The Nottingham and Nottinghamshire avoidable injuries strategy for children and young people

July 2014

Rebooting injury prevention work

Over the past year (2013-2014) partner organisations in Nottingham and Nottinghamshire have been collaborating to develop a strategy to reduce avoidable injuries* for children and young people.

 There is a long history of working together to reduce avoidable injuries to children and young people in Nottingham and Nottinghamshire. In April 2013 the transfer of public health to local authorities along with the mandate for the avoidable injuries agenda and associated outcomes measures, created an opportunity to add momentum to the agenda, which the public health teams seized upon. The road safety partnerships are  strong and other services were tackling issues related to injuries in and around the home for young children.

Data provided a powerful starting point. The rates of unintentional injures for children varied considerably depending on where people lived. For example, in some parts of the city, rates of childhood emergency admissions amongst 0-4s were significantly higher than the England average.

The political structure

 Nottinghamshire County Council is an upper tier county council. There are seven district councils and six clinical commissioning groups (CCGs). Nottingham City is a unitary authority with one CCG. This structure, and the wide geographical area covered (urban and rural communities) presents challenges for injury prevention co-ordination. For example, some service providers cover the whole county, others only cover particular districts or areas.

Diverse needs

The population’s needs vary across the county and city. Nottinghamshire’s joint strategic needs assessment (JSNA) explains that the county is a mix of deprived and affluent areas. Deprivation levels in Nottinghamshire are comparable with England. However, within Nottinghamshire there are communities with both some of the highest levels of deprivation in the country and some of the lowest levels of deprivation. The most deprived areas are Mansfield, Ashfield and Bassetlaw and the least deprived area is Rushcliffe. Nottingham city is much more ethnically diverse than the county and although the social gradient in the city is not so extreme, the overall level of deprivation is high.

Bringing stakeholders together

A major stakeholder event was an important step in galvanising interest. In July 2013, the Director of Public Health opened an event for professionals in a wide range of relevant roles from across the county and city. Presentations considered local data and effective interventions (CAPT). A large group activity enabled the participants to begin mapping current activities that were playing a part in reducing avoidable injuries. Samia Latif a Specialty Registrar was then leading on the development work coordinated the event and ensured the data told the story of what was happening in the city and county.

Building on momentum and creating a draft strategy

The success of the stakeholder event meant that there was support for action. The public health team then continued the work on mapping injury prevention activities.

Sonya Clark, Public Health Manager for Nottinghamshire County Public Health and Sarah Quilty, Public Health Manager for Nottingham City Public health are co-ordinating the strategy’s development work. They explained:

"The mapping work showed us that a lot of good work was going on but it was a bit piecemeal and patchy. There was evidence of silo working and ongoing sustainability issues for many initiatives. In some cases resources were not in the right places to meet specific needs."

Multi-agency strategic partnership steering group

The next important step was the creation of a multi-agency strategic partnership steering group, which met three times in its first year and its initial task was to develop a draft avoidable injuries strategy on behalf of the Health and Wellbeing Boards.

A significant element of the strategy was the emphasis on collaborative working. The document begins with a pledge:

We collectively pledge to work in partnership:

  • to achieve the aims and objectives of the strategy
  • to share and make best use of local resources
  • to influence the agenda and ensure avoidable injuries are afforded the attention they require locally.

A wide range of organisations signed up to the pledge including the city and county councils, the children’s safeguarding boards; Children’s Trust Board; Children’s Integrated Commissioning Hub; East Midlands Ambulance Service, Fire and Rescue, Home Start, the local CCGs, the police, Nottingham University Hospitals, Sure Start Children’s Centres, Nottingham CityCare Partnership, Nottinghamshire Healthcare Trust and the University of Nottingham. The Royal Society for the Prevention of Accidents (ROSPA), and CAPT also pledged to support the strategy.

Following a formal public consultation, the draft strategy was further revised and then approved by the Health and Wellbeing Boards in Nottingham City and Nottinghamshire County.

Reducing Avoidable Injuries in Children and Young People: A Strategy for Nottingham and Nottinghamshire 2014-2020 was launched at the start of Child Safety Week – 23rd June 2014.

The strategy is a comprehensive document that includes:

  • the aim and principles of the strategy
  • background information about avoidable injuries
  • the policy context
  • analysis of local information including mortality and hospital admissions data
  • the evidence base for interventions
  • information about the stakeholder day, the mapping exercise and the consultation
  • the reporting structure
  • evaluation
  • an action plan.

Reducing inequalities across avoidable childhood injuries

The strategy’s aim is to reduce the social gradient in inequalities across avoidable childhood injuries; focusing on three areas:

  1. home safety for under fives
  2. road safety
  3. leisure time/activities safety.

At this stage home and road safety have been prioritised. The multi-agency partnership steering group has created subgroups to develop the work further. Work on leisure safety will follow later.

Home safety

Public Health in Nottingham City in partnership with the University of Nottingham has secured funding of £460,000 for two years from the NHS Nottingham City CCG to set up a home safety equipment scheme that will target areas in the city where A&E admissions for injury in the 0-5 age range are highest.

The contract was awarded in June to Nottingham CityCare Partnership in consortium with CRESTA with an education element provided by Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma at Queens Medical Centre. It will be managed by the CCG and the aim is for the service to be in place late autumn 2014.

Road safety

The road sub-group is the existing road safety partnership with membership widened. The major new initiative is the implementation of 20mph speed limits for a number of suitable roads/areas by both councils.

Reporting arrangements

The Avoidable Injuries Multi-Agency Partnership Group reports to both the city & county Health and Wellbeing Boards (HWB). The strategy and the partnerships actions will be formally reviewed annually.

Co-ordination

Because injury prevention work falls within the remit of a wide range of services and activities, co-ordinating injury prevention work is a crucial across both Nottingham City and Nottinghamshire County. Sonya Clark and Sarah Quilty explained their roles:

"My job has a co-ordination element, but not in the sense of co-ordinating the activities in preventing avoidable injuries – more in helping partners to work together more cohesively and to work on prioritising areas."

- Sonya Clark

“I have been involved in the development of the avoidable injuries strategy from the start, I co-ordinated the first stakeholder event and subsequent developments of the strategic partnership group and home safety subgroup.”

- Sarah Quilty

The roles do not encompass the fullest range of possible tasks. For example, they do not include  managing the home safety equipment scheme. Sonya and Sarah’s work is essentially strategic and encompasses engaging with partners to:

  • develop the strategy
  • develop interventions
  • attract funding or additional resources
  • support best use of resources for the greatest impact.

These functions are well suited to public health managers. Other partners will look at key areas that relate to their specialism such as road safety.

Building capacity

In Nottingham City and Nottinghamshire County the approach is to link in with existing programmes, and build on those, rather than trying to set up a new separate avoidable injuries scheme. This work is well underway, but the strategy is still in its early stages. The aim is to widen the links and embrace other programmes that reach children and families, especially where the risk of avoidable injuries are high such as the Troubled Families programme in Nottinghamshire County and Priority Families within Nottingham City. Sonya stressed why it is important to take a wide-angled view:

"The focus of a project might be on helping the parent get off an addiction or on getting kids to school, but if you’ve got an under five at risk of being scalded or falling down stairs and having a traumatic brain injury you are just adding to that family's problems if you can prevent something like that happening it is better for everyone."

Future developments

Digging deeper into local data

The authorities have been doing more detailed data analysis for each of the areas where the injury rates are highest. The plan is to work closely with the respective CCGs and partners on the local priorities. For example, analysis of one area is showing high levels of poisonings – primarily from medicines.

Continued integration with existing programmes

Future work will include more joined-up work with health visitors, school nurses, community safety officers and (social) housing providers. This work will hopefully include training and introducing more systematic measures for reporting injuries and follow-up action. The move to the local authority of the Healthy Child programme (0-4) including health visiting in October 2015 will also provide more opportunities for improved synergy between services.

Children’s Centre staff training

Sure Start Children’s Centres have great potential to pass on knowledge about child safety to the mothers and fathers that they work with. The strategic partnership has strong links with the Injury Epidemiology and Prevention Research Group at the University of Nottingham and the group, with funding from the Royal Society for the Prevention of Accidents (RoSPA), will be piloting a training resource for children’s centre staff and evaluating aspects of its effectiveness.

Investment and funding

Nottingham City was awarded £45 million over 10 years from the Big Lottery Fund to help improve the lives of 12,000 vulnerable babies and children in the city. Injury prevention is an embedded part of the project.

The investment goes to the Small Steps Big Changes project led by Nottingham CityCare Partnership CIC, which will support expectant parents and families in Arboretum, St Ann’s, Aspley and Bulwell. Nottingham is one of five areas to benefit from this investment.

This funding is part of the Fulfilling Lives: A Better Start programme to deliver preventative approaches in pregnancy and the first three years of life to improve life chances of over 60,000 babies and very young children.

A key outcome of the programme is to reduce avoidable injuries in the targeted wards with funding allocated to the development of a home safety equipment scheme.

Keeping the momentum going

A major challenge for 2014-15 will be keeping momentum going especially given likely funding constraints.

In tough times there is a danger of focusing on treatment rather than prevention.

There is also a need to communicate information about the benefits of injury prevention more effectively. This will be achieved by building evaluation and consultation into new initiatives and also telling young people’s own stories through accessible case studies.

Staff are particularly keen to keep their eyes on a range of outcomes – with the benefits to children at the top of the list. They also want to be sure that any investment up front is also saving money in the long term. Reducing the number of emergency hospital admissions for children and young people through a range of interventions such as the home safety equipment scheme will be a good starting point.

The last word for now...

This new phase in work to reducing avoidable injuries in Nottingham and Nottinghamshire is now one year old. There have been considerable achievements: top level leadership, buy-in from key services and agencies; fundraising success and dedicated co-ordination responsibilities at a strategic level. Sonya Clark and Sarah Quilty are clear why the work deserves its increased focus:

"It’s such a big issue. It’s the biggest cause of inequalities for children and young people. The admissions and the A&E attendances you get – the majority of the injuries can be avoided by simple things like moving a cup of tea onto a shelf or putting a stair gate in and using it properly. It’s crazy when you think of the disability and heartache it causes."

- Sonya Clark

“The avoidable injuries agenda crosses over into other children and young people’s agendas with those children who are more likely to have an injury are more like to be living in poverty, have low educational attainment and have time off from school therefore it is essential to work together in partnership across health, education and social care to improve lives for children and families.”

- Sarah Quilty

Further information

For more information about Nottingham and Nottinghamshire’s avoidable injuries strategy for children and young people, contact Cheryl George, Senior Public Health Manager or Sarah Quilty Public Health Manager.

 

* In Nottinghamshire/Nottingham the term ‘avoidable injuries’ is preferred to ‘accidents’ or ‘unintentional injuries’. It was chosen to convey a strong sense that such injuries are not ‘inevitable’.

Updated August 2014