Planning and commissioning services

March 2013

The starting point for commissioning effective child accident prevention services is forming strong local partnerships and building a sound understanding of local needs. This section describes the commissioning cycle for child accident prevention work and highlights key things to consider at each stage.

The commissioning cycle

The ‘commissioning cycle’ is an established principle for effective commissioning. Our diagram shows the key points in commissioning child accident prevention services:1

Commissioning cycle for child accident prevention services

Below we highlight some key points to consider at each stage of the commissioning cycle. These points focus specifically on the commissioning of child accident prevention services; for general advice on commissioning please see the external links at the bottom of this section.

1. Build partnerships

  • Partnership working can support the commissioning and delivery of effective child accident prevention services in a number of ways, including through:
    • providing information and local intelligence for needs assessments – local voluntary and community sector organisations have a particularly valuable role to play in helping commissioners to understand the needs of local populations and identify gaps in services
    • joint commissioning arrangements – a programme or project could be commissioned jointly by, for example, a public health lead and an early years lead; a public health lead and a road safety team; or a public health lead, a safeguarding children board business manager and a clinical commissioning group commissioning manager
    • finding new opportunities for programme and project delivery – many partners will be able to offer a range of opportunities for delivering services and there may be opportunities to collaborate for increased efficiency and effectiveness.
  • Effective partnership working is a key way to reduce the number of children killed or seriously injured in accidents – it should form an important part of any area’s childhood unintentional injury prevention strategy. Potential partners include statutory bodies and voluntary / community sector organisations, as well as local authority teams in areas such as road safety, leisure and housing. Partnership working can help to achieve cost-effective commissioning arrangements and avoid duplication of effort, making sure that all available resources are used in the best possible way. It can also support a more family-centred approach to service commissioning and delivery. See the how to work in partnership section of this guide for more information on getting started with partnership working.
  • Once you’ve identified who you’d like to explore working with, you can start to consider what might motivate each partner to link up with you, or how to get the issue onto their agenda – it could be links with other local strategies and programmes of work, the opportunity to work more efficiently, or the potential for cost savings. See the policy framework section of this guide for more information about how child accident prevention relates to different policy areas.
  • Use local and national data to demonstrate that child accident prevention programmes are a smart investment. As well as highlighting the financial savings for health and social care, you can show the effects on school attendance, parental absence from work and the long-term impact for children and families. See the how to find and interpret data section of this guide for more information on working with data.
  • Make the case for a co-ordinated approach to child accident prevention by showing the impact you’ve achieved with recent programmes involving partnership working, or by using examples from other areas. Our case studies highlight work being done by practitioners across England.

2. Assess needs and set priorities

  • The joint strategic needs assessment (JSNA) process can be used to build a picture of unintentional childhood injuries and current interventions in your area. If you’re already delivering a range of child accident prevention activities, the needs assessment process can help you to identify priorities, work in a more co-ordinated way, plug gaps in provision and strengthen key services. Areas to focus on in the JSNA include:
    • national and local data on childhood accidents, including emergency hospital admissions and highlighting the link to inequalities – see the how to find and interpret data section of this guide for more information
    • targets for reducing serious unintentional injuries
    • local views of parents, children and young people
    • links to local and national strategies
    • current services and where the gaps are
    • evidence of what works in child accident prevention
    • recommendations for commissioning / future work.
  • Working with local partners to complete a separate needs assessment focusing on child unintentional injury prevention can give you a more comprehensive local picture than may be possible through the JSNA process. Our case study on NHS Salford explains how they went about doing this and you can also download Salford’s unintentional injuries needs assessment.
  • Child accident prevention priorities identified through the needs assessment process should be integrated into the joint health and wellbeing strategy and other relevant local plans and strategies, for example those that address child poverty.

3. Design evidence-based services

  • Co-ordinating injury prevention services across a local area is an opportunity to achieve greater impact along with potential cost-savings through avoiding duplication. The NICE guidance includes a recommendation for areas to appoint injury prevention co-ordinators. Find out more in our injury prevention co-ordination topic briefing.
  • It’s not always necessary to create a new service to meet a local need you’ve identified. There will be lots of opportunities to embed accident prevention work into existing services for children and families, such as those offered by health visitors, children’s centres, or Cook and Eat after-school schemes. Our Advocating Child Safety resource highlights opportunities for embedding child safety into mainstream programmes.
  • You may wish to commission external support, for example from CAPT, to help you identify priorities and opportunities, develop a multi-agency, evidence-based implementation plan, and agree roles and responsibilities.
  • The following table provides an overview of the types of information that it’s helpful to include in business cases for child accident prevention activities. You can also download a template business case developed by Cornwall and Isles of Scilly PCT.
Business case content area What it should highlight
Background / rationale for the work
  • links to JSNA
  • links to national and local policies / guidance / outcome frameworks.
The proposal
  • options for service delivery
  • evidence and impact for each option
  • role of partnership working
  • projected costs and investment required per year.
Financial and non-financial benefits
  • financial cost savings to the NHS, local authorities, partners and employers (see our articles on the costs of child accidents for information about the financial costs of unintentional injuries)
  • emotional cost savings from avoiding the psychological impact that serious injuries have on children and families
  • other non-financial benefits such as reductions in serious unintentional injuries and improved parental skills / knowledge
  • potential impact on other programmes of work eg public health programmes on smoking cessation
  • cost-benefit analysis.
  • It’s essential to build monitoring and evaluation into your plans from the outset and this includes gathering baseline data against which you can measure changes in accident rates and other ‘proxy indicators of success’, such as parental knowledge and awareness. Accident prevention has a reputation for being difficult to evaluate but being able to prove the impact of your work will help you to build the case for future interventions. See section 6 below for more information on monitoring and evaluation.

4. Source providers and agree outcomes

  • Explore a range of providers, including those from the voluntary and community sector where possible. Voluntary organisations with strong community links have a valuable role to play in helping commissioners to understand the needs of local populations and identifying gaps in services. They can also be in a strong position to engage hard-to-reach audiences and drive change at a grassroots level. See our briefing on working with the voluntary sector for more information.
  • In tender evaluation forms and interviews, ask questions that require organisations to provide evidence of successful engagement with parents and, where relevant, young people. For larger or long-term tenders, such as those for children’s centre provision, you could consider bringing parents onto the tender interview panel. Embedding the Safe Network Standards self-assessment tool into the tendering process for children’s services can help you to obtain consistent and comprehensive information about the safeguarding practices of potential providers. Our topic briefing on working with the voluntary sector explains how Lincolnshire children’s services commissioning team uses the Safe Network Standards. The self-assessment tool can also be used for monitoring and improvement purposes.
  • Targets relating to emergency hospital admissions and A&E attendances can be integrated into performance management criteria, but make sure that you will have ready access to the data you want to track – for example, if the service is for under 5s, is a breakdown of data available for this age group? Parent surveys can also be a helpful way to gauge the impact of some child accident prevention services. Read more about some of the challenges of working with data in the how to find and interpret data section of this guide.

5. Deliver to users

  • Once the outcomes have been agreed, aim to adopt a flexible approach to how the service is delivered – give the provider room to innovate and use their expertise to achieve the specified outcomes in ways that allow them to add most value.

6. Monitor, evaluate, improve and share learning

  • For long-term programmes and services, monitoring and evaluation could involve the provider completing self-evaluation forms at certain intervals, gathering feedback from service users, reviewing progress against targets (for example, the number of items of safety equipment fitted in the homes of vulnerable families with children under five years old) or commissioning independent evaluations at key points. It may also involve reporting to local organisations such as the health and wellbeing board, local safeguarding children board or children’s trust. For projects, it could involve collecting data, user feedback and other evidence throughout the delivery period to feed into an end-of-project evaluation. Read more about success factors and evaluation in our Advocating Child Safety resource.
  • Share learning through your local networks and with other professionals nationally by submitting case studies or resources to Making the Link – please email us at info@makingthelink.net if you’d like to do this. You could also take part in one of our master class events which support peer to peer knowledge exchange and learning. Upcoming events are listed in our news section.

Related links

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External sites

Notes on this article

  1. Diagram adapted from commissioning models developed by the National Audit Office, the NHS Institute for Innovation and Improvement and the British Association for Community Child Health in its publication Introducing the “Family Friendly Framework” (PDF).
Updated June 2013