Halton Joint Strategic Needs
Assessment 2015/16
Unintentional Injuries
across the lifecourse
Unintentional Injuries across the lifecourse
2015/16
Reader Information
Author
Caroline Nyakundi, Anna Blennerhassett
Contributors
James Watson
Jennifer Oultram
Sharon McAteer
Trauma and Injury Intelligence Group
Reviewer
Number of pages
Date release
Description
Sharon McAteer and Katherine Woodcock
49
March 2016
The document describes the policy context, estimated prevalence, risk
factors and sub-groups of need, current service provision and national
best practice in relation to unintentional injuries across the lifecourse
in Halton.
Contact
[email protected]
Related
documents
PHE Injury profiles
Halton Falls Strategy
Halton Children's JSNA
Please quote the JSNA
We would like to know when and how the JSNA is being used. One way, is to ask people who use the JSNA
when developing strategies, service reviews and other work to quote the JSNA as their source of information.
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Unintentional Injuries across the lifecourse
List of Abbreviations
A&E
Accident and Emergency (hospital department)
GP
General Practitioner
HCP
Healthy Child Programme
HSAB
Halton Safeguarding Adults Board
HSE
Health and Safety Executive
JSNA
Joint Strategic Needs Assessment
LSCB
Local Safeguarding Children Board
LTP
Local Transport Plan
NHS
National Health Service
NICE
National Institute for Health and Clinical Excellence
ONS
Office for National Statistics
PHE
Public Health England
PSHE
Personal Social and Health Education
PYLL
Potential Years of Life Lost
TIIG
Trauma and Injury Intelligence Group
UI
Unintentional Injury/ Injuries
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2015/16
Unintentional Injuries across the lifecourse
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Contents
Key Findings ............................................................................................................................................ 8
1. Introduction ........................................................................................................................................ 9
2. Policy Context ................................................................................................................................... 11
2.1 National ....................................................................................................................................... 11
2.2 Local – North West and Halton ................................................................................................... 13
3. Level of need in the population ........................................................................................................ 15
3.1 At risk groups .............................................................................................................................. 15
3.1.1. Age ...................................................................................................................................... 15
3.1.2. Gender ................................................................................................................................ 15
3.1.3. Ethnicity .............................................................................................................................. 15
3.1.4. Other Protected Characteristics.......................................................................................... 15
3.1.5. Deprivation.......................................................................................................................... 16
3.1.6 Other risk factors ................................................................................................................. 16
3.2 Estimated prevalence ................................................................................................................. 16
3.3. Accident and Emergecy attendances due to UIs ....................................................................... 18
3.4. Hospital admissions ................................................................................................................... 20
3.4.1. all ages................................................................................................................................. 20
3.4.2. under 5s .............................................................................................................................. 20
3.4 3. children and early adolescents ........................................................................................... 21
3.4.4. Transitional age 15 to 24..................................................................................................... 21
3.4.5 Young adults aged 25 to 44.................................................................................................. 22
3.4.6. 45 to 64 aged population .................................................................................................... 23
3.4.7. Over 65s .............................................................................................................................. 23
3.4. Causes of Accidental Injury ........................................................................................................ 25
3.4.1. all ages................................................................................................................................. 25
3.4.2. amongst children ................................................................................................................ 25
3.4.3. transition age ...................................................................................................................... 25
3.4.4. working age adults .............................................................................................................. 25
3.4.5. Older People ....................................................................................................................... 26
3.4.6. Road Traffic Collisions ............................................................................................................. 26
3.4.8. Fire service data .................................................................................................................. 28
3.4.8. Deprivation.......................................................................................................................... 30
3.4.9. Alcohol ................................................................................................................................ 31
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4. Impacts of Accidental Injury ............................................................................................................. 33
4.1. To the individual and their family .............................................................................................. 33
4.2. To the public sector ................................................................................................................... 35
4.3. To wider economy/ society........................................................................................................ 36
4.4. Mortality .................................................................................................................................... 36
5. Services ............................................................................................................................................. 38
6. Projected level of Need ..................................................................................................................... 40
7. User Views......................................................................................................................................... 42
8. Best Practice...................................................................................................................................... 43
8.1. NICE guidelines on accidents( clinical & public health) ............................................................. 43
8.2. NICE guidance: In development ................................................................................................. 43
8.3. Compliance with NICE guidelines .............................................................................................. 43
8.3. Other sources ............................................................................................................................. 45
Appendix 1: Breakdown by age and sex of emergency admissions in Halton for unintentional injuries,
2012/13 – 2013/14 ............................................................................................................................... 47
References ............................................................................................................................................ 48
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Figures
Figure 1: The result of unintentional injuries in children aged 0-5 in England, 2008-2012.................. 17
Figure 2: Emergency admissions in Halton due to accidents by age and sex (2013-2014) .................. 20
Figure 3: Accidents resulting in emergency admissions in the 0-4 age group for each Halton ward
(2012-2014)........................................................................................................................................... 21
Figure 4: Accidents resulting in emergency admissions in the 0-14 age group for each Halton ward
(2012-2014)........................................................................................................................................... 21
Figure 5: Accidents resulting in emergency admissions in the 15-24 age group for each Halton ward
(2012-2014)........................................................................................................................................... 22
Figure 6: Accidents resulting in emergency admissions in the 25-44 age group for each Halton ward
(2012-2014)........................................................................................................................................... 22
Figure 7: Accidents resulting in emergency admissions in the 45-64 age group for each Halton ward
(2012-2014)........................................................................................................................................... 23
Figure 8: Accidents resulting in emergency admissions in the 65-79 age group for each Halton ward
(2012-2014)........................................................................................................................................... 23
Figure 9: Accidents resulting in emergency admissions in the 80+ age group for each Halton ward
(2012-2014)........................................................................................................................................... 24
Figure 10: Killed casualties in Great Britain, 2005 – 2013 .................................................................... 26
Figure 11: The road user type of the casualties killed in reported accidents in Great Britain, 2013 ... 27
Figure 12: Road traffic collisions in Halton that required the fire service, 2009/10 – 2014/15 ........... 27
Figure 13: Type of injury resulting in injury that the Cheshire fire and rescue team responded to in
Halton (2009/10 – 2014/15) ................................................................................................................. 28
Figure 14: Rate of accidental fire victims in Halton by age and sex (2009/10 – 2014/15) ................... 30
Figure 15: emergency admission rate for accidents in Halton compared to deprivation scores ......... 31
Figure 16: Alcohol related emergency admissions for accidents in Halton per age group .................. 32
Figure 17: Emergency admision rates for fractured neck of femurs in Halton, the North West and
England (2003-2013) ............................................................................................................................. 34
Figure 18: Mortality in the Halton Wards where there was an accident code, 2010-2014 ................. 36
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Tables
Table 1: Public Health Outcomes Framework 2013-2016 .................................................................... 11
Table 2: Predicted number of falls in Halton in those over 65 and how many resulted in hospital
admision, 2015 ...................................................................................................................................... 17
Table 3: Unintentional injury attendances to Whiston Hospital and Warrington Hospital by month,
Halton residents (April 2010 to March 2015) ....................................................................................... 18
Table 4 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by gender,
Halton residents (April 2010 to March 2015) ....................................................................................... 18
Table 5 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by age group,
Halton residents (April 2010 to March 2015) ....................................................................................... 18
Table 6 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by gender
and age group, Halton residents (April 2010 to March 2015) .............................................................. 19
Table 7 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by age group,
Halton residents (April 2010 to March 2015), crude rate per 1,000 population.................................. 19
Table 8: Unintentional injury attendances to Whiston Hospital and Warrington Hospital by injury
group, Halton residents (April 2010 to March 2015) ............................................................................ 19
Table 9: Injuries caused by incidents that the fire service responded to in Halton (2009/10 –
2014/15)................................................................................................................................................ 28
Table 10: Unintentional fires causing injuries in Halton (2009/10 – 2014/15) .................................... 29
Table 11: Top 5 causes of unintentional fires in Halton (2009/10 – 2014/15) ..................................... 29
Table 12: People involved in unintentional fires at home in Halton .................................................... 29
Table 13: The index of multiple deprivation for Halton wards, 2007 and 2010 ................................... 30
Table 14: Hospital admissions due to falls amongst those aged 65+, 2010/11 to Q3 2014/15 ........... 33
Table 15: Cost of unintential injuries to society ................................................................................... 35
Table 16: Number of deaths by type of injury and age group, 2010-2014........................................... 37
Table 17: Number and percentage of deaths due to injuries 2010-2014............................................. 37
Table 18: Deaths due to falls, all ages and amongst those age 65 and over, 2009/11 to Q3 2011/Q2
2014 ...................................................................................................................................................... 37
Table 19: Local services......................................................................................................................... 38
Table 20: Population projections, 2014 to 2015 ................................................................................... 40
Table 21: Predicted number of falls, 2014 to 2015 .............................................................................. 40
Table 22: Predicted number of hosital admissions due to falls amongst those aged 65 and over, 2014
to 2025 .................................................................................................................................................. 41
Table 23: A summary of procedures in place to prevent unintentional injuries in under 15s in the
Halton Borough Council ........................................................................................................................ 43
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Key Findings
Priority
Intelligence
Goal
A dataset that
enables a full
understanding of
unintentional
injuries throughout
the lifecourse.
Description
 Data on unintentional injuries (UI) within Halton is available on a regular
basis from Trauma and injury Intelligence Group (Accident and Emergency
(A&E) department data) which serve the Halton area. Data is also collected
on hospital admissions and from Cheshire Fire and Rescue Service


Level of Need:
Children

Level of Need:
Transitional
Age
Level of Need:
working age
adults and
older people

Reduce the
number of
unintentional
injuries occuring in
Halton throughout
the lifecourse.






Level of Need:
At risk groups

Service
Provision:
Ensure that Halton
continues to
provide services
that meet people’s
needs and
prevents
unintentional
injuries.






Impacts
Reduce the impact
unintentional
injuries has on
morbidity,
mortality.

Children aged 0-17 account for the highest number and have the highest
rate of A&E attendances due to unintentional injuries
Falls account for the majority of accidents in children aged 0-14, with boys
having more falls than girls (this pattern is also seen for males and females
generally)
Children aged 0-4 are at high risk of falls, in Merseyside between April
2007 to March 20011 they accounted for 33% of all A&E attendances due
to injuries
Young people between the age of 15-24 years old can display high risk
behaviours
Although falls accounts for the most A&E admissions due to UI, the
number of injuries due to transport accidents increases in this group
As age increases so does the incidence of falls
In the 25-44 year olds, 33% of UI leading to an emergency admission were
due to falls, with transport injuries also playing a big role at 13%. While in
those 45-64, 57% were falls, 8% transport injuries
Falls accounted for 79% of UI presenting in A&E in the 65-79 year olds, and
increased to 88% in those over 80
The ages on either end of the life course are most at risk of unintentional
injuries; these are those 0-4 years old and those 80 years and over
There is a correlation between deprivation and the incidence of UI.
Windmill Hill, Halton Lea and Riverside tended to have the most
admissions due to UI for those 0-24, 25-44, >45 years respectively
Alcohol increases the risks of UI. Males in the borough had a higher rate of
admissions for UI related to alcohol than females, especially in those 85
years and over
There is a wide variety of services in place to reduce the incidence of UI
Services range from those aimed as families with babies, such as the Home
Equipment Low Price Scheme (HELPS) and children’s centres, to those
aimed at the elderly, including sure start to later life and falls prevention
service
Despite the range of service available there is no coordinated, strategic
approach to injury prevention, apart from the Falls Strategy for older
people
UI continue to have a significant impact on morbidity and mortality locally
Although Halton rates of fractured neck of femurs due to falls has
decreased over recent years, rates remain higher than both the North
West and England
Falls accounted for the majority of emergency admission for UI, but only
14.9% of deaths due to UI. The majority of deaths were caused by
accidental poisoning and exposure to noxious substances (43.5%)
With any injury there is always a financial impact, which is also the case
with UI. Childhood accidents cost the NHS an estimated £131 million per
year on emergency hospital admissions. The Department for Transport
estimates that the average cost per seriously injured casualty of any age on
the road is £189,519 and that the average cost per fatality is £1.69 million.
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1. Introduction
Injuries are caused by predicable interactions between individuals and the environment in which
they live and work. The term ‘accident’ is no longer used as it tends to suggest that injuries are
random events and not amenable to prevention when they usually follow a predictable pattern of
exposure and are largely preventable. Increasingly references are made to unintentional injuries (UI)
or events, such as crashes or collisions, rather than terms such as ‘accidental injury’ or ‘road traffic
accident’.
The World Health Organisation has identified the huge health benefits to be gained from preventing
injuries and has developed a number of strategies and action plans which are available on their
website http://www.who.int/topics/injuries/en/ (accessed 6 June 2015).
UI and their consequences produce a heavy burden on society in terms of short and long term
disability, mortality, economic loss and health care costs. Every year in the UK, 1 million children
under the age of 15 are taken to accident and emergency (A&E) units following injuries occuring in
the home. Many more are treated at home or by their GP.
The vast majority of UI do not result in death. Many people across the country are injured each year
and a significant proportion of these injuries are life changing. These are untimely, often violent,
events which blight families and communities but their effects are rarely measured in terms of their
wider social and health impacts, including poverty and deprivation.
Falls can destroy confidence, increase isolation and reduce independence. For older people, a fall
can hasten a move into residential care. After a hip fracture, 50 per cent of people can no longer live
independently. The after-effects of even the most minor fall can be significant for an older person’s
physical and mental health. Fear of falling again, among older people and those who care for them,
reduces quality of life and well-being, even if a fall does not result in serious consequences.
Whilst injuries accounted for only 3.73% of total deaths in England and Wales during 2013, the
distribution of the age of death in those dying is very different from most other causes of death with
a high proportion of deaths occurring in the young. After the age of one injury is the first or second
leading cause of death in most European countries. When a different measure of counting the
impact of death is used, potential years of life lost (PYLL) before age 75, injuries account for around
13% of all premature mortality in England (approximately 304,200 PYLL up to age 75), mainly due to
intentional self-harm/injury of undetermined intent (39%) and motor vehicle traffic accidents (16%).
The Chief Medical Officer’s 2011 annual report[1] noted that, in 2010, there were 15,915 deaths due
to injury. In 2010/11, there were 798,024 emergency hospital admissions due to injury, accounting
for around 3,441,000 emergency hospital bed days (8% of all bed days), mainly due to accidental
falls (58% of bed days due to injuries).
Injuries are a leading cause of death in children. Suffocation is the main cause of death from injury in
children under five, whereas motor vehicle traffic accidents lead to most deaths in children over five
and teenagers. Self-inflicted injury and injury of undetermined intent are also considerable causes of
death in young people.
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People aged over 75 experience the highest rates of death and hospital admission due to injury, with
falls being the leading cause. Injuries from motor vehicle traffic accidents, self-inflicted injury and
suffocation are also of particular concern in this age group.
There is a relationship between injury and deprivation. In 2010, those living in the most deprived
areas had nearly twice the rate of mortality due to injury compared to the least deprived.
Injuries are a key public health concern, as they are often preventable. Strategies and policies
relating to children, young people and older people need to incorporate injury prevention.
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2. Policy Context
2.1 National
Unlike many other public health issues, there is no dedicated national strategy on injuries. The Public
Health Outcomes Framework includes some indicators relating to unintentional injuries, mainly falls
in older people
Table 1: Public Health Outcomes Framework 2013-2016
Indicator
1.10
2.7
2.24
4.14
Description
Killed and seriously injured casualties in on England’s roads
Hospital admissions caused by unintentional and deliberate injuries in U18s
Injuries due to falls in people aged 65 and over
Hip fractures in people aged 65 and over
There are several national strategies and programmes that include accident prevention.
Healthy Child Programme (HCP) – the first five years of life (2009): advice and information on
safety, preventing accidents and the correct use of safety equipment is covered under the keeping
safe element within the promotion of health and wellbeing. There are universal and progressive
elements to this.
Healthy Child Programme – from 5 to 19 years (2009): accident and injury prevention (including
road accidents) is recommended as a part of all pupils receiving a comprehensive age appropriate
programme of personal social and health education (PSHE). PSHE contributes to staying safe and the
statutory safeguarding duty on schools. The delivery of the HCP (0-19 yrs) is endorsed within the
Health Visitor Implementation Plan 2011–15 (2011) and the new school nursing call to action Getting
it right for children, young people and families (2012).
One of the key themes within the Strategic Framework for Road Safety 2011 is education, to ensure
children and young people develop the skills they need to stay safe. The road safety education that
children receive sets their behaviour as adults. Think Education, Kerbcraft and Bikeability re
referenced as evidenced-based programmes that work with children and young people. It
recommends linking to other agendas like public health and sustainable travel to help remove
barriers to increased walking and cycling.
Delivery of Local Road Safety (2011) recommends integrating road safety into wider policy areas,
considering the intended and unintended consequences of investment and partnership working. To
achieve attitude and behaviour change it is important to understand the characteristics and social
context of the groups being targeted.
In addition to the National Institute for Health and Clinical Excellence (NICE)i, there are a number of
national organisations that produce guidance and tools to support commissioners and front line
professionals in action to prevent injuries.
i See section 8 for a list of NICE guidance
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Royal Society for the Prevention of Accidents (ROSPA)ii: As a UK charity that has been working for
almost 100 years to prevent accidents. RoSPA has been working to change both legislation and
attitudes surrounding accidents. From the compulsory wearing of seatbelts and the campaign to
stop drink driving, to the Cycling Proficiency Test and to the more recent ban on handheld mobile
phones behind the wheel, RoSPA has been instrumental in changes to legislation and helping to
shape public attitudes to these issues through research and campaigning as well as education and
informing policy makers, employers and the public.
Child Accident Prevention Trust (CAPT)iii: A leading UK charity working to reduce the number of
children and young people killed, disabled or seriously injured in accidents. They mainly work across
four domains:




Child safety advice to families
Supporting professionals working with children and families
Supporting senior professionals and policymakers
Advising the government and organisations on child safety
Health and Safety Executive (HSE)iv: It is 40 years since the Health and Safety at Work Act received
Royal Assent, providing a new regulatory framework for work place health and safety in Great
Britain. This has helped make Britain one of the safest places in the world to work, saving thousands
of lives, preventing many more injuries at work and reducing the economic and social costs of health
and safety failures. The HSE works to prevent death, injury and ill health in Great Britain’s
workplaces through education, support and investigating incidents. It is the national independent
watchdog for work-related health, safety and illness. It acts in the public interest to reduce workrelated death and serious injury across Great Britain’s workplaces.
Age UKv: The country's largest charity dedicated to helping everyone make the most of later life. The
over-60s is the fastest-growing group in society and there are more of us than ever before. Ageing is
not an illness, but it can be challenging. Age UK provides services and support at a national and local
level to inspire, enable and support older people. They stand up and speak for all those who have
reached later life, and also protect the long-term interests of future generations.
All produce a range of guidance and tools to help prevent unintentional injuries.
ROSPA, in partnership with Public Health England (PHE), report on Delivering Accident Prevention2
concentrates on the preventable nature of accidents. It advocates that each local authority should:
-
Complete a Joint Strategic Needs Assessment (JSNA) that includes a comprehensive
assessment of unintentional injuries
Ensure action to prevent/reduce unintentional injuries is included with the Health and
Wellbeing Strategy and investment plan
ii http://www.rospa.com/
iii http://www.capt.org.uk/
iv http://www.hse.gov.uk/index.htm
v http://www.ageuk.org.uk/
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-
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Prepare to commission public health services, including those focussed on accidents
There are links between accident prevention and other agendas. The term safeguarding has become
synonymous with abuse. However, definitions of safegaurding include protection from impairment
to health and wellbeing. As such there are clear links with unintentional injuries. This includes links
therefore to both the Local Safeguarding Children Boards and adult social care/ Adult Safegaurding
Board agendas. The prevention and wellbeing focus within the Care Act gives further impetus to
local action to prevent unintentional as well as intentional injuries.
Local Transport Plans: Under Section 108 of the Transport Act 2000, all transport authorities are
required to produce a Local Transport Plan (LTP) in which they set out their objectives and plans for
transport development. Typically, they contain policies, strategy and implementation plans which
can be reviewed independently of each other.
2.2 Local – North West and Halton
Trauma and Injury Intelligence Group (TIIG)
TIIG was established in Merseyside in 2001 to develop a quality Injury and Surveillance System. It
facilitates data collection, analysis and dissemination across the North West of England. TIIG collates
data from A&E departments and the North West Ambulance Service. It can be used to inform new
and ongoing prevention policies and encourages working together. They produce annual reports for
each emergency department as well as a number of themed reports for each of the three subregions across the North West. Recent reports for Cheshire & Merseyside have included child
accidents and injuries and injuries during the winter months.
Halton Health & Wellbeing Strategy
One of five Halton Health and Wellbeing Strategy 2013/16 priorities is to reduce the number of falls
in older people. In response to this a Halton Falls Strategy covering 2014 to 2018 has been
developed to highlight methods to tackle these.
Cheshire Fire and Rescue Service
Cheshire Fire Authority are building a new Safety Centre as part of a “ Building for a Safer Future”
strategy. This aims to act as a platform for coordination of community safety training targeted
towards at risk groups.
Environmental Health team
Environmental Health play a key role in prevention of workplace accidents. They are a statutory
enforcing authority for the Health and Safety at Work Act 1974. The enforcement responsibility is
shared with the Health and Safety Executive (HSE). This act aims to ensure workplaces comply with
duties under this legislation to protect the health, safety and welfare of employees and members of
the public who visit the premises.
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Local Safeguarding Children Board (LSCB)
Safeguarding and promoting the welfare of children requires effective co-ordination in every local
area. For this reason, the Children Act 2004 required each Local Authority to establish a Local
Safeguarding Children Board (LSCB).
The LSCB is the key statutory mechanism for agreeing how the relevant organisations in each local
area will co-operate to safeguard and promote the welfare of children in that locality, and for
ensuring the effectiveness of what they do.
Halton Safeguarding Children Board is a statutory body consisting of agencies and professionals
responsible for promoting and safeguarding the welfare of children and young people across the
borough.
The LSCB annual report 2012/13 recognised the important role that public health can make to ts
work. In particular through the JSNA it should help the LSCB to understand the needs of vulnerable
children. To this end, the 2014 Children's JSNA includes a dedicated chapter to Safeguarding. It
includes analysis of childhood accidental injury.
Local Transport Plan (LTP)
In April 2014, Merseyside and Halton came together to formally establish the Liverpool City Region.
The Combined Authority was established to strategically lead work on transport, economic
development, housing, employment and skills in the City Region to, in turn, support sustainable
economic growth. It enables the City Region to speak with one voice in a democratically
accountable structure which can attract funding and devolved powers from Government. Transport
is a key focus of the Combined Authority, in recognition of the central role it plays in helping to grow
the economy and in enabling and encouraging regeneration. As such an overarching Transport Plan
was developed in 2015 to act in synergy with the two existing plans for Merseyside and Halton.
Health is a key consideration within all these LTPs, both in terms of encouraging active travel but
also to ensure the excellent work in reducing road traffic accidents continues.
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3. Level of need in the population
3.1 At risk groups
There aree significant inequalities in death and injury from accidents.[3] Children of parents who
were long-term unemployed or who had never worked were 13 times more likely to die as a result
of unintentional injury and 37 times more likely to die from exposure to smoke, fire or flames than
children of parents in higher managerial or professional occupations.
More people die from accidents at home than on the roads. In the UK, injuries that occur in and
around the home were the most common cause of death in children over the age of one.
Speeding traffic was the greatest contributory factor to accident frequency and severity. Children in
the 10% most deprived areas of the UK were five times more likely to die as a pedestrian than
children in less deprived areas, partly because they have fewer safe places to play and may walk
more as their parents do not own a car.
3.1.1. Age
Nationally, accidents in the home occur most frequently among those aged over 65 and under 5, and
are the most common cause of death in children over one year of age.[ 4] Unintentional injuries in the
home are more common than road injuries - in 2010/11 5,000 people in the UK died as the result of
an accident at home, compared with 1,901 on the road. Nationally, young people aged 15-24 are
most likely to be injured on the roads . Those aged between 10 and 24 experience the greatest
number of injuries sustained from leisure activities.
3.1.2. Gender
More women than men over the age of 65 die as the result of an accident in the home, but more
boys have accidents in the home than girls.
3.1.3. Ethnicity
3.1.4. Other Protected Characteristics
Under the Equality Act there are nine population groups who face particular challenges in society
which can and often do, result in health and social inequalities. Known as ‘protected characteristics’
consideration should be given in JSNAs to the experiences these groups have in relation to
whichever topic/issue is under consideration. Some have been covered above. They are:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Age
Gender
Martial status
Maternity
Ethnicity
Religious beliefs
Sexual Orientation
Disability
Gender reassignment
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3.1.5. Deprivation
Nationally, children and young people from lower socio-economic groups are more likely to
experience unintentional injuries than those from more affluent groups (Towner et al, see NICE
p33). Children or parents who have never worked or who are long-term unemployed are 13 times
more likely to die from an unintentional injury than children of parents employed in managerial or
professional occupations. This social gradient is particularly steep for accidents caused by household
fires (child with a long-term unemployed parent living in a disadvantaged area is 37 times more likely
to die from exposure to smoke or flames than a child of a parent with a high earning managerial
profession), cycling and walking. Poor housing and overcrowded conditions lead to an increased
numbers of accidents.
Among young people aged under 15, the likelihood of dying as a car occupant is 5.5 times higher if
their parents are unemployed than if they have managerial or professional jobs. This ratio exceeds
20 among pedestrians and cyclists. Similarly, more than one quarter of child pedestrian injuries
happen in the most deprived tenth of wards (Greyling et al. 2002). The largest factor resulting in this
difference in death rate is exposure to danger rather than behaviour (Edwards et al. 2006). People
from lower socioeconomic groups are more likely, for example, to live in neighbourhoods with onstreet parking, high-speed traffic and few or no off-street play areas.
3.1.6 Other risk factors
Other risk factors relate to:



The environment (e.g. living in poor-quality housing, or living in a house which opens onto a
road). Most traffic casualties among children and young people occur in urban rather than
rural areas (2073 compared with 734 among those aged 0–15 years in 2008). In addition, the
percentage of pedestrian casualties is higher in urban compared to rural settings (73%
compared with 36% in 2008) (Department for Transport 2010b).
behaviours (e.g. risk-taking, leisure activities)
personal attributes (age, physical ability and medical conditions)
For road transport injuries, certain transport modes increase the risk of injury. Motorcycle users, per
mile ridden, are roughly 35 times more likely to be killed in a road traffic accident than car
occupants. Pedestrians and pedal cyclists, per mile walked and cycled respectively, are roughly 11
times more likely to be killed in a road accident than car occupants. Motorcyclists are over 50 times
and pedal cyclists 30 times more likely to be seriously injured in a reported road accident than a car
occupant.
3.2 Estimated prevalence
Public Health Endland in conjunction with ROSPA released a report on reducing unintentional
injuries in and around the home in under 5 year olds. Figure 1 shows the rough number of
unintentional injuries in those 0-5 years old that present to a hospital in England each year.
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2015/16
Figure 1: The result of unintentional injuries in children aged 0-5 in England, 2008-2012
62 die
40,000 are admitted
450,000 attend A&E
Reducing unintentional injuries in and around the home in under 5 year olds 
5
There are many children who do not attend the emergency department, but instead see the GP or
are self treated however this number is not known.
Around 2 million children in the UK under 15 years of age attend emergency departments each year
as a result on unintention injuries.6 The Halton 2013 mid-year estimate for those aged 0-14 was
23,500. Applying the UK statistics to the Halton population results in an estimated prevalence of
4,073 UI in those 0-14 years in the Halton area. Of those who attend with UI 44% will be as a result
of falls;7 This is an estimated prevalence of 1,792 falls in children requiring emergency department
attendance.
The Projecting Older People Population Information (POPPI) system predicted the number of people
aged 65 and over that would have a fall (Table 2) in Halton in 2015. The percentage of these likley to
require a hospital admission increases with age.
Table 2: Predicted number of falls in Halton in those over 65 and how many resulted in hospital admision, 2015
Falls
Number of falls
resulting in
admissions
65-69
1,581
40
Percentage of
falls resulting in
admission
2.5%
70-74
1,182
46
3.9%
75 and over
2,764
328
11.9%
TOTAL (65 and
over)
5,527
414
7.5%
Age
Source: POPPI
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2015/16
3.3. Accident and Emergecy attendances due to UIs
The Trauma and Injury Intelligence Group (TIIG) looks at both intentional and unintentional injuries
causing emergency admission in Merseyside and Cheshire. Halton residents tend to present to either
Warrington Hospital or Whiston Hospital. Table 3 shows the number of Halton residents who
presented to both hospital’s emergency department in the months between April 2010 and March
2015. The total number of admissions during this five year period was 32239 with more injuries
occuring in July than in any other month.
Table 3: Unintentional injury attendances to Whiston Hospital and Warrington Hospital by month, Halton residents
(April 2010 to March 2015)
Table 4 shows that males accounted for the most attendances due to injuries (52%) and this was
consistently the case over the five years worth of data available (ranging from 50.5% to 52.5% for
individual years).
Table 4 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by gender, Halton residents
(April 2010 to March 2015)
Gender
2010/11
2011/12
2012/13
2013/14
2014/15
Total
Males
3481
3458
3585
3190
2958
16672
Females
3148
3235
3492
2991
2701
15567
Persons
6629
6693
7077
6181
5659
32239
Source: TIIG, Centre for Public Health, Liverpool John
Moores University
There were more attendances amongst younger people, aged 0-17 years, than any other single age
group.
Table 5 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by age group, Halton residents
(April 2010 to March 2015)
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Table 6 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by gender and age group, Halton
residents (April 2010 to March 2015)
When converted to a crude rate, the level of attendances reamins highest in the younger age group.
However, whilst the second highest group in terms oof numbers was 30-49, in relation to the size of
population, the second highesat rate is seen in the 65 and over age group.
Table 7 Unintentional injury attendances to Whiston Hospital and Warrington Hospital by age group, Halton residents
(April 2010 to March 2015), crude rate per 1,000 population
Unfortunately, despite the work TIIG have done with emergency department satff there remains an
issue with coding when breaking the data down further into injury type. The majority of injuries
have an ‘other’ coding, meaning the type of injury is not recorded. Of those that are recorded, falls
constitutes the highest proportion of injuries.
Table 8: Unintentional injury attendances to Whiston Hospital and Warrington Hospital by injury group, Halton residents
(April 2010 to March 2015)
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3.4. Hospital admissions
3.4.1. all ages
UI can occur at any age. Most occur in the home, especially in young children and the older
population; with children under 5 being most vulnerable at home.
Figure 2 shows the trend in emergency admissions with an injury code. It can be clearly seen that
most admissions to A&E are from those over 85 years old.
Before the age of 65 admission rates due to UI are higher in males than females. At birth upto 4
years of age there is little difference in accidents between the sexes. From 5 years onwards there are
fewer accidents in females wheras the number of accidents in males appears stable until 30 years of
age where it starts to decrease with a spike in the 45-49 age group.
Figure 2: Emergency admissions in Halton due to accidents by age and sex (2013-2014)
3.4.2. under 5s
Information was gathered from a needs assessment on childhood injuries in Merseyside from April
2007 to March 20011, it showed that children aged 0-4 made up 33% of all A&E attendances in
Merseyside due to injuries.8
Figure 3 shows the emergency admisions due to accidents for each ward in Halton. Nine wards show
significantly higher rates of emergency admissions due to accidents than the average rate in Halton,
with Hale having the highest rate. However, due to its small population (60 children aged 0-4) any
slight increase or decrease in the number of UIs will result in marked changes in Hale’s admission
rate.
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2015/16
Figure 3: Accidents resulting in emergency admissions in the 0-4 age group for each Halton ward (2012-2014)
3.4 3. children and early adolescents
‘More than two million children under the age of 15 experience accidents in and around the home
every year, for which they are taken to accident and emergency units. Many more are treated by
GPs and by parents and carers. Over 76,000 under the age of 14 are admitted for treatment of which
over 40% are under 5 years of age.’9
In Halton most admisions from the 0-14 age group come from Windmill Hill which is one of the most
deprived wards.
Figure 4: Accidents resulting in emergency admissions in the 0-14 age group for each Halton ward (2012-2014)
3.4.4. Transitional age 15 to 24
According to the Office of National Statistics (ONS) mid year population estimates, in 2012 there was
7.5 million 16-24 year old individuals in the UK.[10] This is an important age of transition from
dependent children to independent adults. Individuals in this age group can be prone to experiment
more and take greater risks which can be detrimental to both themselves and others surrounding
them.
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2015/16
In Halton, Windmill Hill has the highest emergency admission rates in the transition age per 100,000,
with Beechwood having the least.
Figure 5: Accidents resulting in emergency admissions in the 15-24 age group for each Halton ward (2012-2014)
3.4.5 Young adults aged 25 to 44
In the 25-44 age group Halton Lea had the highest rate of emergency admissions per 100,000 due to
accidents, Hale had the lowest.
Figure 6: Accidents resulting in emergency admissions in the 25-44 age group for each Halton ward (2012-2014)
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3.4.6. 45 to 64 aged population
There are 11 wards which show emergency admissions due to UI which are significantly higher than
the Halton average in the 45-64 year olds, with the most admissions per 100,000 coming from
Riverside.
Figure 7: Accidents resulting in emergency admissions in the 45-64 age group for each Halton ward (2012-2014)
3.4.7. Over 65s
The population aged 65+ has risen in Halton in the last decade. The 2001 Census estimated the
population aged 65+ to be 47,308. By the 2011 census it was estimated at 53,100. The risk of falls
increases with age.
Riverside had the most emergency admissions per 100,000 for accidents in the 65-79 age group,
followed closely by Appleton.
Figure 8: Accidents resulting in emergency admissions in the 65-79 age group for each Halton ward (2012-2014)
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In the over 80s, 9 wards had significantly higher emergency admissions for accidents than the Halton
average. Riverside again had the most admissions per 100,000 and Beechwood the least.
Figure 9: Accidents resulting in emergency admissions in the 80+ age group for each Halton ward (2012-2014)
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3.4. Causes of Accidental Injury
3.4.1. all ages
According to RoSPA, falls account for the majority of accidents which can cause a serious injury at
any time. The risk of falls increases with age. This accounts for the increase in emergency admissions
in the elderly seen prior in figure 2 above.
Appenddix 1 shows that falls account for the majority (64%) of emergency admissions due to injuries
in Halton for all ages. The second commenest cause being exposure to inaminate mechanical forces.
3.4.2. amongst children
TIIG has been working with all A&E departments in the region to develop standardised coding for
deliberate and accidental injuries. When the data was further analysed to identify what the causes
of children aged 0-4 being admitted to hospital falls was the most common reason, followed by
‘exposure to inanimate mechanical forces; which includes, ‘striking against or struck by other
objects’; ‘contact with sharp glass’ and ‘caught, crushed, jammed in or between objects.’8 This is
also the case in Halton as shown by table 1 in the appendix.
Falls accounts for the majority of emergency admissions in the 0-14 age group. Followed by
exposure to inanimate mechanical forces which accounts for 22% of admissions.
3.4.3. transition age
Although the majority of admissions are caused by falls, there are a lower percentage of admissions
due to falls (30%) in the 16-24 year olds than in all other age groups. The number of people being
admitted due to accidents caused by exposure to inanimate mechanical forces has increased to 26%
in this age group. Emergency admissions due to transport accidents, which is rare in other age
groups, account for roughly 14% of the admissions in 15-24 year olds; this includes both non-car
occupants and car occupants in transport accidents.
Table 1 in the appendix shows a more detailed breakdown of the types of accidents in 15-24 year
olds needing emergency admission in Halton. 69.8% of the admissions were male and only 30.2%
female. Males account for double the emergency admissions due to falls as compared to females,
and in the case of admissions due to exposure to inanimate and animate mechanical forces almost
triple. There were no injuries in the female population causing admission from motorcycle injury,
whereas this injury accounted for 4.7% of the admissions and they were all male.
3.4.4. working age adults
Falls accounts for the most emergency admissions due to accidents (39%) in the 25-44, followed by
exposure to inanimate mechanical forces which accounts for 21%. Emergency admissions for
transport accidents accounts for around 13%; 9% were non-car occupants with 4% being car
occupants. This is similar to those in the 15-24 age group.
The number of emergency admissions caused by falls increased to 57% in the 45-64 year olds,
whereas the number of admissions due to exposure to inanimate mechanical forces and transport
accidents decreased respectively to 13% and 8%.
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3.4.5. Older People
According to the department of work and pensions falls affect over a third of people over 65 years
old and 40% of people over 80.11 In Halton 79% of emergency admissions due to accidents were as
a result of falls for those 65-79 years old.
As the population ages the number of emergency admissions due to falls increases; 88% of the
admissions due to accidents in those over 80 were due to falls, of which 62.9% were female. In this
age group there was no emergency admissions for injuries caused by transport accidents.
3.4.6. Road Traffic Collisions
The department of transport has data on road traffic collisions that result in either death or a serious
injury. In 2013 there were 183,670 road traffic accident casualties of all severities in Great Britain
and in Halton there were 267. 21,657 were seriously injured which is 43% lower than in 2000, and
1,713 people were killed which is the lowest number on record. Figure 10, which is taken from the
department of transport report, shows the changes from 2005 to 2013 in the number of road
casualties in Great britain who were killed.
Figure 10: Killed casualties in Great Britain, 2005 – 2013
Source: Department for Transport
The majority of casualities that were killed in 2013 were car occupants, followed by pedestrains. This
can be seen in figure 11 below.
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Figure 11: The road user type of the casualties killed in reported accidents in Great Britain, 2013
*others consist of mainly goods vehicle and bus and coach occupants.
Source: Department for Transport
The department of transport also looked at road traffic collision casualties between 0-15 years of
age. They reported 15,756 total casualties in 2013 which was a 9% drop from 2012; the number
killed or seriously injured was 1,980, a drop of 13%.
17-24 year olds accounted for ¼ (133 out of 542) of the car drivers who died on Britain’s road in
2013; 1,245 were seriously injured.12
The Cheshire and Merseside fire service have data on road traffic collisions in Halton that they
responded to. Figure 12 shows that men between 20-34 years of age were involved in more road
traffic collisons than any other demographic group. In this group 18 people were between 20-24, 14
between 25-29 and 12 were 30-34 years of age.
Figure 12: Road traffic collisions in Halton that required the fire service, 2009/10 – 2014/15
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Incident rates involving a road traffic collision were highest in areas of main roads or traffic hotspots
- in Daresbury ward (M56, A56) and Mersey ward (Runcorn bridge).
3.4.8. Fire service data
The majority of incidents that the Cheshire fire and rescue service respond to are road traffic
collisions (44%), followed by fires (29%).
Figure 13: Type of injury resulting in injury that the Cheshire fire and rescue team responded to in Halton (2009/10 –
2014/15)
Fires are a cause of unintentional accidents that can cause injury requiring emergency admision.
According to Cheshire fire and rescue there was a total of 61 fires in Halton in the five year period
2009/10 – 2014/15. Table 9 is information taken from the Cheshire Fire and Rescue Services on
incidents that they responded to which led to an injury.
Table 9: Injuries caused by incidents that the fire service responded to in Halton (2009/10 – 2014/15)
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
Total
Fire
7
14
9
13
6
12
61
Special
Service*
Grand Total
16
28
20
21
33
30
148
23
42
29
34
39
42
209
* this is anything except a fire that requires a rescue e.g. road traffic collision
Source: Cheshire Fire and Rescue Service
84% of the fires were residential fires, and out of the 61 fires 54 (89%) were accidental. Table 10
shows the number of unintentional fires in each year.
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Table 10: Unintentional fires causing injuries in Halton (2009/10 – 2014/15)
Year
Incidents
2009/10
2010/11
7
13
2011/12 2012/13
7
10
2013/14
2014/15
Total
6
11
54
Source: Cheshire Fire and Rescue Service
The main cause of unintentional fires was cooking, the other top causes can be seen in table 11
below.
Table 11: Top 5 causes of unintentional fires in Halton (2009/10 – 2014/15)
Cause
Cooking
Faulty equipment
Percentage (%)
43
13
Combustible articles too close to heat
source (or fire)
13
Careless Handling
9
Source: Cheshire Fire and Rescue Service
37% of unintentional residential fires involved a lone person under 60 years of age, 22% involved
those over 60. Table 12 shows other people involved in the fires that occurred at home.
Table 12: People involved in unintentional fires at home in Halton
Household type
Lone person aged under 60
Lone person aged over 60
Lone parent with dependent
child(ren)
Percentage (%)
37
22
15
Couple with dependent child(ren)
11
2+ adults aged under 60, no
children
9
Source: Cheshire Fire and Rescue Service
Of the above 26% of accidental fires involved someone having fallen asleep, 20% of accidental fires
involved someone under the influence of a substance. Of the accidental injuries caused by fires, the
majority of victims were males between 20-34 years old. Figure 14 shows the breakdown of fire
victims by age and sex.
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2015/16
Figure 14: Rate of accidental fire victims in Halton by age and sex (2009/10 – 2014/15)
3.4.8. Deprivation
In 2010 Halton was ranked 27th most deprived area out of the 326 local authorities in England.
In Halton there are areas which are more deprived (Windmill Hill) than others (Birchfield). Table 13
shows the index of multiple deprivation (IMD) for the Halton wards with 1 representing the most
deprived and 21 the least deprived.
Table 13: The index of multiple deprivation for Halton wards, 2007 and 2010
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Unintentional Injuries across the lifecourse
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Figure 15 shows there is a correlation between the number of emergency admissions caused by
accidents and the level of deprivation the patients are from.
Figure 15: emergency admission rate for accidents in Halton compared to deprivation scores
R=0.67
The correlation coefficiency (R) is 0.67 which means that there is a moderate relationship between
deprivation and emergency admissions due to accidents in Halton.
This can be seen from the data collected; Windmill Hill accounted for the highest emergency
admission due to accidents per 100,000 between ages 0-24, Halton Lea for 25-44 year olds and
Riverside for those 45 and over. These three wards are among the top 5 most deprived in the Halton
area.
3.4.9. Alcohol
In 2012/2013 there were 22 million accident and emergency admissions. In 2012 there were 8,367
alcohol related deaths in the UK.13
According to the Institute of Alcohol Studies (IAS), alcohol is the biggest single cause of accidents in
the home. There are around 4,000 fatal domestic accidents each year of which 400 are alcohol
related.14
According to the public health annual report for Halton, two in three working age adults drink
alcohol (68%); this is higher than both the average rate for the whole of Merseyside and England.
Older people are more likely to drink at home alone and the measures poured are likely to be bigger
than in pubs and restaurants. It is therefore no surprise that accidents which are linked to alcohol
requiring emeregency admissions are highest in those over 85 years of age followed by those
between 45-49 years old. This is seen in figure 16 below; for all age groups males have more alcohol
related emergency admissions for accidents than females which is probably due to the fact that men
are more likely than women to drink excessively.
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Figure 16: Alcohol related emergency admissions for accidents in Halton per age group
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4. Impacts of Accidental Injury
At a recent (February 2016) workshop between RoSPA and staff working in Halton the importance of
investment in interventions to prevent UI was explored. Using the RoSPA Matrix tool together with
national and local data, the relative importance of UI as one of the significant causes of preventable
mortality and morbidity was underlined.
UI affects many people of all ages. Especially due to the impact it can have on children and young
people it can result in a huge loss of life years or life-long impairment and therefore a considerable
number of Disability Adjusted Life Years (DALY). Whilst the ROSPA tool suggests it is the joint highest
cause of DALY(the same at metnal health and higher than cardiovascualr disease and cancers), the
methodology currently used, utilising the WHO Global Burden of Disease figures for the UK suggest it
as the 7th highest cause of DALY.15
Despite these differences, both the analysis in this report and the work by RoSPA show the
importance on working to reduce UIs, especially as parents and carers of children and young people
tend to be extremely receptive to any advice that can help them reduce the risk of harm.
4.1. To the individual and their family
Although most falls do not result in a serious injury, being unable to get up exposes the faller to the
risk of hypothermia and pressure sores.16
As seen already, falls cause the majority of accidents requiring emergency admissions in those over
65 years old. The overall rate of emergency readmissions for any reason has increased steadily over
the last decade, from 8.4% in 2000-01 to 11.63% in 2010-11; the increase has been particularly steep
in those over 75.
The table below shows numbers and rates of admissions with falls for 0ver 65s and how many
readmissions they were with the same problem. In 2013/14 the were the highest rates of
readmissions to hospital where the original admission was falls.
Table 14: Hospital admissions due to falls amongst those aged 65+, 2010/11 to Q3 2014/15
Admissions Category
Value
2010/11
2011/12
2012/13
2013/14
868
4773.4
Q2
2013/14
to Q1
2014/15
838
4539.1
Q3
2013/14
to Q2
2014/15
842
4553.0
65+ Hospital
Admissions
due to falls
65+ Hospital
Admissions for
injuries due to falls
65+ Hospital readmissions where
original admission
due to fall
Number
Rate
885
4896.0
944
5191.0
837
4601.4
Number
Rate
625
3758.0
667
3613.8
624
3293.5
646
3565.7
623
3388.3
630
3414.5
Number
Rate
129
713.4
162
885.0
128
697.2
184
1021.8
173
954.6
166
903.6
Source: SUS data
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Falls in the elderly can lead to fractures, in particularly fractured neck of femurs which are linked to
high morbidity and mortality. Figure 17 shows the Halton rates of emergency admissions for
fractured neck of femurs compared to the rates in England and the North West. Halton rates of
fractured neck of femurs are higher than the North West and England, however they have dropped
considerably since 2003/2004.
Figure 17: Emergency admision rates for fractured neck of femurs in Halton, the North West and England (2003-2013)
Once an elderly patient has been admitted to hospital due to an injury from a fall, it can often herald
the start of a deterioration in health. Any fall even if small can lead to a loss in confidence and a loss
of independence. In a number of incidences, the individual once discharged from hospital, is unable
to return to their own home and is put in a nursing or residential home. This for most elderly people
can be a ‘fate worse than death’.17
Studies show that around 50% of those who enter hospital due to a fall leading to a fractured neck of
femur are unable to live independantly after. Of the patients discharged 5-12% will be readmitted
into hospital in the next 6 weeks, 5-10% die within the month, 20-30% die within the year.18
According to the British Geriatrics society, for a population of 320,000; 15,500 will fall each year of
which 6,700 people will fall twice, 2,200 will attend accident and emergency departments or minor
injuries units, a similar number will call an ambulance and 1,250 will have a fracture of which 360
will be hip fractures.19
Other groups, for example children, have a high incidence of falls however they are less likely to
have serious injuries from them, and most injuries they do get tend to recover quickly.
Accidents to an individual can have an impact on families as in addition of the trauma of having a
loved one being injured, they are often called upon to care for the injured person. This can result in
stress, time away from work and, sometimes, lost income.
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It is hard to quantify the emotional effect of accidents in the same way you can the financial effect.
Accidents themselves can cause disfigurement, and are traumatic enough to leave emotional effects.
Often the individuals suffer from anxiety and in some cases post-traumatic stress disorder (PTSD).
4.2. To the public sector
Childhood accidents cost the NHS an estimated £131 million per year on emergency hospital
admissions.20
If a child were to have a severe traumatic brain injury from the accident, the approxiamate lifetime
medical, educational and social cost would be £4.89 million. Table 15 is taken from the Public Health
England report on reducing unintentional injuries in and around the home in under 5s. It shows the
breakdown of the £4.89 million.
Table 15: Cost of unintential injuries to society
The Department for Transport estimates that the average cost per seriously injured casualty of any
age on the road is £189,519 and that the average cost per fatality is £1.69 million. The annual
combined cost of road accident fatalities and serious injuries among 0-15 year olds stands at £547
million.
Another cause of injury which leads to emergency admissions is unintentional poisoning by exposure
to noxious substances. The cost to the NHS for hospital admissions in children for poisoning is
around £2 million a year.
Burns can have a significant financial cost to the NHS in additional to the emotional cost to the child
and family. It is estimated that it costs £2,000 per child for a simple tea burn which requires one or
two days treatment, and £60,000 for a major burn which requires intensive care.
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The risk of falling increases with age. Falls cost the NHS more than £2 billion a year and as the
population of over 65s was set to increase by 2 million from 2013-2021, the cost on the NHS
continues to rise.
4.3. To wider economy/ society
Unintentional injuries can also have significant costs to the local auithorities and society as a whole.
A traumatic brain injury to a child from a serious fall can lead to disabilities which require additional
support leading to higher educational and social care costs in addition to a reduced earnings from
parents and benefit costs to the state.21
According to the Child Accident Prevention Trust (CAPT), for a parent who is employed full-time,
taking two weeks off work while their child is in hospital costs the economy £7,600.
The Confederation of British Industry (CBI) 2013 absence survey found that the average total cost for
buisnesses for each absent employer (whether they are the patient themselves or a family member)
in 2012 was £975.22
4.4. Mortality
Around 10 children die as a result of falls each year - some from windows and balconies and the
remainder mostly from stairs.23
Accidents are the leading cause of death in children and although this is not the case in the elderly
they still account for a substantial number of deaths. According to RoSPA, accidents in those 65 and
over accounted for 7,475 deaths in England and Wales alone in 2009. Figure 18 below shows
mortality in the Halton wards where there was an accident code; Birchfield (the least deprived ward)
had the least deaths per 100,000 deaths with Windmill Hill (the most deprived ward) having the
most.
Figure 18: Mortality in the Halton Wards where there was an accident code, 2010-2014
Table 16 shows the number of deaths for each age group and what type of accident caused the
majority of those deaths. Although in all age groups falls accounts for the majority of emergency
admissions, it is not the main cause of death. Poisoning by exposure to noxious substances was the
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2015/16
most common casue of death by accident in 4 age groups. Transport accidents as well as poisoning
by exposure to noxious substances was a cause of deasths in the 15-24 age group. In the 0-14 age
group the majority of deaths was for accidental threats to breathing (asphyxiation, strangulation,
aspiration, suffocation or obstruction of airway). Accidental exposure to other and unspecified
factors caused the majority of deaths (55%) in the over 80s, 20% was from poisoning and 20% from
falls.
Table 16: Number of deaths by type of injury and age group, 2010-2014
Age
Group
0-14
15-24
25-44
45-64
65-79
80+
Total Main causes
< 10
< 10
36
44
55
111
Other accidental threats to breathing
Noxious substances, car/motorcycle/pedestrian accidents
69% Noxious substances
61% Noxious substances
65% Noxious substances
55% Accidental exposure to other and unspecified factors, 20%
Noxious substances, 20% Falls
43.5% of deaths due to accidents in Halton were caused by accidental poisoning by and exposure to
noxious substances. The table below shows the types of accidents that lead to death.
Table 17: Number and percentage of deaths due to injuries 2010-2014
Type of accident
Accidental poisoning by and exposure to noxious substances
Accidental exposure to other and unspecified factors
Falls
Other accidental threats to breathing
Car occupant injured in transport accident
Pedestrian injured in transport accident
Other e.g. motorcycle or pedestrian accident, drowning
Number
Percent
111
43.5%
74
29.0%
38
14.9%
15
5.9%
6
2.4%
5
2.0%
6
2.4%
Falls accounted for the majority of emergency admisions due to accidents in all age groups but only
14.9% of the deaths caused by accidents. Table 18 looks at the mortality rates due to falls at
different dates; the rate of mortality due to falls has increased from 2009 to 2013.
Table 18: Deaths due to falls, all ages and amongst those age 65 and over, 2009/11 to Q3 2011/Q2 2014
Admissions Category
Value
2009-11
2010-12
2011-13
All Age Mortality due to falls
Number
Rate
Number
Rate
20
5.2
14
26.5
19
5.6
15
28.7
21
6.2
17
31.8
65+ Mortality due to falls
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Q2 2011
to
Q1 2014
22
7.7
18
34.0
Q3 2011 to
Q2 2014
22
7.5
18
33.3
Unintentional Injuries across the lifecourse
2015/16
5. Services
The following table has a list of services that are available to the community in terms of preventing
unintentional accidents. N.B the information was correct on September 2015
Table 19: Local services
Area
Runcorn
Children’s
Centres
Widnes
Children’s
Centres
Home Safety
Roads Safety
Falls prevention
Service
Brookvale
Halton Lodge
Halton Brook
Windmill Hill
Ditton
Kingsway
Upton
Warrington Rd
Halton HELPS
Home
Improvement
Agencies
Fire and rescue
services
Road Safety
Team (Council)
Falls prevention
exercise classes
Target Group
Parents-to-be and
parents with
children under 5
Description
Children centres aid the family in a number of
ways one of which is safety. They offer advice
on water safety, home safety, baby sleep
safety, feeding safety and travel safety.
Families with
young children
All ages
Offers support and advice in purchasing home
safety equipment.
Carry out home safety checks, fit equipment
to homes and carry out repairs.
All ages
Free home fire safety assessment, some
might be eligible for free fire alarms.
Advice and support to fit booster seats,
delivery of road safety sessions to parents
and their young children, training of staff who
are responsible in transporting children.
Families with
young children
Over 50s
Gentle Easy
Exercise
Falls Prevention
Awareness
Session
Over 50s
Falls Prevention
Training
Staff
Sure start to
later life
Age UK
Environmental
Safety
15 week programme to improve strength,
balance, coordination and confidence.
Includes health & wellbeing education.
Transport can be provided.
A follow on class for clients who have
completed the falls prevention exercise class
(above). It is a low intensity class that’s
designed to maintain and improve strength
and balance.
A one hour falls prevention awareness
session for community groups giving advice
on how to prevent falls and where to access
falls prevention support if needed.
This is for frontline staff to ensure they can
use a falls risk assessment tool and follow the
Halton falls pathway.
Both organisations provide advice and
information on falls prevention. There are
factsheets on falls prevention available.
Over 55s
Independent
living centre
Over 55s
Provides advice on falls prevention
equipment.
Control of
substances
harzadous to
All ages
COSHH requires employers to regulate
substances that are harzadous to health.
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Unintentional Injuries across the lifecourse
Area
39 | P a g e
Service
health (COSHH)
Control of
marjor accident
hazards
(COMAH)
Environmental
Health Officers
Target Group
2015/16
Description
COMAH regulations ensure that buisnesses
take all necessary measures to prevent major
accidents involving harmful substances.
Investigates health hazards in a wide range of
settings.
Unintentional Injuries across the lifecourse
2015/16
6. Projected level of Need
Below is a table showing predicted population changes in halton over the next 10 years.
Table 20: Population projections, 2014 to 2015
Ages
2014
2015
2020
2025
18-24
10,400
10,200
9,100
9,000
25-34
16,200
16,300
16,300
15,300
35-44
16,000
15,900
15,300
16,100
45-54
18,100
18,100
16,900
15,300
55-64
16,300
16,300
17,300
17,400
65-69
7,400
7,700
7,300
7,700
70-74
5,000
5,000
7,000
6,700
75-79
3,800
3,900
4,300
6,100
80-84
2,700
2,700
3,100
3,500
85-89
1,500
1,600
1,900
2,200
700
800
1,000
1,300
147,200
148,100
152,300
156,300
90 and over
TOTAL (18 and
over)
Source: Office of National Statistics
The popultation of people aged 18-34 and 45-54 is predicted to fall over the next 10 years, as this is
the age group where there are more road traffic collisions we would expect a decrease in the
incidence of this type of accident.
The overall population size continues to rise and so does the life span so we get more people living
to 90 and over. The table below shows the predicted number of falls in those over 65 will increase
over the next 10 years.
Table 21: Predicted number of falls, 2014 to 2015
Ages
2014
2015
2020
2025
65-69
1,517
1,581
1,522
1,586
70-74
1,182
1,182
1,652
1,585
75-79
890
890
1,001
1,415
80-84
885
885
981
1,142
85 and over
946
989
1,204
1,505
5,420
5,527
6,360
7,233
TOTAL (65 and
over)
Source: POPPI
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Unintentional Injuries across the lifecourse
2015/16
As the number of people over 65 who have a fall increases, the number of people who will be
admitted to hospital as a result is also predicted to fall, with the greatest increase being seen in
those 75 years and over. This can be seen in table 22.
Table 22: Predicted number of hosital admissions due to falls amongst those aged 65 and over, 2014 to 2025
2014
2015
2020
2025
65-79
38
40
38
40
70-74
46
46
64
62
75 and over
320
328
379
482
TOTAL (65 and over)
405
414
481
584
Source: POPPI
41 | P a g e
Unintentional Injuries across the lifecourse
2015/16
7. User Views
Falls prevention programmes have been ongoing in the community in UK. In 2010 there was a
report24 published on the results of a questionnaire on the falls prevention services. The Healthcare
Quality Improvement Partnership with support from Age Concern/Help the Aged (Age UK)
commissioned this work; it was conducted by the Royal College of Physicians and the Clinical
Standards Department. Below are some user views of the falls prevention services.
“The falls team have been very helpful in their assessment of my husband’s condition.
He was having as many as 3 and 4 falls weekly and of late he has hardly had any. We
have both gained the excellent information and advice we have been given by the
falls team. They have been wonderful. Long may their work continue.”
Three-quarters of people felt the service had been useful for them, while just under
one in eight said it had been “quite useful for me but could be better” or “not useful
for me.”
“I think it would help if the exercise programme could go on for a longer period than
10 weeks, as it gave my husband more confidence, and it helped me in knowing he
was in good hands at the clinic.”
The majority of users felt that the programme was beneficial. Areas of improvement that seemed to
come out from the report were a longer programme would be useful, some felt they had to long
wait before being contacted after referral into the services, a minority felt that the programme
would have been useful a few years earlier when they first started falling.
Falls prevention and falls care is a high priority in the Halton Local Authority as Haltons falls rate is
higher than the national average. There is a 2014-2018 falls strategy, although the falls prevention
service started in 2005 with the number of referrals growing each year. There has been a
consultation event to acertain user views of the service provided, the majority of feedback has been
positive.
Mr B and Mrs H both wanted to praise the work of the Falls Prevention team as
they had received very positive experiences that had improved their mobility and
confidence. Mr B had been into hospital for a planned admission and on discharge
had been given good information. Following this, Mr B’s doctor then signposted
him to the falls Prevention team.
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Unintentional Injuries across the lifecourse
2015/16
8. Best Practice
8.1. NICE guidelines on accidents( clinical & public health)
Guideline
CG161
PH30
PH31
PH29
Pathways
Quality
standard
Description
Falls – assessment and prevention of falls in older people
Preventing unintentional injuries among the U15s in the home
Preventing unintentional road injuries among the U15s
Strategies to prevent unintentional injuries in the U15s
( in particular injury prevention coordinator)
Falls in older people
Unintentional injuries among under 15s
Falls in older people: assessment after a fall and preventing further falls (QS86)
March 2015
8.2. NICE guidance: In development
Quality standard: Preventing unintentional injury among children and young people under 15 (GIDQSD112) January 2016
Quality standard: Preventing unintentional injury (GID-QSD111) TBC
8.3. Compliance with NICE guidelines
A copy of NICE guideline assessment tools for unintentional injury prevention in children under 15
years old was sent out to relevant individuals. Table 23 shows a summary of what Halton Borough
Council (HBC) has in place to prevent unintentional injuries in different areas. Completed forms can
be seen in the appendix.
Table 23: A summary of procedures in place to prevent unintentional injuries in under 15s in the Halton Borough Council
Areas
Home Safety
Things in place
 Information from households with children is gathered through visits from
Health Visitors, Family Support workers, Child in Need teams, Children’s
Centre staff and from housing associations.
 Home Equipment Low Price Scheme (HELPS) is in place, its main focus is
families with under 5’s.
HELPS is a 3 tier scheme which involves:
1. HELPS – Universal for Halton, sells subsidised recommended safety
equipment.
2. Free HELPS – Provides the most vital equipment free for qualifying families.
3. Fit4safety – Provides stairgates/fireguards which are fitted by advocates
from the Cheshire Fire and Rescue Services (CFRS).
The 3 schemes are designed as ‘mix + match’ to best cater for the individual
family needs.
 HELPS provides safety leaflets for Health Visitors etc to assist with educating
parents on age-appropriate dangers and possible preventative measures.
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Unintentional Injuries across the lifecourse
Areas
2015/16
Things in place
 CFRS has been commissioned by Halton Borough Council to engage hard to
reach families across the borough to provide practical help in reducing
accidents and deaths, in addition to providing home safety assessments and
the Halton Fit4safety scheme.
 Midwives provide all women with a home antenatal appt at about 36 weeks
gestation. Pet safety, SIDS and sleep safety is discussed and leaflets given.
Fire Safety
 CFRS have a system in place to identify areas, schools and homes at greatest
risks of injury from fires.
 Referrals to CFRS from different agencies.
 CFRS arrange home safety assessments and free smoke alarms with 10 year
batteries are fitted if needed.
 CFRS deliver fire safety talks to 7-11 year olds in all schools.
 Phoenix project – Occurs in 8 schools. Targeted at areas of increased
deprivation with the aim of improving child safety and developing good
citizens through the use of fire fighter role models. The phoenix project also
annually has a phoenix sports challenge to promote healthy eating and
fitness.
 CFRS Business Intelligence Team produces a Halloween & Bonfire Period
Analysis Report each year. The team use historical data plus socio
demographic data and local school information to accurately predict the
location of the majority of incidents in the borough during the bonfire period
and as a consequence the Service work in collaboration with local partners
through the Tasking and Coordination Group (T&C) to reduce deliberate fires,
anti-social behaviour and injuries.
 Using the Halton Halloween & Bonfire Period Analysis Report the stations in
Runcorn and Widnes target schools in ‘hot spot’ areas for educational
programmes in the run up to the bonfire period.
 CFRS Communication Teams use a variety of communication tools including
Twitter, Facebook, podcasts and local press to deliver safety campaigns in the
run up to celebratory periods renowned for fireworks.
 CFRS personnel will visit premises storing fireworks in the run up to the
bonfire period (only premises using ISO containers or storage more than
2000Kg of fireworks). Specialist Fire Protection Officers will provide guidance
etc. on use of the building etc. however Trading Standards Officers will
provide advice on firework use.
Road Safety
 Health professionals attend quarterly LSP Transport Group which discusses
all forms of transport and highway issues.
 Highway Authority officers work closely with developers to ensure road
schemes consider all aspects of road safety when developing sites.
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Unintentional Injuries across the lifecourse
Areas
2015/16
Things in place
 Killed or Seriously Injured (KSI) data plays a fundamental role in directing
local safety schemes in Halton. Schemes are also run targeted at over
presented KSI groups i.e. young drivers and motorcyclists.
 Any new or improved road/path/infrastructure is consulted on with the
surrounding community where appropriate.
 Local road safety schemes are reviewed throughout the calendar year and
addressed if needed. Schemes such as ‘20s is plenty’ initiative is continuing.
 School travel plans are reviewed by road safety and transport teams as well
as the health improvement team and are updated and launched yearly.
Water Safety
Area to be looked at.
Outdoor play
Area to be looked at.
Additional
 1st aid courses –eg Millie’s Trust - are offered to families to increase parents
understanding of safety issues and 1st Aid.
 Volunteer organisations – Venus and Innovate – will shortly be training
parents to work in the community to support vulnerable families to engage
with services i.e. HELPS. These volunteers will provide peer support for
parents and may therefore be more readily accepted by the family than a
professional worker.
 CFRS are developing a safety and life skills centre aimed at reducing
accidental injuries among children and young people. It is a joint partnership
with police and social care. The centre is to open in Lymm in January 2017.
As a council we have a variety of things in place to prevent unintentional injuries in under 15s in the
home or as a result of fire; there are a variety of things in place ie Home Equipment Low Price
Scheme (HELPS) and fit4safety. It was difficult to find someone who has responsibility over water
safety and safe play outdoors i.e in playgrounds therefore assessments in those areas are missing;
this is an area to be looked at in the future.
NICE recomends having a senior public health position which includes leading on and responsibility
for injury prevention and risk reduction, this is something HBC can put in place.
8.3. Other sources
Unintentional injuries comprise a wide and diverse range of injuries, and may be experienced by a
range of age-groups in many settings. Evidence about what works to reduce these injuries is
therefore varied, depending on the type of injury, setting, and age group of the target population.
In July 2009 the Department of Health produced a 'Prevention package for older people resources'
set of guidance which included falls and fractures. These can be found in the gov.uk archived site at
45 | P a g e
Unintentional Injuries across the lifecourse
2015/16
http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publication
sandstatistics/Publications/PublicationsPolicyAndGuidance/DH_103146
The Royal Society for the Prevention of Accidents, supported by Public Health England, recently
published a series of factsheets and case studies on accident prevention across themes of home
safety, road safety, leisure safety and safety education.
For home safety, RoSPA states that a combination of factors are required to address the
environment (e.g. planning and design, fireguards and safety gates); education; empowerment; and
enforcement (e.g. legislation around product safety and safe dwellings).
The Health and Safety Executive has a range of guidance on the prevention of unintentional injuries
within the workplace, by both injury type and industry type.
46 | P a g e
Appendix 1: Breakdown by age and sex of emergency admissions in Halton for unintentional injuries, 2012/13 – 2013/14
Falls
0-14
%M
%F
29.2 16.2
15-24
%M
%F
20.1 10.5
25-44
%M
%F
23.3 17.7
45-64
%M
%F
29.0 31.0
65-79
%M
%F
31.9 48.5
Exposure to inanimate mechanical forces
11.9
9.6
18.5
5.2
15.0
4.4
9.7
3.0
3.1
2.5
<1
2.2
Pedal cyclist injured in transport accident
3.6
1.3
4.2
<1
2.6
<1
2.3
0.1
0
0
0
0
Exposure to animate mechanical forces
3.2
4.3
8.4
3.0
5.1
2.6
2.3
1.9
<1
<1
<1
<1
Accidental poisoning by and exposure to noxious
substances
Accidental exposure to other and unspecified
factors
Other accidental threats to breathing
2.5
4.0
3.0
3.5
4.1
2.1
2.5
1.0
<1
<1
<1
<1
2.3
1.7
4.2
1.6
4.1
2.1
3.2
2.2
2.1
2.5
1.7
2.8
0
0
0
0
0
0
0
0
0
0
<1
<1
Contact with heat and hot substances
1.9
2.3
0
0
<1
<1
0
0
0
0
0
0
Pedestrian injured in transport accident
1.5
<1
<1
<1
1.3
<1
<1
<1
0
0
0
0
Car occupant injured in transport accident
<1
<1
2.6
2.8
2.3
2.3
1.1
1.9
<1
<1
0
0
0
0
0
0
0
0
4.7
0
0.0
0
0
1.2
2.0
0
<1
<1
0
<1
1.1
<1
0
<1
<1
0
0
0
0
0
0
0
0
0
0
0
0
0
<1
<1
58.5
<1
<1
41.5
0
1.6
69.8
0
<1
30.2
0
3.1
63.6
0
1.4
36.4
0
1.5
55.8
0
<1
44.2
0
<1
42.1
0
<1
57.9
0
<1
29.6
0
<1
70.4
Motorcycle rider injured in transport accident
Bus occupant injured in transport accident
Other land transport accidents (all were fall from or
being thrown from animal)
Exposure to smoke fire and flames
Overexertion, travel and privation
80+
%M
%F
26.2 62.9
References
1. Chief Medical Officer annual report 2011
2. ROSPA (2014) Delivering Accident Prevention at local level in the new public health system
3. http://www.rospa.com/about/currentcampaigns/publichealth/info/hs1-factsheet.pdf
4. http://www.rospa.com/about/currentcampaigns/publichealth/info/hs1-factsheet.pdf
5.
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
5. Department of Trade and Industry (2003) 24th (final) report of home and leisure accident
surveillance system. London: DTI
7. Consumer Safety Unit (2002) 24th Annual Report, Home Accident Surveillance System. London:
Department of Trade and Industry
8. http://www.haltonchildrenstrust.co.uk/wp-content/uploads/2014/04/Childrens-JSNA-Chapter-4Early-Years.pdf
9. http://www.rospa.com/home-safety/advice/child-safety/accidents-to-children/
10. http://www.ons.gov.uk/ons/dcp171776_387750.pdf
11. Department for Work and Pensions (no date) Falls in older people
12. Department for Transport (2013) Reported road casualties Great Britain: annual report 2012,
13. http://www.ons.gov.uk/ons/rel/subnational-health4/alcohol-related-deaths-in-the-unitedkingdom/2012/stb---alcohol-related-deaths-in-the-united-kingdom--registered-in-2012.html
14. http://www.ias.org.uk/Alcohol-knowledge-centre/Health-impacts/Factsheets/Alcohol-accidentsand-injuries.aspx
15. http://www4.halton.gov.uk/Pages/health/PDF/health/DALY2014%20(2012popfigures).pdf
16. Department of Trade and Industry (2002) Home accident surveillance system: 24th annual
report. London: DTI
17. Clarity and The EAR Foundation (2007) Study: Seniors fear loss of independence more than death
18. Castronuovo E, Pezzotti P, Franzo A, et al (2011) Early and late mortality in elderly patients after
hip fracture: a cohort study using administrative health databases in the Lazio region, Italy BMC
Geriatr. 2011 Aug 5;11:37. doi: 10.1186/1471-2318-11-37.
19. British Geriatrics Society (2010) Key Facts on Falls
Unintentional Injuries across the lifecourse
2015/16
20. http://www.makingthelink.net/tools/costs-child-accidents
21.
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
22. CBI/Pfizer (2013) Fit for purpose: Absence and workplace health survey 2013
23. Office for National Statistics: Mortality Statistics; injury and poisoning 2002: England & Wales.
Series DH4 no. 27) (General Register Offices for Scotland: Annual Report of the Registrar General for
Scotland 2002) (General Register Office (Northern Ireland): Registrar General Annual Report 2002:
Section 6- Causes of death
24. https://www.rcplondon.ac.uk/sites/default/files/experiences-of-falls-prevention-services-report10-february-2010_1.pdf
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