Learning from the past

January 2014

How can past policy papers and action plans help us in planning current and future child accident prevention work? Here we summarise the recommendations and main themes from three national reports published between 2002 and 2009, and highlight the lessons that child accident prevention practitioners and policymakers can draw from them today.

What this summary covers

This summary focuses on three reports:

  • Preventing Accidental Injury – Priorities for Action: Report to the Chief Medical Officer from the Accidental Injury Task Force, 2002
  • Staying Safe: Action Plan, Department for Children, Schools and Families, 2008
  • Accident Prevention Amongst Children and Young People: A Priority Review, Department for Children, Schools and Families, Department of Health and Department of Transport, 2009

Our summary covers:

  • the background and purpose for each report
  • the main recommendations made in each report
  • a discussion of the common themes and issues raised
  • the lessons that child accident prevention practitioners and policymakers can apply to their work today.

The summary will be helpful to anyone involved in commissioning and delivering accident prevention services for children and young people in the new public health system.

Preventing Accidental Injury – Priorities for Action, 2002

Background and purpose

The Accidental Injury Task Force was established to provide a basis for cross-government action on unintentional injury prevention. The task force decided that its purpose should be to provide a framework for delivery, rather than setting detailed plans for delivery. The report identified priority groups for action along with evidence-based interventions which would have the greatest impact in reducing accidental deaths and injuries.

Recommendations

1. Delivery framework

The report highlighted the need for, “a more integrated approach to accident prevention, coupled with a strong lead at every level”, and recommended that:

  • regional directors of public health lead on co-ordinating the delivery of accidental injury prevention
  • local authorities, PCTs and other local organisations should come together through local strategic partnerships to deliver accidental injury prevention
  • local directors of public health should work through the local strategic partnerships to co-ordinate work at a local level
  • the Department of Health should be responsible for cross-government co-ordination
  • the Public Health Observatories, together with their counterparts in local government, should play a key role in the surveillance of accidental injury.

2. Local implementation

The report outlined the following steps for local implementation of its framework:

  • using data collected to a common format to show where action is needed most
  • adapting key interventions to specific local needs where they have the greatest impact
  • developing and disseminating good practice to show what can be done
  • involving all stakeholders in producing a local action plan
  • developing a well-trained workforce with capacity to undertake injury prevention work
  • recruiting support from the voluntary sector
  • identifying indicators to monitor performance.

3. National infrastructure

The report proposed the following steps for developing a stronger national infrastructure to support the delivery of accident prevention work at the local level:

  • adoption of a common minimum dataset
  • use of a central website with a gateway to give access to injury data at national, regional and local level across all sectors
  • dissemination of examples of good practice.

4. Headline interventions

The task force recommended that a series of headline interventions form the core of local implementation plans, with an emphasis on targeting areas of health inequality.

Table 1: Headline interventions in the Preventing Accidental Injury report

Priority areas

Headline interventions

Falls at or near home

1. Referral of individuals to a falls prevention programme

2. Targeted exercise programmes for falls prevention

3. Prevention and treatment of osteoporosis

4. Home safety checks*

Road accidents

1. 20mph speed limits in areas of higher pedestrian activity

2. Local child pedestrian training schemes and safe travel plans

3. Systematic road safety intervention in inner city areas

4. Advice and assessment programmes for elderly car drivers

Dwelling fires

1. Installation of smoke alarms by fire brigades

2. Home fire risk assessments, safety checks and escape plans*

3. Target deprived groups, particularly children and older people in privately rented and temporary accommodation, and househoulds in which people smoke

Play and recreation

1. Increase number of children undertaking cycle training and wearing cycle helmets

2. Produce guidelines for safety in children's sports

3. Strengthen risk and safety education in schools

* Scope to combine the two

Staying Safe Action Plan, 2008

Background and purpose

The Staying Safe Action Plan followed the publication of the Children’s Plan and the Staying Safe strategy in 2007. The Staying Safe strategy covered the full span of the Every Child Matters ‘stay safe’ outcome, including keeping children safe from accidents.

Delivery framework

To support the Staying Safe Strategy, in October 2007 the government announced the creation of Public Service Agreement (PSA) 13 – improving children and young people’s safety (link opens a PDF). The Staying Safe action plan explained that Local Safeguarding Children Boards (LSCBs) would have a crucial role to play at local level in delivering improvements against the PSA. LSCBs would be responsible for securing support from partners in driving local change and improving frontline practice. At a local level, the PSA was reflected in the new national indicator set for local government (which was effective from April 2008 to March 2011). There were 16 indicators in the NIS that related to children and young people’s safety, including:

  • NI48 – children killed or seriously injured in road traffic accidents (0-15 years)
  • NI70 – hospital admissions caused by unintentional and deliberate injuries to children and young people.

Commitments for 2008-11

The action plan made a series of commitments for improving the safety of children and young people, to be delivered from 2008-11. The main actions relating to child accident prevention were to:

  • establish a new Child Safety Education Coalition to ensure that more children have access to fun and practical safety education opportunities (funding for the coalition was withdrawn at the end of December 2010 but an archived version of the CSEC website is still available)
  • launch a major new communications campaign on children’s safety, including targeted information for more vulnerable groups and public communications to encourage people to take responsibility
  • fund a new home safety equipment scheme totalling £18 million over three years, targeted at families in disadvantaged areas (this became the Safe at Home scheme)
  • complete a priority review of local area accident prevention which will make a number of recommendations about how accident prevention work might be improved (this was published in 2009 and is discussed later in this summary).

Accident Prevention Amongst Children and Young People – A Priority Review, 2009

Background and purpose

Accident Prevention Amongst Children and Young People is the ‘priority review’ of local accident prevention which was promised in the Staying Safe Action Plan. The report covers injuries and deaths among children and young people up to age 18 in England. Evidence for the review was gathered over four months from August 2008, through a literature review, interviews with stakeholders and visits to a number of local areas. The recommendations made in the report were considered at central government level as part of PSA 13.

Recommendations

The recommendations made in the report included:

1. Using existing evidence more effectively

  • central government should develop a toolkit or guidance for local areas on finding and using data and evidence on local unintentional injury issues.

2. Addressing gaps in data and research

  • central government should extend existing economic analysis on unintentional injury prevention to all other areas of unintentional injury
  • central government should develop a cross-government plan of research on unintentional injury.

3. Sharing knowledge and good practice

  • central government should create a structured system of knowledge-sharing for practitioners
  • central government should identify opportunities to spread good practice through national or regional workshops.

4. Partnership working

  • local areas should identify opportunities, incentives and motivations for partnership work on injury prevention
  • central government should undertake a national mapping exercise to identify partnership working opportunities and develop practical advice for local areas on how to influence partners
  • central government should produce guidance on expectations of local partnership work, including the commissioning of injury prevention services
  • central government should help local areas to find ways of pooling resources and funding
  • children’s trusts and LSCBs should consider how they can strengthen injury prevention work, including through local plans and injury prevention sub-groups.

5. Workforce

  • central government should consider the creation of an injury prevention co-ordinator post in every local authority
  • central government should work with employers to explore how injury prevention specialists could be offered more structured qualification and career paths
  • local areas should work to improve the level and quality of public health analytical skills in their workforces
  • central government should develop guidance for practitioners about key safety messages and the different levels of risk at different ages.

6. National co-ordination and leadership

  • central government should develop guidance for local areas on working with national indicators relating to child unintentional injury prevention, and encourage more areas to include these indicators in their local area agreements
  • central government departments should co-ordinate policies and action on unintentional injury.

7. Public communication campaigns

  • central government should develop a sustained, long-term public communications campaign on unintentional injury prevention, using social marketing techniques and building on existing campaigns such as Think! road safety, Fire Kills and Child Safety Week.

8. Safety training in schools

  • central government should consider how to promote safety and risk awareness through PSHE, Healthy Schools, Sustainable Schools and Change4Life, as well as through children’s centres.

9. Home, road, fire and water safety

  • central government should consider further measures to address the issues of accidents in the home, particularly among under fives
  • central government should consider fire safety issues including how to encourage smoke alarm use and how kitchen safety messages can be included in children’s cooking lessons
  • central government should consider further measures to address the issues of high levels of injury and death to young drivers and their passengers
  • local areas should undertake a risk analysis of water hazards and take action where this is found to be a priority.

Discussion

National indicators

The 2009 Priority Review found that stakeholders felt that the national indicators relating to injury had provided a sense of focus for local areas, but that locally-set injury reduction indicators were far more influential. The review found that only a small number of local area agreements incorporated the national indicator for child injury (NI 70) – it appeared in just 5 agreements, compared to 21 for child emotional health, 77 for street cleanliness and 99 for childhood obesity. The low take-up was felt to be down to the complex, cross-cutting nature of unintentional injury work and success against the indicator being dependent on partnership work. The review found strong support for guidance for local areas on working more effectively with and through national indicators on unintentional injury prevention.

Data

The Preventing Accidental Injury report emphasised the importance of good data on accidental injuries in targeting interventions effectively and for monitoring the effect of interventions. It identified problems relating to working with data including:

  • difficulties with comparing national data because definitions and coding conventions vary across government departments and agencies
  • a lack of centrally available data from health service sources such as A&E departments and general practices
  • a lack of aggregated regional data, except in the road transport area, and fragmentation of local data
  • differences in administration boundaries which make it difficult to collate data at the local authority or primary care trust level.

In the 2009 Priority Review, the collection, use and sharing of data and knowledge again emerged as a significant barrier to progress on reducing unintentional injury. The review suggested that just the ‘tip of the iceberg’ was known about, with only a limited understanding of the links between unintentional injury and other health and social issues. Specific problems highlighted in the review included:

  • a limited understanding of the impact and cost of unintentional injuries
  • lack of time and resource for data analysis
  • significant gaps in data collection, including of A&E data (the report made note that that the Information Centre for Health and Social Care had begun collecting an A&E data set for the Hospital Episode Statistics database)
  • data sharing and resourcing issues encountered when attempting to obtain local data direct from hospitals
  • the discontinuation of the HASS/LASS data set, which could have provided valuable information about the safety of new products such as hair straighteners.

Partnership working

The Staying Safe consultation revealed a need to learn more about the work of local agencies involved accident prevention, and to promote local partnership working. The action plan highlighted the important role of LSCBs in promoting partnership working and in establishing child death review functions. The 2009 Priority Review found that stakeholders generally felt very positive about partnership working on unintentional injury and saw it as a vital part of prevention work. Stakeholders stressed the importance of partners having a good understanding of each others’ motivating factors and points of influence:

“Probably the most important issue for stakeholders was the identification of incentives that could lead others to prioritise and collaborate on schemes which had an impact on local injury prevention. Stakeholders considered it crucial that those people who were responsible locally for injury prevention should identify the opportunities, incentives and motivations that other partners had, and to use them to maximise delivery of injury prevention. Frequently identified agendas where common interests could be identified included obesity and healthy living, alcohol reduction, sustainable development and play.”

One concern expressed was that the local profile of injury prevention is highly dependent on ‘championing’ by committed individuals. Stakeholders suggested that the following actions would be of significant help to local partnership efforts:

  • having a child injury prevention co-ordinator in each local authority to provide a clear focal point for partnership work
  • guidance from central government on expectations of local partnership work, including the commissioning of services and how to pool funding and resources effectively
  • a national mapping exercise to identify opportunities for partnership working
  • practical advice and examples for local areas on how to influence partners effectively.

The review found that children’s trusts and LSCBs, when they were engaging with injury prevention, played a crucial role in driving partnership work. However, there was a feeling that some LSCBs were focusing too narrowly on child protection issues and could contribute much more to unintentional injury prevention.

Developing and sharing knowledge and good practice

Preventing Accidental Injury highlighted gaps in knowledge about injury prevention, including:

  • nationally agreed costing standards and conventions
  • data on the costs over time of preventing accidents, treating injury, and for rehabilitation and care
  • data on the cost-effectiveness of interventions to reduce inequalities in childhood injuries, particularly injuries incurred in the home
  • information about the effectiveness of community-based injury prevention programmes
  • research into how to turn evidence into practice
  • research into access to injury prevention programmes and advice by social group, and into why interventions were or were not effective in different social groups
  • standard definitions to be used by agencies collecting data on accidental injuries, including a definition of the severity of injury not based on length of hospital stay.

The Staying Safe Action Plan highlighted how sharing material and good practice could help to widen access to children high quality safety education. Consultation participants were keen to see more sharing of good practice models between LSCBs.

There was also strong support for a more structured system of knowledge-sharing in the 2009 Priority Review. Examples of useful resources mentioned include as a website with examples of good practice, guidance on data and research, guidance on commissioning, information about cost-benefit analysis and evaluation of interventions.

Cost-benefit information was felt to be particularly valuable as it would help stakeholders to build the economic case for prevention work and raise the local priority of profile of child accident prevention, including through the joint strategic needs assessment (JSNA) process. The report suggested that it would be most efficient for costs data to be produced centrally, since government departments have figures for many costs relevant to unintentional injury.

Inequalities

In 2002, Preventing Accidental Injury highlighted the impact of inequality on unintentional injuries, with children and young people from the lowest social groups suffering most from injuries. The 2008 and 2009 reports highlighted the same issue, with no suggestion of progress having been made in closing the gap.

Safety education

The Staying Safe consultation revealed strong support for safety education schemes such as Crucial Crew and LASER, although stakeholders felt that the provision and quality of safety education varied greatly throughout the country.

In the 2009 Priority Review, stakeholders welcomed the announcement that PSHE, including the safety training element within it, would become statutory. Stakeholders highlighted the need to deliver safety training throughout a child’s school ‘career’, including beyond the end of PSHE at Key Stage 4, with messages tailored by age group.

n the pre-school age group, the review team heard much praise for the work of children’s centres in educating parents and children, and the emphasis on injury prevention in the early years foundation stage. Stakeholders also praised the contribution to injury prevention and risk awareness made through the Healthy Schools, Extended Schools and Sustainable Schools Programmes, and were keen to explore the possibility of extending these programmes into the early years and further education sectors.

There was a call for more information about the quality and effectiveness of the huge number of safety training packages and resources that were currently available.

Legislation

The 2009 Priority Review reported that most stakeholders felt that the key to reducing unintentional injury lay mainly in behaviour change rather than legislation. One area where there was support for new legislation was in the regulation of water temperature in domestic dwellings to prevent bath water scalds.

Lessons for practitioners and policymakers today

  • The link between childhood accidents and deprivation is well-established. The Public Health Outcomes Framework (PHOF) includes a firm commitment to reducing health inequalities, noting that injuries disproportionately affect children from lower socio-economic groups. Find out more in our briefing on inequalities and deprivation.
  • Partnership working is recognised as the most effective way to make progress on reducing unintentional childhood injuries. While the new public health system has brought many changes to the accident prevention landscape, many of the key partners involved in commissioning child accident prevention services remain the same.
  • Issues around working with data on unintentional injuries that are commonly raised by practitioners today have persisted for many years. In particular, there is still no centralised or reliable source of data on A&E attendances. Child death overview panels are now providing good information about fatal accidents at a local level, although this still needs to be joined-up at the national level. See our guide to working with data and statistics for more information.
  • There has been little progress made in the creation of injury prevention co-ordinator roles within local areas, despite strong support from stakeholders and the inclusion of this recommendation in the NICE guidance on preventing unintentional injuries among under 15s. For many areas, creating and funding a new full-time position has not been realistic because of budget pressures and organisational restructuring. It may be necessary to think more creatively about how to deliver injury prevention co-ordination effectively in your area. Our November 2012 topic briefing on injury prevention co-ordination has more information on how local areas have approached co-ordination.
  • Significant progress has been made with the sharing of knowledge and good practice. Making the Link was established in 2009 in order to support senior practitioners and policymakers involved in child accident prevention. Our website has grown into a valuable resource that contributes to many of the information needs identified in the reports discussed here, including:
Updated January 2014