HC 1048-III Health CommitteeWritten evidence from Child Accident Prevention Trust (PH 71)

“...illness and injury can have a long-lasting impact on a young person’s life and ultimately on their life chances and therefore on our economy and society. In turn this can impact significantly on their family’s life. So this matters for all of us.”

1. Summary

We believe that the following priorities are key to the development and implementation of new proposals for public health organisation and delivery. A new approach to public health should:

retain a strong focus on children and young people;

ensure that child injury prevention, with its extensive links to the wider determinants of health and health inequalities, is recognised throughout this process and during the subsequent transition period as an essential and fundamental prerequisite of children’s wellbeing; and

ensure the retention of the proposed key drivers for improvement, including health and wellbeing boards and the hospital admissions/child injury indicators of the draft Public Health Outcomes Framework.

2. Background

The Child Accident Prevention Trust (CAPT) is the UK’s leading charity working to reduce the number of children and young people killed, disabled or seriously injured in preventable accidents, and thereby enhance children’s life chances. We have contributed to and followed with interest the continuing debate and discussion on the planned NHS reforms. We have been actively involved in strategic leadership events such as the Public Health Congress. We would like to use the opportunity of the Public Health inquiry to reinforce what we believe should be key considerations for ensuring the health, safety and wellbeing of children and young people.

3. Childhood accidental injury is one of the biggest killers of children, second only to cancer. In 2009, 193 children and young people under 15 died in accidents in England and Wales. 105,000 children and young people under 18 were admitted to hospital as a result of unintentional injuries in 2007–08. Children from the poorest families are 13 times more likely to die from accidental injury and three times more likely to be admitted to hospital with serious injuries. Child injury prevention is therefore a significant public health and inequalities issue.

4. Key Considerations

(i) Ensuring a focus on children and young people

We share the concern, expressed by many practitioners, that the debate on NHS reforms has, once again, marginalised the role of children and young people. This is in spite of:

the conclusions of the Kennedy Review that services for children and young people have a low priority; that many GPs have little or no experience of paediatrics as part of their professional training, and that the investment in services for children and young people is at its lowest in the early years;

the findings of the King’s Fund inquiry that despite the potential to promote the health and wellbeing of the population covered by GP practices, there has been little success in drawing GPs ‘beyond the surgery door’, and GPs still concentrate on clinical activities;

the commitment—clearly set out in Achieving equity and excellence for children—to improve experiences and outcomes for children and young people through “strong joint arrangements and local partnerships”; and

the moral, social and economic imperatives to use every opportunity to improve prevention and to reduce the numbers of children admitted to hospital or attending A&E departments. With unintentional injury resulting in over 100,000 hospital admissions each year among under 18s in England, we strongly endorse the evidence-based finding that “too many children are admitted to hospital ... it should not be forgotten that admission is traumatic and distressing for the child and his or her family and it is a very expensive option.”

(ii) Ensuring that children’s safety and wellbeing are at the heart of action to address inequalities

5. The wellness and wellbeing of children, and the positive impact this has on “starting well”, “developing well” and future life chances, depends on children being able to lead fulfilling, active lives which are free from the disabling effect of serious accidental injury. The strong links between preventable childhood injury and deprivation underline the fact that this should be a key priority for action to tackle health inequalities.

6. Given the wider determinants that influence children’s safety and wellbeing—including families and parenting, housing and the built environment, roads and traffic, and community development— there is strong evidence of the need for effective joint working to reduce unintentional childhood injury. The experience of successful local partnerships confirms that a coordinated approach contributes to the achievement of wider health and wellbeing benefits for children and young people.

(iii) Ensuring that the new public health system incorporates drivers for children’s safety

7. At a time of scarce resources—for health and local authorities alike—it is clear that there must to be strong and explicit drivers for improvement as a focus for local accountability, ownership and joint working. Through our first hand experience of working with local services, and as part of the Making the Link programme, we recognise how challenging it can be in practice to bring together health and local authority specialists and to achieve greater integration around shared aims, common ‘language’ and organisational cultures.

8. Health and wellbeing boards, and the draft public health outcomes framework (with “lifecourse” indicators which include children’s hospital admissions due to unintentional injury), are therefore vital to the success of the new public health system.

9. CAPT’s original response to the consultation on funding and commissioning routes for public health stated that: “The health and wellbeing board will be a key driver for the kind of local action and partnership work which has characterised good practice in the field of child injury prevention. Coordinated planning and partnership working is, for example, at the heart of the evidence-based recommendations contained in NICE public health guidance on preventing unintentional injuries among under-15s. To achieve the ‘deep and productive partnerships’ envisaged in the DH Next Steps document, it is appropriate that health and wellbeing boards are the right place to bring together ring-fenced public health and other budgets.”

10. We were therefore concerned to read the Commons Health Select Committee recommendation that the proposal to establish Health and Wellbeing Boards “should be dropped”, This was in spite of the Committee’s agreement that ‘it is important to encourage the development of collaborative working between NHS commissioners and local authorities’ and the need to broaden the basis of stakeholders who are involved in the NHS commissioning process.”

11. CAPT shares the belief of many public health professionals and practitioners that the health and wellbeing boards—with their central roles in Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategies—have the potential to provide a real incentive for the type of coordinated local action and ownership which is needed to address deeply entrenched public health issues. The apparent success of the invitation for local areas to establish “early implementer” health and wellbeing boards appears to suggest that this is also an approach which is rooted in reality, as opposed to more fragmented concepts.

In Conclusion

Based on our experience of working closely with health and local authority teams, the Child Accident Prevention Trust has been a strong advocate for changes in public health which will see greater levels of partnership working and a sharper focus on the needs of children, young people and their families. We have also argued that the safety and wellbeing of children must be explicitly included in the role of health and wellbeing boards, and in the final version of the public health outcomes framework. Finally, we believe that child accident prevention should be recognised as a public health and local partnership priority, reflecting the clear recommendations of successive studies and reports in the last 10 years.

June 2011

Prepared 28th November 2011