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Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, September 21, 2021

Agenda: Time for Reflection, Business Motion, Topical Question Time, Covid-19 Update, Scottish Ambulance Service, Net Zero Nation, Decision Time, Brain Injury in Football


Contents


Brain Injury in Football

The Deputy Presiding Officer (Liam McArthur)

I remind members that Covid-related measures are still in place in the chamber and around the Holyrood campus and that face coverings should be worn when moving around the chamber and accessing your seat.

The final item of business is a members’ business debate on motion S6M-01042, in the name of Michael Marra, on action on brain injury in football. The debate will be concluded without any question being put.

Motion debated,

That the Parliament understands that an increasing number of ex-footballers in the North East Scotland region and across the country are making public a diagnosis regarding brain injury, and that a growing research base highlights the increased risk of such injury that professional players face; notes the view that the sport’s governing bodies must take swift action to support former players and protect those currently involved in the game; further notes calls for such conditions among footballers to be considered as an industrial injury; recognises the campaigning by PFA Scotland, the GMB and other organisations regarding this, and notes calls for a working group to be established to consider these issues, which should also focus on the grassroots game.

17:47  

Michael Marra (North East Scotland) (Lab)

I thank the members from all five parties who supported the motion, and I thank my Labour colleagues for allowing me to lead the debate. That cross-party support is a small reminder of the universality of football—our national sport and national obsession. It is a force that can, at its best, bring unity and joy—the beautiful game.

A few years ago, headlines relating to the dementia suffered by a Scottish footballing great would have been shocking. Now, we see them every few weeks. The late, great Billy McNeill was a player who would have led any team in any era. His skill was considerable, but he was also a man who was blessed with strategic understanding, tactical cunning and a depth of emotional intelligence. He was articulate, funny and a born leader. We knew instinctively what the cause of his dementia had been.

From the snippets of news and the mention of Jeff Astle—that great header of the ball at West Bromwich Albion, who had suffered dementia—we had a vague idea that the number of diagnoses was growing. Now, we hear of them constantly. In recent weeks, Gordon Wallace, who scored Dundee’s 1973 league cup winner, Gordon McQueen, who headed Scotland to victory at Wembley in 1977, and Denis Law—perhaps our greatest and most powerful centre forward—who was dominant in the air for Manchester United and Scotland, have all gone public with their diagnoses. We will hear more in the weeks, months and years to come—that is now inevitable.

Those are just the ones we know about. Many families of household names choose to preserve their privacy and maintain their public dignity when dementia has stripped them of so much. There are also those whose names would not command headlines but who played and entertained—and loved the game—and who now suffer.

The results of the research undertaken by Dr Willie Stewart of the University of Glasgow are clear. A professional goalkeeper has the same chance of developing dementia as any citizen, a striker is three and a half times more likely to suffer, and a defender is five times more likely to suffer. Of his own diagnosis, Denis Law said:

“What else would it be? That was what caused damage to the brain. You were heading the ball, which was quite heavy in those days, but you didn’t think about it. We just thought it was normal.”

We must be clear that this is not a debate about concussion. The medical condition we are discussing comes from repeated brain trauma from the repeated heading of a football on the pitch and in training. The striker Chris Sutton, who lost his beloved footballer father to dementia, estimates that his own repetitive trauma amounts to heading the ball 70,000 times during his career. Chris has backed the campaign and is calling on Scotland to show leadership.

Put simply, for a generation of our greats, this is injury time—and time is running out. Our injury time campaign, which was launched on Sunday, before the Dundee derby, has three demands for the Scottish Government and Scottish footballing authorities: first, classify brain injury in football as an industrial injury; secondly, fund research into the practical and preventative support that is needed in the game; and thirdly, establish a working group to consider issues around brain injury and dementia, including in the grass-roots game.

Brian Whittle (South Scotland) (Con)

I have a great interest in this subject, which I spoke about in the previous session of Parliament. Would the member agree that there is a lot more research to be done, especially around the impact on those who are under 16, when bone density is not fully developed, and around advancements in technology? For instance, he mentioned the heaviness of the ball. There is a lot more research to be done on that. Perhaps the way forward is to stop under-16s from heading the ball in training, as has been done in the United States.

Michael Marra

I certainly agree that a significant amount of further research is required. Dr Willie Stewart, whom I met last week, compared the repeated heading of the ball to the punches from a sparring partner in boxing repeatedly, every day, all day in training. For a young person, some of the impact is just the same as it would be for an adult. Much more needs to be done to model the impact and to better understand it.

For under-12s, heading of the ball has already been prevented in training—it is now banned. As a youth football coach, I know that we do not do heading drills—players can head the ball in the game, but they do not have repeated drills. There is a big debate around young people. I will speak a little bit more about that and participation in it, so I thank Brian Whittle for the question.

For those who have been professionals and have suffered already, the main issue pertains to the idea of industrial injury. The Industrial Injuries Advisory Council advises United Kingdom ministers on which injuries should be recognised for industrial injuries disablement benefit. The benefit is devolved, but it is currently administered by the Department for Work and Pensions under an agency agreement.

In its paper entitled “COVID-19 and occupation: position paper 48”, on considering Covid as an occupational disease, the council noted:

“In considering the question of prescription the Council searches for a practical way to demonstrate in the individual case that the disease can be attributed to occupational exposure with reasonable confidence; for this purpose, ‘reasonable confidence’ is interpreted as being based on the balance of probabilities.”

In the instance that we are discussing, the balance-of-probabilities test has been met. The Scottish Government must classify dementia in former footballers as an industrial injury when it assumes responsibility for that benefit.

What of now? A generation of footballers who recently retired know that the same is coming for many of them. How can we best support them and advise them to take their own preventative action in the coming years? Urgent research is required on that issue. What of our children who love the game, such as my Riverside West End 2013s? Their passion for the game is unlike anything that I have ever seen. They dream of goals, and their joy when they score them lights me up.

We have banned heading for under-12s, but what happens next? What steps will we take to protect them? What of the women’s game? What can we do to ensure that protections are in place for women as their game continues its rapid, and very welcome, growth?

The wise old men of Mount Florida created the modern game by playing the ball on the ground. They passed it, rather than hoofing it long like their English contemporaries. Had God intended football to be played in the air, he would have put grass in the clouds. Now may be the moment for Scotland to reinvent the game again, but let us start by honouring all the memories and the heroes who suffered for having entertained us.

I will close with the story of Frank Kopel and his widow Amanda, who first saw her childhood sweetheart at the age of 10, heading the ball against the wall of his house, hour after hour. She followed his career from Manchester United to my own club, Dundee United. She watched as he scored a goal for the ages against Anderlecht under the great Jim McLean. Amanda nursed Frankie through dementia, fought for justice for Frankie and for those who suffered as he did, and cradled Frankie in her arms as he breathed his last.

That is undoubtedly, indisputably, industrial injury. I hope that the Scottish Government recognises that tonight, so we can start the work of getting those men and their families the support that they deserve.

17:56  

Audrey Nicoll (Aberdeen South and North Kincardine) (SNP)

I thank Michael Marra for bringing the debate to the chamber. I have a rugby family, and for many years I have been a child protection officer for a local rugby club in Aberdeen, so I am sensitive to, and supportive of, the work to improve safety in sport.

As members will recall, I asked a question on this very issue earlier this month, following the news that Denis Law, Scotland’s joint all-time leading football scorer, had confirmed his own diagnosis of mixed dementia. The beautiful game is an essential part of life for many generations of boys and girls: idolising their favourite players, posters on bedroom walls, stickers swapped at school, and players reinvented as characters in computer games. However, behind the glamour, football players are, first and foremost, human beings with friends and families who love and support them. I know the emotion that is felt when a pal, brother or father is diagnosed with dementia.

As an Aberdeen constituency MSP, my thoughts turn to two individuals in particular. The first is Jimmy Calderwood, who was Aberdeen team manager for five years during the 2000s and led the team into the latter stages of a European competition. Mr Calderwood went public with his own diagnosis of Alzheimer’s in 2017, but he maintained a very positive attitude in managing his condition and enjoying life. I understand that he is open-minded on whether heading the ball may have been a factor behind his diagnosis.

Dons fans through the 1970s will remember Chic McLelland, who made more than 150 appearances for Aberdeen but sadly suffered from early-onset dementia for 10 years. I am aware that Mr McLelland’s family believe that football may well have played a part in his diagnosis.

I note the research, to which Michael Marra referred, by Dr Willie Stewart, who found that former football players are three and a half times more likely to die of neurodegenerative disease in comparison with non-footballers. Outfield players are four times more likely to suffer from brain disease, and defenders—the position that Mr McLelland played—were found to be five times more likely to suffer from dementia.

Sadly, it would appear that Mr McLelland’s family had good reason to believe that heading footballs contributed to his condition. Likewise, the risk for Mr Calderwood, having played as a midfielder, may have been increased.

The Minister for Public Health, Women’s Health and Sport, in answer to my question in the chamber, confirmed that the Scottish Government is

“in regular contact with the Scottish Football Association”,

and I was encouraged to hear that the Scottish Football Association has

“produced guidance ... on heading”—[Official Report, 2 September 2021; c 5.]

for clubs and coaches to follow.

It is reassuring to know that there is specific guidance for primary and secondary school children, so that future generations of footballers will not face the same risks as those in the past or, indeed, in the present. I also welcome the Scottish Government’s plans to “substantially increase funding” for Scotland’s national health service and social care system in order to ensure that older people, including football players who are living with dementia, receive the care that they need.

We all know how important it is to encourage people, especially children and young people, to participate in sporting activities. I commend the work of researchers in the field of brain injury and sport, as well as the many others who have helped to raise the profile of this important issue and have worked so hard to improve safety in football and similar sports. It is vital that that work is supported and continued.

I am pleased to support Michael Marra in bringing the issue to the Scottish Government’s attention. I will follow developments very closely and will do what I can to ensure that work continues at not just a national but an international level.

18:00  

Richard Leonard (Central Scotland) (Lab)

First of all, I refer members to my entry in the register of members’ interests.

The history of democracy in this country is one of converting privileges into rights—the right to equality, the right to access to the justice system, even the right to vote itself—and what all of that history tells us is that each generation has to fight many of the same battles over and over again. Just as our forebears fought for the recognition of asbestosis and mesothelioma as industrial diseases, of pneumoconiosis as being caused by hazardous working conditions and of deafness among factory workers as the result of a failed duty of care to them, so today we are fighting for recognition of the direct link between playing professional football and a dramatically heightened risk of dementia.

We will, no doubt, hear from the minister that we need more research and to prove—and prove absolutely—cause and effect, and she will tell us that she is exploring links and considering further inquiry. However, that is not going fast enough or far enough, and it is not good enough simply to say that we cannot act until we get more research. Enough of a link has been proven already. My question, therefore, is: how many families and former footballers are going to have to suffer before we see action? In my view, it can no longer be denied that there is a direct link between a career in football and a heightened risk of dementia. It might be the result of head impact, it might be the result of head injury, it might be neither or it might be both.

Of course, even in the grimmest of situations, humour can be found. I am reminded of a story by the late John Lambie. One of his Partick Thistle players was injured after a head knock, and when the physiotherapist shouted over to the bench, “He must be concussed, because he’s asking who he is,” Lambie shouted back, “Tell him he’s Pelé and get him playing again!”

Of course, the serious point—and the powerful fact—is that the status of a professional footballer is different from that of an amateur. The players whom we are predominantly talking about in this debate were professional and so were party to a contract of employment. That meant that their employer had a duty of care to them, but it also meant that they were in a master-servant relationship. The relations of power were and still are very unequal, and that, for me, is the clinching argument.

Brian Whittle

I agree with a lot of what has been said. However, as we were discussing before in private, the issue, from a legal perspective, will be proving not that heading a ball can cause or is a contributory factor to dementia but that it happened when the person in question was under a professional contract. How do we ensure that a professional footballer’s career gets taken into account when a legal team might argue that the contributory factor came beforehand, when he was an amateur? How do we square that circle?

I am very happy to recompense you for the time, Mr Leonard.

Richard Leonard

These problems are not insurmountable. Indeed, we faced them with mesothelioma and asbestosis. I will draw on a personal example of a friend of mine who worked in several industries as well as being in the Royal Navy. When his case came to court, the insurers of the employer he was pursuing said, “How do you know it’s us? How do you know it’s not the navy? How do you know it’s not a former employer?” However, in the end, they conceded the ground and made the compensatory payment.

These are not insurmountable issues for any good personal injury lawyer to pursue and track down. It is pretty clear to me that the case that we are making tonight—the start, not the end, of a campaign—is worth pursuing.

The long-established industrial injuries disablement benefit will, under the Scotland Act 2016, be transferred to this Parliament—we hope as early as next year—in the shape of the devolved employment injury assistance payment. That makes this debate all the more relevant. We are at a juncture at which action can be taken and a decisive intervention can be made by the minister and the Scottish Government.

I say to the Government that, if it does not act, today will not be the end of this campaign—it will be the beginning of it.

18:05  

Maurice Golden (North East Scotland) (Con)

I thank Michael Marra for bringing this important debate to the chamber.

I grew up playing youth football and then 22 seasons of amateur football, amassing around 800 games. Until recently, there was no indication or general awareness that every time a footballer headed the ball it could be contributing to permanent brain injury. That an action so central to the game could have such significant long-term consequences is deeply worrying.

I commend all the research that has been undertaken to shine a light on the issue, including that of Dr Stewart from the University of Glasgow, whose leading research found that professional footballers were up to five times more likely than people in the general population to die of a degenerative brain disease.

Scottish footballers such as Billy McNeill, Denis Law, Gordon Wallace and countless others have been affected by the issue, and of course Frank Kopel’s death from dementia led to the introduction of Frank’s law, thanks to his wife Amanda’s tireless campaigning. Amanda has now turned her attention to leading the injury time campaign that we are here to debate today. It is a call to action to which we must give serious attention.

When it comes to funding research into the practical and preventative support that is needed in the game, the Scottish football authorities and the Scottish Government have a leading role to play. However, this is a global issue that the sport faces and effective funding would be small change for the likes of FIFA, the Union of European Football Associations and the major leagues around the world. I call on them to do more.

I would very much support the establishment of a working group to consider the issues to do with brain injury and dementia, and I would particularly support the inclusion of the grass-roots game.

The impacts of brain injury are starting to be understood among ex-professional footballers—the people who were likely to be heading the ball with more frequency and ferocity than their recreational counterparts—but there are tens of thousands of Scots who play football at lower levels, for whom Saturday and Sunday football has been a way of life since childhood and sometimes well into their 40s and even 50s. For some of those people, particularly centre backs, the frequency of heading the ball might not be dissimilar to that of their professional counterparts.

The classification of brain injury in football as an industrial injury is an area on which I would like more detail. I would particularly like more detail on the nuances and impacts in the context of the lower levels of the professional, semi-professional and junior game.

Michael Marra

Does the member agree that there is an opportunity for the Scottish Government, as it establishes Social Security Scotland, to model a new approach? In the current circumstances, test cases and the kinds of legal action that Mr Whittle described are taken, but we could do things in a better and more dignified way in Scotland by considering the medical evidence in the round and having speedier decisions. Is that an opportunity that the member supports our taking?

Maurice Golden

It is an opportunity that we need to explore further. There are a number of nuances. For example, I can think of people with whom I played who played professionally for perhaps only one game and then played amateur football for the rest of their time. There are legal issues, in particular, about who would be liable in such cases. We absolutely should look into that and see whether legal minds can work that through. To give an example, Dave Narey played for one club—Dundee United—for the vast majority of his career, until he moved to Raith Rovers. The link is far more compelling in that case.

Football is significant to the fabric of our nation and our national psyche, and the game’s importance for those who play and love it cannot be overstated, but brain injury is a critical issue in sport that needs to be better understood.

I call Mark Griffin, who joins us remotely.

18:10  

Mark Griffin (Central Scotland) (Lab)

I am sorry that I cannot be with everyone in the chamber for the debate. I fully support Michael Marra’s motion and welcome the opportunity to ensure that our footballers’ trauma does not go unheard.

Establishing a working group is a vital step. There is no body in Scotland that could consider the evidence on brain injury and make recommendations to support and protect former and current players. As the motion says, we must get together the sport’s governing bodies, consider the issues and urgently look at the growing body of research.

I am keen for us to agree that brain injury should be seen as an industrial disease. Through Social Security Scotland, we have major new powers that could be focused on providing support to those who are suffering now. As Michael Marra highlighted, Dr William Stewart’s findings of 3.5 times more chance of dying from a neurodegenerative disease and of a fivefold increase in Alzheimer’s disease among former footballers substantiate the growing link between being a former professional footballer and having a condition such as dementia.

When evidence emerges—we have heard about heartbreaking experiences, such as those of Denis Law and Billy McNeill—we should use the knowledge to act. Just yesterday, I lodged again my proposal for a Scottish employment injuries advisory council bill, which would establish an independent body to research, shape and scrutinise the benefits that are available to those who are injured through their work. No such body exists in Scotland. The funding for any such payments runs through the Scottish budget, but our powers over industrial injuries disablement benefit are in no practical sense being exploited, and the Scottish Government is not thinking about the illnesses and diseases that are acquired in modern workplaces and are affecting workers now.

Michael Marra is right in saying that the evidence is clear. The balance-of-probabilities test—when the incidence of a disease in an occupation is twice the rate in another—has clearly been met, but the Scottish Government does not seem to be prepared to classify dementia among professional footballers as an industrial injury. The current scheme is becoming increasingly outdated and out of step with modern work, modern working patterns and the harms that workers encounter, and much more can be done to support people who are injured through their work.

In December, when I asked the First Minister about prescribing long Covid as an industrial disease, the Scottish Government deferred to waiting on the view of the United Kingdom advisory council, which said, “Not yet” to the UK Government. However, the Scottish Government should have asked a Scottish advisory council that had mandated trade union members, along with scientists and legal experts who could scrutinise the evidence and advise on changes to Scotland’s benefit system. No such council has been established.

Unions including the GMB, Unite the Union and the Union of Shop, Distributive and Allied Workers, organisations such as the Royal Society for the Prevention of Accidents, and academics including Professor Andrew Watterson of the University of Stirling back the proposed bill. We should assemble the experts on a powerful statutory body that is independent of the Government and has the authority and tools to secure an employment injury system that is fit for purpose.

Like key workers in the NHS, social care workers, shop workers, bus drivers or train staff with long Covid, our footballers have developed their illness simply from doing their jobs. Securing changes to the new benefit for those who have unknowingly sacrificed their health for our entertainment would be a bold sign that we are willing to support all workers who are injured through their work. We have a generational chance to provide an industrial injuries benefits system that is fit for the 21st century and that reflects the modern harms that workers face. We should take it.

18:15  

Carol Mochan (South Scotland) (Lab)

I thank Michael Marra for bringing this important debate to the chamber.

The increased number of former professional footballers speaking publicly about their dementia diagnoses in recent years has undoubtedly encouraged increased research into the links between playing the sport professionally and being diagnosed with a neurodegenerative disease. The bravery of those former professionals in speaking out means that we can have this debate. Therefore, I encourage the Scottish Government to act purposefully to support professional footballers who are living with dementia and those who are currently playing the sport and might be worried about the impacts that it could have in later life.

Other members have quoted the statistics on the increased link, so I will not repeat them. However, the University of Glasgow found that, although the likelihood of being diagnosed with a disease such as dementia might vary depending on career length, it does not vary depending on the era during which a player played. That confirms that we have made little progress in making the game safer, which is an important point.

The diagnosis of those former footballers relates to an injury caused at work. That is the link. Football is a global, multibillion-pound industry in which a decent career can ensure financial stability for life. However, that was not always the case for footballers who played in the 1950s, 1960s and 1970s. Their commitment to football often only just managed to pay the bills and put food on the table. It is important to note that many professional football players today are not paid the breathtaking figures that we read about in relation to high-profile players. They continue to play football, doing a job—just like the rest of us—that makes them much more susceptible to conditions such as dementia than the average person.

Wider discussion is needed in the football and health communities about reducing the incidence of dementia among professional footballers in the future. As I said, there is a clear link between playing professionally and dementia. It is an industrial injury.

It is in the Scottish Parliament’s power to right a historical wrong, lead the way and classify such incidences as cases of industrial injury. If we do so, players who are affected will be entitled to receive the industrial injury disablement benefit and have the fact that they were injured at work recognised by the state. That would be a small but important step, and it is supported by the Professional Footballers Association Scotland and the GMB. It would go towards helping former professionals who are affected and would be a great step for the future of current players who might be worried.

We can all agree that the personal stories of those former professionals and their families are devastating. Too many lives have already been lost and too many more people will suffer unduly if no action is taken. The Scottish Government has the power to act. In the interests of supporting and protecting our former, current and future professional players, I support Michael Marra’s motion and hope that the Government will do more with purpose before it is too late for many players.

18:19  

The Minister for Public Health, Women’s Health and Sport (Maree Todd)

I thank Michael Marra for his motion and for raising an important issue. The debate has raised many questions, which highlights how complicated the issue is. The Scottish Government wants people to take part in sport and physical activity in a safe environment.

Concern around head injuries in sport has been growing for a number of years, so I want to mention the changes and practices that our sports governing bodies have implemented to protect their players of all ages and abilities. I am proud that Scotland produced the first concussion national guidance, which continues to be refreshed using the latest international research. Dr Niall Elliott and his team at the sportscotland institute for sport, along with the lead clinicians from our sporting governing bodies, came together to produce the guidelines, and they continue to review them.

However, it is not an issue of simply publishing guidance and leaving it there. Education is the best way of protecting those who participate in sport. Education for coaches, parents, medical staff and players is vital to ensure that, when someone receives a head knock, they get consistent advice on what to do and a pathway for getting the appropriate rest before considering going back to sport.

A United Kingdom parliamentary committee recently published a report on concussion that noted Scotland’s approach in a positive light. One of its recommendations for the UK Government was to create a UK-wide set of guidelines, and officials in the active Scotland division have already begun discussions with the Department for Digital, Culture, Media and Sport on how our guidelines were created and how a joined-up approach might work to ensure that guidance can be amended to reflect changes in research.

Although that is a positive step forward, I am aware that a lot of the discussion tonight has focused on the care for players who have retired from playing sport and, in particular, football. As many members have mentioned, a growing number of former footballers have bravely come forward to say that they have a diagnosis of dementia, and my thoughts go out to them and their families.

I commend those ex-players—including Denis Law, who recently came forward and who, as my Aberdonian colleague has reminded me, is still the only Scottish winner of the FIFA Ballon d’Or—for taking that public step, as it helps not only to increase awareness of how the progress of dementia impacts those affected and their families but to tackle stigma. The Scottish Government is committed to increasing our knowledge of the possible links between neurodegenerative disease, including dementia, and sports-related brain injury. We recognise the call to establish a working group on the issue and will respond to that in due course as part of our on-going consideration.

A University of Glasgow study published in 2019 on lifelong health outcomes in former professional footballers, especially in relation to dementia, contained evidence of a possible increased risk of dementia among professional ex-footballers. Further work is under way to establish why footballers and rugby players might be at greater risk. We will also give full consideration to the report of the study led by Dr Willie Stewart, which was published in August.

We remain in close contact on the issues with experts at the sportscotland institute of sport and with the chief medical officer at the Scottish FA, and we will work with all partners, including the Professional Footballers Association Scotland, to carefully consider emerging evidence on former footballers developing dementia.

I want to quickly mention the Scottish FA’s guidance to all clubs and coaches on heading footballs, which makes it clear that heading is not permitted for the under-12s and is to be introduced only slowly as players get older. Again, the guidance is there to be followed and adapted, and I commend the Scottish FA and its partners for bringing in that change.

I am also aware that questions have been asked in the chamber about whether the Scottish Government has plans to classify dementia that is developed through sport as an industrial disease. Unfortunately, industrial injuries disablement benefit is currently delivered by the UK Government, and I understand that it does not currently consider dementia to be an industrial injury.

Michael Marra

Does that not provide an opportunity for the Scottish Government to show leadership in the area by putting in place its own process that would, as Mark Griffin highlighted, allow the decisions to be made in Scotland? The Scottish Government has promised a service from Social Security Scotland that is different and that will give people dignity. Is this not an opportunity to do that and to put in place a better system that allows us, in Scotland, to come to conclusions on the basis of the evidence?

Maree Todd

The member is absolutely right to suggest that the service will be delivered by the Scottish Government in future, but it will be delivered after a full public consultation on how best to meet people’s needs. I agree with Richard Leonard that it is a good thing that we are debating the issue in our Parliament. All the points that have been raised this evening and at many other times can be aired in the consultation, and all the complexities can be explored.

For the first time in Scotland, we are taking a specific national approach to dementia risk reduction and prevention in our public health and clinical services. Brain Health Scotland, which was established by the Scottish Government in 2020 with investment of £1 million over five years and which is hosted by Alzheimer Scotland, will publish in 2021 its first population-level dementia risk reduction and prevention strategy. We will also be piloting brain health services to identify and support pre-symptomatic patients who might show clinical indicators of brain decline and dementia risk and to provide personalised risk reduction and prevention plans.

Several groups might be at even greater risk of dementia than the background population, although I should point out that the background risk is high, with one in three of those over 80 affected. Those groups include people with a strong family history, those with a history of heart disease, diabetes and stroke and those who have had repetitive brain injury. From this latter group, research led by the University of Glasgow has recognised the increased risk of dementia in retired football players. The same is possibly true of rugby, too, but more research will be required on that. Research funded by the Alzheimer’s Society and PFA Scotland and led from the University of Edinburgh—it involves the PREVENT dementia rugby and football cohort—is looking at identifying the underlying reasons why the link might exist.

That high-risk group can be seen in clinical services identical to those envisaged for the general population. In fact, I should point out that not only is it a high-risk group for dementia, but retired players in mid-life and older are becoming increasingly anxious about their brain health through awareness of, as other members have noted, the increasingly frequent high-profile cases of people being diagnosed with dementia.

The Scottish Government is fully behind making sport safer, especially when it comes to the prevention and treatment of head injuries. As the minister responsible for sport, I regularly meet sportscotland and governing bodies to discuss a range of topics, including safeguarding.

I thank Michael Marra for bringing the debate to the Parliament, and I thank everyone who has contributed to tonight’s discussion.

Meeting closed at 18:26.