We now move to item 10, which is a short debate, and I call on Steffan Lewis to speak on the topic that he has chosen. Steffan.

Diolch, Ddirprwy Lywydd. I’m fairly confident this will be the shortest of short debates, the Minister will be pleased to hear, at the end of a long day.

I’m pleased to have this opportunity to raise the issue of chronic traumatic encephalopathy and its possible links with contact sports like football. I first became aware of this issue after hearing an interview with the wife of the late Frank Kopel, a former Dundee United player who was diagnosed with dementia at the age of 59. She’s been campaigning for greater awareness of CTE since Frankie’s death and has spoken very eloquently about her experiences in caring for him in later life.

Brain scans re-examined by Dr Willie Stewart, a neuropathologist, led him to the conclusion that Frankie’s condition was caused by years of repeated head impacts from other footballers and also heading footballs—bearing in mind that Frankie played in an era when footballs weighed around 450 g. The issue of a link between head injuries in sport and brain damage has been debated recently in relation to rugby and there are long-standing pointed debates in American football.

But, it’s only in the very recent past that a link between CTE and football is being fully discussed and considered. Last month, pioneering research was published by scientists from University College London and Cardiff University, focusing on retired footballers in the Swansea area. From 1980 to 2010, 14 retired footballers who had been referred to the old-age psychiatry service in Swansea were monitored until their deaths. All the retired footballers developed progressive cognitive impairment, and neuropathological examination revealed septal abnormalities in the six players where a postmortem brain examination was carried out. Twelve cases died from advanced neurodegenerative disease and four cases had pathologically confirmed CTE.

The study does not directly confirm a link between repetitive head impacts and CTE, but says that further research is needed. An average player heads the ball six to 12 times in a football match and at least 2,000 times in a 20-year career. But, head injuries are more likely caused by head-player contact than head-ball contact. The difficulty in identifying harm arises from the fact that most impacts are sub-concussive, meaning that they do not result in concussion or display overt neurological symptoms.

In my view, it’s far too early to make concrete assertions about footballers and CTE, beyond what we know from the most recent research in which Welsh scientists played a leading role. Indeed, the chief scientist of the Alzheimer’s Society has said the research carried out in Swansea does not provide proof that heading a football causes dementia, but it is clear—and there is agreement across research and among scientists on this—that further research is needed and there needs to be a raising of awareness of the impact of repetitive head injuries on a footballer over the course of their career.

As a football fan myself, I absolutely would not want to rush to conclusions and decide to make it harder for young people to participate fully in the sport. As a lover of the game, I would not want us to rashly rush to a situation where the nature of the game is materially changed. But, the purpose of my raising this short debate today and raising this specific issue is to ask Welsh Government if they would consider doing two things. Firstly, what is clear to me is that there is a need for raising awareness of CTE and head injuries in general in football, and how we deal with head injuries in the sport as they occur. Rugby has taken steps to protect players better when they have head injuries during match time. So, I wonder if the Minister would agree to at least consider convening a summit of football governing bodies and representative bodies in Wales to share information and best practice in the sport, which could involve experts in the field as well as scientific and medical experts, so that we share best practice and at the grass-roots level in particular, football coaches and parents and others involved can be aware to look out for signs of head-to-head contact and to take particular care and attention in determining whether it is safe for a player to continue.

Secondly, I wonder if the Minister would consider—seeing as Wales has been central to the most recent research, as I mentioned, with Cardiff University scientists involved in that research in Swansea—working with those involved to build on Wales’s potential global reputation in the area of CTE and sport research. So, perhaps the Welsh Government could hold an international conference on CTE and sport in Wales, maybe using the exposure of Wales in the UEFA Champions League final this year as a platform to garner interest and to invite FIFA, UEFA and football associations from around the world to come together with the scientific researchers and with the experts that we have in this country in the field. This could be another golden opportunity to strengthen Wales’s reputation as a global centre for excellence in research as well as, of course, learning much more about CTE and football, so that we can prevent the very sad cases that have happened in recent years in terms of long-term head injury and premature dementia. Diolch yn fawr.

Thank you very much and I call on the Minister for Social Services and Public Health to reply to the debate. Rebecca Evans.

Thank you and I’d like to thank Steffan Lewis for raising this important topic and for promoting this debate today.

Chronic traumatic encephalopathy or CTE is a progressive, degenerative disease of the brain found in people with a history of repetitive brain trauma, including recurrent episodes of concussion or repeated blows to the head. The potential for links between the condition and certain sporting activities has been documented for some time. Boston University in the United States reports that CTE has been known to affect some boxers since the 1920s, when it was termed ‘punch-drunk syndrome’.

However, it is now known that the condition is not confined to ex-boxers. More recent studies have explored the potential links with other heavy-contact sports, such as American football and ice hockey. There remains some debate about how widespread the condition is. In many spheres of life, and in sports and public health in particular, there are always risks and benefits to consider alongside each other. Evidence plays a crucial role in helping us to make more informed choices when balancing these risks and benefits.

Many sports carry some element of risk of injury in the short or long term. It’s important that we put proportionate steps in place to create safe sporting environments for all, whilst not limiting opportunities for children and adults to undertake physical activity and engage in sports. We also know of the multiple positive physical and mental health benefits, as well as a number of social benefits, of participating in sport.

Our programme for government makes it clear that we have a commitment to promote and raise awareness of the importance of healthy lifestyle choices, including being more physically active. We naturally want all young people to have a wide range of opportunities to participate in sport, building on Wales’s long history as well as recent successes. We must nevertheless take the issue of safety in sport very seriously. We all have a responsibility, individually and collectively, to ensure that everyone, including young people, children and older people, are able to participate safely. Where necessary, we should take reasonable steps to mitigate injury for professional sportspeople and for people who play sport just for pleasure.

Some of you may remember the news some years ago of the tragic and untimely death of Benjamin Robinson. Benjamin was only 14 years old when he died as a result of sustaining a double concussion during a school rugby match in Northern Ireland. Benjamin sustained his first concussion at the start of the second half, but played on for another 25 minutes and was involved in two further heavy collisions. The coroner ruled that Benjamin’s death was second-impact syndrome following concussion, and could have been avoided had someone been able to recognise the signs of concussion and remove him from the game.

Government was determined to act to avoid similar cases arising in future. In September 2014, the Welsh Government, working closely with the Welsh Rugby Union, issued guidance on concussion for school and community sport up to the age of 19. The guidance sets out the recognition and management of the symptoms of concussion following a head injury sustained during physical activity in children. It also includes guidance for the gradual return to play and schoolwork for children diagnosed with a concussion injury. It is aimed at a wide variety of professionals and bodies, including sporting professionals, teachers, school governing bodies, further education institutions, national sporting bodies and youth sports coaching and support staff. It requires that those involved in sport in schools and the community ensure that the guidance is followed, disseminated properly and embedded into any policies relevant to dealing with head injuries sustained by children and young people up to the age of 19 in any environment where physical activity is taking place. That includes football. It is reassuring to see the example set by international rugby in the recent RBS 6 Nations, where we saw a zero-tolerance approach applied to the players sustaining head injuries, with players removed from the game for a full medical assessment before a return, if it was safe to do so.

I have previously mentioned maintaining the balance between safety and encouraging engagement in physical activity. There have been calls to ban certain aspects of rugby for young people. The Sports Collision Injury Collective wrote an open letter to the UK Government and the devolved administrations in 2016, calling for a ban on contact rugby for school-age children, citing the dangers of long-term injury to young people, such as concussion. In response, the UK chief medical officers commissioned the UK physical activity expert committee to consider the evidence presented by SCIC. Following a review of this evidence, the committee rejected the call to ban tackling and did not feel that rugby participation poses an unacceptable risk of harm. The committee also reported that the benefits of experiencing, learning, training and playing rugby with appropriate supervision, safety and coaching considerably outweigh the risks of injury.

In February this year the media reported emerging evidence to a link between heading a football and dementia. The study was focused on the topic of our debate today—CTE. The headline was prompted by the results of a small study where postmortems were carried out on six ex-professional players with a history of dementia. The study was carried out by researchers from University College London, Cardiff University and the Cefn Coed Hospital in Swansea. It was funded by the National Institute for Health Research and the Drake Foundation. Researchers found four players had a pattern of brain damage consistent with CTE. The suggested reason for injury in the four football players was repeatedly heading a ball. While these results sound concerning, this was a small, descriptive study that has not proved repeated heading of the ball was the cause of brain damage seen in the players. Dr Helen Ling, the key author of the study, said:

it is important to note we only studied a small number of retired footballers with dementia, and that we still do not know how common dementia is among footballers....The most pressing research question is therefore to find out if dementia is more common in footballers than in the normal population.’

The study sets out proposals for the further research that would be required to confirm the potential causal relationship between CTE and exposure to repetitive head impacts from playing football. It’s positive to see the Welsh academic institutions at the forefront of the research in this area, and I hope this continues.

Dr David Reynolds of Alzheimer’s Research UK commented that the benefits of regular exercise in terms of dementia prevention may well outweigh any risk, especially for those who play football on a recreational basis.

On reading these reports, I sought advice from our own chief medical officer. This pointed to a discussion between the UK’s four chief medical officers at which they agreed causation was not sufficiently established to support a ban on heading footballs. As well as prioritising safety in sport, this Government has also been proactive in terms of looking to reduce risks in various forms of dementia. There is clear evidence that a healthy lifestyle can reduce the risk of dementia by up to 60 per cent. Following the recommended levels of physical activity alone can reduce the risk of some forms of dementia by 20 to 30 per cent. Our dementia risk-reduction campaign calls on people to act now to reduce their dementia risk through healthy and active lifestyles.

So, to conclude, I do agree that it is important that research into CTE continues, and that we’re able to help reduce the risks now and in the future of CTE in an informed and proportionate way. I’m grateful again for the opportunity to discuss this important issue, and I’d like to extend the offer of a further meeting with Steffan to discuss the specific suggestions that he had in the debate today. Thank you.

Thank you very much. That brings today’s proceedings to a close. Thank you all.

The meeting ended at 19:15.