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 10:43:42
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1. What are the key issues?

In 2013/14, 53.6% of 5-year-olds were school ready; this is lower than the England average (60.4%).

In 2012, 25.4% of children (under 16 years) in Redcar & Cleveland 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 Redcar & Cleveland (199.5 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 Redcar & Cleveland (154.1 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 Redcar & Cleveland (220.3 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 Redcar & Cleveland are:

  • Falls;
  • Exposure to inanimate forces;
  • Poisoning;
  • Exposure to animate forces; and
  • Unspecified factors
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

2015/01

Use up to date and relevant data to influence local plans and strategies.

2015/02

Develop a sustainable plan to deliver Road Safety Awareness programme for primary schools.

2015/03

Develop a sustainable plan to ensure Home Safety and Fire Safety checks are carried out in homes of children under 5 years.

2015/04

Publicise and make use of national child safety campaigns.

2015/05

Set targets and measures to reduce the number of accidents.

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 Redcar & Cleveland is significantly worse than the England average. This has been the case for at least the last 6 years. The gap between Redcar & Cleveland 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 Redcar & Cleveland 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 Redcar & Cleveland 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 15-24 years) who are residents of Redcar & Cleveland is significantly worse than the England average. This has been the case for at least the last 4 years.

Between 2013/14 and 2014/15, there were more than 716 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 Redcar & Cleveland; 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 Redcar & Cleveland, 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 Redcar & Cleveland, 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

As well as the Royal Society for the Prevention of Accidents (ROSPA) scheme (which has benefited over 500 families so far), Redcar & Cleveland centres also offer their own safety equipment scheme which gives families the opportunity to purchase equipment at cost price. This is funded by the children’s centres core budget and is available to all parents.

The initial task group that was established to lead on the ROSPA scheme now meets twice monthly and has evolved to take on a wider accident prevention role. Staff at the centres receive annual training provided by the ‘WHOOPS!’ Child Safety Project.

Schools and universal settings

School travel plans

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 and the yearly refresh process is an opportunity to raise any issues relating to injuries and introduce or enhance prevention strategies such as cycle training.

Pedestrian and cycling training

Pedestrian 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. In 2011/12, 3675 children in Cleveland participated in pedestrian training and 2677 participated in cycling training.

Crucial Crew events

Year 6 pupils (10 and 11-year-olds) participate in a variety of scenarios which aim to give the children the chance to learn how to cope with a wide range of safety issues.

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.

Last updated: 04/01/13

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 for less than 24 hours.

Last updated: 09/09/15

Key contact: Julie Everson

Job title: Inspection and Contracts Officer

e-mail: julie-everson@redcar-cleveland.gov.uk

Phone number: 01642 771542

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

Redcar & Cleveland Health and Wellbeing Strategy 2013-2018