1 Recommendations

This is NICE's formal guidance on preventing unintentional injuries in the home among children and young people aged under 15. When writing the recommendations, The Public Health Interventions Advisory Committee (PHIAC) (see appendix A) considered the evidence of effectiveness (including cost effectiveness), fieldwork data and comments from stakeholders. Full details are available online.

The evidence statements underpinning the recommendations are listed in appendix C.

The evidence reviews, supporting evidence statements and cost effectiveness modelling are available online.

PHIAC considers that the recommended measures are cost effective. For the gaps in research, see appendix D.

Context

The recommendations in this guidance should be implemented as part of a broader strategy to reduce unintentional injuries in the home. This would include the use of regulations and the provision of safety education to prevent such injuries. (Note that in November 2010, NICE published guidance on strategies, regulation, enforcement, surveillance and workforce development to prevent unintentional injuries.)

This guidance focuses on home safety assessments and the supply and installation of home safety equipment, either delivered separately or together. It also covers education and advice when delivered as part of these interventions.

Implementation of all the recommendations should ensure a systematic approach can be adopted. This involves prioritising households at greatest risk of unintentional injuries and establishing partnerships to ensure coordinated delivery and follow-up on home safety assessments and equipment interventions. In addition, the recommendations make the consideration of home safety issues a part of routine practice for all practitioners visiting children and young people at home.

Definitions

NICE uses the term 'unintentional injuries' rather than 'accidents', since 'most injuries and their precipitating events are predictable and preventable'[1]. The term 'accident' implies an unpredictable and therefore, unavoidable event.

The process of systematically identifying potential hazards in the home, evaluating the risks and providing information or advice on how to reduce them is described here as a home safety assessment. Other terms commonly used to describe the same process include 'home risk assessment' and 'home safety check'. It may be carried out by a trained assessor or by parents and other householders, using an appropriate checklist[2].

In this guidance, home safety equipment is any device used to prevent injury in the home. This includes door guards and cupboard locks, safety gates and barriers, smoke and carbon monoxide alarms, thermostatic mixing valves and window restrictors.

For the purposes of this guidance, 'home' refers to inside the dwelling itself. It does not include the garden or outbuildings.

Whose health will benefit?

The recommendations aim to help children and young people aged under 15 years who are at greatest risk of an unintentional injury and their parents and carers. In particular, it is aimed at those living in disadvantaged circumstances.

Recommendation 1 Prioritising households at greatest risk

Who should take action?

  • Local safeguarding children boards.

  • Local authority children's services and their partnerships.

  • Local strategic partnerships.

  • Local authority health and wellbeing boards and partnerships (where they are not part of the local strategic partnership).

What action should they take?

  • Determine the types of household where children and young people aged under 15 are at greatest risk of unintentional injury based on surveys, needs assessments and existing datasets (such as local council housing records).

  • Prioritise the households identified above for home safety assessments and the supply and installation of home safety equipment (see recommendations 2 and 3). 'Priority households' could include those with children aged under 5, families living in rented or overcrowded conditions or families living on a low income. It could also include those living in a property where there is a lack of appropriately installed safety equipment, or one where hazards have been identified through the Housing Health and Safety Rating System (HHSRS)[3].

  • Provide practitioners who visit children and young people at home with mechanisms[4] for sharing information about households that might need a home safety assessment. This includes health visitors, social workers and GPs.

  • Ensure practitioners adhere to good practice on maintaining the confidentiality and security of personal information. (For example, this includes using end-to-end encryption when sharing data with other agencies.)[5]

Recommendation 2 Working in partnership

Who should take action?

  • Strategic planners and leads with responsibility for child health.

  • Fire and rescue services.

  • Housing associations.

  • Local authorities: leads for children's services, environmental health, accident prevention and home safety and housing.

  • Sure Start and children's centres.

What action should they take?

  • Establish local partnerships with relevant statutory and voluntary organisations or support existing ones. Partners could include:

    • local community and parent groups

    • organisations employing health and social practitioners who visit children and young people in their homes (for example, health visitors)

    • child care agencies

    • others with a remit to improve the health and wellbeing of children aged under 15

    • local umbrella organisations for private and social landlords

    • those involved in lifestyle and other health initiatives.

  • Use these partnerships to:

    • help collect information on specific households where children and young people aged under 15 may be at greatest risk of an unintentional injury (see recommendation 1). The collection and sharing of information should adhere to the standards referred to in recommendation 1

    • help determine and address barriers to creating a safe home environment. (For example, the cost of equipment, cultural norms, issues of trust or a lack of control over the home environment may all be barriers to installing safety equipment)

    • get the community involved (as outlined in NICE public health guidance 9 'Community engagement'). For example, local 'community champions' could be used to promote home safety interventions and help practitioners gain the trust of householders

    • carry out home safety assessments[2] and supply and install home safety equipment, in line with recommendation 3.

Recommendation 3 Coordinated delivery

Who should take action?

Those who carry out home safety assessments and provide home safety equipment (see recommendation 2).

What action should they take?

  • Offer home safety assessments[2] to the households prioritised in recommendations 1 and 2. Where appropriate, supply and install suitable, high quality home safety equipment. Home safety equipment should adhere to the British 'Kite mark' standards or the equivalent European standard. Where resources are limited, it may be necessary to narrow down further the households being prioritised (for example, to those with children under the age of 5 years).

  • Ensure the assessment, supply and installation of equipment is tailored to meet the household's specific needs and circumstances. Factors to take into account include:

    • the developmental age of the children (in relation to any equipment installed)

    • whether or not a child or family member has a disability

    • cultural and religious beliefs

    • whether or not English is the first language

    • levels of literacy

    • the level of control people have over their home environment. (Many people may not have the authority to agree to an installation, for example, tenants of social and private landlords and those who are unable to make household or financial decisions)

    • the household's perception of, and degree of trust in, authority.

  • Ensure education, advice and information is given during a home safety assessment, and during the supply and installation of home safety equipment. This should emphasise the need to be vigilant about home safety and explain how to maintain and check home safety equipment. It should also explain why safety equipment has been installed – and the danger of disabling it. In addition, useful links and contacts should be provided in case of a home safety problem.

Recommendation 4 Follow-up on home safety assessments and interventions

Who should take action?

Those who carry out home safety assessments and provide home safety equipment (see recommendations 2 and 3).

What action should they take?

  • Prevent duplication of effort by keeping a record of households that have been given safety advice or equipment. (It may be possible to use an existing local database.) Ensure the records are accessible to all those with a direct or indirect responsibility for preventing unintentional injuries in the home.

  • Adhere to the standards referred to in recommendation 1 in relation to the collection and sharing of information.

  • Use the records to identify when maintenance and follow-up are required, to feed into strategic planning and to prioritise future interventions (see recommendation 1).

  • Contact homes identified as being in need of an equipment maintenance check or follow-up. Offer to revisit them to see if the equipment is still appropriate and functional (and in case of a product recall or faults). Ascertain whether there are any new requirements (for example, due to changes in the building or the family). Reinforce home safety messages during these visits.

Recommendation 5 Integrating home safety into other home visits

Who should take action?

Practitioners who visit families and carers with children and young people aged under 15. This includes GPs, midwives, social workers and health visitors.

What action should they take?

  • Recognise the importance of measures to prevent unintentional injuries in the home among children and young people aged under 15, particularly among those living in disadvantaged circumstances.

  • Provide child-focused home safety advice. If the family or carers agree, refer them to agencies that can undertake a home safety assessment and can supply and install home safety equipment.

  • Encourage parents, carers and others living with children and young people aged under 15 to conduct their own home safety assessment. They should use an appropriate tool, as outlined in recommendation 3.



[1] Davis R, Pless B (2001) BMJ bans 'accidents'. Accidents are not unpredictable. BMJ 322: 1320–21.

[2] Home safety assessment tools are available from The Royal Society for the Prevention of Accidents and SafeHome.

[3] The Housing Health and Safety Rating System (HHSRS) is a risk assessment procedure for residential properties.

[4] An example might include the common assessment framework (CAF).

[5] See for example, HM Government (2008) Information sharing: guidance for practitioners and managers. London: Department for Children, Schools and Families and Communities and Local Government.

  • National Institute for Health and Care Excellence (NICE)