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: 2016-01-27 12:28:28
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1. What are the key issues?

In 2013/14, 50.2% of 5-year-olds were school ready; this is lower than the England average (60.4%).

In 2012, 21.9% of children (under 16 years) in Stockton-On-Tees 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 Stockton-On-Tees (178.2 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 Stockton-On-Tees (136.4 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 Stockton-On-Tees (172.3 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 Stockton-On-Tees are:

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

2. What commissioning priorities are recommended?

2012/01

Ensure unintentional injury is included in local plans and strategies.

  • Achieved through the Stockton-On-Tees Borough Council Local Children’s plan and Health & Wellbeing Strategy.

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.

  • Ongoing. This is done through children’s centres via home safety workshops and through a targeted outreach scheme aimed at the most vulnerable families in Stockton-On-Tees.

2012/04

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

  • Ongoing. Local plans consider safety and incorporate the appropriate risk assessments.

2012/05

Consider housing associations and landlords as key partners.

  • Progressing. Housing and public health teams currently reviewing the needs of the most vulnerable in private rented stock.

2012/06

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

  • Achieved. Completed by the Tees Valley Public Health Shared Service and North of England Commissioning Service.

2012/07

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

  • Ongoing. The development of the ‘Early Help’ strategy and the children’s plan will support the identification of vulnerable families.

2012/08

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

  • Health visitors receive information on children reporting to A&E and walk-in clinics. Notifications are sent to the child’s health visitor to arrange an appointment. Once seen, the health visitor determines the significance of the attendance and will plan a review if needed.

2015/01

Prioritise the houses that are most at risk, review the BRE housing impact assessment for Stockton-On-Tees and identify an approach to targeted working with families with children under 5 years.

2015/02

Work with key partners (including the fire brigade, LA housing department and the children’s centres) to support targeting of work for children who are the most vulnerable to injuries, in particular those under 5 years.

2015/03

Review opportunities to provide home safety information e.g. school nurses, health visitors, social workers and VCS.

2015/04

Consider key local authority strategies; including the child poverty strategy and the early help strategy, to raise awareness of childhood injury prevention with other key stakeholders.

2015/05

Work with children’s centre volunteers/outreach workers to raise awareness of childhood injury prevention within the community.

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 Stockton-On-Tees is significantly worse than the England average. The gap between Stockton-On-Tees and England appears to be widening each year.

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 Stockton-On-Tees is significantly worse than the England average. This has been the case for at least the last 4 years. However, the gap between Stockton-On-Tees and England appears to be narrowing.

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 Stockton-On-Tees 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 Stockton-On-Tees is significantly worse than the England average. This has been the case for at least the last 4 years. However, the gap between Stockton-On-Tees and England appears to be narrowing.

Between 2013/14 and 2014/15, there were 991 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 in Stockton-On-Tees; 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 Stockton-On-Tees, 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 Stockton-On-Tees, 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

Between 2008 and 2012, 311 children (under 5 years) died from unintentional injuries.

Between 2008 and 2012, 199 children and young people (aged 5 to 14 years) died from unintentional injuries.

Between 2008/09 and 2012/13, the rate of emergency hospital admissions to hospital for children (under 5 years) due to a fall from furniture (268.2 per 100,000) was higher than the England average (149.2 per 100,000).

Last updated: 09/09/15

5. What services are currently provided?

Children’s centres

The Home Safety Loan Scheme is co-ordinated by the children’s centres. It provides free home safety equipment and general safety advice and information to targeted families. There is a dedicated home safety officer who works closely with children identified as vulnerable on an outreach basis.

Each of the children’s centres offers a continuous programme of home safety awareness sessions.

Health visitors follow the healthy child programme working one-to-one with families and take the opportunity to signpost to appropriate services in particular the children home safety scheme.

The Family Nurse Partnership work with vulnerable young mums under the age of 25 to support them, they provide intensive interventions that would support the prevention of childhood injuries.

School travel plans

Most schools in Stockton-On-Tees have a travel plan (including a road safety element).  They 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 and introduce or enhance prevention strategies such as pedestrian and cycle training.

Road safety

Stockton-On-Tees local authority provides a number of programmes to support schools with road safety:

Key Stage 1 Road Show: Approximately 1,800 students have seen the show.

Crucial Crew: Approximately 1700 students participated in this.

Cycle training: This is offered to years 5, 6 and 7.

Child car seats

Approximately 60 car seat checks are carried out each year in Stockton-On-Tees, around 50% of them need readjustment for safety reasons.

Youth direction/public health

Youth direction runs a risk taking behaviour roadshow for year 9 pupils. The roadshow aims to prevent young people from participating in activities that could cause them harm. The roadshow is available to all secondary schools in Stockton-On-Tees.

For further information  about local services, please see:

www.stockton.gov.uk/families

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?

Road safety

Not all the schools in Stockton-On-Tees offer the road safety programme to its pupils. If they all did offer the programme, it would be unlikely that the local authority would have the capacity to deliver it in all the schools.

Homes safety training

This is currently delivery by children’s centres but is not always consistent and the capacity for outreach work is limited.

Private rented stock

There are an increasing number of families living in private rented stock, which is potentially poor quality housing.

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?

Currently no additional needs assessment is required; a Housing Impact Needs Assessment has already been undertaken and work will continue to build on this.

Last updated: 09/09/15

Key contact

Topic lead

Name: Jane Smith

Job title: Children & Young People’s Early Interventions Manager

e-mail: jane.smith@stockton.gov.uk

Phone number: 01642 527237

Topic author

Name: Aisha Waithe

Job title: Projects & Partnerships Officer

e-mail: aishah.waithe@stockton.gov.uk

Phone: 01642 526828

References

Audit Commission/Healthcare Commission (2007) Better safe than sorry: preventing unintentional injury to children. London: Audit Commission

Better safe than sorry. Preventing unintentional injury to children, Audit Commission, 2007

Child Accident Prevention Trust (2008) Child Accident Prevention Trust factsheet: preventing bath water scalds using thermostatic mixing valves. London: Child Accident Prevention Trust

Edwards P, Roberts I, Green J et al. (2006) Deaths from injury in children and employment status in family: analysis