1. Implementing NICE guidance
Preventing unintentional injuries among under-15s: recommendations for local multi-agency partnerships
Implementing NICE guidance
ABOUT THIS PRESENTATION:
This presentation has been written to help you raise awareness of the recommendations for local multi-agency partnerships made in three pieces of public health guidance published by NICE:
Strategies to prevent unintentional injuries among under-15s (PH 29)
Preventing unintentional injuries among under-15s in the home (PH30)
Preventing unintentional injuries among under-15s: road design (PH31).
For all the other recommendations that have been made, including those for national organisations, commissioners and other practitioners, please refer to the quick reference guide or the individual pieces of guidance. We recommend that you hand out copies of the quick reference guide at your presentation so that your audience can refer to it. (See page 1 for a list of all groups that are being advised to take action.) See the end of the presentation for ordering details.
You can add your own organisation’s logo alongside the NICE logo.
We have included notes for presenters, broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on. Where necessary, the recommendation will be given in full.
DISCLAIMER
This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself.
PROMOTING EQUALITY
Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
2010
NICE public health guidance 29, 30 and 31

2. What this presentation covers
Background
Scope
Recommendations
Costs and savings Discussion
Find out more
NOTES FOR PRESENTERS:
In this presentation we will start by providing some background to the guidance and why it is important.
We will then present the recommendations aimed at local multi-agency partnerships.
(Please see the QRG or the three separate publications for recommendations which are not included in this slide set.)
Next, we will summarise the costs and savings that are likely to be incurred in implementing the guidance.
Then we will open up the meeting with a list of questions to help prompt discussion on local issues for incorporating the guidance into practice.
Finally, we will end the presentation with further information about the support provided by NICE.

3. Background
The phrase ‘unintentional injuries’ (rather than ‘accidents’ ) is used as most injuries and their causes are predictable and preventable
Unintentional injury is a leading cause of death and injury among children and young people
Children and young people from lower socioeconomic groups are more likely to be affected by unintentional injuries
NOTES FOR PRESENTERS:
Key points to raise
[Bullet 1]
All three publications use the term ‘unintentional injuries’ rather than ‘accidents’ as the term ‘accident’ implies an unpredictable and, therefore, unavoidable event.
[Bullet 2]
In 2008 in England and Wales, 208 children and young people aged 0–14 died from unintentional injuries. (Refer to the guidance for more statistics.)
[Bullet 3]
Children whose parents have never worked (or are long-term unemployed) are more likely to die from an unintentional injury compared to children whose parents are in higher managerial or professional occupations. The social gradient is particularly steep in relation to deaths caused by household fires, cycling and walking.
Additional information:
The term ‘vulnerable’ is used to refer to children and young people who are at greater than average risk of an unintentional injury due to one or more factors. For example, they may be vulnerable if they:
are under the age of 5 (especially in the home)
are over the age of 11 (especially on the road)
have a disability or impairment (physical or learning)
are from some minority ethnic groups
live with a family on a low income
live in accommodation which potentially puts them more at risk (this could include multiple-occupied housing and social and privately rented housing).

4. Scope The three pieces of guidance focus on:
Broad, strategic prevention activities
Home safety assessments and the supply and installation of safety kit
Making routes safer through speed limits and engineering measures
NOTES FOR PRESENTERS:
Key points to raise
This presentation highlights NICE recommendations for local multi-agency partnerships made in three separate pieces of guidance. Throughout, we use the short title in each case to refer to each piece of guidance.
[Bullet 1]
‘Strategies to prevent unintentional injuries among under-15s’ focuses on broad and strategic actions that cover local planning and coordination, workforce training, injury surveillance, home safety assessments and outdoor play and leisure.
[Bullet 2]
‘Preventing unintentional injuries among under-15s in the home’ focuses on providing home safety assessments, supplying and installing home safety equipment and providing education and advice when carrying out these activities.
[Bullet 3]
‘Preventing unintentional injuries among under-15s: road design’ focuses on 20 mph limits, 20 mph zones and engineering measures to reduce speed or make routes safer.

5. Recommendations Planning and coordination Home safety
Outdoor play and leisure
Road safety
NOTES FOR PRESENTERS:
Key points to raise
We will consider NICE’s recommendations for local multi-agency partnerships in each of the areas outlined on the slide.
NICE has also made recommendations for commissioners and practitioners, government departments and other national organisations – for information on these please refer to the relevant piece of guidance or the quick reference guide.

6. Planning and coordination
Ensure local plans commit to preventing unintentional injuries among under-15s, with a focus on those who are most at risk
Ensure there is a trained child and young person injury prevention coordinator in each locality
Provide a wider childcare workforce with access to injury prevention training
NOTES FOR PRESENTERS:
Key points to raise
‘Strategies to prevent unintentional injuries among under-15s’ (PH 29).
[Bullet 1] Recommendation 1
Ensure plans and strategies include: support for cross-agency working, information about how partners will collaborate on injury prevention, support for monitoring outcomes and for the development of workforce capacity in this area. This includes the provision of suitably trained staff and opportunities for initial and ongoing multi-agency training and development.
[Bullet 2] Recommendation 2
Local authority children’s services and their partnerships should develop a 2 to 3-year strategy which is integrated into all relevant local plans and strategies for children and young people’s health and wellbeing, and raise local awareness about the need for prevention activities. (This includes sitting on the local safeguarding children board and acting as a local source of information and advice on prevention). They should monitor progress, reporting to the director of children’s services.
[Bullet 3] Recommendation 6
Professional standards are needed to set out the knowledge and skills (or ‘competencies’) for a range of injury prevention roles within and outside the NHS. The Faculty of Public Health, the Children’s Workforce Development Council and other appropriate national organisations (see recommendation 4) should develop professional standards for unintentional injury prevention. They should also take practitioners’ views into account and ensure all relevant organisations incorporate these standards into their professional skills development programmes.
Additional information:
NICE recommends that local authority children’s services and their partnerships report on progress to the local strategic partnership (see recommendation 1, page 9).
NICE recommends that national agencies establish a national injuries data surveillance resource (see recommendation 7 on page 14) and also makes recommendations for commissioners to assist in data collection (see recommendation 8, page 16).

7. Home safety
Include home safety assessments and education in local plans
Consider having local agreements with housing associations and landlords on installing permanent home safety equipment
Establish multi-sector partnerships or support existing ones to collect information carry out assessments and promote home safety
NOTES FOR PRESENTERS:
Key points to raise
[Bullet 1] Recommendation 11 – taken from ‘Strategies to prevent unintentional injuries among under-15s’ (PH 29):
Home safety assessments and education should be aimed at families with a child under 5 or with other children who may be particularly vulnerable to unintentional injuries.
[Bullet 2] Recommendation 9 - taken from ‘Strategies to prevent unintentional injuries among under-15s’ (PH 29):
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 hard-wired or 10-year, battery-operated smoke alarms, thermostatic mixer valves for baths, window restrictors and carbon monoxide alarms.
Provide information about these arrangements to those responsible for social and rented dwellings, such as landlords and social housing providers, practitioners with an injury prevention remit - or who have an opportunity to help prevent injuries among children and young people, practitioners with a role in assessing health and safety in residential properties and residents in rented and social dwellings.
[Bullet 3] Recommendation 2 - taken from ‘Preventing unintentional injuries among under-15s in the home (PH30):
Local partnerships could include: community and parent groups, health and social practitioners who visit children and young people in their homes and others with a remit to improve the health and wellbeing of children aged under 15, childcare agencies, local umbrella organisations for private and social landlords and those involved in lifestyle and other health initiatives.
Additional information:
Home safety assessment tools are available from The Royal Society for the Prevention of Accidents ( and Safe Home (

8. Home safety: households at greatest risk
Identify and prioritise households most at risk and offer home assessments
Ensure the assessment, supply and installation of equipment is tailored to need and includes the provision of information and advice
Provide practitioners who visit children and young people at home with mechanisms for sharing information
Ensure practitioners adhere to good practice on maintaining the confidentiality and security of personal information
NOTES FOR PRESENTERS:
Key points to raise:
‘Preventing unintentional injuries among under-15s in the home’ (PH 30)
[Bullet 1] – Recommendations 1& 2
Collect information on specific households where children and young people aged under 15 may be at greatest risk of an unintentional injury and to help determine and address barriers to creating a safe home environment.
Risk factors could include overcrowding, low income and lack of appropriately installed safety equipment. The data could come from surveys, needs assessments and existing datasets. Or it could be gathered as part of routine practice by social workers, GPs and health visitors.
[Bullet 2] – Recommendation 3
Factors to take into account when assessing the need for - and supplying and installing – safety equipment include: the developmental age of the children (in relation to any equipment installed), whether or not a child or family member has a disability, cultural and religious beliefs, whether or not English is the first language, levels of literacy, the level of control people have over their home environment and the household’s perception of, and degree of trust in, authority.
[Bullet 3] Recommendation 4
The practitioners will include health visitors, social workers and GPs.
[Bullet 4] Recommendation 5
An example of good practice on maintaining confidentiality and security of personal information includes using end-to-end encryption when sharing data with other agencies.
Additional Information
Prevent duplication of effort by keeping a record of households that have been given safety advice or equipment.
Use the records to identify when maintenance and follow-up are required, to feed into the strategic planning and to prioritise future interventions.
Contact homes identified as being in need of an equipment maintenance check, and offer to revisit them to see if the equipment is still appropriate and functional.

9. Outdoor play and leisure
Ensure a prevention policy is in place which balances fun, physical activity and learning
Provide education, information and advice on the use of equipment to manage risk
Encourage cycle training and promote the use of correctly fitted and fastened cycle helmets
Conduct local injury prevention campaigns for all events where fireworks may be used
NOTES FOR PRESENTERS:
Key points to raise
‘Strategies to prevent unintentional injuries among under-15s’ (PH 29).
[Bullet 1] Recommendation 12
Ensure a policy is in place which:
counters excessive risk aversion
promotes the need for children and young people to develop skills to assess and manage risks, according to their age and ability
takes into account children and young people’s preferences about the types of outdoor play and leisure they want to participate in
is inclusive, taking into account the needs of all children and young people, including those from lower socioeconomic groups, those from minority ethnic groups with specific cultural requirements and those who have a disability.
[Bullet 2] Recommendation 12
Prevention initiatives could also include the modification of equipment and the environment, and the provision of safety equipment.
[Bullet 3] Recommendation 15
This recommendation applies to off-road cycle safety
Campaigns could focus on younger children learning to cycle, for example in gardens and parks, and older children and young people who go BMX racing or mountain biking. The campaigns could suggest that adults set an example by wearing helmets when they cycle.
Retailers should provide point-of-sale advice on how to fit 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.
[Bullet 4] Recommendation 16
Trading standards officers should ensure adults are given the firework safety code when they buy fireworks, as a condition of the license to store and sell fireworks. The code should be available in a range of languages and formats.

10. Road safety: partnerships
Maintain road safety partnerships to help plan, coordinate and manage road safety activities
Ensure a senior public health person leads – and is responsible for – health sector involvement
Ensure local child safety reviews are carried out at least every 3 years
Ensure consistency within local child safety policies, local plans and strategies
NOTES FOR PRESENTERS:
Key points to raise
‘Strategies to prevent unintentional injuries among under-15s (PH 29):
[Bullets 1 & 2] Recommendation 17 (PH29) and recommendation 1 (PH30)
Road safety partnerships 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.
[Bullet 3] Recommendation 18
To ensure consistency within regions, ensure child safety reviews include all road injury data collected by road safety partners, data which can identify whether some social groups experience more injuries than others (inequalities data), risks to local children and young people and information about all types of journey, not just those to and from school.
[Bullet 4] Recommendation 19
Ensure consistency between the road injury prevention priorities 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.)
Additional information:
Recommendation 17 also says: Draw on all available information to plan road injury reduction programmes, as part of the local community safety strategy. 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. NICE also recommends consulting local children and young people about their road use (Recommendation 18).

11. Road safety: speed reduction
Introduce engineering measures to reduce speed in streets that are primarily residential or where pedestrian and cyclist movements are high
Consider changing speed limits and introducing appropriate engineering measures to: - reduce speeds on rural roads - provide safer routes commonly used by children and young people
NOTES FOR PRESENTERS:
Key points to raise
‘Preventing unintentional injuries among under-15s: road design’ (PH 31).
Recommendation 3
[Bullet 1]
Engineering measures could include:
- speed reduction features (for example traffic-calming measures on single streets, or 20 mph zones across wider areas)
- changes in the speed limit with signing only (20 mph limits) where current average speeds are low enough, in line with Department for Transport guidelines
Use factors such as traffic volume, speed and function to determine where to implement changes.
[Bullet 2]
Consider making these changes on rural roads where the risk of injury is relatively high, in line with Department of Transport guidance.
Additional Information:
Also, refer to recommendation 20 on ‘promoting and enforcing speed reduction’ in ‘Strategies to prevent unintentional injuries among under-15s’ (PH29).

12. Costs per 150,000 population Recommendations with significant costs
(£ per year)
Coordination of unintentional injury prevention activities
40,000
Delivery of home safety assessments and installation of home safety equipment
42,000
Estimated cost of implementation
82,000
ADAPTING THIS SLIDE FOR LOCAL USE:
Local factors such as incidence and baseline can vary considerably when compared with the national average. NICE has provided a costing template for you to calculate the financial impact this guidance will have locally. We encourage you to calculate this impact by amending the local variations in the template such as incidence, baseline and uptake. You can then remove the national figures from the table and replace them with local figures to present to your colleagues.
Please note: these assumptions are based on the employment of one child and young person injury prevention coordinator and providing about 1000 families with a home safety intervention. However, if the local population is considerably smaller or larger than 150,000 – or considerably younger or older than average, you should use the costing template to calculate local costs.
NOTES FOR PRESENTERS:
NICE has worked closely with people within and outside the NHS to look at the major costs and savings related to implementing these three pieces of guidance. It is estimated that the national, annual change in costs and savings arising from local implementation is £27 million. The costs per150,000 population are summarised in the table.
NICE has produced a costing report that provides detailed estimates of the national costs and savings. We have also developed a costing template to calculate local costs.
Please note: local authorities may be able to negotiate with their partners to reconfigure existing resources - or pool them - to implement the recommendations without incurring significant additional costs.
Also note: The cost of implementing a number of the recommendations is not easy to quantify and will vary according to local circumstances and priorities. Further information is provided in the costing report to help local authorities and their partners consider the resource impact of:
road design and modification
workforce development
unintentional injury prevention campaigns
data collection and management
policy and strategy development
partnership working
installation and maintenance of permanent safety equipment in social and rented dwellings

13. Savings per 150,000 population
Preventing 10% of unintentional injuries among under-15s could:
save up to £80,000 by reducing emergency department visits and hospital admissions
lead to savings for GPs
lead to savings for the ambulance, police and fire and rescue services
NOTES FOR PRESENTERS:
It is not possible, with any degree of certainty, to quantify the savings that can be made by implementing the three pieces of guidance. However, the costing report has identified the potential savings outlined in this slide. Preventing unintentional injuries may also improve general health outcomes, as well as quality of life and school attainment among children and young people.
[Bullet 1]
£80,000 is a figure arrived at after extrapolating the national savings detailed in section 3.4 of the costing report to a local level.

14. Discussion
How can we improve the way we coordinate our work to prevent unintentional injuries among under-15s?
How do we meet the needs of the most vulnerable under-15s in this respect?
How does our injury prevention training link to – and support – the wider child health remit?
NOTES FOR PRESENTERS:
These questions are suggestions that have been developed to help provide a prompt for a discussion at the end of your presentation – please edit and adapt these to suit your local situation.
Other suggestions are:
How can we begin to implement some of these recommendations locally?
What are the next steps?
What are the barriers to collecting and sharing data on unintentional injuries and how can we overcome these?

15. Find out more
Visit and for:
the guidance
a quick reference guide
a costing report and template
three self-assessment tools (one for each piece of guidance)
NOTES FOR PRESENTERS:
You can download the following from NICE’s website:
The three pieces of guidance, which include the recommendations in full, plus considerations and evidence statements.
A quick reference guide, which includes the recommendations from all three pieces of guidance.
For printed copies of the quick reference guide, phone NICE publications on or and quote reference number N2351.
NICE has developed tools to help organisations implement this guidance. These can be found on the NICE website:
Costing tools – a costing report gives the background to the national savings and costs associated with implementation, and a costing template allows you to estimate the local costs and savings involved. There is one costing report and template for all three pieces of guidance.
Three self-assessment tools, one for each piece of guidance.