Wednesday, 27 November 2013

When it comes to head injuries in sport, we can learn a lot from looking to America

Hugo Lloris returned to the Tottenham Hotspur line-up on Sunday, but not to the kind of game he'd have liked. The Frenchman has been in the wars lately, with a controversial head injury in his team's fixture against Everton on 3 November. The last thing he would have wanted was to be on the end of a 6-0 drubbing by an effervescent Manchester City frontline.

But at least Lloris was fit to play. Too often, this is not the fate of sportspeople who suffer head injuries. The tragic example of American high school football player Charles Youvella is a case in point. Just over two weeks ago, Youvella died after sustaining a head injury while playing a game in the Arizona Interscholastic Association.

By all accounts a brave and talented player, Youvella's injury came in a Saturday night game, when he was felled by what witnesses described as a 'routine football tackle'. Routine it may have been, but the back of the young man's head hit the ground with considerable velocity. Two days later, on Monday 11 November, Youvella was dead of a traumatic brain injury - notwithstanding, in uncomfortable echoes of the Lloris incident, the fact that immediately after the initial impact he got to his feet and lined up for two more plays.

High stakes

Terrible, premature deaths like Youvella's remind us of the high stakes in many sports, from football, whether American or in the form of 'soccer', to rugby, horse-racing and boxing.

No one would seek to ban people from taking part in sport, the upsides of which embrace an individual's health and sense of self-respect and have a wider societal benefit in fostering discipline, camaraderie and teamwork.

But in many things America shows the way - and last August the National Football League agreed to a $765m (£478) out-of-court settlement with a group of former players who had sued the league for, as The Guardian put it, "its role in hiding or underplaying the effects of brain trauma in the game, while glorifying its violence, a cover-up which has been exposed in a series of recent books and documentaries." Happily - in a development that we should applaud - Microsoft co-founder and Seattle Seahawks owner Paul Allen last week announced that he will fund a two-year, $2.4 million study into whether repeated blows to the head can lead to dementia.

American football is not only sport in the spotlight for its alleged laissez-faire attitude to head injuries. Just this week, 10 players from the National Hockey League began legal proceedings against the league for negligence and fraud, alleging that the sport’s officials should have done more to address head injuries but instead celebrated a culture of speed and violence.

Too robust?

Could the same thing happen here? British sporting culture prides itself on being robust, on taking the knocks and getting up and playing on. But 'being robust' can have deadly consequences. Hugo Lloris was, thankfully, lucky; the next footballer encouraged to play on after a head injury might not be.

The key message is that prevention is better than cure - especially when it comes to brain injuries. We must remain vigilant and astute to the dangers of 'getting on with it'; so too must we keep a watchful eye on medical developments in this complex area. And, looking across the pond, we could sensibly take a leaf out of Paul Allen's book - at the same time as hoping that British sportspeople don't find themselves forced to take class actions to achieve recompense for traumatic head injuries.

Wednesday, 20 November 2013

The HMRC's overnight change to policy on the release of employment histories is flawed and dangerous. It must be reversed

Sometimes it's tempting to conclude that the only feasible reaction to policy changes under the present government is despair. For all the committees, consultations and conferences - for all the ticking of 'impact assessment' boxes and due regard for the views of stakeholders - things still seem to happen without rhyme or reason.

The latest example of this comes in the form of an entirely unheralded change in policy by HM Revenue & Customs.

No consultation

HMRC now says that a request for the employment history of a deceased person will only be released to that person's representatives on receipt of a court order served on the General Counsel and Solicitor to HMRC. Only a matter of days ago, it was the case that a deceased's personal representatives had so sign and provide a form of authority for the information to be released. Not any more, thanks to a change that's been introduced overnight, without any form of consultation with affected parties.

The new system has major ramifications for mesothelioma claims. When a person dies with mesothelioma as a likely cause, it's vital for the estate to be able to establish the deceased's employment history. This is often difficult to piece together, but an HMRC work history schedule (based on national insurance contributions) will list all the deceased's employers since 1961. With this information to hand, solicitors can begin the process of establishing where and when a deceased worked, the extent of exposure to asbestos and identifying the correct defendant.

Now, though, the time, expense and inconvenience of an application to court is necessary. Only then will the information be disclosed.

Staff at HMRC's Longbenton office say the reason for this change of policy is "because the records are stored in accordance with the Data Protection Act." In other words, disclosing them would be a breach of privacy under the Act. This, the Association of Personal Injury Lawyers have pointed out, is wrong. It is arguable that, like the right to sue for defamation, rights to privacy die with the individual, but in any event any such privacy rights (if they still exist) must pass to the deceased's personal representatives. It is for them to give consent for the release of employment records.

Delay and expense

Why has this policy change been made? Its only effect will be to cause delay and expense for those who wish to bring a claim for loved ones tragically killed by mesothelioma. It flies in the face of the government's declared aim of speeding up the claims process for mesothelioma sufferers.

A conspiracy theorist might point to the number of ministerial shareholdings in insurers and suggest that overnight changes such as this don't happen by accident. A cynic might point to the government's regular announcements of a war on bureaucracy and say that this is precisely the sort of meaningless red tape it is fighting. And those who feel so despairing at the injustice of contemporary politics that they cannot rouse themselves to vote might simply sigh and say 'what do you expect?'

But I think we should resist conspiracies, cynicism and despair. Instead, we should campaign to reverse this absurd change in policy. Please retweet, comment, reblog and otherwise disseminate this piece and your support for its views in the hope that HMRC sees reason.

Tuesday, 12 November 2013

Where have all the ethics gone? That the police need a code on ethics is a damning indictment of modern society

Yesterday's Times carried a short piece about the anger of those whose loved ones were caught up in the Hillsborough disaster towards Sir Bernard Hogan-Howe, the Metropolitan Police Commissioner.

Their anger stems from "confusion" over whether Sir Bernard - who, on the day of tragedy, was an officer at a club in Sheffield where families waited for news about fans - gave a statement to the Hillsborough inquiry carried out by Lord Taylor of Gosforth, the late Lord Chief Justice. Sir Bernard is on record as saying that he provided statements to Lord Taylor, but they do not appear in the archives of official documents published by last September's Hillsborough Independent Panel report.

Confusion all round

Sir Bernard now stands accused of making misleading statements about the inquiry into the tragedy. He himself says he was "confused" when he said that he had made a statement to Taylor inquiry.

Hillsborough's families would like the Independent Police Complaints Commission to investigate Sir Bernard's account and why he appears never to have made an official statement to the inquiry, despite having been an inspector in South Yorkshire police at the time of the disaster. The IPCC may well take up the baton; Sir Bernard says he will welcome any investigation they chose to undertake. For now, it would be wrong to prejudge what will come of this.

But if time will reveal the ramifications of the "confusion", the families' ire is understandable. It comes as an IPCC investigation into alleged police misconduct during and in the aftermath of Britain's worst sporting disaster continues. So much remains unresolved about police culpability at Hillsborough that fateful day; feelings cannot but run high.

All this might also explain paradoxical feelings about the Home Secretary's recent announcement that the police are to have their own code of ethics. The Times trailed this towards the end of October with a story headlined: "Officers must agree to 'respect and obey law'."

Ethics go for a bike ride

Draft Code of Ethics for policing in England and Wales
Those who gasped in astonishment at the notion that police officers were being asked to agree to respect and obey the law would only have grown more disconcerted by the story itself.

It transpired that in the wake of 'Plebgate' - the infamous incident involving the police, a politician, his bike and an unholy aftermath - the Home Secretary felt it necessary to issue the police with a new code of ethics. Its core message was exactly as per The Times' headline - that police officers would be reminded, via the code, of their duty to respect and obey the law. The College of Policing, itself a recent creation of Theresa May (who set it up in 2011 to professionalise the police force), had been tasked with drafting the code. The rationale saw professionalism invoked as the name of the game, with the College writing to its members (serving police officers) and saying it was "professionalising the service in the same way we see the General Medical Council's Standards and ethics guidance for doctors or The Bar Council's Code of Conduct of the Bar of England and Wales."

Professionalism is one thing. Having a police force that needs to be reminded of its duty to "respect and obey" the law is another. And yet to look at just three incidents in the past 25 years is to behold a police force that has a dubious relationship with its rationale.

The police are supposed to embody the rule of law. They're supposed to be peacekeepers, not law breakers. In living memory, they were also essentially benign characters, as helpful as they were authoritative. But we have seen poor behaviour by the police at Hillsborough and in its aftermath. We have seen racism – witness the death of Stephen Lawrence and the Macpherson Report. And now, after Plebgate, it transpires that nine out ten police officers believe the force must change.

Perhaps, then, we should be thankful to Theresa May and her innovative new ethical charter for the police. But we might ask what this says about our society. If our police need to be reminded to obey and respect the law, where have all the ethics gone?

Thursday, 7 November 2013

All's not well that ends well when there's a risk of serious brain damage. Spurs were wrong to let Hugo Lloris play on

"It's OK. I'm fine. I want to carry on."

These words are often heard by boxers when they've come round after a KO punch. Whether the fighter is out for just a few seconds, or a matter of minutes, his instinct is almost invariably to fight on.

In fact, the boxer's brain and nervous system have been scrambled so much that he doesn't even realise that the referee has stopped the fight. The minutes of unconsciousness are precisely that. They're lost forever. There's no getting the time back, there are no memories to retrieve. To be 'out cold' hints at just how much damage has been done by the KO blow: after all, we're at our coldest when we’re dead.

A disturbing response

As a lifelong football fan, only rarely have I seen head injuries of the kind that boxing fans often witness. But last Sunday's game between Tottenham Hotspur and Everton yielded one. And the way it was dealt with cannot but be disturbing.

Huge Lloris, the Spurs goalkeeper, was knocked out when challenging for the ball against the onrushing Everton striker Romelu Lukaku. To view the footage on YouTube is to see that Lukaku's knee clatters forcefully into Lloris's head. The velocity must have been easily the same as a boxer landing his best punch.

No wonder, then, that Lloris was rendered unconscious. There is doubt as to whether the goalkeeper lost consciousness completely or suffered a 'transient' alteration of consciousness but what is abundantly clear is that he took several minutes to recover. But astonishingly, and despite his French keeper's unsteady feet when he was finally able to stand up, the Spurs manager Andre Villas-Boas did not substitute Lloris. He had a very able deputy in Brad Friedel, but decided to let his injured goalkeeper play on - mindful, perhaps, of Football Association guidelines to the effect that a merely 'transient' alteration of consciousness does not mean a player cannot return to play.

Villas-Boas also elected to ignore the obvious concerns of his captain, Michael Dawson, who appeared to try to persuade Lloris to go off after he got to his feet. "He took a really bad whack and I was worried when he went down and stayed down," said Dawson. "When he got up his legs gave way, but he stayed on and made two good saves. I lead those boys but safety is the most important thing. He was in a bad way, but, by the time he came around, he was wanting to stay on."

All's not well that ends well

So, was all well that ended well? Hardly. Spurs' decision has rightly attracted much criticism, not least from the brain injury charity Headway. Its spokesman, Luke Griggs, had this to say:

"When a player - or any individual - suffers a blow to the head that is severe enough for them to lose consciousness, it is vital they urgently seek appropriate medical attention. A physio or doctor treating a player on the pitch simply cannot accurately gauge the severity of the damage caused to the player's brain in such a setting as there may be delayed presentation of symptoms." And yet more tellingly: "By continuing to play, the player may have caused greater damage to his brain. He should have been removed from the game immediately and taken to hospital for thorough tests and observation."

Headway chief executive Peter McCabe also commented on Spurs' decision here.

Happily for Lloris, it seems that subsequent scans show that he has emerged unscathed from the clash with Lukaku. But, quite rightly, the Professional Footballers' Association (PFA) says that players should be automatically removed from the pitch should they suffer "a severe trauma" to the head that causes a loss of consciousness. So, too, do players' union FifPro and world governing body Fifa.

Those calling for caution are correct. Spurs behaved in a cavalier fashion in letting their player continue. In such circumstances, just like a KO'd boxer, the decision is not the player's; it is the club's. The club should not have taken the risk of Lloris potentially being concussed and suffering serious brain injury.

In boxing, a KO'd boxer is not allowed to fight again for at least 28 days from the date of the KO. Villas-Boas could still set the right example by giving Friedel the nod and resting Lloris for 28 days. But the odds that this will happen must be very long indeed.