Chief Medical Officer's report 2012

December 2013

Our Children Deserve Better: Prevention Pays, the 2012 report of the Chief Medical Officer (CMO), was published in October 2013. The report presents the case for a greater focus on prevention and partnership working to improve the health and wellbeing of children and young people, and unintentional injuries are one of four major child health challenges it examines.

Purpose of the CMO’s report

In her introduction to the report, CMO Professor Dame Sally Davies explains that the purpose of the annual report is to, “provide an assessment of the state of the public’s health and to advise government on where action is required”. The 2012 report is in two sections, with the first volume presenting data and information on the health of the population.

This year, the second volume provides independent advocacy on the health and wellbeing of children and young people. The CMO chose to focus on this area because of wide variations in the health and wellbeing of children and young people (0-24 years) in the UK and because there is strong evidence that what happens early in life affects health and wellbeing later in life.

What does the report say about unintentional childhood injuries?

The scale of the problem

  • In England in 2011/12, unintentional injuries led to around 135,000 admissions to hospital among children and adolescents aged 0–14. Around 6,000 children were hospitalised for at least three days because of severe injury.
  • Unintentional injuries are a major cause of morbidity and mortality during the early years, with a significant proportion (around 14.5%) of attendance at A&E departments being children under 10 years of age. Unintentional injuries and accidents are the leading cause of mortality among secondary school children (10–19 years).
  • The causes of injury are diverse and risks vary with age. The main causes of unintentional injury are road traffic injury (and pedestrian injury in particular), drowning, poisoning, falls and burns. Infants and toddlers are most at risk of injuries in the home, while older children are most at risk of road traffic injuries. Unintentional injuries become increasingly important causes of disability as children get older.
  • Children from deprived backgrounds or living in urban areas are more likely to suffer injury than children from more affluent backgrounds or those living in rural areas. Boys are more likely to suffer injury than girls.
  • Severe injuries are associated with a range of health and psychosocial problems in both the short term and long term. These problems include post-traumatic stress, physical disability, cognitive or social impairment and lower educational attainment and employment prospects. There can also be significant psychological burden for families and carers.
  • Hazard surveillance and home safety schemes can have a significant impact on injury reduction in young children. Local authorities have an important role to play in making sure that public housing allocated for families with young children is fitted with appropriate safety equipment and that injury hazards are minimised.

Inequalities and deprivation

  • Death rates for injury and poisoning have fallen for all social groups except the poorest: these children are 13 times more likely to die.
  • Those in the lowest social economic group are 9 times more at risk of sudden unexpected death in infancy.
  • Social disadvantage disproportionately affects the young: 26.9% of children and young people (aged 0–19) are living in or at risk of poverty or social exclusion, compared with the overall population rate of 22.6%.

Variations in the UK and Europe

  • The UK does well when compared with the EU 15+ countries for injuries, but there is variability for 10–18 year olds across the four devolved UK administrations, with England performing better than its neighbours. Deaths from road-related injury show a more than tenfold variation across the UK regions.
  • While mortality from injury is an area in which England is performing well, there is profound variation across the country.
  • Annex 9 to the report is the Atlas of Variation in Healthcare for Children and Young People. This is a series of maps which illustrate some of the variation in health and healthcare across England. The maps of most relevance to professionals working in child accident prevention are:
    • Map 1: Child poverty
    • Map 2: Family homelessness
    • Map 12: Hospital admissions due to injury 0-17 years
    • Map 13: Injuries from road traffic accidents 0-15 years
    • Map 14: Mortality from accidental injury 0-24 years
    • Map 35: A&E attendance under 5s.

The costs of unintentional childhood injuries

The report provides an overview of the annual costs of unintentional childhood injuries in the UK. Supporting information 3.2 in the report provides a breakdown of the data sources used, which include our article on the costs of head injuries.

Item
Cost
Total annual A&E cost of unintentional injury in England
Around £9 million
Short-term health cost of treating one severe injury £2,494 – £14,000
Annual short-term hospital costs of severe unintentional injuries to children £15.5 million – £87 million
Annual short-term hospitals costs of road traffic injuries Around £31 million
Potential annual long-term societal cost of one childhood traumatic brain injury£1.43 million – £4.95 million
Potential annual long-term societal cost of childhood traumatic brain injuries £640 million – £2.24 billion

The report notes that as there have been few estimates of the economic costs associated with unintentional childhood injury, none of the cost estimates are specific to children. The estimates are based on children aged 0-14 years and do not include costs associated with minor or moderate injuries treated in primary care or by GPs, physical therapists or pharmacists. For more information on costs, see our articles on the costs of child accidents.

What does the report say about unintentional childhood injury prevention?

The report highlights that home and road safety are two of the priorities defined by NICE public health guidance to prevent unintentional injuries in childhood.

Road safety

  • The use of cycling helmets has been associated with a 63–88% reduction in the risk of head, brain and severe brain injury for all ages of cyclists involved in accidents.
  • With only 17.6% of children wearing cycling helmets in 2008 in Great Britain and about 10% of severe traumatic brain injuries (TBIs) in children aged 0–14 attributable to cycling injuries, interventions promoting the use of helmets have the potential to reduce the number of severe TBIs in children.
  • The introduction of speed cameras has been linked to a reduction in car crashes of between 8%–49%, and a reduction in road traffic injuries and deaths among the general population of between 11% and 44%.

Home safety

  • A systematic review of the impact of home safety interventions found such interventions to be effective in increasing the proportion of families with home safety equipment.
  • Families who received the interventions were:
    • 1.4 times more likely to have safe hot water temperatures and were better equipped against fire
    • 1.8 times more likely to have functional smoke alarms
    • twice as likely to have a fire escape plan
    • 1.5 times more likely to store medicines and cleaning products safely
    • 2.7 times more likely to have safer electrical sockets
  • Little is known about the cost-effectiveness of home safety interventions. A Canadian evaluation of the cost-effectiveness of home safety assessments and provision of injury prevention information packs estimated a cost of £303 per injury prevented. In the UK, an evaluation of the cost-effectiveness of introducing bath thermostatic mixer valves (TMVs) in social housing reported that every £1 spent on TMVs would save £1.41 in healthcare costs. For more information, see our news story on the TMVs evaluation.

Policy

In the section on key messages for policy, the report states that there should be a strong commitment to developing and implementing accident prevention strategies targeting home safety and road traffic injuries (NICE PH29, 30, 31 on prevention of unintentional injuries in under 15s).

Ways of working

The report highlights how setting, “major long-term transformative goals at a local level” through health and wellbeing boards could support collaboration on early intervention programmes to improve the health and wellbeing of children and young people. It also stresses the importance of implementing evidence-based practice and, “investing in data in a way that gives a comprehensive understanding of local need, a realistic assessment of the costs of ongoing intervention and the potential benefits of preventive action”.

What recommendations does the report make?

The report puts forward 24 recommendations. Recommendation 24 has the most direct relevance to accident prevention as it advocates the need to take a co-ordinated approach to tackling blind cord deaths among babies and young children, and highlights how sharing data on patterns of child deaths allows trends in preventable childhood deaths to be identified.

The CMO says: “I am keen to build on the work carried out in Northern Ireland by the Chief Medical Officer, Dr Michael McBride, and others such as the Child Accident Prevention Trust (CAPT) to better understand and reduce deaths from blind cords. Pooling data on patterns of child deaths allows key trends such as these to be identified.”

Below is a list of all of the recommendations that link to work on child accident prevention.

  • Recommendation 1 - National Children’s Week: Cabinet Office supported by Public Health England, and the Children’s Commissioner, should consider initiating an annual National Children’s Week.
  • Recommendation 2 - evidence for early intervention: Public Health England in collaboration with the Early Intervention Foundation should assess the progress on early intervention and prevention, continue to develop and disseminate the evidence base for why this matters and build advice on how health agencies can be part of local efforts to move from a reactive to a proactive approach.
  • Recommendation 3 - spreading learnings: Public Health England, working with Directors of Public Health and Health and Wellbeing Boards, should support the work of the Big Lottery Fund programmes and ensure that the lessons learnt are disseminated.
  • Recommendation 4 - Healthy Child Programme: Public Health England should undertake a Healthy Child Programme evidence refresh, starting with the early years.
  • Recommendation 8 - Troubled Families Programme: Public Health England should work with NHS England, the Department for Communities and Local Government and the Department of Health to identify how the health needs of families are met through the Troubled Families Programme.
  • Recommendation 9: involving young people: The Department of Health, NHS England and Public Health England, alongside representatives of children and young people, should build on the You’re Welcome programme and the vision outlined in the recent pledge for better health outcomes for children and young people to create a ‘health deal’ which outlines the compact between children and young people and health providers, and creates a mechanism for assessing the implementation of this.
  • Recommendation 17 - good practice in schools: Public Health England, the PSHE Association and other leading organisations in the field should review the evidence linking health and wellbeing with educational attainment, and from that promote models of good practice for educational establishments to use.
  • Recommendation 18 - Children and Young People’s Health Outcomes Forum: The Children and Young People’s Health Outcomes Forum annual summit should provide an opportunity for the review of health outcomes that are relevant to children, and to examine regional variation.
  • Recommendation 19 – regulation and inspection: Regulators, including the Care Quality Commission and Ofsted, should annually review the effectiveness of inspection frameworks and the extent to which they evaluate the contribution of all partners to services for children and young people. This includes the contribution of statutory partners, local safeguarding boards and health and wellbeing boards to the health and protection needs of children and young people.
  • Recommendation 24: - blind cord deaths: The four UK Chief Medical Officers have agreed that the Chief Medical Officer in Northern Ireland, Dr Michael McBride, will lead a group with the four public health agencies and The Royal Society for the Prevention of Accidents (RoSPA) to develop strategies to combat blind cord deaths.
Updated December 2013