Unintentional injuries: prevention strategies for under 15s

Local authority children's services and their partnerships, in consultation with local safeguarding children boards.

Government departments with a responsibility for preparing policy and plans relating to children and young people's health and wellbeing.

Ensure local and national plans and strategies for children and young people's health and wellbeing include a commitment to preventing unintentional injuries among them. In particular, the plans and strategies should aim to prevent unintentional injuries among the most vulnerable groups to reduce inequalities in health. This commitment should be part of a wider objective to keep children and young people safe.

Ensure plans and strategies include the following to prevent unintentional injuries among children and young people:

Local authorities should report to the local strategic partnership on progress made to meet the commitments set out in the plans and strategies. This should include details on the experiences of children, young people, their parents and carers.

Local authority children's services and their partnerships, in consultation with local safeguarding children boards.

Local highway authorities and their road safety partnerships.

Other local authority services that may have a remit for preventing unintentional injuries such as education, environmental health and trading standards.

Ensure there is a child and young person injury prevention coordinator. The aim is to help achieve the commitments set out in local plans and strategies for children and young people's health and wellbeing. The coordinator could be someone in the local authority, an NHS organisation or another local partner organisation (such as the fire and rescue service or a housing association). Alternatively, the coordinating role could be jointly funded by several local partners.

Ensure the coordinator:

Ensure the coordinator understands the range of preventive measures available and is trained – and has the skills – to carry out the above activities. Provide them with both informal and formal learning opportunities. (The former could include using peer support and 'cascade learning' within placements. The latter could include the acquisition of qualifications at different stages of a formal career pathway.)

Ensure specialist learning and training is monitored and evaluated to see what effect it has on the coordinator's performance. Revise approaches that are found to be ineffective.

Staff in emergency departments and minor injuries units, including triage nurses.

Local child and young person injury prevention coordinators.

Local safeguarding children boards.

Liaison health visitors.

Staff offering out-of-hours health services for children and young people (for example, in walk-in centres).

Faculty of Public Health.

Royal colleges and professional bodies (for example, the Nursing and Midwifery Council).

Health and Care Professions Council.

Sector skills councils.

Relevant voluntary sector organisations.

Universities.

Develop professional standards for unintentional injury prevention. These should take into account the different roles and responsibilities of professionals working within and outside the NHS. They should also take practitioners' views into account.

Ensure all relevant organisations incorporate these standards into their professional skills development programmes.

Department of Health and Social Care.

Department for Education.

Local authority children's services and their partnerships, including local safeguarding children boards.

Local injury prevention coordinators.

Commissioners, managers and practitioners working in health, social care and education services.

Relevant organisations in the voluntary and private sector.

Provide access to appropriate education and training in how to prevent unintentional injuries for everyone who works with (or cares for and supports) children, young people and their families. Prioritise those who work directly with children, young people and their families.

Ensure the education and training:

Ensure specialist education and training is monitored and evaluated to see what effect it has on practitioner performance. Revise approaches that are found to be ineffective.

College of Emergency Medicine.

Government departments including Department of Health and Social Care and Public Health England, Department for Education, Department for Transport, Ministry for Housing, Communities and Local Government and the Home Office.

Office for National Statistics.

The Information Centre for Health and Social Care.

Establish a national injuries surveillance resource covering all populations and injuries to help monitor injury risks and the effects of preventive measures. It could be provided by a network of agencies but there should be a single point of contact or a coordinating agency. The resource could be part of the proposed information revolution, see the Department of Health's: An information revolution.

Ensure the resource includes local, regional and national injury datasets and data sources. For example, it should include data gathered from: emergency departments, walk-in centres, minor injury units, Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR), Hospital Episode Statistics (HES), coroner reports, ambulance call-out reports, fire and rescue service reports, reported road casualty statistics (STATS19) and the child death review process (as data become available).

The coordinating agency or network of agencies should:

Ensure national guidance on data-sharing protocols is adopted by all agencies that collect local injury data. This includes: ambulance services, child death overview panels, coroners, emergency departments, fire and rescue services, the Health and Safety Executive and police forces. See the NHS Information Governance Toolkit and the Department of Health's: NHS information governance guidance on legal and professional obligations. Also, see HM Government: Information sharing advice for safeguarding practitioners.

Promote the development of an enhanced national emergency department dataset based on submissions from a representative sample of hospitals. Ensure it includes additional data on events and activities leading to an injury. Such a dataset is being piloted by the Department of Health and the College of Emergency Medicine. It contains similar detail to that previously collected for the Home and Leisure Accident Surveillance Systems [HASS/LASS] and the results are presented as anonymised, aggregated data.

Ensure all hospital trusts are made aware of the data collection requirements for the universal and mandatory A&E (minimum) commissioning dataset.

Ensure commissioning contracts for emergency departments (including minor injury units and walk-in centres) stipulate that all required data are collected – and to the required A&E (minimum) commissioning dataset standard. Contracts should also stipulate which data collection and submission methods should be used.

Ensure contracts include financial penalties for failure to meet the requirements of the A&E (minimum) commissioning dataset.

Ensure all hospital trust injury data are submitted to the NHS Information Centre for Health and Social Care.

Consider developing local agreements with housing associations and landlords to ensure permanent home safety equipment is installed and maintained in all social and rented dwellings. Priority should be given to accommodation where children aged under 5 are living. Use the Housing Health and Safety Rating System (HHSRS). Permanent safety equipment includes:

Publicise any local agreements to install and maintain permanent safety equipment. Provide information about these agreements to the following groups and evaluate their awareness:

Department of Health.

Department for Education.

Ensure home safety assessments and education are incorporated in local plans and strategies for children and young people's health and wellbeing. They should be aimed at families with a child under 5 or with other children who may be particularly vulnerable to unintentional injuries.

Commission local agencies to offer home safety assessments and, where appropriate, supply and install suitable, high quality home safety equipment (whenever possible, adhering to British or equivalent European standards.)

Ensure commissions specify that the assessment and the supply and installation of equipment needs to be tailored to meet the household's specific needs and circumstances. Factors to take into account include the developmental age of the children and whether or not a child or family member has a disability. Cultural and religious beliefs, whether or not English is the first language and levels of literacy within the household also need to be noted. In addition, the level of control people have over their home environment and the household's perception of, and degree of trust in, authority should be taken into account. Many people may not have the authority to agree to an installation, for example, tenants of social and private landlords and those who are unable to make household or financial decisions.

Ensure commissions specify that the assessment needs to help parents, carers, older children and young people identify and address the potential risks from water in the home (this includes baths and garden ponds). For example, advice from the National Water Safety Forum and leaflets and booklets from the Child Accident Prevention Trust.

Ensure commissions specify that education, advice and information is needed both during a home safety assessment and during the supply and installation of home safety equipment. This should emphasise the need to be vigilant about home safety and explain how to maintain and check home safety equipment. It should also explain why safety equipment has been installed – and the danger of disabling it. In addition, commissions should specify that useful links and contacts need to be given to householders as part of this provision, in case of a home safety problem.

Head teachers and school governors.

Local strategic partnerships.

Play and leisure providers in the public, private, voluntary and community sector. This includes representatives of the leisure industry, parish and town councils and early years services. It also includes private providers of outdoor play facilities that are open to the public, such as pubs and hotels.

Public, private, voluntary and community sector managers and decision makers responsible for play and leisure policies.

Ensure a policy is in place which:

Use local information and data on environments, equipment and behaviour that pose a risk of serious unintentional injury to help plan prevention initiatives. Include information and data provided by practitioners, play and leisure providers, children, young people, their parents and carers.

Focus prevention initiatives on groups most at risk of an unintentional injury. Initiatives could include modification of equipment and the environment, and the provision of information, education and safety equipment.

Take into account the principles of British and European standards covering equipment and the environment (where they exist) as part of a risk-benefit assessment of outdoor play and leisure environments. This includes standards covering playgrounds, fairgrounds, toy safety and swimming pools, as well as those for inspection and maintenance.

Where equipment and the environment cannot be modified, provide information, advice and education about risk management and the use of any appropriate safety equipment.

Injury prevention coordinators and health practitioners (for example, health visitors and school nurses).

Lifeguards.

Outdoor activity and holiday centre managers.

Schools.

Swimming instructors.

Swimming pool managers.

Know which groups of children and young people are at high risk of drowning – and when that risk is increased. For example, children with certain medical conditions may be more at risk and boys are more likely to be at risk than girls. In addition, older children are more likely to drown outside the home.

Provide children, young people, their parents and carers with information and education on water safety in play and leisure environments (for example, advice from the National Water Safety Forum, the RoSPA water safety code for children and the Child Accident Prevention Trust). The information provided should be appropriate to the age, developmental stage and experience of the child or young person and meet the household's particular needs and circumstances. It should be readily available in a suitable format. It should also be factually correct and consistent.

Ensure the information and education:

Provide timely information and advice, for example, during the holiday season and for dealing with conditions such as heatwaves and extreme cold. (Ice might form on ponds, rivers and lakes during extreme cold spells.) This could include clearly displayed information at appropriate locations.

Encourage children, young people, their parents and carers to become competent swimmers and to learn other water safety skills (for example, so that they know how to effect a rescue).

Ensure swimming lessons include general and specific water safety information. Specific information could include detail on the meaning of different coastal warning flags. It should also raise children and young people's awareness of how difficult it is to assess and manage the hazards posed by water in a range of different outdoor environments.

Use risk analysis and management procedures to identify where there may be a risk of drowning. Minimise that risk, wherever possible, without discouraging swimming.

Provide water safety information in a range of languages and formats. This could include clearly displayed information at appropriate locations. Ensure provision is timely. For example, ensure it is provided during the holiday season and in extreme weather conditions such as heatwaves and extreme cold. (Ice might form on ponds, rivers and lakes during extreme cold spells.)

NHS and other health organisations.

Local authorities.

Schools and school travel advisers.

Injury prevention coordinators.

Police.

Retail outlets and cycle hire centres.

NHS, other health organisations and local authorities should use local information campaigns and ongoing education to encourage cycle training and promote the use of correctly fitted and fastened cycle helmets while cycling off the road. Campaigns could focus on younger children learning to cycle, for example in gardens and parks, and on older children and young people who go BMX racing or mountain biking. The campaigns could suggest that adults set an example by wearing helmets whenever they cycle.

Schools, school travel advisers, injury prevention coordinators, local authorities and the police should ensure travel plans cover off-road routes. They should also encourage children and young people to undertake cycle training and to wear cycle helmets.

Retailers should provide point-of-sale advice on the correct fitting of cycle helmets (this includes online sales). They should also consider setting up a certified retailer scheme like that run by the British Equestrian Trade Association.

Cycle hire centres should advise about the advantages of children and young people wearing correctly fitted and fastened cycle helmets. They should provide them if requested.

Environmental health officers.

Fire service.

Clinical commissioning groups and hospital trusts.

Injury prevention coordinators.

Local authority children's services and their partnerships.

Police.

Schools.

Trading standards officers.

Use emergency department surveillance data to inform local firework injury prevention campaigns.

Conduct local firework injury prevention campaigns (See Department for Business, Energy and Industrial Strategy: Firework safety: be media wise) during the lead up to all celebrations and festivals where fireworks are used. This includes Bonfire Night, New Year and Diwali. Use the principles of NICE's guideline on behaviour change to inform campaign planning, delivery and evaluation. Evaluate the effectiveness of campaigns.

Trading standards officers should ensure adults are given the firework safety code when they buy fireworks, as a condition of the licence to store and sell fireworks. The code should be available in a range of languages and formats.

Maintain the existing road safety partnership (or establish one where none exists) to help plan, coordinate and manage road safety activities. It should include the road safety team, fire and rescue services, the injury prevention coordinator, the NHS, police, local education authorities and local safeguarding children boards.

Ensure the health sector plays an active role in the partnership (see NICE's guideline on unintentional injuries on the road: interventions for under 15s).

Nominate a member of staff who is responsible for road safety partnership work.

Work with the partners listed in the first action point above, children and young people's services, relevant voluntary sector organisations and others to identify and manage road environments that pose a high risk to children and young people.

Secure funding streams for local road safety initiatives and support these partnerships by promoting good practice.

Ensure the road safety partnership develops policies, strategies and programmes which are based on an understanding of how children and young people use (and wish to use) their environment. This involves consulting parents and carers about their children's road use and safety. It also involves gaining local information from other professional partnerships, children's councils and neighbourhood forums.

Ensure the road safety partnership draws on all available information (such as demographics and risk-exposure data) to plan road injury reduction programmes, as part of the local community safety strategy. The programmes should take into account how injury risk differs according to age and road type. They should also reflect the increased risks facing children and young people from disadvantaged areas and communities.

Evaluate programmes using a range of outcome measures, including road injury data. A variety of evaluation methods should be used, such as controlled trials, 'stepped-wedge' trials (sequential rollout to all participants) and process evaluations.

Ensure local child road safety reviews are carried out at least every 3 years. To ensure consistency within regions, ensure they include the following:

Ensure local children and young people, particularly those from disadvantaged communities, are consulted about their road use and their opinions about the risks involved. In addition, consult parents and carers about their children's road use and safety.

Use the reviews and consultation findings to inform local initiatives to reduce road injuries among children and young people.

Evaluate the impact of initiatives on local policies (including health inequalities policy), practice and injuries.

Local authority children's services and their partnerships, in consultation with local safeguarding children boards.

Local highway authorities and their road safety partnerships.

Review local partners' priorities and strategies to ensure they are coordinated.

Involve the local injury prevention coordinator in the development of the child road safety review and liaise with them about consultations with the local community.

Ensure consistency between the road injury prevention priorities and strategies within child safety policies, local plans and strategies for children and young people's health and wellbeing, the road safety strategy and local authority community safety plans. (This includes ensuring consistency at all levels within non-unitary organisations.)

Use signage, road design and engineering measures to reduce vehicle speeds on roads where children and young people are likely to be, such as those passing playgrounds or schools (see NICE's guideline on unintentional injuries on the road: interventions for under 15s).

Use signage to warn drivers of the likely presence of children and young people in areas that they frequent (such as schools and playgrounds) and the need to comply with safety measures.

Use national and local education and media campaigns to promote the benefits of safety initiatives – including 20 mph speed limits and zones – in areas frequented by children and young people.

Evaluate compliance with speed limits.

Where evaluation shows that compliance is poor, work with the police to improve it through education and, where necessary, enforcement activities.

Her Majesty's Inspectorate of Constabulary.

The Home Office.

Include road safety and enforcement in Her Majesty's Inspectorate of Constabulary (HMIC) evaluation tools (report cards) to ensure both are considered when police priorities are set.

Encourage the police to work with other local partners (see recommendations 17–20) on road safety issues in relation to children and young people aged under 15. In particular, encourage the police to contribute to driver education initiatives on the need for compliance with speed limits.

Encourage the police to work with the existing road safety partnership (or with relevant agencies if there is no such partnership) to determine areas where vehicle speeds need to be reduced. Draw upon the knowledge of safer neighbourhood teams and the demographic and consultation data within community safety plans to understand local children and young people's use of the road environment.