Two more named in Players' dementia action

The legal action against rugby union’s authorities took a decisive step forward on Thursday when the firm representing nine players diagnosed with long-term brain injuries sent pre-action letters of claim to World Rugby, the Rugby Football Union and the Welsh Rugby Union. Rylands Law also revealed the identities of two more of the nine players involved in the test cases alongside Steve ThompsonAlix Popham and Michael Lipman. They are the former Wales under-20 centre Adam Hughes and the former England under-21 back-row Neil Spence.

The development comes as the former England captain Dylan Hartley spoke out about the lack of teaching in rugby around the risk of dementia. “From when I started until last week, I didn’t know dementia was a potential outcome for any rugby player,” Hartley said on RugbyPass’ Offload podcast. “That wasn’t educated or taught to us.” Hartley admitted he is having his “own problems” with concussion in retirement, but said he does not want to reveal more about them.

Neil Spence during his playing career at Rotherham.
‘A side of me is lost for ever’: two more rugby players on their brain injuries

Hughes, 30, is the youngest player involved in the action so far. He has been diagnosed with “having brain injuries and post-concussion symptoms”, and has been told he is on a “similar medical trajectory” to Popham, Lipman, Thompson and Spence, who have all been diagnosed with early-onset dementia and probable chronic traumatic encephalopathy. Hughes played for the Dragons, Bristol and Exeter between 2010-18, and his experience throws doubt on the argument that the game has become significantly safer in the past decade.

Hughes was forced to retire at the age of 28 after a particularly severe concussion and is now working as a financial adviser. “It was just one head knock too many. I was finding it more and more difficult to recover from each and every bang to the head,” he said. He reports being knocked out eight times in his career. “At first it was the bigger concussions where I was completely knocked out that took me ages to recover from then over the time even the smaller ones started to have an impact. For the sake of my health, I had to bring it to a halt.”

One of Hughes’s former coaches, Rob Baxter at Exeter, said last week the game’s approach to head injuries has improved so much in the years since Thompson, Lipman and Popham retired that “there’s almost very little value in trying to compare the two”. Hughes, who played for the Chiefs in 2014-15, told a different story. “For me, I think the biggest issue around concussions was attitude. It was often treated like a weakness if you don’t dust yourself down and carry on.”

He added that “the game still has a very long way to go in terms of education about concussion”.

Adam Hughes (left), pictured in action for Dragons in 2016, retired age 28 after a severe concussion.
Adam Hughes (left), pictured in action for Dragons in 2016, retired age 28 after a severe concussion. Photograph: Huw Evans/Shutterstock

Four more players involved in the test cases have decided to remain anonymous. Rylands Law is already representing around 100 former rugby players and said 30 more have been in contact since the involvement of Thompson, Popham and Lipman was revealed by the Guardian last week.

In a statement World Rugby, the RFU and the WRU said: “We have been deeply saddened to hear the brave personal accounts from former players. Rugby is a contact sport and while there is an element of risk to playing any sport, rugby takes player welfare extremely seriously and it continues to be our number one priority. As a result of scientific knowledge improving, rugby has developed its approach to concussion surveillance, education, management and prevention across the whole game.

“We have implemented coach, referee and player education and best-practice protocols across the game and rugby’s approach to head injury assessments and concussion protocols has been recognised and led to many other team sports accepting our guidance. We will continue to use medical evidence and research to keep evolving our approach.”

Sir Bill Beaumont, the chairman of World Rugby, added: “As a player who retired on medical advice in the early 1980s, I care deeply about the welfare of all players. As an administrator, I will do all I can to maintain the confidence and wellbeing of those who play the game.”

The pre-action letters of claim set out the broad allegations upon which the cases are based. They state the governing bodies had a duty “to take such steps and to devise and implement such rules and regulations as were required in order to remove, reduce or minimise the risks of permanent brain damage as a consequence of the known and foreseeable risk of concussive and sub-concussive injuries”.

They also allege the risks of concussions and sub-concussive injuries were “known and foreseeable”, listing 24 failures on the part of World Rugby, RFU and WRU. The governing bodies have a maximum of three months from the date of acknowledgment of the letters of claim to provide their initial responses.

Health-Areas to be Addressed

Areas to address:

We believe there is merit in strengthening the links between these existing and future clinics to build a more cohesive response to the problems caused by concussion occurring in a sporting context.
DCMS needs to improve liaison with other Government departments on concussion issues in sport, to share best practice and improve the effectiveness of concussion health interventions in emergency medical settings for those engaging across the sporting landscape.

Action to be taken:

DCMS will work on strengthening and coordinating links across Government. This will include more effective protocols and pathways for use in treating concussion in sport injuries in NHS Accident & Emergency settings which will focus on the specific needs and issues of individuals and continually improve the safety of players of all levels, genders and ages across sport.

We will liaise with key organisations such as the Medical Research Council, UK Dementia Research Institute, Alzheimer’s Research UK and leading centres of research in the UK to provide a focal point and encouragement for research in this field. We will also consider the approach of the Ministry of Defence (MOD), who have undertaken extensive work on concussion in regards to the UK armed forces. (The Department for Health and Social Care, through the National Institute for Health Research (NIHR), and the MOD are co-funding the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) at the Queen Elizabeth Hospital Birmingham. This joint funding has been supporting the REpetitive COncussion in Sport (RECOS) project in the SRMRC portfolio, which seeks to develop a yes/no concussion test with the aim of catching all concussion, working with participants who had suffered blast and concussion injuries).

We will be asking sports to convene with player associations to discuss training protocols. DCMS ministers will contact sports to stress the crucial need to account for the long-term welfare of players when considering their training methods. We expect sports to go further in ensuring that player safety is treated with maximum importance. Should sports not demonstrate sufficient progress in prioritising player protection, Government will be prepared to consider the matter through the lens of welfare in sport.

Our discussions with player associations made clear the importance of sports addressing training protocols. The associations were keen to contribute to further discussions with sports on this important issue.

We acknowledge that sports have progressed work in this area, such as The FA’s introduction of heading guidance, focused on training sessions (where most heading occurs) across the professional and amateur game from the start of the 2021-22 season. The Premier League’s two research studies into heading in training are also welcome initiatives. World Rugby has also recently introduced guidelines to reduce the amount of full contact training undertaken by rugby players to 15 minutes per week.

We will also explore further the possibility of working with the Premier League on a pilot scheme for clubs to embed player welfare as part of the governance of their organisations which could then be extended across the sporting sector.

Premier League clubs have been working on integrating their duty of care responsibilities into governance plans. This work needs further examination and could prove to be a useful template for other parts of the sport sector. The Premier League Board recognises that it has a legal duty of care towards protecting the health and safety of its employees and others, and that managing health and safety is a business-critical function.

This work needs further examination with the help of the Premier League’s Football Medical Governance Group, and could prove to be a useful template for other parts of the sport sector.

Milestones:
• The first phase of LOTG’s feasibility study into improving coordination and use of existing medical centres/clinics will be completed during 2022. DCMS will consider the recommendations of the study aligned to its ongoing work in this area.
• The Minister for Sport will write to national governing bodies to emphasise the importance of player welfare, including concussion, when formulating governance procedures for their sports by the end of 2021.
• DCMS will convene a meeting with the Premier League and relevant Premier League clubs to discuss player duty of care as a key requirement of those clubs’ training and playing contracts. We will then look to initiate a pilot scheme in partnership with selected clubs to assess the effectiveness of introducing such a governance requirement for players with a view to further rollout into other parts of the sporting sector.

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