Brain Injuries in Football

Damian Collins Excerpts

Wednesday 24th April 2024 Westminster Hall

[Damian Collins (Folkestone and Hythe) (Con)]

I beg to move,

That this House has considered brain injuries in football.

The fact that so many Members are present to seek to intervene or speak in this short debate shows the great interest in the topic. The subject of brain injuries in football and concussion, and brain injuries in sport as a whole, has received considerable attention in recent months, but it is an issue we have been familiar with for many years. My wife’s grandfather, George Richardson, who played professional football for Sheffield United and Hull City, died from a brain haemorrhage in 1968 aged just 56. It was widely believed in the family that it was a consequence of heading heavy footballs when playing as a striker in the football league in his youth.

In 1966, famous for the England World cup win, there was also the end of the first domestic season in which injury substitutions were allowed in English football. A report that I read in the Liverpool Echo from that year recorded that 772 injury substitutions had been made, of which more than 10% were made as a consequence of concussion or head injury. The vast majority were for leg injuries—understandable for football—but even then quite a high number of players were taken off for concussion. We can imagine the high bar there would have been at the time, given that understanding of the consequences of concussion and long-term health impacts were not as well understood.

Staying with 1966, five members of England’s World cup-winning team have subsequently died as a consequence of dementia or brain-related conditions. Recently, other well-known England and Scotland footballers, such as Jeff Astle, Gordon McQueen and Joe Kinnear, have also died from brain-related injuries. However, no longer is this just a matter of tragic stories being brought into the public domain of great loss and sympathy for the families concerned; it is now a matter of increasing scientific study, especially in Scotland, with the 2019 field study conducted by Doctor Willie Stewart of the cases of more than 7,000 former Scottish professional footballers, looking at their cause of death against a study of the general population involving 23,000 people.

[Ian Blackford (Ross, Skye and Lochaber) (SNP)]

I congratulate the hon. Gentleman on securing this debate. He makes an important point about that field study in Scotland. At the time some people dismissed it, because it was only one study, but what has changed in the intervening years is that there have been studies in other European countries. I would argue that the evidence is now overwhelming. It is not just the high-profile cases that he talked about; thousands of footballers are caught up in this and are in financial difficulty. What we really need, given this understanding, based on the scientific evidence, is to have this type of injury classed as an industrial injury by the Industrial Injuries Advisory Council.

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[Damian Collins]

The right hon. Gentleman makes an incredibly important point.

I will dwell briefly on the main statistical outputs of that field study, because it is the best baseline that we have in the UK. The figures are stark. The study discovered that former footballers have a fivefold increase in Alzheimer’s disease, a fourfold increase in motor neurone disease and a twofold increase in Parkinson’s disease against the base level for the general population.

Further medical studies have identified, too, the medical condition of chronic traumatic encephalopathy, or CTE, which is linked to head trauma—head injury. It can be caused by a severe blow to the head, but also within the course of playing football. It causes a release within the brain that is made worse by repetitive injury. That is why the right hon. Member for Ross, Skye and Lochaber (Ian Blackford) has a point about classifying this as a form of industrial injury caused by the circumstances of playing football. It can have prolonged and lasting effects. Players who have received concussion injuries on several occasions may be more likely to have severe trauma later on, even if it is recognised at the time.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this subject forward. It has taken some time and I commend him for his zeal in making it happen. There have been advances and helpful discussions with the Irish Football Association. Does the hon. Member agree that the lessons learned have meant that changes must be made, including the pilot scheme that was introduced by the IFA in 2020 to allow substitutions for suspected concussion with no disadvantage to the teams? That means that players do not feel that they have to shake it off and can be medically wise. There are some things that can be done. For every debate that we bring forward, it is important to highlight the issues, but it is also important to highlight the possible solutions.

[Damian Collins]

I agree with the hon. Gentleman that concussion substitution would be a sensible measure. In Scotland, I believe there is a campaign for rugby called, “If in doubt, sit them out”, which recognises the danger of concussion injuries and allows a pause in play. Often the incentive within professional sport is to keep people playing as long as possible, and often the players want that themselves. However, there must be proper safety standards so that the right decision is made and the incident does not lead to lasting injury and trauma.

In the United States of America, the recognition of CTE as an injury caused by playing professional sport, particularly American football, is well recognised. The National Football League is providing hundreds of millions of dollars of support for players who are diagnosed as having CTE. There is recognition of the link between head injury and playing sport, and people are properly supported and compensated.

There are two challenges that we have to look at. First, how can we prevent unnecessary and lasting injury as a consequence of head and brain injuries in football and other sports? Secondly, how do we support people who, late in life, are suffering as a consequence of the injuries they sustained during their playing career? The question of compensation is one that families in particular have raised. While a £1 million fund has been created by the Premier League, administered by the Professional Football Association, the concern is that there is no guarantee beyond the first year of its operation, which we are still in, that the fund will continue—although we hope that it will. It needs to have proper resources and to be properly accessible to families.

I spoke recently to John Stiles, the son of former England footballer Nobby Stiles, who made it clear to me that in his father’s case, his care costs per year were over £100,000, and yet the cap for funding from the current fund is £60,000 a year. That would not have been enough. In that case, Nobby Stiles decided to sell his medals, including his World cup-winning medal, which helped pay for his retirement and his costs. However, not everyone is in that position. Many other footballers and their families can be in a position where they are required to sell the family home, although they were told that would not be the case when the fund was created. Some former players and their families have had to sell their homes.

[Duncan Baker (North Norfolk) (Con)]

Last week I raised on the Floor of the House the point about funding, because Chris Sutton, the former Celtic, Chelsea, Blackburn Rovers and—more importantly, being in Norfolk—Norwich City legend, is my constituent. Currently, support is in place from the PFA and the Premier League’s brain health fund, which has already paid out thousands to help families. That is positive, but a proper registered charity would be the way forward to ensure that the funding is in place. Does my hon. Friend think the Minister could help with putting the proper vehicle in place?

[Damian Collins]

I am sure that the Minister has heard the point my hon. Friend makes. I think the Minister’s convening power could be extremely helpful in this case. There needs to be a properly resourced fund that football pays into. There is enough money in football to provide compensation for players who clearly need it.

The cap on the fund means that it will not cover some care costs; it would not have done so in the case of Nobby Stiles, had it existed at that time. However, there have been other deaths of former players recently, such as Chris Nicholl, a former player for Aston Villa and Southampton, who died without his family receiving a penny of funding. Similarly, John McNamee, a former Newcastle player, died as a consequence of CTE and his family had to sell the family home to cover care costs. Real concerns are being raised by the families that, limited though these funds are, they are not universally accessible, and there is no guarantee they will exist in the future.

[Sir Gavin Williamson (South Staffordshire) (Con)]

I congratulate my hon. Friend on securing the debate. The points that have been made about the brain health fund are incredibly important. Does my hon. Friend agree that in addition to the Premier League and the Professional Footballers Association, the Football Association and the English Football League also have a part to play, and that it is by all partners and Government coming together that we can deliver much more for players today and into the future?

[Damian Collins]

I completely agree with my right hon. Friend. There has been criticism from the families about the fund. It was created voluntarily by them, but the EFL and the FA are not part of it, and they need to be. All the groups that represent professional football need to come together and provide that support fund.

I agree with the right hon. Member for Ross, Skye and Lochaber (Ian Blackford) that we should look at classifying these as industrial injuries, but football does not need to wait for that classification; more could be done now to put those support elements in place. This is where I look to the Minister. I know that the issue has been raised with him before, and he has taken a keen interest in it. I believe the Government can play a role in bringing the parties together. There should be a recognition of the link. I know that the Department is supporting more research and convening a forum to decide where the areas of priority research should be. That will help us to understand how we can safeguard young sports players today and safeguard against brain injuries in the future.

More must be done now to recognise the existing link and accept a responsibility. There is a danger sometimes that people are concerned about legal liabilities; but we have known about this link for a while. In March 2024, Dan Roan of the BBC published a report showing that FA board minutes from 1983 recognised the concern about head and brain injuries and the causal link between those injuries and playing football, so let’s not pretend that this link was not known. Something needs to be done now.

Does the Minister think he can play a role bringing the FA and the English Football League together with the Premier League and the PFA to agree a package of financial support to make the available fund sustainable, to look at lifting the cap above £60,000 a year and to guarantee that no family will ever have to sell their home to pay for the care costs of a former footballer? Will football accept its responsibility to care for these heroes of the past, who incurred their injuries while providing entertainment and joy for millions of people and who have enriched other people who have made money out of the game?

Yesterday, on Second Reading of the Football Governance Bill, I raised the case for player welfare to be part of the remit of the regulator. I do not think the regulator’s job should be to write rules for football; it should be there to ensure that competition organisers and clubs adhere to the standards that have been set by the competitions with regard to athlete and player welfare. That would be consistent with the corporate governance responsibilities that the regulator sets. In terms of funding support for players’ care costs in later life, that could be another opportunity where the fines collected by the regulator could support both grassroots sport and legacy injuries related to football, particularly brain injuries. The fund could be used helpfully in that way. I do think there is enough money in football that primarily the professional football organisations themselves should set that standard.

Finally, as has been mentioned, the question of the rules that govern concussion and brain and head injuries in sport today is really important. I do not want to see things like heading the ball removed from football. It is a physical game and is enjoyed as such, but players should be aware of the risks they are running. There should be safety standards, such as concussion substitutions during matches or training, and ensuring that people sit out when they have had a head injury and are given a proper amount of time to recover. There should also be consideration as to whether unnecessary repetitive exercises in training that include heading the ball are really necessary if they cause damage. These things need to be properly understood. In some cases, more research may be needed. We should look at this on an ongoing basis.

As a starting point, let us recognise the link that exists and the genuine need of support that some former players and their families have now. Football already respects the fact that the connection does exist, but we need a proper agreement to resource this and make sure that the support is there and the fund continues. I ask the Minister, as the Football Governance Bill passes through the House, to consider the role that the regulator can play in ensuring that the welfare and safety standards we should expect from clubs and competition organisers are actually followed through.

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[Stuart Andrew]

It was certainly a pleasure to respond to that debate, and I made a commitment to write to the Department, which I did. I was due to meet the Minister for Disabled People yesterday, but I had to spend all day in the Chamber for the Second Reading of the Football Governance Bill. That meeting will be rearranged, and I will be sure to raise the right hon. Gentleman’s request. I will come on to his point about industrial injuries shortly.

The safety, wellbeing and welfare of everyone who takes part in sport is paramount. I also know how important football clubs and players are to all our local communities. The recent examples of dementia-related deaths of former footballers are of great concern to Members across the House and to me as the Minister for sport. It is important to acknowledge that the vast majority of people play sport safely, but head injuries in sport do occur.

Player safety must be a major focus for sport, as we recently highlighted in our Government sport strategy, “Get Active”. More work is still needed to ensure that robust measures are in place to reduce that risk and improve the diagnosis and management of sport-related head injuries at all levels of sport. That should apply during not just matches but training, and there should be provision for both professional and amateur players, as hon. Members have mentioned.

The national governing bodies are rightly responsible for the regulation of their sport and for ensuring that appropriate measures are in place to protect participants from serious injuries. I am pleased to say that positive progress has been made across different sports in recent years. For example, home nation football associations have changed their guidelines to prevent under-11s from heading footballs during training in England, Scotland and Northern Ireland, and the FA is co-funding research with the Professional Footballers’ Association to build the evidence base relating to brain injuries in football. It is not just national governing bodies contributing to improvements in player safety; players’ associations such as the PFA also play a valuable role in supporting professional players and providing short and long-term support to those affected by sporting injuries.

[Damian Collins]

The Minister mentions that further work is being done by the FA, but is there any doubt in his mind or the Government’s about the link between brain injury and sporting injury?

[Stuart Andrew]

I will come on in a minute to research and to some of the things I want to take from the debate.

Hon. Members have mentioned the brain health team and the range of support for former players and their families, which of course includes assistance with claiming state support and benefits. I have discussed the work on player welfare with the PFA’s chief executive, including the football brain health fund for players affected by dementia, which was established last year with the aim of providing financial support for players. An initial amount of £1 million has been made available to provide discretionary financial support, as assessed by an independent panel, to improve quality of life.

I welcome the creation of the fund, the first of its kind in English football. I hope that it will provide support to those former players who need it most. The PFA has confirmed that further investment will be forthcoming, but I will seek further reassurances for that fund. I acknowledge that there is some scepticism from former footballers who have contacted me to express doubts about the fund’s effectiveness.

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[Stuart Andrew]

I thank my right hon. Friend for his intervention. I have had letters from former footballers expressing concern about the fund, and I wrote just yesterday to the PFA to seek assurances that the fund is working. I recognise that there is wider work to be done, and I will be more than happy to convene a meeting or roundtable with all the interested bodies and reflect the comments that right hon. and hon. Members have made today. I will, of course, include FIFA.

[Damian Collins]

I am very glad to hear that. At that roundtable or a subsequent one, will the Minister also meet the families who are raising concerns about the practical operation of the funds and the difficulty of accessing them?

[Stuart Andrew]

I would be more than happy to do so. In fact, I suggest that it is probably sensible to do so before we do the roundtable, so that I can reflect what I hear from the families.

There has been some discussion of the industrial injuries disablement benefit. The Department for Work and Pensions provides specific support for that benefit and the Industrial Injuries Advisory Council is the independent scientific body that will make recommendations. I know that many Members feel strongly that the council should explore professional footballers’ access to the benefit. My understanding is that the council is currently considering any connection between neurodegenerative diseases such as dementia and the possible effects of repeated head injuries sustained during a career as a professional sportsperson. It needs to give further consideration to the evidence before it can make a decision and will publish its findings when the investigation is complete. It would be premature for me to speculate on how that will progress, but I will definitely raise the matter with the disability Minister.

[Stuart Andrew]

I will try to reflect the right hon. Gentleman’s comments as accurately as possible at my meeting with the disability Minister.

It is important to highlight that the Government are leading work on brain injuries in sport, and specifically on concussion. As part of that, my Department has worked with interested parties to develop the first ever single set of shared concussion guidelines for grassroots sports across the UK. The guidelines, which were published last April, were developed by a panel of UK and international experts in the field of sport-related concussion. They build on the world-leading work in Scotland that hon. Members have mentioned.

We are grateful for the support of Scottish, Welsh and Northern Irish colleagues in expanding the remit of the new guidelines to cover the whole UK and their full use for everyone involved in grassroots sport, from school age upwards: participants, coaches, volunteers and parents, as well as those working in education settings and healthcare professions. Through the guidelines, we want to encourage more people to enjoy the benefits of being active and playing sport. We hope that they will be a useful tool in reducing the risks associated with concussion. At all levels of sport, if someone is suspected of having concussion on the field of play, the overarching message, as my hon. Friend the Member for Folkestone and Hythe said, is “If in doubt, sit them out.”

Evidence-based research is an important component of ensuring that sport is made as safe as possible. My Department has therefore established a research forum to look at concussion in sport. That group brings together key academic experts with experience in traumatic brain injury, neurology and concussion to identify the priority research questions around sports concussion that still need to be addressed for the sporting sector. It is now formulating a report to identify the priority research questions, which is expected to be completed this year. Alongside that, our Department has established an advisory panel with the aim of identifying tech innovations that can help with concussion in sport.

Separately, the Department of Health and Social Care is formulating the Government’s new strategy on acquired brain injury, including dementia. Our Department is feeding into that process to ensure that those who play sport are represented in the gathering of evidence. We remain committed to working with the sector to make sport safe and enjoyable for everyone, including through technological solutions and the prevention of concussion.

[Damian Collins]

I thank the Minister for giving way one last time. Alongside the establishment of new guidelines based on research, which everyone welcomes, is the question of enforceability. There is a sad history in sport of anti-doping regulations and other welfare standards not being enforced properly because there is no external validation. Policies are often executed within team and club environments by the coaches and the medical staff who report to them, with no external supervision. Having an external actor to check that the right things are being done will be important to making the new guidelines effective.

[Stuart Andrew]

I heard my hon. Friend’s comments very clearly yesterday. The regulator we have established for football has a very tight scope—we needed to do that—but my hon. Friend raises some interesting points that I will take away and consider. I will certainly make the point, when we convene the roundtable with all the interested parties, that further work is needed in this area. Much good work is going on across Government, but I recognise that we need to do more.

I understand the strength of feeling about the issue and its effects on those who suffer from this terrible illness and on their families. We will continue to work with the sports sector, including the football authorities, to ensure that player safety is prioritised so that everyone can take part in sport safely. I thank my hon. Friend again for securing this debate, and I thank everyone present for their thoughtful contributions and their interest in the area. Once I have had the roundtable, I will be happy to update hon. Members on the outcomes of the discussion.

Question put and agreed to.