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David Oliver: What the party manifestos should cover on health and social care but probably won’t

BMJ 2024; 385 doi: (Published 05 June 2024) Cite this as: BMJ 2024;385:q1202

Rapid Response:

Accident prevention: effective measures need to be implemented

Dear Editor
Oliver recommends some credible positions on crucial health policy areas including the NHS, social care and public health; political parties should take heed.(1) In relation to public health he covers key issues; however bearing in mind his profession we were surprised that he did not mention an area that would help to lessen the demand on the NHS and social care, that is, accident prevention.

Accidents are amongst the leading, but preventable causes of death, serious injury and long-term disability affecting individuals and families.(2-5) The total cost of accidents to the NHS, in terms of treatment, follow-up and rehabilitation of patients is undoubtedly substantial. Other organisations also have significant costs related to accidents: the police, social services, fire service and local authorities are some examples.

In the past when funding has been applied to effective measures there has been significant impacts.(6-14) There is sound evidence of success in homes, workplaces and the roads. Currently, Bloomberg Philanthropies, for example, are helping to save millions of lives by spreading solutions that have been proven to work in low and middle-income countries.(14,15)

In the UK in the recent past, there is also evidence of accidents prevented and lives saved by organisations such as the Royal Society for the Prevention of Accidents (RoSPA) working in partnership with a wide range of organisations.(16) But much more could be achieved with a comprehensive strategy and adequate funding.

Successful accident prevention often involves a range of different individuals, organisations and agencies. Partnerships and coordination are needed to ensure the work is focused and that there is synergy.(2,17-19) In the UK, strong leadership and coordination are required at two levels, local and national.(3,4)

In relation to home-safety we could be doing much more to protect the very young and older people from accidents. For example, between 2009 and 2011 the Government funded a major (£11 million) time-limited initiative aimed at reducing unintentional injury through providing home safety equipment and advice to disadvantaged families with children aged under 5.(13,20,21) This successful programme was designed and implemented by RoSPA. An important impact of the scheme was it was associated with a reduction in injury-related hospital admissions in children under 5.(13) A more recent home-safety intervention implemented in one city has also just been shown to be a cost-saving intervention.(22)

We could also be preventing more accidents and saving lives in relation to roads. England is lagging behind similar countries.(5,23) The country needs a proactive approach focusing on prevention, protection, and post-collision response.(5) Examples of specific initiatives needed include:
• Graduated Driver Licensing for younger drivers
• Safer driving campaigns (e.g. covering – alcohol, speeding, distractions, drugs)
• Courses and awards for young drivers and couriers.

The Global Status Report on Road Safety that was published in December 2023 reviewed current research and it showed that improvements are possible if effective measures are implemented.(14) At the launch the representative from Bloomberg Philanthropies was very clear about the central role that data has to play in effective accident prevention campaigns. It is vital for planning, evaluation and promoting action. In England, for example, good national data from emergency departments would greatly assist home accident prevention initiatives.

There is considerable evidence from a range of sources, which indicate that accident prevention should be a higher priority for the new Government. Epidemiological, effectiveness and economic data all support the case. A comprehensive strategy, strong leadership and targeted funding would help to reduce the burden of serious accidental injuries, promote safe and active lives, and lessen the strain on the NHS and social care.

1) Oliver D. David Oliver: What the party manifestos should cover on health and social care but probably won’t BMJ 2024; 385 :q1202 doi:10.1136/bmj.q1202

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

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

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

5) Parliamentary Advisory Council for Transport Safety. Manifesto for Road Safety 2024. A Call to Action for the Incoming Government. London: PACTS, 2024.

6) Centers for Disease Control and Prevention. Ten Public Health Achievements of the Twentieth Century - United States, 1900-1999. MMWR Weekly 1999;48(12):241–3.

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

8) Kendrick, D., Young, B., Mason-Jones, A. J. et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.:CD005014.

9) 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.

10) Kendrick, D., Mulvaney, C. A., Ye, L. et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database Syst Rev. 2013, 3:CD006020.

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

12) Watson M C and Lloyd J. IHPE Position Statement: Unintentional Home Injuries to Children, June 2019. Lichfield, Institute of Health Promotion and Education.

13) Hill T, Coupland C, Kendrick D, et al. Impact of the national home safety equipment scheme ‘Safe At Home’ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis. J Epidemiol Community Health 2022;76:53-59.

14) World Health Organization. Global status report on road safety 2023. Geneva: World Health Organization, 2023.

15) Bloomberg Philanthropies. The Bloomberg Philanthropies Initiative for Global Road Safety. (Accessed 07/06/2024)

16) Royal Society for the Prevention of Accidents (RoSPA). Our history. (Accessed 07/06/2024)

17) Watson M C. Alliances against Accidents. Practice Nursing 1994, 5(13), 20.

18) Christoffel T, Gallagher S. Injury prevention and public health practical knowledge, skills and strategies. 2nd edn. Sudbury, MA: Jones and Bartlett, 2006.

19) Peden, M., K. Oyebite, J. Ozanne-Smith. et al. World Report on Child Injury Prevention. Geneva: WHO, 2008.

20) Errington G, Watson MC, Hamilton T. et al. Evaluation of the National Safe At Home Scheme - Final Report. Nottingham: University of Nottingham, 2011.

21) Mulvaney, C. A., Watson, M. C., Smith, S., & Errington, G. An independent evaluation of a home safety equipment scheme in a high-risk community: views and safety practices of families. International Journal of Health Promotion and Education, 2013: 51(6), 312–322.

22) Jones M, Orton E, Taylor M. et al. Cost-effectiveness of the "Stay One Step Ahead" Home Safety programme for the prevention of injuries amongst children under five years. Injury Prevention (In press)

23) Jordan B. Road Safety Strategy. Hansard Volume 834: debated on Monday 18 December 2023 (3.05pm) (Accessed 07/06/2024)

Competing interests: Dr Michael C. Watson is also a Trustee of RoSPA (unpaid position).

10 June 2024
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr Karen E. Neil, Member, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, 2nd Floor, Fairbank House, 27 Ashley Road, Altrincham, Cheshire, WA14 2DP.