Injuries

Childhood injuries are the leading cause of avoidable death and disability. It is one of the most common reasons for admissions to hospital (Audit Commission 2007).

There is strong evidence to show that injuries to children and young people are more likely in more deprived communities. People from poorer communities are more likely to die as a result of unintentional injury. Nationally, although the number of accidental deaths has fallen in recent years, the rate of deaths among the poorest children has risen.

Childhood injuries are accepted as an inevitable part of usual child development. Although protecting children and young people from every perceivable harm would be impossible, there is evidence to suggest that a large proportion of unintentional and intentional injuries are preventable.

The cost of childhood injuries to the NHS is estimated to be £2.2 billion. The wider costs to the NHS associated with domestic injury is estimated to be in the region of £25 billion (this includes indirect costs such as days lost to education, parents and carers taking leave from the workplace and the psychological effects caused by some injuries). (Audit Commission, 2007)

There are two million visits to A&E departments in the UK each year as a result of unintentional childhood injuries (Audit Commission 2007)

The need to rebalance normal development and preventing serious injury was highlighted in a 2009 government review. Preventing childhood injuries is an important public health priority and has been identified by the government within the Public Health Strategy ‘Healthy Lives Healthy People (DH 2010). Hospital admissions due to unintentional and deliberate injury have been included as an indicator within the Public Health Outcomes Framework (DH 2012).

This topic is most closely linked to:

Education

Housing

Transport

Poverty

Last updated: 2015-09-09 10:30:34
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1. What are the key issues?

In 2013/14, 60.2% of 5-year-olds were school ready; this is slightly lower than the England average (60.4%).

In 2012, 29.8% of children (under 16 years) in Hartlepool were living in poverty; this is significantly worse than the England average (19.2%).

In 2013/14, the rate of children and young people (0-4 years) admitted to hospital as a result of unintentional or deliberate injury in Hartlepool (196.2 per 10,000) was significantly worse than the England average (140.8 per 10,000).

In 2013/14, the rate of children and young people (0-14 years) admitted to hospital as a result of unintentional or deliberate injury in Hartlepool (154.0 per 10,000) was significantly worse than the England average (112.2 per 10,000).

In 2013/14, the rate of young people (15-24 years) admitted to hospital as a result of unintentional or deliberate injury in Hartlepool (171.1 per 10,000) was significantly worse than the England average (136.7 per 10,000).

The five most common injuries that result in a hospital admission in Hartlepool are:

  • Falls;
  • Exposure to inanimate forces;
  • Exposure to animate forces;
  • Unspecified factors; and
  • Poisoning.
Last updated: 09/09/15

2. What commissioning priorities are recommended?

2012/01

Ensure unintentional injury is included in local plans and strategies.

2012/02

Ensure adequate resources are available for local partnerships and prevention strategies.

2012/03

Ensure that in local plans, the home safety assessments and education is aimed at vulnerable families with a child under-5 years old.

2012/04

Local plans should consider outdoor play, leisure and road safety.

2012/05

Consider housing associations and landlords as key partners.

2012/06

Develop a standardised data collection method that enables sharing within and between organisations.

2012/07

Improve identification of vulnerable families and strengthen planning and co-ordination of prevention activities.

2012/08

Develop guidelines for management and pro-active follow-up of childhood injuries.

2015/01

Maintain the profile for the recording and monitoring of unintentional injuries in local plans and strategies .

2015/02

Integrate home, water, personal, internet and road safety into core business delivered by partners.

2015/03

Identify the key pathways to addressing preventable injuries to children and young people.

2015/04

Identify a robust strategy and mechanism for addressing the safety of the most vulnerable.

2015/05

Identify and deliver targeted interventions to those families and young people most at risk through data analysis.

2015/06

Develop a coordinated project of safety awareness programmes to families, individuals, to schools and communities involving all agencies to deliver road, internet, water, fire and home safety intervention programmes.

2015/07

Establish a reporting framework where all safety related activities are recorded, reported and measured.

2015/08

Set key performance indicators for the reduction in the number of children and young people receiving care as a result of an unintentional and deliberate injury.

2015/09

Enhance existing partnerships and establish a new coordination and delivery group of strategic leads and practitioners and ensure that these groups are suitable resourced.

2015/10

Establish a medium for the promotion of safety awareness messages using community workers, digital media, press and public relations and the internet.

2015/11

Develop bespoke safety awareness related resources to be used in schools and in families for parents, teachers and children to use.

Last updated: 09/09/15

3. Who is at risk and why?

Age

Of all the children admitted to hospital as a result of an injury, the under 5-year-olds represent the highest proportion.

Gender

A higher proportion of males are admitted to hospital as a result of injury than females.

Disability

Children with a disability or impairment (particularly sensory impairments) are at a higher risk of injury (HDA 2005).

Socioeconomic status

There are persistent and widening inequalities between socioeconomic groups for childhood deaths from accidents (Audit Commission 2007). Children who are affected by poverty are twice as likely to live in poor housing conditions which have significant effects on physical and mental health and educational attainment. (Shelter 2006)

Children whose parents have never worked (or are long-term unemployed) are thirteen times more likely to die from an unintentional injury compared to children whose parents are in a higher managerial role (Edwards et al 2006).

There is a higher incidence of injury amongst under 18-year-olds from vulnerable groups.

A higher proportion of children from deprived areas are admitted to hospital than more affluent areas.

Environment

Children living in accommodation which potentially puts them at risk (including multiple occupied housing and social and privately rented housing) are at a higher risk of being injured (NICE 2010).

Last updated: 09/09/15

4. What is the level of need in the population?

The chart below shows that the proportion of children (under 16s) in poverty is Hartlepool is significantly worse than the England average. This has been the case for at least the last 6 years. The gap between Hartlepool and England appears to be widening.

The chart below shows that the rate of Hospital admissions caused by unintentional and deliberate injuries in children (aged 0-4 years)  who are residents of Hartlepool is significantly worse than the England average. This has been the case for at least the last 4 years.

The chart below shows that the rate of Hospital admissions caused by unintentional and deliberate injuries in children (aged 0-14 years) who are residents of Hartlepool is significantly worse than the England average. This has been the case for at least the last 4 years. The gap between Hartlepool and England appears to be widening.

The chart below shows that the rate of Hospital admissions caused by unintentional and deliberate injuries in children (aged 15-24 years) who are residents of Hartlepool is significantly worse than the England average. This has been the case for at least the last 4 years. However, the gap between Hartlepool and England appears to be narrowing.

Between 2013/14 and 2014/15, there were 513 admissions to hospital as a result of unintentional injuries for children under the age of 18 years (See below chart).

Source: NECSU

The chart below shows the rate of admissions to hospital for unintentional injuries for under 19-year-olds by electoral ward Hartlepool; in order of deprivation score (IMD 2010). The linear trend on the above chart shows that the more deprived the ward is, the greater chance there is of a child or young person being admitted to hospital.

 

Source: NECSU

The chart below shows the rate of admissions to hospital for unintentional injuries for under 19-year-olds who are residents of Hartlepool, split by single year of age. It shows that the younger the child is, the more likely they are to be admitted to hospital for an injury.

Source: NECSU

The table below shows the number of admissions to hospital for unintentional injuries for under 18-year-olds who are residents of Hartlepool, split by diagnosis. It shows that the most popular diagnosis for and admission is due to a fall, followed by injury due to inanimate forces.

Source: NECSU

Last updated: 09/09/15

5. What services are currently provided?

Children’s centres

PATCH (Parent And Toddler Care Hartlepool) are responsible for overseeing the ROSPA (Royal Society for the Prevention of Accidents) home loan scheme which offers free supply and fitting of home safety equipment. These families are also referred to Cleveland Fire Brigade for home fire safety advice and free smoke alarm fitting.

Parent safety classes have been delivered to parents in Hartlepool within children’s centres and with support from the Hartlepool council adult education department. The classes attended by parents are around home, internet, fire, water and road safety.

A fixed Sure Start referral process is in place in Hartlepool, where midwives seek consent to share patient details so that all eligible women are registered prior to birth. This ensures that promotional material can be sent out at the time of birth. There is also a teenage parent pack for under 18-year-olds which is funded from a variety of sources.

Schools and universal settings

School travel plans School Safety Awareness Events

Most schools have a travel plan (including a road safety element).  School travel plans can be used as a lever for addressing accident/safety issues. The yearly refresh process is an opportunity to raise any issues relating to injuries. They also introduce or enhance prevention strategies such as cycle training. Annually, all schools are invited to attend ‘Crucial Crew’ which is an interactive safety event involving partner agencies to deliver home, personal, water, fire, road and building site safety messages in a series of workshops. Over 1200 pupils attend the event each year.

Pedestrian and cycling training

Pedestrian cycle training is offered to all primary schools and all programmes are led by the local authority. Cycling training is offered to all primary and secondary schools.

Integrated youth services

Injury prevention was not a core issue addressed by integrated youth service teams though some ad-hoc exposure to first aid courses does take place.

Last updated: 09/09/15

6. What is the projected level of need?

There are currently no projected levels of need.

Last updated: 09/09/15

7. What needs might be unmet?

Pedestrian and cycling training

Not all schools take up the offer, if all schools did positively respond to the offer it would be unlikely that local authority would have the capacity to deliver in all schools.

Pedestrian training is no longer delivered in schools and this is seen as an integral element of reducing child road casualties and promoting walking to schools which impacts on the longer term health and fitness of pupils.

Teenagers and young drivers

Teenagers continue to be a concern in terms of their casualty risk. This is an area where it is difficult to deliver safety messages. The use of theatre is seen as one of the best methods of improving the safety of this road user group.

Young drivers are over represented in all casualty statistics and continue to pose a significant risk as drivers and passengers. The development of a pre-driver and post-test safety awareness programme would address the issues faced by this vulnerable road user group.

Parents as a protective factor

Due to funding constraints, the continued delivery of parental safety awareness classes ceased. These classes, targeted at the most vulnerable, deliver basic home, water, fire, internet and road safety messages and are seen as the most effective method of delivering education direct to those families posing the greatest safety risk.

Publicity, marketing, events and awareness campaigns

There is currently no co-ordinated and structured way of delivering safety awareness messages to schools, children & young people, families and communities. The promotion of safer practices is seen as vital to addressing injury prevention in Hartlepool.

Home loan safety equipment

Due to funding reductions, PATCH (Parent And Toddler Care Hartlepool) are ceasing to deliver their home loan safety equipment scheme. This schemes provides vulnerable families with home safety equipment to reduce the risk of injuries to children. Therefore, particularly with vulnerable families, there is an increased risk of injury to children and young people as a result of slips, trips, falls, burns, scalds etc.

Last updated: 09/09/15

8. What evidence is there for effective intervention?

There are many core resources that provide guidance on the effectiveness of methods for injury prevention, treatment and rehabilitation.

Public Health England

Reducing unintentional injuries on the roads among children and young people under 25 years.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/322210/Reducing_unintentional_injuries_in_and_around_the_home_among_children_under_five_years.pdf

Reducing unintentional injuries in and around the home among children under the age of five years.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/322210/Reducing_unintentional_injuries_in_and_around_the_home_among_children_under_five_years.pdf

England injury information resources guide

The South West Public Health Observatory provides a guide to national strategies and policies as well as a variety of injury statistics and costs.

http://www.swpho.nhs.uk/resource/item.aspx?RID=63592

Injury Observatory for Britain and Ireland (IOBI)

IOBI is an international collaborative venture representing public health observatories from Wales, Scotland, Ireland, and regions of England. It is managed by a steering group of public health professionals committed to injury prevention.

http://www.injuryobservatory.net/

Collaboration for Accident Prevention and Control (CAPIC)

IOBI works closely with other injury prevention websites, most notably CAPIC, based in the Welsh School of Medicine.  CAPIC reviews the scientific literature to identify all the relevant studies across the world, appraise the quality of the studies and summarise the findings of those meeting a quality threshold. There are often several reviews on a particular topic. CAPIC aims to include all the reviews and not just the recent on the focus and inclusion and exclusion criteria can differ between reviews

http://www.capic.org.uk/

National Institute for Health and Clinical Excellence (NICE)

NICE develops guidance to support health and social care professionals to make sure that care provided (including primary prevention) is of the best quality.  The guidance is intended for use by the NHS, local authorities, charities and anyone with commissioning healthcare, public health or social care services.

A list of NICE resources for injuries, accidents and wounds is available.

http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7280&set=true#/search/?reload

Specific public health guidance has recently been published for three topics:

1. Strategies to prevent unintentional injuries among the under-15s (PH29)

http://publications.nice.org.uk/strategies-to-prevent-unintentional-injuries-among-the-under-15s-ph29

2. Preventing unintentional injuries among under-15s in the home (PH30)

http://publications.nice.org.uk/preventing-unintentional-injuries-among-the-under-15s-in-the-home-ph30

3. Preventing unintentional road injuries among under15s: road design (PH31)

http://publications.nice.org.uk/preventing-unintentional-road-injuries-among-under-15s-ph31

Strategies to prevent unintentional injuries among children and young people aged under 15: Evidence Update (2013)
Available from: www.nice.org.uk/nicemedia/live/13272/66798/66798.pdf

EUROSAFE

The European Association for Injury Prevention and Safety Promotion runs the Effective Measures in Injury Prevention (EMIP) Programme. EMIP produces short evidence statements on effective injury prevention interventions for practitioners.

http://www.eurosafe.eu.com/csi/eurosafe2006.nsf/wwwVwContent/l2effectivemeasures.htm

Royal Society for the Prevention of Accidents (ROSPA)

ROSPA is a registered charity at the heart of accident prevention in the UK for almost 100 years. It promotes safety and the prevention of accidents at work, at leisure, on the road, in the home and through safety education.

http://www.rospa.com/about/default.aspx

Childhood Accident Prevention Trust (CAPT)

CAPT is the leading charity in the UK working to reduce the number of children and young people who are killed, disabled or seriously injured in accidents.

http://capt.org.uk/

There are several of guidance documents which highlight the following approaches:

  • Legislation;
  • Environment changes;
  • Use of safety equipment;
  • Education;
  • Skill building; and
  • Multi-faceted approaches.

Making the Link (CAPT supported by the Department for Transport)

Making the Link provides tools to encourage effective partnership working to reduce deaths and hospital admissions from child accidents. http://www.makingthelink.net/

Provide support with:

  • Policy
  • Data and Statistics
  • Commissioning
  • Strategy

Wood, S., Bellis, M.A., Towner, E. and Higgins, A. (2010) ‘Childhood Injuries: A review of evidence for prevention’

NICE Public Health Guidance, 29, 30 and 31

Last updated: 09/09/15

9. What do people say?

There have been no local consultations about childhood injuries. This is an item for development.

Last updated: 04/01/13

10. What additional needs assessment is required?

Further and more detailed analysis of the reasons for admissions is required, particularly for those in the young age range and those admissions that last less than 24 hours.

Last updated: 04/01/13

Key contact: Paul Watson

Job title: Road Safety Section Manager

e-mail: paul.watson@durham.gov.uk

Phone number:  03000 268166

References

Local strategies and plans, with dates

Healthy Lives Healthy People DH 2010

PH Outcomes Framework

CYPP M’bro H’pool Stockton, R&C

Wood, S., Bellis, M.A., Towner, E. and Higgins, A. (2010) ‘Childhood Injuries: A review of evidence for prevention’

NICE Public Health Guidance, 29, 30 and 31

www.capt.org.uk

Brown G and Thomas E.  Unintentional and deliberate injuries to children (in Teesside). NHS Tees, October 2010.

http://www.teespublichealth.nhs.uk/Download/Public/1012/DOCUMENT/9754/Childood%20Injuries%20in%20Teesside%202010.pdf