I hope in the near future—but the Industrial Injuries Advisory Council report in 2005 concluded that there was “insufficient evidence to recommend prescription of dementia in boxers or footballers”. That was 16 years ago. That means nothing has happened for 16 years effectively in relation to making progress on this being classed as an industrial injury. If we wait around for 110% proof, nothing will ever happen.
Nigel Huddleston: I agree with you, but that probably speaks to why it is that the then Labour Government, of which you were part, did not act in 2005 or 2010 as well. I am not going to pretend that this is not a difficult issue or a difficult area to tackle. We want further action, and we will decide what activities we can take in Government, as well as putting the pressure on the sports to take responsibility.
Kevin Brennan: It is not a party political matter, Minister.
Nigel Huddleston: No, it is not at all, but the point I am raising is that it is not like it is just this Government that have struggled with these problems. If it was raised back in 2005, it says quite a lot about why it is that action was not taken back then.
Q487 John Nicolson: Minister, I have been listening carefully to your evidence and writing down some of the things that you have been saying this morning. You said that you wanted people to understand and participate in sport—these are your words—in full knowledge of the risks. All of us would regard that as a laudable aspiration, but it may well ignore the reality of the pressures, because we have heard time and time again from sportspeople who when young probably did understand, to a degree at least, the risks but were induced by their coaches and others to ignore the risks and to carry on. How do we deal with the pressures that young sportspeople are put under?
Nigel Huddleston: You raise an important societal and cultural issue that potentially goes beyond sport. You are right that, when we look at schools and at the challenges for young people, in particular, to feel obliged to participate in things that perhaps they do not really want to do, this becomes quite a challenging area.
I would say overall, as we discussed earlier, there is a cultural change going on. There is less pressure in sport. There is greater awareness of physical and mental wellbeing now than there was a few years ago. There is no easy answer to this, because you are raising a cultural issue.
Q488 John Nicolson: That takes us on to the question of specific injuries. Again, you were asked a question by one of my colleagues: when does heading the ball become dangerous? If it is several thousand times does it become dangerous? You agreed that it was dangerous at that level, but I have spoken to sports injury experts at the University of Stirling. They believe that, depending on your predisposition, perhaps heading the ball as few as eight times could lead to dementia. We are talking about an enormously dangerous activity. You would be in huge trouble with the tabloids if you were to turn round and say, “I do not think we should be heading the ball at all, even eight times.” They would go for you.
Nigel Huddleston: As a former journalist, you know full well what the answer to that is. You are raising an important point, though. As I said, we need to avoid unnecessary risk, but to a degree those risks will depend on the individual as well. In particular, I am concerned about the lack of evidence and research about the impact of concussion on women. Also I would be very wary of saying, “Let’s legislate” or push rules through for the worst-case scenario with the most vulnerable person and then apply that across the whole population. I do not think we should be doing that either.
Q489 John Nicolson: That is not what I am saying because like you, like all of us, we are lay people here and we listen to the medical evidence. What I was struck by was the evidence of the research that the people at the University of Stirling were telling me about. They think that a large percentage of the population have a predisposition to early-onset dementia if they carry out activities that are not natural. It is not natural to bang your head repeatedly against something. That is just not natural. They think this is a hugely dangerous activity, and we are collectively blind to it because we do not like the implications.
Nigel Huddleston: Again, you are raising the point that there is emerging information. There is emerging research coming through, and we need to learn the lessons from all of it. I am wary of using one anecdote or one piece of research to say, “Let’s do a blanket change based on that,” but as time goes on, and it is going on and more research is coming in, there is a preponderance of evidence, there is more and more information coming through. Precisely the concern about heading is exactly why now in schools, at primary schools, you do not do heading in training. There is better guidance now on heading; in fact, it is discouraged through the teens. There is increasing awareness within football, within the FA and within the Professional Footballers Association about heading as well.
Some of this goes back to a point I made earlier. Sports themselves have to take this responsibility seriously, and I think they are. It is not good for the sport to be encouraging, supporting or allowing unnecessarily dangerous activities to be taking place in their own sport. I do not think that is a good idea for sports at all.
Q490 John Nicolson: That is to place logic at the heart of decision making, and often decisions are not logical. Sadly, the folk who go on to develop dementia are no longer the responsibility of the coaches. The coaches may believe it happens long after they have stopped playing sport. One of the other things that we have discovered in the course of these hearings is that it is not just concussion, which all of us recognise is intrinsically dangerous. If somebody falls over and is knocked unconscious, that is a shocking thing to watch. It is the sub-concussion that may be the secret hidden danger, what some people refer to as the sparkles. All of us have had that when we have knocked our head on something and we have seen stars, but sportspeople are experiencing that time and time again. It is that sub-concussion that does not result in unconsciousness that may lead to early-onset dementia if people have a predisposition, which many people have.
Nigel Huddleston: You are absolutely right. There is more research going on in this area, and it goes beyond concussion. This is where I am somewhat optimistic that there is not just general research but forensic and interesting stuff going on, with new technologies as well, which will help with this decision making. Again, we have to question where that money should come from in terms of pushing it forward. Whether it is biomarkers in saliva, which can help identify the extent of some injuries apparently. There is emerging research there and in some other areas.
As you raised earlier, trying to identify somebody’s predisposition to dementia or other things is important, not only in sport but in many other areas as well. I could not agree with you more that more work needs to be done in this area.
Q491 John Nicolson: You have referred to the roundtable discussions that you have been having with various interested parties. Some of the scientists that I have spoken to say that they think there is a problem with the funding of some of this research by sports bodies. They think the problem is that the sports bodies will often show preference to doctors and scientists whom they think will downplay the risks because they do not want to see a threat to their sport. Would you agree that there is perhaps an argument for independent bodies who take the money from the sports organisations but then allocate the funding, not just to preferred scientists or preferred doctors but to independent scientists who will fund research without fear or favour?
Nigel Huddleston: The way that you have characterised the concerns leads to the conclusion that you have made as being a perfectly valid one. That may well be the case. I cannot say definitively yet whether I agree 100% with you, because I have seen some research and heard of research coming from the sports themselves that does stand up to scrutiny and is well conducted.
If there is that suspicion that the research is conducted in such a way that it is not credible, the mechanism you are proposing is a reasonable one. I am not saying no to that idea or proposal.
Q492 John Nicolson: You are open to it. That is good, because I cannot think of an argument against an independent body that funds this research. It seems to me to be fair, and it would remove any suspicion that there was preferential funding.
Finally, Minister, you mentioned that there are more consistent guidelines in Scotland. We have heard that from a number of different witnesses. One of the arguments is that in Scotland there is a more collaborative approach, with multiple sports bodies involved but also chief medical officers and Government Ministers. Do you think there are lessons to be learned from that?
Nigel Huddleston: Yes, we are looking at what the other nations and other countries are doing in this area. I am more than happy to steal good ideas from others in this. I have no shame in doing so. The culture of co-operation, sharing data and information, learnings and best practices is absolutely a theme that we have heard over the past few months. I would be happy to look at those activities.
I do agree with you that there is a potential need for more research funded in a way that is beyond question, absolutely scrupulous. We also need to recognise that, just because a sport conducts some research of its own volition, it does not mean that it is untrustworthy and we should be suspicious about all of it. They still have an obligation to conduct their own research. I would not want to smear them all by saying, just because it is conducted by an individual sport, it means we cannot trust it. I don’t think that is the case.
John Nicolson: I don’t think that is the case either. I am merely—while trying to push my cat out of shot—saying that it is what some scientists have said to me. Perhaps, for the avoidance of any suspicion, an independent funding body might be the answer to that. I am just raising that because it has been suggested to me a number of different times.
Q493 Clive Efford: Minister, to sum up the Government’s position at the moment, they accept that there is a problem but do not feel able to act because that may impact on individual sports and change the nature of those sports. Is that a fair summation of what you have been saying to us this morning?
Nigel Huddleston: No. I would say that we are aware there is a problem and, therefore, in the same way that you are conducting a review as this Committee, the Government are also conducting a review so that we can identify where action is required and what next steps are needed. This is the first time a Government have looked into this issue in sport, and so we are trying to identify, by conducting these activities, where we need to go.
Q494 Clive Efford: Is there a set of terms of reference for your review that we could look at? I have looked for one and I cannot find it. I apologise if that is because I am not so adept at investigating or interrogating the internet, but is there a set of terms of reference?
Nigel Huddleston: On terms of reference, it is not like we are going through some huge public consultation exercise. At the moment we are not. We wanted to conduct a series of roundtable exercises and work with sports, governing bodies, medical advisers and other Departments to identify where the gaps and issues are. We will be reporting later on this year, hopefully in the autumn. If that suggests that more work is required, we might need to do something more substantial but, at the moment, it is very much a status-gathering exercise.
Q495 Clive Efford: In 2016, the Concussion in Sport Group looked at all the research that had been undertaken in the previous 10 years. That was 3,819 pieces of research. It is quite a substantial number. That is more than one published per day for that 10-year period, which shows an incredible amount of activity and research in this field and this area of injury. They only accepted 47 of those, because they were looking for research that was longer term—10 years or more—so that discarded the rest of the research. That points to the fact that there is a great deal of research in this area, and obviously a great deal of concern. Therefore, should we be taking a precautionary approach until such time as we find the research that you are looking for, the silver bullet that tells us exactly what we should and should not be doing?
Nigel Huddleston: You are right. One of the things that struck me as I started getting into this—because I came into it thinking there was not a lot of research—is that very quickly, after talking to the governing bodies and others, I realised there was a lot of research out there. As I say, my concern is there are still some gaps, even within that massive amount of research—women’s sport in particular being one of them—and I was not convinced that the learnings were being shared in an effective way.
You are right that there is a lot of research out there, but some of it is probably of more value and more insightful than others. Also, there are some quite significant gaps.
Does it mean that we should, by instinct, be precautionary on everything? The culture of sport, the nature of sport, some of the changes that governing bodies have brought in, is more cautious than in the past. For example, we have seen that with heading in football for under-11s. There is an argument as to whether it is enough. We are seeing more caution being brought into multiple sports. We are seeing more consideration on and off the pitch and education and learning about sport.
I don’t know when we will conclude. We will wait for your review and for the review the Government are conducting to see if we need to give any clearer instruction.
Q496 Clive Efford: The Concussion in Sport Group, do you think it is too academic or that it is too conservative in its approach? Should it be more accepting of some of the research? Obviously some of the research may not be of a standard that they would accept, and we would expect that, but 47 pieces of research out of nearly 4,000, it seems excessive to discard so much research in this area.
Nigel Huddleston: I cannot definitively give you an answer on that without looking at the research in detail, but you are making a fair point. That looks like an alarmingly low number of pieces of evidence, given the total volume. Although what some people call research might be just a few stats on a spreadsheet pulled together from a few clubs. Some of that, genuinely, probably is not fully validated research, so I can understand why a lot of it would be thrown out. If there are multiple thousands of pieces of identified research, and then it ends up with double digits, that is a bit of a worry.
Q497 Clive Efford: Earlier, in answer to my colleague Alex Davies-Jones, did you say you expect to require sports’ governing bodies to do more in this area?
Nigel Huddleston: Yes.
Q498 Clive Efford: Can I just point out to you that the Premier League, over the weekend, announced that the prize money for the clubs totals around £2.5 billion being shared out? One of the answers that we had from the researchers was that they would think Christmas had come if they got £250,000, which is 0.01% of that sum of money. Do you think it is about time that you said to these very rich sports, where this is a matter of concern, “It is time you put some serious money into independent research in this field”?
Nigel Huddleston: You put that point very clearly, very effectively, and I agree with you.
Clive Efford: That is nice to hear.
Q499 Chair: Finally, Minister, Damian Green referenced the session we had with the two Team GB athletes. One of them, Monica Petrosino, was an ice hockey player who retired in her mid-20s due to successive concussive injuries, and she then became a coach. What she said to the Committee at the time was—we asked her about training in relation to concussion for coaches—“No, for me as a coach there is no formal training on head injury or concussion protocols. We all have to do our coaching courses, our safeguarding courses and our general first aid courses. There is absolutely no awareness of concussion.” That is in ice hockey, which is a high impact sport. What do you say to Monica’s assertion?
Nigel Huddleston: That is an alarming comment and quote. The ice hockey governing bodies might say that there is information and greater awareness but, to be honest, if individual anecdotal evidence says to the contrary that is of itself valid and it is alarming to hear. It speaks to the work that needs to be done.
Q500 Chair: What will you do about it?
Nigel Huddleston: Again, I will repeat what I have said throughout this. We are at the beginning of our work. We have not come to the findings and recommendations, but clearly evidence like that shows a lot more work to be done. If there are individual sports where they are falling behind others then—
Chair: Forgive me, but how much evidence and how many roundtables are needed in order to come to a very simple conclusion that a sport such as ice hockey, which involves people impacting each other at high speed, head collisions, that coaches in that game should be given formal training? I do not mean just information—a little handout, leaflet—but formal training in concussive injuries. Spotting the signs and the ways in which they can design their training programmes in order to avoid them. That seems to be an obvious point.
Nigel Huddleston: It does, but if we go to the ice hockey governing bodies, I suspect they would have a different view and would probably argue that more is done than nothing, which seems to be being suggested there. You are right that there is a lot more that many sports can do. Even if there is training, if there is advice and if there is information shared and offered, quite clearly that evidence shows it is not enough.
Q501 Chair: Will you commit to write to the Ice Hockey Federation, and also to other major high impact sports, and say categorically that you want them to incorporate specific concussive head injury training into their coaching programmes, yes or no?
Nigel Huddleston: I suspect that will be one of the conclusions of the findings of the review. I am not going to commit here and now to any individual thing, because then we will play that game and every single suggestion I say yes to and then it is—
Chair: I am not giving you anymore. Just that one.
Nigel Huddleston: I suspect it is highly likely that those kinds of recommendations will be precisely the kind of recommendations that come out of your report and, indeed, mine. The whole point is to try to identify where there are weaknesses and gaps.
Q502 Chair: How many people have had head injuries in the interim? This is an obvious one. We can all agree, and I know you are a sensible and compassionate individual—I know that personally—we can all agree that this is absolutely something that should happen.
Nigel Huddleston: Yes, it is, broadly.
Chair: Write the letter today.
Nigel Huddleston: We are having discussions with all the governing bodies at the moment and, believe me, we have put the pressure on them. I have told them that they need to do more, and I would be wary of identifying one individual sport, or indeed others, and saying, “Here is what we want you to do” when I want to be comprehensive in the conclusions and recommendations coming out.
Q503 Chair: Is there any reason why a sport would not introduce concussive head injury training into its coaching programme?
Nigel Huddleston: Again I would expect that they all—
Chair: Maybe tiddlywinks.
Nigel Huddleston: I would expect that they all would do this.
Chair: Snooker maybe, but I would imagine that anything with—
Nigel Huddleston: There are a lot of entities on the sports list that you would question whether they are sports. I do not want to be awkward because I agree completely with the instinct of what you are asking. What I am reluctant to do is, more on a process angle, say, “Yes, I will do X, Y and Z” when in fact I want to make sure our conclusions and recommendations are comprehensive.
I would be amazed if I did not do something exactly along the lines of what you are recommending, but I am reluctant to say yes to an individual thing because somebody else will come out and say, “Well, do this and do this and do this and do this as well” and all of a sudden I am disrupting the review by making interim announcements. I am reluctant to do that because it would be wrong.
Ben Dean: What we do know is that all rugby coaches have that training, for example. There is clearly best practice there, and we clearly do expect any sport to learn best practice.
Chair: That concludes this session on concussion in sport.