Intended for healthcare professionals

Rapid response to:


Sure Start cut child admissions and health inequalities, report finds

BMJ 2019; 365 doi: (Published 04 June 2019) Cite this as: BMJ 2019;365:l4043

Rapid Response:

Child accident prevention: evidence-based approaches

We welcome the research produced by the Institute for Fiscal Studies which estimated that Sure Start children’s centres reduced child hospital admissions and saved the NHS millions of pounds.(1,2) Their findings are in line with “Keeping Children Safe”: a large NIHR funded, multicentre programme of research.(3)

Although “Keeping Children Safe” focused on the under-fives it did provide evidence about the effectiveness of, as well as economic evaluation of, home safety interventions.(3) The study found that providing evidence based resources for children’s centres increased their injury prevention activity and changed some parental safety behaviours.

The research also indicated that there was a wide variation in the priority accorded to child unintentional injuries and the prevention activities undertaken by different children’s centres.(4,5) Although the managers had positive views about injury prevention roles, they would need considerable support to fully develop them.

There is now growing evidence about the potential for accident prevention: much suffering could be prevented and more lives could be saved.(6-11) Both Public Health England (12,13) and NICE (14-16) have published guidance in order to try and ensure that people are safer on the roads and in their homes. In relation to schools, priorities for children and young people have been produced.(17) It is clear, as in the case of children’s centres, that funded accident prevention interventions can produce positive public health outcomes.

There are some very good examples of accident prevention across the country. However, there is little consistency in the quantity and quality of interventions.(4,5,18) The Royal Society for the Prevention of Accidents in conjunction with many important partners including The Royal College of Emergency Medicine and Royal College of Nursing have just published an executive summary of their national strategy for England – “Safe and active at all ages”.(19) It draws upon the significant evidence-base, including guidance from NICE and Public Health England. The strategy serves as a call to action in the delivery of effective accident prevention interventions.

The strategy is ground-breaking as it quantifies and addresses the different safety challenges across the whole life course. It could have a significant impact on preventable causes of ill health, early deaths, and on our overstretched health and social care services. At a time when A&E departments are having to cope with unprecedented levels of pressure, it is vital that we recognise the contribution that evidence-based accident prevention could make to relieve some of the demand.

The success of the strategy will depend upon the involvement of a wide range of partners and RoSPA is working hard to secure sustained commitment from different individuals, groups and organisations. Accident prevention should be included as a key area in the forthcoming Green Paper on Prevention and sufficient funding should be made available so that the evidence-based interventions that are recommended by NICE and PHE can be put into practice.(12-16)

1) Institute for Fiscal Studies. The health effects of Sure Start. London: Institute for Fiscal Studies, 2019.

2) Mahase E. Sure Start cut child admissions and health inequalities, report finds. BMJ 2019;365:l4043 doi: 10.1136/bmj.l4043

3) Kendrick D, Ablewhite J, Achana F, et al. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. Programme Grants Appl Res. 2017;5(14).

4) Watson, M., C. A. Mulvaney, D. Kendrick, J. Stewart, C. Coupland, M. Hayes, and P. Wynn on behalf of the Keeping Children Safe programme team. “National Survey of the Injury Prevention Activities of Children's Centres.” Health & Social Care in the Community 2014; 22 (1): 40–46.

5) Watson, M., C. Mulvaney, C. Timblin, J. Stewart, C. Coupland, T. Deave, M. Hayes, and D. Kendrick. “Missed Opportunities to Keep Children Safe? National Survey of Injury Prevention Activities of Children’s Centres.” Health Education Journal 2016; 75 (7): 833–842.

6) CDC. Ten Public Health Achievements of the Twentieth Century - United States, 1900-1999. MMWR Weekly 1999;48(12):241–3

7) British Medical Association. Injury Prevention. London: BMA, 2001.

8) Christoffel T and Gallagher S. Injury Prevention and Public Health. Practical Knowledge, Skills and Strategies. Sudbury: Jones and Bartlett, 2006.

9) Peden, M., K. Oyebite, J. Ozanne-Smith, A. Hyder, C. Branche, F. Rahman, F. Rivara, and K. Bartolomeos. World Report on Child Injury Prevention. Geneva: WHO, 2008

10) Hemenway D. While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.

11) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health.2016; 26(5), 194-199

12) Public Health England. Reducing unintentional injuries in and around the home among children under 5 years. London: Public Health England, 2018.

13) Public Health England. Reducing unintentional injuries on the roads among children and young people under 25 years. London: Public Health England, 2018.

14) National Institute for Health and Clinical Excellence. Preventing Unintentional Injuries in the Home among Children and Young People Aged under 15: Home Safety Assessments and Providing Safety Equipment. NICE Public Health Guidance 30. London: NICE, 2010.

15) National Institute for Health and Clinical Excellence. Strategies to Preventing Unintentional Injuries in under 15s. NICE Public Health Guidance 29. London: NICE, 2010.

16) National Institute for Health and Clinical Excellence. Strategies to Prevent Unintentional Injuries among Children and Young People Aged under 15: Evidence Update February 2013. London: NICE, 2013.

17) Lloyd J, Baillie M, Evans I, James A, Bennetts J, Watson M C, Safety Education: Priorities for children and young people – A Manifesto for Action. Welwyn: Institute of Health Promotion and Education, 2015.

18) Chisholm A, Watson M, Jones S, Kendrick D. Child injury prevention: a survey of local authorities and health boards. International Journal of Health Promotion and Education 2017; 5(4):205–214.

19) RoSPA. Safe and active at all ages: a national strategy to prevent serious accidental injuries in England. Birmingham: RoSPA, 2018.

Competing interests: No competing interests

10 June 2019
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, Welwyn AL6 0UD, UK.