Response: Concussion in Sport DCMS Report
The Faculty welcomes the report of the House of Commons Digital, Culture, Media and Sport Committee on Concussion in Sport. It is an important contribution to the debate in this complex and emotive area. Since March the committee has been taking oral and written evidence from a variety of sporting, government and medical sources. There were significant contributions from our Members and Fellows – many of which positively influenced the report.
The adverse neurological consequence of sport is a complex area. The evidence is incomplete, the terminology is confusing and the conditions, understandably, cause considerable distress for players and family members. The report tends to blur concussion, post-concussion syndromes, dementia and Chronic Traumatic Encephalopathy. There is a tendency in the report to disparage some of the National Governing Bodies as well as players’ associations, many of which have been the main contributors to research and concussion protocols – although there is clearly more that can be done. The report is positive about the professionalism and influence of SEM doctors in this area and has given the Faculty some very specific tasks. We did not think the committee was always appropriately respectful of Fellows giving evidence and we did – at the time of the hearings – draw their attention to our concerns over this.
Significantly, the report expressly states the important health benefits to people through mass participation in sport. ‘An active lifestyle promotes overall good health, including reducing the risk of dementia in later life’. It is important that any measures to prevent concussion do not limit participation and cause ill-health through other means.
The committee recognised the fragmented approach to concussion in sport and advocated a more coherent approach to the education, management and research into this area. We note that It was not overly supportive of the Consensus Statement from the Concussion in Sport Group – feeling it to be overly conservative in its interpretation of the scientific data.
The report repeatedly advocates taking the ‘Precautionary Principle’, such as reducing the amount of heading in football. Such an approach may be effective, although with the nature of the conditions we are examining the evidence for the effectiveness of these interventions may take a long time to obtain. All doctors would wish to reduce the risks to which their players are exposed but taking precautions for exposures where the evidence is limited must not delay us determining other – potentially more important – risk factors. The report is clear that the potential adverse neurological effects of sport are not purely related to concussion. The precautionary principle is not without risk itself.
What was not addressed in detail was the potential to treat patients with cognitive, affective and behavioural symptoms arising from neurological injury – based on the well-established management of mild traumatic brain injury in other contexts. The Faculty would strongly advocate that this is an area which should be addressed in any future research or treatment guidance.
The key recommendations are:
NHS England in collaboration with FSEM(UK) prepares a learning module on the best practice for treating and advising those who present with concussive trauma
The Faculty would be eager to take on this responsibility with the appropriate resources.
The ambition that all GPs and A&E doctors are mandated to take this module every 2 years may be less achievable and not within the power of the Faculty
We would welcome the opportunity to lead on information for participants, coaches, teachers and family and friends about concussion and its appropriate management. We are already in discussion with DCMS about this.
A coherent UK-wide protocol for concussion across all sports to act as minimum standards for in creating the rules for their sports
The Faculty would welcome the opportunity to coordinate this activity and draft appropriate guidance which could be applied to grass roots sports also.
That NHS England reviews the way in which it collates data and concussion and concussion related brain injury. Doctors to have a full history available about patients with concussion
We would support better data capture by the NHS.
That the government mandate UK Sport to take a governance role in assuring that all sports it funds raise awareness of the dangers of concussion effectively. Protocols should be proactively implemented
The report recommends a more precautionary approach with a greater proportion of the money spent on elite sport focussed on protecting athletes
The funding of a CMO to attend events like the Olympics to decide who should be allowed to continue compete in the event of injuries
The logistics and feasibility of a CMO would need to be examined in full but the Faculty could have a role in training and regulation of such a doctor.
That the government mandates the Health and Safety Executive to work with NGB of all sports to establish, by July 2022, a national framework for reporting sporting injuries
Current frameworks for reporting injury to the HSE are not designed for sporting injuries. Due the nature of the current reporting structures at HSE any new framework may not be sensitive enough to capture data relevant for research or the design of injury prevention strategies in sport. The timelines are ambitious and the Faculty believes this proposal needs closer examination.
The report recommended that the government convenes interested parties to establish a single research fund that will coordinate and fund research and incentivise sport and other groups to contribute this through match-funding
The Faculty supports extra funding for this area of research and the activity to carried out at scale in a coordinated fashion. There may be a role here for the National Centres for Sport and Exercise Medicine (NCSEM) as well as the MRC and NIHR.
There also needs to be research into effective treatments for the long-term consequences of brain injury
The government convenes its own specialist group on concussion – drawing on campaign groups, scientific expertise and sporting institutes to assess emerging evidence
The Faculty believes there must be clear terms of reference for such a group and the must be caution about duplication of activity – particularly where there are international groups with similar objectives.
The government delivers a comprehensive communications campaign to ensure that everyone involved in sport is aware of best practice
The Faculty would be happy to support any such communication exercise drawing on our successes and experiences from the Moving Medicine initiative.
The Faculty believes there are real opportunities arising from this report and it is keen to work with the DCMS and other agencies to help improve the prevention and management of concussion in sport.