Written evidence submitted by Head for Change

Submission to parliamentary inquiry – March 2021

Background

1. Head for Change is a recently registered charitable foundation with the goal of revolutionising the way we approach the current and future crisis in sports-related head injury. We have created a safe space for sporting families in rugby and football who are suffering from sports related brain injuries, and, through this, want to lead the way in the innovation of ideas and solutions to this public health problem. As part of this, Head for Change has coordinated the formation of an independent research group founded on precautionary principles, the Repercussion Group, which connects with key figures in science and research in this field in order to bring about positive change. 

2. Each trustee of Head for Change is a family member of someone suffering from sports related neurodegenerative disease. They bring their lived experiences, together with significant professional qualifications and skills in senior management, health, education and academia, to bear on the aspirations of the charity. Dr Judith Gates is the wife of a former professional footballer suffering from dementia and is an international management consultant, a founding member of an international charity, a former university lecturer, school inspector and head teacher; Dr Sally Tucker is the daughter of an ex-professional footballer suffering from dementia, and is an NHS Surgeon with a special interest in Medical Ethics and Law; Melanie Bramwell-Popham is the wife of a rugby player recently diagnosed with dementia at the age of 41, and is a partner of a global recruitment agency with a 20 year recruitment career based in London. 

3. Three pillars underpin the work of Head for Change: care and support for ex-players and their families; education and advocacy to raise awareness of sports related neurodegenerative disease among all stakeholders; research, with a particular emphasis upon independent research which is founded upon the precautionary medical principle of ‘first do no harm’.  

Context

4. Head for Change is deeply appreciative that this parliamentary inquiry has been convened. Having reviewed the contextual history of traumatic brain injuries in both rugby and football, Head for Change believes in learning from the evident mistakes that have been made in order to find solutions for the future by working collaboratively with all parties. Indeed the core values of Head for Change are to ‘be part of the solution’ and to ‘protect the players and protect the games’. This submission respectfully suggests possible solutions to what is currently an intractable problem. 

5. The trustees have followed the progress of the parliamentary inquiry in detail, and have read available transcripts and watched available recordings. This submission is therefore premised upon a deep knowledge of the proceedings to date. 

Submission

This submission is structured in two parts:

Part A highlights agreement with issues that have already been discussed in the inquiry. 

Part B makes concrete suggestions as to solutions for the future, including an innovative, unique and comprehensive approach, HEAD SAFE.

Part A - Agreements
 

6. Need for government ownership - We acknowledge the evidence which notes that the self governing sporting bodies in both rugby and football have not responded either promptly or appropriately to the ‘silent killer within sport’, namely the concussion crisis. Viewing this as a public health issue, we strongly support the requests for the government to take ownership immediately and to initiate remedial action. 
7. Immediate change to sporting protocols - Sport needs to act now to protect players whilst we hone down on risks and their preventative strategies. Head for Change agrees with the changes in protocols suggested by both the Progressive Rugby Group and representatives from the footballing community. In football these changes include limiting heading in training and by youths and the need for temporary concussion substitutes. Protocol changes in rugby include limiting contact in training and extending the time for ‘return to play’. However, much more research needs to be done in this area, and the overriding principle should be to ‘do no harm’, i.e. act now to protect players whilst we hone down on risks and their preventative strategies.
8. Education and awareness putting players first - Head for Change recognises that extensive education and awareness raising is needed to change the culture of the games. Currently the requirement to win is paramount, with players under implicit pressure to continue to play despite head injuries. Instead, the welfare of players should be the predominant guiding principle.
9. Potential CISG conflict of interest - From an extensive review of the composition of the CISG, together with their consensus statements, Head for Change agrees that the CISG presents an ultra-conservative perspective emanating from a group of researchers significantly funded by sporting governing bodies. Comments have been made as to the obvious potential for conflict of interest within this group.
10. Supporting ex-players - Head for Change supports the stated necessity for practical support, including full time care when necessary, for ex-players suffering from neurodegenerative disease. 

Part B - Solutions 
 

11. Introduce “HEAD SAFE” kitemark - Head for Change requests that the government introduce a mandatory kitemark qualification, namely HEAD SAFE. To satisfy the criteria for this qualification, sporting and educational organisations would have to demonstrate compliance with agreed criteria necessary to ensure the safety of players and sporting participants. Compliance would be specific to the differing contexts and would require evidence of appropriate policies leading to effective practice. Head for Change has given considerable thought to this suggested solution and, if required, would be prepared to take a leadership role in developing and piloting this proposal in collaboration with other professionals. 
12. Financial support for ex-players - Head for Change respectfully suggests that the government requires sporting governing bodies in rugby and football to each establish a fund to support the care of ex-players. These funds would be administered according to relevant criteria determined by an externally appointed body. Precedents have been established by both the NFL and Australian Rules Football.  
13. Research based on precautionary principles - Head for Change respectfully requests that government requires future research projects to be premised upon guiding principles which are both player-centred and precautionary. Whilst it is impossible to ever prove absolute causal connections, credence should be given to evidence of strong associative links between head injuries and the subsequent development of neurodegenerative disease. As part of our research group we have formulated a list of guiding principles, adherence to which aims to ensure research is both player-centred and free of conflict of interest.
14. Designating neurodegenerative disease as an industrial disease - Dr. Judith Gates, co-founder of Head for Change, was an author of a position paper submitted to the Industrial Injuries Advisory Council in January 2020. This paper requested that neurodegenerative disease in ex professional footballers be designated as an industrial disease. Although this has been placed on the IIAC agenda, to date no decision has been made. Designation as an industrial disease would be of significant benefit to affected players and their families.   
15. Independent ethical oversight of sporting bodies - Head for Change noted and was deeply concerned by the comment of Dr Mike Loosemore in which he stated that he felt that the physical benefit to children of boxing outweighed the risks of sustaining head injuries. Head for Change respectfully suggests that the ethical tightrope upon which medics and researchers affiliated with Sporting Bodies are required to walk may make decision making and judgement incredibly difficult, and this facet of the industry may benefit from ethical moderation and opinion by external health professionals and player advocates. Head for Change would be willing to work with the government on expanding this idea.