Accidents JSNA | Boltons Health Matters
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Accidents JSNA

Abstract

This is the JSNA chapter on childhood accidents. Theme chapters summarise who is at risk and why, the level of need in the population, service provision and use, unmet needs, the evidence base, highlight the key issues and gaps, and provides recommendations for commissioners.

Introduction

Accidents do happen and are part of growing up. Children should always have the opportunity to:-

  • have fun
  • explore their physical and social environment
  • develop friendships and independence
  • gain strength and dexterity
     

However there is a body of evidence to show that many accidents are preventable and the impact of those that do occur can be reduced. Often simple interventions and common sense behaviour can ensure that the environment is safer for us and those around us.

Key Issues and Gaps
  • Bolton's Safeguarding Children's Board (LSCB) has a statutory duty to safeguard and promote the welfare of children, which includes keeping children safe from accidental injury and death.
  • The LSCB has developed an Accident Prevention Strategy and Action Plan and a multi-agency Accident Prevention Steering Group has been formed to oversee the strategy.
  • National Indicator NI 48 measures the number of children killed or seriously injured over a 3 year rolling period. Since 1994 this has reduced from an average of 36, to an average of 16 for the 2006, 2007 and 2008 calendar years. This can, however, be a particularly volatile indicator as one serious motorway incident can affect the averages greatly in any particular year.
  • Causes and settings of accidents for children vary across age groups.
  • Rates of childhood accidents are linked to deprivation.
  • Greater understanding of local issues to improve local targeting of interventions including through schools, Children's Centre etc.
  • Future impact of RBH becoming a centre of excellence for child and maternal health
     
Recommendations for Commissioning

In line with Bolton's Accident Prevention Strategy, activities should be focussed on accidents that have a high probability of fatal, serious or disabling injury and where action can be taken pro-actively to increase awareness among parents, carers, children and young people.

Community education relating to road safety target zones of traffic management in hotspot areas. General education through schools as more concentrated areas of school age residence mirrors accident profiles as would be expected.

Who's at Risk and Why?

There is a clear link between deprivation and avoidable injury:

  • Children whose parents have never worked, or are long-term unemployed are thirteen times more likely to die from avoidable injury than children of parents in higher managerial and professional occupations.
  • Children in the most deprived 10% wards in England are three times more likely to be hit by a car than children in the 10% least deprived wards.
  • Hospital admissions due to accidents are concentrated in the central most heavily populated wards areas of Rumworth, Halliwell, Harper green, Farnworth and Great Lever.
  • Road Traffic Accident casualties have a particular concentration in Rumworth though this does have one of the highest populations of the specific age group.
     

Please see mapping in Data Sheets.

The Level of Need in the Population

Bolton has a higher number of children per 10,000 young persons admitted to hospital than the national average ((152.9 per 10k - Bolton) (123.1 per 10k Nationally) - 2007). Both the national average and the Bolton average are increasing with time with a steady increase in this number over the previous 5 years, from 96.6 to 158.6 per 10k for Bolton from 2004 to 2008.

Current Services in Relation to Need

Services in this area are co-ordinated by Bolton's Accident Prevention Steering Group the membership of which includes senior officers from Children's Services, Greater Manchester Police/BeSafe Partnership, Greater Manchester Fire Service, Road Safety Partnership, Trading Standards, Bolton Primary Care Trust, The Royal Bolton Hospital, Bolton at Home, the Voluntary Sector, Faith Communities and Public Health

The Steering Group meets every 6 weeks to:

  • develop an understanding of rates and types of accidental injury to children in Bolton
  • identify and prioritise local needs
  • identify and respond to any local correlation between deprivation and accident prevention or diversity and accident prevention
  • review accident prevention work and ensure it meets local needs
  • identify opportunities to enhance co-ordination and delivery of accident prevention work, minimising duplication
  • further develop the roles and functions of Bolton's Accident Prevention Steering Group
  • To ensure all stakeholders participate and contribute to the strategy's implementation and future development
     
Projected Service Use and Outcomes

Prevalence of overall number will increase, due to general population increases

Evidence of What Works

"Better Safe than Sorry - Preventing Unintentional Injury to Children", a report published by the Healthcare Commission in 2007 highlighted a number of key findings from national research into accidental injury:-

  • 3 children per 100,000 population are killed each year
  • In 2005 3472 children were killed or seriously injured on the roads
  • Each year approximately 50 children die from fire in the home
  • 45% of all severe burns occur in children under 5
  • Each year 2 million children attend Accident and Emergency departments, costing £146 million
  • There is a strong correlation between deprivation and accidental injury:-
  • Children of parents who have never worked or are long-term unemployed are 13 times more likely to die from accidental injury and 37 times more likely to die as a result of exposure to smoke, fire or flames than children of parents in professional occupations
  • Children in the 10% most-deprived wards are 3 times more likely to be hit by a car than children in the 10% least-deprived wards
     

Across Bolton there is a somewhat similar picture -

  • In 2005-2006 31 children and young people (0-18) were admitted to hospital as a consequence of fires in the home; 77% occurred in the most deprived wards in Bolton (GM Fire Service data)
  • In 2008 calendar year 17 children and young people (0-15) were killed or seriously injured on Bolton's roads which include motorways.
     
Unmet Service Needs and Gaps

An evaluation and review of the Accident Prevention Strategy is due in 2010. This should also identify any further work required to address unmet needs and provide an action plan for its implementation.

Recommendations for Further Needs Assessment Work

Further work on possible repeat locations - e.g. small hotspot in Kearsley and examine hotspots in more depth to investigate if the same types of injury are repeated in identified hotspots, i.e. do types of injury vary spatially?

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