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.