Today (7th December 2018), John Marshall would have celebrated his 40th birthday. 23 years ago, he was a promising young footballer who featured prominently for England’s under-15 team. He honed his skills at the famous Lilleshall National Sports Centre for two years. Clubs were vying for his signature – such as Blackburn, Aston Villa, West Ham and Liverpool. But he decided to join Everton. The Blues were tracking his progress for 18 months and were pleased that he decided to join them. In June 1995, John returned home from holiday in Spain with his friends from Lilleshall. He was at home with his family, playing with his sister, and suddenly, he became very seriously ill. He was in intensive care for a few days but the doctors sadly couldn’t save him. He passed away on 3rd July 1995 – the day he was about to sign for Everton as an apprentice. He was just 16 years old.

The cause of his death was subsequently confirmed as HCM (hypertrophic cardiomyopathy). HCM is a hereditary heart condition which occurs when the muscle wall of the heart becomes thickened. The thickening makes it harder for the heart to pump out blood.

I remember I was absolutely delighted. Every now and again, you realise you have got a talent. I think we have a number of them now at the club, and John was up there with the best. He was more than just a signing to me. He became part of the family and his death has put a cloud over our whole build-up. The lad achieved so much in his short life. He won England caps, medals and shirts.

Ray Hall, Everton youth development officer

The directors, manager, staff and playing squad were all numbed to learn of John’s sudden and sad death. He was a charming young man with a wonderful career before him and will be sadly missed by everyone at the club.

Sir Keith Tamlin, Everton director

His devastated father, John Marshall Sr, spoke after his death:

What has happened is unbelievable. At the moment, it is a mystery to us. John had been on a holiday with the lads from Lilleshall and arrived back tired last week. He seemed perfectly fine but then collapsed and never came around. He went into hospital last Wednesday and it seems to have been something to do with his heart.

The news also devastated former Leeds and Wales player Terry Yorath, whose son also died from HOCM at the age of just 15. His son Daniel, who was also the brother of presenter Gabby Logan, collapsed in his garden before he was about to start his footballing career at Leeds, exactly like his father.

Speaking on Yorath’s behalf, his wife Christine said:

Terry is ill at the moment but when I passed on the news, he filled up. So many of these cases are really a tragic waste of life. There is no screening programme in this country yet it is common for all young people who play sports in the United States, Italy and elsewhere.

Daniel suffered from hypertrophic cardiomyopathy, now recognised as the biggest sudden-death killer among young people. Often on death certificates only natural causes or heart failure is recorded, so there are no precise statistics available.

Following Daniel’s tragic death, Terry and Christine Yorath campaigned for clubs to introduce a screening programme for young players. However, only one club expressed an interest – Everton. The club’s physiotherapist Les Helm said Everton were already planning on screening their young players and John Marshall would have been among the first players to be screened.

We already had the ball rolling after Terry Yorath got in touch with Barry Horne. We were waiting to arrange a date for the people to come up from London to carry out tests at Broadgreen Hospital. […] John Marshall would have been among those tested. It is our wish that other clubs will follow our lead.

Everton promptly became the first football team in the country to introduce a screening programme for young players. Christine Yorath praised the club for getting the ball rolling.

We are pleased that Everton has responded in this way. Let’s hope it is the catalyst for others to follow.

On 13th July, just over a week after John’s death, Everton began screening their apprentices, starting with the 9 youth players who John would have joined training at the club with – Michael Branch, Paul Davies, Adam Denton, Daniel Gabrielson, Chris Hardman, Chris Lane, John O’Toole, Mark Quayle and Andrew West.

We have not launched this scheme because of John – but he would have benefitted from it. The idea began after Terry Yorath’s son, Daniel, died from heart failure. This is the first year we have implemented it. These young lads have come here without any history. They are not professionals, whose backgrounds I can check.

Les Helm

The medicals were carried out by Professor Bill McKenna, a cardiologist from St George’s Hospital in London. McKenna hoped that everyone learns from Daniel Yorath and John Marshall’s deaths and insists that it is important for young athletes to get their hearts checked.

It is vital that we raise awareness of the risks run by young people in sport. If a young person faints during training, they should not be given a cup of tea and told to come back tomorrow. We have to learn from tragedies.

The screening process was: a physical, two different types of electrocardiography (ECG) heart testing, and an ultrasound scan. Apprentice Andrew West, who was being screened in the picture above, believed the addition of screening was beneficial and would help quell any worries about his health.

I think the scheme is a really good idea, especially after we’ve seen what can happen. At least at the end of this, I will, hopefully, have a clean bill of health and be able to put my mind at rest.

John Marshall was continuously on everyone’s minds as three months after his death, £1,400 was raised in his memory during Everton’s League Cup match against Millwall at Goodison Park. The money went towards research and extra facilities at Alder Hey Hospital cardiac unit and maintaining the recently launched National Child Death Helpline at the hospital’s Alder Centre. The match ended in shock elimination for the Blues as they lost 4-2 after extra time, but on that night, given the circumstances, there were things more important than football.

An Alder Hey spokeswoman said:

The hospital would like to thank all the people who have donated money in John’s memory. We would like to offer the Marshall family our most sincere condolences on their recent bereavement. The family thought it seemed like a good idea to donate half the money to the Alder Centre which helps bereaved parents. Originally, all the money was to be donated to the cardiac unit as John died of a heart condition.

The following month, John’s mum Maureen spoke in detail to Liverpool Echo journalist Diana Pulson, about John’s death and the launch of scanning campaign CRY (Cardiac Risk in the Young), which is aimed to raise awareness of sudden cardiac death and sudden arrhythmic death syndrome among young athletes.

Even now, we cannot believe it. Not me, not his dad, or our nine-year-old daughter Hayley. We are all very, very sad, yet we know that life must go on. Which is why we have spoken out about the need for scanning young athletes, so what happened to John doesn’t happen again.

The whole thing happened so suddenly it was difficult to take in at the time. John had returned from a holiday in Spain with friends he had made at Lilleshall, the national soccer school in Shropshire. We met him at the airport and brought him home. He brought a lot of presents for us all. He was lying on the couch, joking and laughing with his sister Hayley, when suddenly he made a noise. We did not know what it was. His dad got hold of him and tried to help. But it was no good.

John had always been interested in football. He was picked for the school team when he was only seven. I can clearly recall him coming home to tell us. He was so excited. Originally, he had been a Liverpool supporter, but he thought the opportunities for young players at Everton were so good, he plumped for the Blues. The success he had already achieved gave us all so much pleasure. His dad went to watch him wherever he played. But now, it’s all over.

Our dearest wish is that the screening campaign is successful. Acuson, who make ultrasound machines, have made the campaign possible by providing machines free of charge for a limited number of public scanning sessions. What is needed is the commitment of professional sporting bodies and funds to establish an ongoing, routine heart scanning programme. Our son John was superfit schoolboy international due to join Everton. If a heart scanning programme had been started by the Football Association two years ago, after the death of Daniel Yorath – the son of Terry Yorath, the former Welsh football manager, who died from the same thing – our son may have been saved. Surely the football authorities should do something about it.

The first aim of the campaign is to reach all adolescents who play sport, and football has been highlighted because it is so physically challenging. For the last two years, John had been at Lilleshall. But sadly, it was not routine for footballers to be screened for heart defects. Yet within weeks of his death, all the other youngsters at the school had been screened. Professor Bill McKenna, cardiologist at St George’s Hospital in London, says that a key element will be to develop expertise centres across the UK. According to Professor McKenna, the consequences of a diagnosis of cardiomyopathies are extremely far-reaching, affecting the patient’s ability to continue an active life and the decision to have children – as the condition is hereditary and may involve a lifelong drug programme.

It won’t, of course, bring our lad John back, but if it helps others, then some good will have come out of his tragically young death.

After initally scanning the club’s apprentices, Everton decided to scan the whole team in November 1995. The club was determined to make sure no player at any level has any heart defects in order to avoid any more tragedies. The scans took place at Broadgreen Hospital in Liverpool and Dr David Ramsdale, who carried out the scans, hoped these tests will help any players who have been diagnosed with a heart defect and make sure the defect won’t result in a cardiac arrest.

As far as I am aware, Everton are the only football club in the country who screen their players. It costs around £100 per test, and the machines which conduct the scans cost about £90,000. But it is the only way to reveal the defect, and once we have done this, we can take steps to alleviate the problem. Those affected will never be able to lead an athletic lifestyle without risk, but we can take steps to ensure that the problem does not lead to cardiac arrest in normal lifestyles.

Everton were the only club taking screening seriously for quite some time. It wasn’t until the summer of 1996 that the PFA and the FA started to recognise the importance of screening. Les Helm said:

The PFA and the FA have met and they are planning to fund an ongoing scheme whereby a mobile unit tours clubs all over the country.

On 7th December 1996, Michael Branch scored his first senior goal for Everton in the Blues’ 2-2 draw against Chelsea at Stamford Bridge. Branch was a very close friend of John Marshall – so close that he was a pall-bearer at his funeral. He dedicated his goal to John. The timing of the goal was very apt as it was scored on what would have been John’s 18th birthday.

We were close mates at Lilleshall and spent two years there playing for England under-15s and under-16s together. At the end of our time there, seven of us went on holiday to Spain and when we got back, John fell ill. I went to see him in hospital and just couldn’t believe it. He died on the day we were due to start as YTS trainees at Everton. It was a nightmare.

His mum asked if I would help carry his coffin and that was the hardest thing I have ever done. I didn’t realise I had scored on John’s birthday until our youth officer Ray Hall told me this week. It makes my goal all the more special. I always said I would dedicate my first one to him and it is just a coincidence that it came on the day he would have been 18.

It must be hard in a way for his parents to see me doing well because John could have been in the same position. I still see them every now an again and always say hello, but it is hard to know what else sometimes. John was a brilliant player and we used to call him ‘Macca’ because he was exactly the same as Steve McManaman, in looks and the way he played. I remember we used to talk about being apprentices at Lilleshall.

He wasn’t sure who to sign for, but in the end went for us. I know he was really looking forward to play for Everton.

In 1998, Les Helm couldn’t speak higher of the club as Everton continued to do regular checks of the players’ hearts and their pioneering made other teams take a leaf out of their book.

We were the first club in the country to insist on the checks as routine. Now I think every Premiership club does it. Every year, every single YTS trainee who comes into the club is checked.

Not only can the scans help find any heart problems but also reassured players of any worries about their health. In February 1998, before Everton’s FA Youth Cup tie against Watford, Francis Jeffers knocked on Helm’s door in the early hours and complained about sharp pains in his chest and breathing difficulties. After Helm checked him, the diagnosis was pericarditis, which was an inflammation around the heart and a treatable condition.

Fran told me he wasn’t well. He said he had chest pains and difficulty in breathing. A layman would immediately think of heart problems, but having screened Francis when he joined our YTS scheme, I knew his heart was working efficiently and to look elsewhere. It turned out that Francis was suffering from pericarditis, which is a virus which attaches itself to the sac around the heart and causes inflammation. That can happen to anybody – no matter how fit or healthy.

Following the diagnosis, Jeffers was pulled out of the tie and didn’t train for six weeks. After his return to training, he helped Everton win the FA Youth Cup by scoring in the second leg of the final against Blackburn.

Les Helm went on implore parents to learn about CRY and to make sure their athletic children get checked regularly.

Every parent should be aware of CRY, particularly those with children who take part in sport. Most people are under the impression that only old and sick people suffer heart attacks and heart conditions. This is not true. We are all at risk to certain conditions. The reason why young people are so at risk, particularly lean and healthy sporting types, is that we are taught, quite correctly, that such a healthy way of life is the way to avoid heart conditions. But if this same healthy person contracts a virus and continues with the same vigorous lifestyle of intensive exercise, they could become a victim of sudden death.

The danger of CRY is the unawareness of this condition by parents. If elderly or overweight people complain of lethargy, breathlessness or muscle aches and pains, they would be told to seek medical advice. But if a young fit athlete – be it professional or amateur – presented the same symptoms, he or she may be told to run it off, be accused of laziness or suspected of making excuses for performing up to usual standards. In some cases, they may be forced to take part in extra training sessions to bring them up to scratch, either by well-meaning coaches or overambitious parents, and so be put at risk of sudden death.

In 1999, Everton decided to screen every youth player from the under-9s onwards as HCM (or HOCM) was still a common cause of death for young people. The club decided to go for the really young players in order to find any problems much sooner so that it can be dealt with better as they get older. Les Helm continued to overlook the screening and said that out of 100 boys aged 9-16 Everton screened, there were youngsters who had murmurs with two of them having serious cases.

HOCM is still the biggest sudden death killer of young people aged 15-25 in this country. If our screening programme detects any serious problems then the boy will have to be ruled out of competitive sport. But at least he can be treated for the illness from an early age and it could save his life.

Out of 100 boys, we had eight positive tests which were heart murmurs. These eight boys were given further tests, and two turned out to be real positive cases. Out of the two cases, one boy had a hole in the heart and the other was liable to infection of the heart. These two boys have since had surgery and will be OK – and the boy with the hole in the heart has been with us at Everton for six years, but his problem has now been put right. He will now lead a normal life, which is the most important thing of all for him and his family. They can have peace of mind.

Helm had also implemented further safeguards to monitors youngsters’ health. Young players had to fill in a medical form signed by their general practitioner in order to train with the club. He also wanted to make sure the players were tested thoroughly in order to prevent any more tragedies and hoped to have screening in schools in the future.

We have gone a step further. In the past, young lads could just walk through the door, and we had people from New Zealand and Australia doing that, but I have put the blocks on that. They have at least got to have a medical form filled in and signed by their GP. Nobody can train unless they have provided us with this.

We take kids from the age of 6 and if they are taken on at 9, they are then screened. The big bonus, which I pointed out to the parents of these youngsters, is that of these 100 boys, we will be lucky if 1% go through to the big time. And once you are a member of the elite group of athletes that gets through, you get the best of everything as far as medical testing is concerned. If you are not, these boys would never be tested – but they are at Everton and these results stress the importance of it, and this is why I want to explain how important what we are doing is. We are not actually targeting the elite but the ones underneath, and they are very fortunate that they have come here because we will screen them very young and ensure that any problems are detected.

Football is leading the way on this score, but the ideal long-term view would be to have this done at schools. It cost the club £5,000 to screen 100 boys – £50 a boy – and I am sure parents would pay for the peace of mind it could give them or if screening showed up any problems. It would be a wonderful thing, and that is why we at Everton are determined to do everything we can as far as heart screening is concerned.

Thanks to Everton and Les Helm, clubs around the country do screening on a mandatory basis. But that hasn’t stopped John Marshall’s family on continuing to raise awareness. In 2009, they launched a screening campaign called the Test My Heart Tour with the aim of reducing the number of deaths among young athletes due to fatal heart conditions. The screening took place at Edge Hill University, where John’s mum Maureen was a catering assistant at the time. Among the attendees at the screening was Leon Osman. John’s sister Hayley said:

About 200 people have booked to be screened over the two days. It’s so important that people get their heart tested so what happened to John doesn’t happen to them.

He was an elite athlete and was classed as one of the fittest in the country, but unknown to anyone he had this heart condition, which goes to show it can happen to the fittest and the healthiest.

The screening happened again at Edge Hill University two years later, with Hayley Marshall saying:

He was classed as one of the fittest in the country, and he was an elite athlete. He passed away suddenly and it came as a big shock to us all because he was so fit.

Twelve people a week die of these cardiomyopathies. We’re here encouraging people between the ages of 14 and 35 to go and get screened and just be aware of it, so it won’t happen to them.

Although deaths from fatal heart conditions have happened in football since John’s death – Marc-Vivien Foe, Miklos Feher and Piermario Morosini to name a few, plus Fabrice Muamba’s extremely close call – as far as we know, hundreds, or maybe even thousands, of young players’ lives were saved because of these checks. The CRY campaign is still going strong, and in August 2018, it was revealed in a 10-year study supported by CRY that the risk of dying from a heart conditon in young footballers, as well as established footballers, is higher than first thought. Of the 11,000+ players who were checked for the study, one in 42 of them had a heart abnormality that needed further monitoring. However, nearly three-quarters of those diagnosed returned to football after their heart issues were resolved.

Since John Marshall’s death, around 170,000 people took part in the screening programme and football clubs all over the country screen their players. The Marshalls’ campaigning and Everton’s pioneering work were a huge success.

RIP John Marshall, 7th December 1978-3rd July 1995