Unintentional injuries in children and young people - a national perspective Bristol Health Partners and CIPIC – September 2014 Eustace de Sousa Deputy Director Children, Young People and Families

Presentation themes Why do unintentional injuries matter? - numbers: people, £££ and healthcare pressures - inequalities - level of preventability Whose responsibility is to it prevent and reduce injuries? - what are the incentives to act? - unintended consequences e.g. lower levels of walking to school, play and more worried parents? What more can be done? - your expertise and thoughts? 2

Two main areas of focus PHE recently published two national reports and resources: UIs of under five year olds Road traffic UIs of under 25s Analysis of key data between 2008 and

Injuries to under fives Most unintentional injuries for children under five years take place in and around the home. Average of 62 died each year across England between 2008 and There were approximately 40,000 emergency admissions a year between 2008/ /13. These injuries result in c.452,000 visits to A&E a year. 4

Numbers of hospital admissions for unintentional injuries, by age group and year Reducing unintentional injuries in and around the home among children under five years Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 5

Hospital admission rates by deprivation quintile for unintentional injuries among under fives, with 95% confidence intervals, 2012/13 Reducing unintentional injuries in and around the home among children under five years Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 6

Causes of emergency hospital admissions and deaths for children under five years Falls lead to most admissions Some causes are more lethal than others Emerging hazards 7

Costs: the economic case for prevention The personal costs can be devastating with significant lasting physical and emotional effects – impact on learning, employment and family relationships. There are high financial costs – severe bathwater scalds incur c.£189,000 lifetime medical costs. A severe traumatic brain injury for a 3 year old costs c.£4.89m including medical, educational, social care, missed employment etc The wide range of costs local authorities incur that are related to individual unintentional injuries are not well documented.. 8

Road safety Between 2008 and 2012, across England there were 2,316 deaths and 35,783 serious injuries recorded by the police among road users under the age of 25 In total there were 322,613 casualties of all severities recorded by the police. There were 68,657 emergency admissions to hospital as a result of road traffic injuries. 9

Killed or seriously injured | rate per 100,000 population | by age band and year | 2008 to 2012 Traffic injuries to children and young people Source: DfT, Reported Road Casualties Great Britain (STATS19) 10

Pedestrian KSI | rate per 100,000 population | by age band and IMD quintile | Traffic injuries to children and young people Source: DfT, Reported Road Casualties Great Britain (STATS19) 11

Child pedestrian KSI | 0-16 years | by hour of the day | Traffic injuries to children and young people Source: DfT, Reported Road Casualties Great Britain (STATS19) 12

Costs: the economic case for prevention In their valuation of traffic injuries, the Department for Transport estimate the average medical and ambulance cost to the NHS to be around £14,000 for every serious injury. Injury can have a wide and long-term impact on health that includes stress, physical disability, cognitive or social impairment, and lower educational attainment and employment prospects. Social care costs that are borne by local authorities. Taking these into account the cost of all severe traumatic brain injuries in one year is between £640 million and £2.24 billion Safe roads can also have wider benefits where they encourage active travel. 13

3 key local actions Home Safety 1.Providing leadership and mobilising existing services prevents injuries 2.The early years workforce needs support and training to enable it to strengthen its central role in helping to reduce unintentional injuries 3.Focusing on five kinds of injuries for the under-fives makes sense Road Safety 1.Improve safety for children travelling to and from school 2.Introduce 20mph limits in priority areas as part of a safe system approach to road safety 3.Action to prevent traffic injury and improve health must be co-ordinated 14

Key Prevention Opportunities – under fives (1) Mobilising existing services prevents injuries Preventing unintentional injuries does not require major new investment; much can be achieved by mobilising existing services, building on strengths and developing capacity – co-ordination is key. Helping to put unintentional injury prevention of everyone’s agenda Broader partnership working across the public, private and voluntary and community (VCS) sectors is essential. 15

Key Prevention Opportunities – under fives (2) The early years workforce needs support and training to enable it to strengthen its role in helping reduce unintentional injuries Key groups such as health visitors, children’s centres and staff in projects and programmes working with under fives need specific training and support/management - to help increase knowledge and skills about what matters and what makes a difference. Making every contact count. 16

Key Prevention Opportunities – under fives (3) Focusing on five kinds of injuries for the under fives makes sense. 17 Choking, suffocation & strangulation FallsPoisoning Burns & scaldsDrowning

Key Prevention Opportunities – road safety 1) Improve safety for children travelling to and from school There is the potential to create a safer road environment on routes to and from school. School travel plans are a way to encourage safe walking and cycling on journeys to and from school. They can be integrated with other approaches such as school route audits, engineering measures, Bikeability cycle training, and enforcement activities. There are opportunities to address road safety issues from key stage 1 of the national curriculum and in personal, social and health education (PHSE). 18

Key Prevention Opportunities – road safety 2) Introduce 20mph limits in priority areas as part of a safe system approach to road safety Local authorities have powers to introduce 20mph speed limits and there is strong public support for 20mph limits. Lower speeds reduce the number of crashes and make a fatal injury unlikely in a collision between a car and a pedestrian or cyclist. On higher speed roads, segregation of road users can prevent human errors from resulting in a fatal injury. 19

Key Prevention Opportunities – road safety 3) Action to prevent traffic injury and improve health must be co- ordinated. Physical inactivity increases the risk of heart diseases and stroke, diabetes, breast and colon cancer, falls in older age, and depression, dementia, and anxiety. Walking and cycling are often the most convenient ways for people to be physically active during day, however the fear of injury can put people off doing so. The planning and evaluation of road safety activities should consider the potential positive impact on other health issues. Closer working can be fostered between transport and public health teams. 20

Inequalities Underpinning all of this is the major health inequalities in child traffic injuries that must be considered in each of these three actions. There would be around 800 fewer serious or fatal injuries to child pedestrians annually, and 136 fewer serious or fatal injuries to child cyclists, if all children had a risk of injury as low as children in the least deprived areas. Local authorities can develop their road safety partnerships to encourage better use of resources and put this issue onto the agenda for more departments. Actions to prevent injury should be universal, but also be proportionate to the risk in each group. 21

What next? Opportunities through the transfer of commissioning for health visiting service to local authorities from October 2015? How can we help parents, children and young people stay safer? How can we make better use of services and service level data? 22

Resources PHE reports and detailed analysis on slides at accidents-to-children-and-young-people-in-the-home-and-on-the-roads accidents-to-children-and-young-people-in-the-home-and-on-the-roads Local authority level under-fives injury profiles at Local authority level road traffic injuries’ profiles at 23