The value of national data in local child accident prevention work

The recent suite of resources produced by Public Health England (PHE) provide a call to action for local work on child accident prevention, prioritising home safety for under-fives and road safety for children and young people under 25.

The data that underpins PHE’s suggested priorities for local action is national data. So what is the place of local data when it comes to devising local accident prevention plans and activities?

This article:

  • Recommends that local accident prevention plans should not be based on local data in isolation.
  • Explains how national data provides a robust body of information to steer local priorities and plans.
  • Signposts a new tool from the Child and Maternal Health Intelligence Network that provides tailored local data for the national priorities.

The big picture

PHE makes a strong argument for local authorities and their partners to focus on tackling the leading, preventable causes of accidental death and serious long-term harm for children and young people.

The PHE briefing on home safety for children under five identifies five main injury types that should be prioritised: choking; suffocation and strangulation; falls; poisoning; burns and scalds; and drowning.

The PHE briefing on road injuries highlights issues around travel to and from school for children under 16, especially from the age of ten when children start to travel to school more independently.

National data

The data that underpins PHE’s advice is national data on hospital admissions (Hospital Episode Statistics – HES), mortality data from the Office for National Statistics (ONS) and police reported STATS19 data about road casualties.

National data provides a broad picture of the injury types that most affect children and young people. It aggregates data about injury types that can be relatively low in individual local authority areas.

It is also important to recognise that the injuries that result in the highest levels of hospital admissions for the under fives are not injuries that result in the most deaths. For example, falls lead to the most hospital admissions for this age group, but choking, suffocation and strangulation cause the most deaths and result in relatively low numbers of admissions. For this reason, PHE has taken into account admissions’ data, mortality data and the scope for prevention when prioritising five injury types for action. 

Local data and the problem of low numbers

Although there are high levels of injury-related hospital admissions for under-fives – roughly 270 each year in an average upper tier local authority in England – when the admissions are broken down locally by accident type, the numbers quickly become too small to give clear guidelines on local needs and on the selection, monitoring and evaluation of prevention programmes.

In addition, the need to preserve confidentiality will limit the availability of local information on hospital admissions. The limited nature of local data can undermine work to make the case for action.

Accident and emergency attendances

For the under-fives, there are about 20 attendances at A&E departments for each hospital admission. Whilst it could be interesting to have accurate detail about the wide range of injuries that lead to these attendances, currently the information is rarely recorded in a way that makes for easy local analysis.

But the lack of local A&E data should not undermine local action. In many cases, attendances at A&E are minor injuries that are relatively hard to prevent without curtailing children’s physical activity.

Local strategies are best based on the most serious accidents and hospital admissions serve as a good enough proxy for serious accidents.

The injury types that result in children staying overnight or longer are the ones that local accident prevention work should focus on. These are the injuries prioritised in the PHE resources.

Information from Child Death Overview Panels (CDOPs)

In England all local safeguarding children boards (LSCBs) are required to review the deaths of all children in their area and this work is carried out by Child Death Overview Panels.

The panels have specific functions which are laid down in statutory guidance, and several relate directly to accident prevention including:

  • determining whether the death was deemed preventable (where modifiable factors may have contributed to the death)
  • deciding what, if any, actions could be taken to prevent future such deaths.

The panels are required to identify patterns or trends in local data and to report these to the LSCB. They also need to ensure that aggregated findings from all child deaths inform local strategic planning, including the local Joint Strategic Needs Assessment (JSNA).

However, although CDOP data is collated nationally, and information is shared between panels informally, there is insufficient analysis to help establish whether injury causes are a ‘one-off’ or part of an emerging trend.

Clearly, CDOP information will help inform local accident prevention strategies and activities, but again, the data is most useful when used in tandem with national data such as mortality statistics.

The two PHE briefings use national (England) mortality data to inform the guidance alongside the other data referred to above. Basing local strategies on local CDOP data in isolation is likely to result in unbalanced priorities.

Targeting specific communities

Children from the poorest families are known to suffer more serious accidents than their more affluent counterparts. But local accident information may not be sufficient to allow precise targeting, especially when trying to address the most serious injuries because the number in a local area is likely to be small.

For example, it will not be effective for a children’s centre to shape its priorities on information about injuries within its immediate catchment area even though this would appear to be a good approach. The number of injuries will be too low and are likely to skew priorities.

Alternatives to injury data may need to be used to shape targeting. As the relationship between deprivation and injury is well established, local information about the location of the less affluent neighbourhoods will assist prioritisation.

Measures of effectiveness

Reducing hospital admissions and deaths are clear objectives, but it can be hard to be sure that local action was associated with changes in these outcomes, especially when (thankfully) the numbers of deaths locally are small.

Using measures such as promoting practices that link nationally with common accidents identified in the PHE briefing and their prevention such as the ownership of safety gates and the safe storage of poisons can act as measures of effectiveness. These practices can also direct the priorities for interventions. 

Tailored local data steered by national priorities

The National Child and Maternal Health Intelligence Network (formerly ChiMat) website contains a tool that presents the specific data for each local area on:

The tool enables users to create reports on these issues that draw text from the respective PHE briefing documents, but include data for their own local authority or local area.

This tool enables authorities to compare performance at local authority level against the national average for each indicator, or to compare the performance of all local authorities within a single PHE centre.

At the time of writing, public health teams in England do not yet have access to an anonymised HES extract service covering the inpatient, outpatient and A&E datasets, although work is underway to provide this information in the near future.

Conclusion

Plans and activities to reduce serious unintentional injuries among children and young people need to be underpinned by data about the causes of the injuries.

National data provides a sound base for action because it aggregates information about injury types which can be relatively low in individual local authority areas. The national data is a robust body of information that can steer priorities for action. It shows the issues that really matter. Local data from a range of sources will help fine tune these priorities.

The suite of resources from PHE provides the mix of national and local information needed.

What do you think about the information in this article? Do you agree with the emphasis on the value of national data. Please let CAPT know by contacting Kevin Lowe, Head of Consultancy Services.

Related links

More information

 

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Updated October 2014