Public health and child accident prevention

December 2013

Topic briefing

The new public health system took effect from April 2013, when Public Health England was established and public health services formally transferred from the NHS to local authorities. Our topic briefing outlines the key roles and responsibilities relating to child accident prevention for organisations in the new public health system.

Key issues

  • Action to reduce unintentional injuries is embedded in the Public Health Outcomes Framework (PHOF). Three indicators are of specific relevance to child accident prevention and six others have links to child accident prevention work.
  • The overarching vision for the PHOF demonstrates a strong commitment to reducing health inequalities. Given the strong link between childhood accidents and deprivation, child accident prevention work can make a significant contribution towards achieving this goal.
  • Accident prevention is one of 17 key areas identified as a responsibility for local authorities within the new public health framework.1
  • NHS England is responsible for commissioning the three main public health programmes for under fives (health visiting, Family Nurse Partnerships and Healthy Child Programme) until 2015. Local authorities are free to commission additional public health services for under fives.

Policy context

In 2010 the government published the Healthy Lives, Healthy People white paper, which set out plans for a comprehensive reform of the public health system. The plans revolved around decentralising public health and giving local authorities more power over the public health budgets in their area. The new system took effect from April 2013, when Public Health England was established and public health services formally transferred from the NHS to local authorities.

Public Health Outcomes Framework

The new public health system focuses on outcomes rather than targets, and these outcomes are set out in the PHOF. There are two high level outcomes:

  • increased healthy life expectancy
  • reduced difference in life expectancy and healthy life expectancy between communities.

The framework is designed to enable local authorities to compare their own outcomes with other local authorities and the PHOF Data Tool facilitates this.

Action to reduce unintentional childhood injuries is embedded in the PHOF, which was revised in November 2013. The indicators are grouped within four domains:

  • domain 1: improving the wider determinants of health
  • domain 2: health improvement
  • domain 3: health protection
  • domain 4: healthcare public health and preventing premature mortality.

Three indicators have specific relevance to child accident prevention work:

  • indicator 2.7: hospital admissions caused by unintentional and deliberate injuries in children and young people aged 0-14 and 15-24 years
  • indicator 1.10: killed and seriously injured casualties on England's roads
  • indicator 4.3: mortality rate from causes considered preventable.

Other indicators which are relevant to this area of work include:

  • indicator 1.01: children in poverty
  • indicator 1.15: statutory homelessness
  • indicator 1.16: utilisation of outdoor space for exercise/health reasons
  • indicator 1.2: school readiness
  • indicator 2.5: child development at 2–2.5 years
  • indicator 4.1: infant mortality.

There are also some indicators relating to inequalities which professionals working in child accident prevention may find helpful:

  • indicator 0.1: healthy life expectancy
  • indicator 0.2: differences in life expectancy between communities
  • indicator 1.3: pupil absence
  • indicator 2.4: under 18 conceptions.

Reducing health inequalities

The overarching vision for the PHOF demonstrates a strong commitment to reducing health inequalities:

“To improve and protect the nation’s health while improving the health of the poorest fastest.”2

Child accident prevention work can make a significant contribution towards achieving this goal. We know that there is a clear link between childhood accidents and deprivation, with children from deprived families being far more likely to be killed, disabled or seriously injured in preventable accidents. Research shows that children from the poorest families are:

  • 13 times more likely to be killed in accidents than those from the wealthiest families3
  • 3 times more likely to be admitted to hospital and to be admitted with more severe injuries.4

How public health is structured in England

This section gives an overview of the organisations involved in the new public health system and summarises their roles and responsibilities in relation to child accident prevention.

Department of Health

The Department of Health (DH) has overall responsibility for public health and works across government departments and national bodies to embed public health into different policy agendas.

Public Health England

Public Health England (PHE) is an executive agency of the DH which took up its full responsibilities on 1 April 2013. PHE is the public health adviser to the government and to the NHS, and supports local authorities by providing knowledge and evidence on local health needs, as well as practical and professional advice on what to do to improve health outcomes. The public health observatories are among the organisations that have been merged into PHE.

Role and responsibilities

PHE is responsible for advising government on the delivery of public health policy and strategy, and for publishing performance against the PHOF on a national and local level. It provides data, analysis, intelligence, evidence and expertise to help local authority public health teams to develop evidence based improvement initiatives and share best practice.

Priority areas of work

PHE has identified a number of priority areas of work for 2013/14, one of which focuses on children and families: “Supporting families to give children the best start in life, through working with health visitors, Family Nurse Partnerships and the Troubled Families Programme.”

The organisation’s work in this area involves:

  • partnering the Troubled Families programme: ensuring that PHE nationally, and the public health system regionally and locally, plays its full part in supporting efforts to improve the life chances and outcomes for troubled families
  • accelerating improvements in child health outcomes through a focus on under fives: supporting the continued development of key programmes for under fives (including health visiting, school nursing and family nurse partnerships) and working with the Department of Health and local government to secure transition to local authorities in 2015
  • promoting early intervention: partnering the Early Intervention Foundation to develop the evidence base for early interventions, championing early interveners and building support and commitment across the public health system and potential investors for practical, evidence-based measures that can support the life chances and outcomes for children, youth and families.

PHE has already placed a spotlight on accident prevention, through its collaboration with RoSPA on the report Delivering accident prevention at local level in the new public health system, which was published in June 2013.

Organisational structure

PHE is organised into four regions (north of England, south of England, Midlands and east of England, and London), with 15 local centres. Each local centre director is a partner in the local public health system, working alongside local government, CCGs and the local NHS.

PHE also has eight regional knowledge and intelligence hubs which sit within the Chief Knowledge Officer’s directorate. Other specialist intelligence networks, including the Child and Maternal Health Intelligence Network (formerly ChiMat), form a part of this directorate.

Health and Wellbeing Directorate

PHE’s Health and Wellbeing Directorate leads work to improve health and wellness and address the major drivers of disease, disadvantage and death in England. The directorate takes a life-course approach, combining prevention and early intervention to support people as they pass through life’s major transitions.

Teams within the directorate that are of particular relevance to child accident prevention practitioners are:

  • the Infants, Children and Youth team, which focuses on improving health and health outcomes for mothers and infants, children, teens and young adults
  • the Accidents, Injury and Violence team
  • the Social Determinants and Inequalities team.

In September 2013 PHE signalled this new body’s commitment to tackling accident prevention as set out in the PHOF through a new violence and unintentional injuries programme:

“The new programme’s two work streams will focus on unintentional injuries (particularly road traffic injuries and child injuries in the home).”

The programme is designed to enable local authorities to take these priorities forward quickly.

The programme board will be chaired by Dr Ann-Marie Connelly, Director of Health Equity and Impact at PHE. The unintentional injuries prevention steering group will be chaired by Paul Brown, Interim Director of PHE’s West Midlands Knowledge and Intelligence team.

CAPT and RoSPA will be working closely with PHE to develop evidence-based resources to support the programme.

NHS England

NHS England supports NHS services nationally and ensures that money spent on NHS services provides the best possible care for patients. It funds local clinical commissioning groups (CCGs) to commission services for their communities and ensures that they do this effectively. NHS England will also commission specialist services where this is most efficient.

NHS England was formally established in October 2012 as the NHS Commissioning Board (NHS CB) and changed its name to NHS England in April 2013.

Public health role

NHS England is responsible for delivering the following public health services for under fives until 2015, when they will be handed over to local authorities:

  • health visiting
  • Family Nurse Partnerships
  • Healthy Child Programme for under fives, which includes injury and accident prevention at key stages of a child’s development.

The public health functions that the DH has delegated to NHS England are set out in an agreement made under section 7a of the NHS Act 2006. There is also a detailed service specification for child public health services. Both of these documents are available on the GOV.UK page on public health commissioning in the NHS.

Local authorities

Outside the clinical arena, the key responsibility for improving the health of the local population, including reducing inequalities, rests with democratically accountable upper tier and unitary health authorities – The Health and Social Care Act, 2012.

Elected members in local authorities have key leadership roles in public health at the local level.

Public health teams formally transferred from the NHS to local authorities in April 2013. Local authorities now have lead responsibility for commissioning public health services and have a ring-fenced budget for this purpose.

Roles and responsibilities

Local authorities have a mandatory duty to provide the following services:

  • weighing and measuring children
  • health check assessments
  • sexual health services
  • public health advice services.

Beyond this, they are free to decide what other public health services are needed to improve the health of their local population.

It is important to note that accident prevention is one of the 17 key areas identified as a responsibility for local authorities within the new public health framework.3

Local authority public health teams are responsible for commissioning any public health services for 5-24 year olds, including the Healthy Child Programme which incorporates child safety. They can also commission additional public health services for under fives outside of the three main programmes that are currently led by the NHS England.

Despite the split in commissioning responsibilities for 0-4s and 5-24s, local authorities have lead responsibility for delivering on the Public Health Outcomes Framework indicator to reduce hospital admissions from unintentional and deliberate injuries for the whole 0–24 age group, with support from other partners in the public health system.

Directors of Public Health

Every local authority now has a Director of Public Health whose role it is to champion public health improvement across all areas of the local authority’s business and with local partners. The Director of Public Health is a statutory member of the Health and Wellbeing Board and is required to support the Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS) process. Identifying and acting upon local child accident prevention needs forms an important part of this process.

How Making the Link can help you

Making the Link is here to support people with a role to play in child accident prevention throughout England. We recognise that effective child accident prevention programmes and strategies happen through successful partnership working.

We’d like to hear about the work you’re doing in your area and what’s worked well, so that we can share the information with other professionals on the Making the Link site.

Email us at to:

  • submit case studies about your child accident prevention work
  • suggest ideas for Making the Link resources that you would find helpful
  • find out more about the project or any of the information on our website. 

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Useful links

Making the Link site links

External links

Download this topic briefing as a PDF

Notes for this feature

  1. Healthy Lives, Healthy People: update and way forward, Department of Health, July 2011
  2. Improving outcomes and supporting transparency. Part 1A: A public health outcomes framework for England, 2013-2016. November 2013
  3. P Edwards et al, Deaths from injury in children and employment status in family: analysis of trends in class specific death rates, BMJ, 2006
  4. Hippisley-Cox et al, Unintentional injury increases with deprivation, BMJ, 2002
Updated January 2014