It is bitterly frustrating that England are heading into another major tournament with an unsettled team and a squad beset by injuries.

This has been going on for years, with England seemingly suffering a disproportionately high number of injuries compared with other major rugby nations. The question has to be asked: Why?

Is this bad luck or is there something at the root of the problem? I believe it is the latter.

Owen Farrell (far left) suffered a knee injury after falling awkwardly following a tackle from Julian Bardy

David Wilson became the latest player to join Stuart Lancaster’s lengthy casualty list

England coach Lancaster is contending with a long injury list due to the amount of rugby being played

There is no doubt player welfare and release periods before internationals have vastly improved compared with when I was coaching England. But the game has also changed dramatically and players are suffering.

Differences in professional opinion between myself and senior medical people at the RFU over players playing when not 100 per cent fit - or needing a rest - was at the forefront of why I resigned, just months after winning the 2003 World Cup.

More than a decade on, nothing has changed and I still hold this firm view - that, if there’s any doubt over fitness, the England coach should have the final say on when England players play for their clubs.

Injury victim Brad Barritt (left) and Billy Vunipola spoke at Pennyhill Park as England trained on Tuesday

Lancaster (left) ad Andy Farrell will have to field an England side that has been patched up somewhat

Unfortunately, there were RFU people who were prepared to accept a compromise where - at best - the England doctor would liaise with the club doctor over when players played. Looks fine on paper, but the game had changed. It was never going to work.

It has resulted in the current situation where in every tournament England’s squad is decimated by injuries. Professional sport, especially rugby, is a brutal business and you just do not win by compromising over areas like this.

This started in 1995-96 when the sport turned professional. The RFU had the opportunity to sign the best players on central contracts - it’s what the southern hemisphere unions did and what the Irish and Welsh Unions have done. Instead of acting decisively, the RFU allowed clubs to sign players and the opportunity was lost.

Kyle Eastmond (right) is still not fully fit as he recovers from a shoulder injury

Owen Farrell (left) and Brad Barritt will miss England's opening Six Nations match owing to injury

I have no problem with club owners or directors of rugby wanting their players to play for their clubs.

They are out there smashing seven bells out of each other in every single match...

People like Nigel Wray at Saracens, the Walkinshaw family at Gloucester and Bruce Craig at Bath have pumped vast amounts of personal wealth into the professional game and in many ways are the heroes of the sport, the men who have moved it into the modern era. Club rugby is still so important.

I’m also not doubting the integrity of club doctors. They are not sending players out to get injured. Having injured players is not in their interests. But are England and the clubs working together effectively enough to give our players the best chance of staying fit and healthy? I’d say not.

Wasps captain James Haskell (left) is in great form for his club and will comfortably slot in at blindside flanker

Despite losing Farrell through injury Bath No 10 George Ford was already a favourite to start

At the moment there’s ‘England time’ and ‘club time’. The players desperately want to play for England, it is the pinnacle of the game and they’ll do anything to nail down their place, especially in a World Cup year. Equally though, they are loyal to their clubs and love playing for them, especially in Europe. That should never change.

But players are under pressure from both sides. Once they arrive in England camp, they are aware these chances do not come round often. Then, when they return to their clubs, it’s time to get to work again and they are eager to contribute.

Within this tug of war, the medical teams for club and country are under huge pressure to deliver players for selection. My concern is that there’s too much emphasis, in both set-ups, to keep players going, week in, week out.

Northampton's Tom Wood has an ankle injury which will rule him out of England's clash with Wales

Barritt walks away during his return to club side Saracens last weekend in a 33-10 victory over Munster

Although players may ‘technically’ pass a fitness test, how often are they still rested to avoid any chance of further injury? Or rested to ensure they’re available for an England camp - especially in a World Cup year?

We’ve seen with some of the recent stories on concussion in rugby in Sportsmail’s sister paper, the Mail on Sunday, players do not always feel able to speak up about questionable practices. But it’s vital players are allowed to speak out if they feel they are being asked to play when they are injured. Players like Shontayne Hape and Lewis Moody have been brave on this front and I’d like to see current players do the same.

With the best will in the world, this tough game will cause injuries. As England coach, you want your top players in big club games, just as long as they are fit.

Wales captain Sam Warburton (left) and England skipper Chris Robshaw (right) with the Six Nations trophy

England head coach Lancaster is having to contend with a host of injury headaches

Some injuries, like Owen Farrell’s, are unavoidable. But a lot of the injuries England’s players are suffering are not one-off unfortunate events. We are seeing cumulative injuries brought about by wear and tear in one of the most physically-demanding sports. It is quite clear too many players are playing on with existing injuries and, in World Cup year, that is not good enough.

No country could suffer the number of injuries England are facing and consistently challenge the best in the world. Part of the problem for Stuart Lancaster is that he still hasn’t settled on his first-choice XV and that means none of his players know whether they should be prioritising England. Nobody knows the team.

Back in 2003 I was able to speak openly and frankly to the top 20 players in my squad and say, ‘Just look after yourself’.

George Ford (left) had to undergo concussion tests after suffering a heavy blow during Bath's win on Sunday

Wood, a regular on England’s blindside of the scrum under Lancaster, limped off injured on Saturday

I made it crystal clear that if I heard any of them were playing for their clubs with injuries, they were risking a once-in-a-lifetime opportunity and not only letting themselves down but also the team... in fact, the whole country.

At the moment we have only three or four players who are nailed-on starters and some of these are out of form.

So what we have is the entire England squad out there smashing seven bells out of each other, desperate to prove their worth.

Newcastle tight-head Kieran Brookes has been called into England’s training squad to replace Wilson

Second row Geoff Parling is another player absent after injuring his knee while playing for Leicester

Let’s not forget rugby has changed beyond recognition over the past 20 years. It is now described as a ‘collision’ sport rather than a ‘contact’ sport and the hits players are taking are massive. They are warriors playing a sport vastly different to when I played the game.

But without players there is no game and they need to be looked after better. That means not playing when injured and being given more time off between seasons to rest their battered bodies.

England’s players deserve better and so do the fans.