The Public Health Interventions Advisory Committee (PHIAC) took account of a number of factors and issues when developing the recommendations.
3.1 Both generic and targeted interventions are used to prevent injuries in the home. The former could include legislation – for example, to improve the way homes are constructed. The latter could include the provision of safety equipment. Both generic and targeted interventions aim to do three things, either independently or in combination: change attitudes and behaviour, alter the environment, and provide information or training (Lund and Aarǿ 2004).
3.2 PHIAC noted that forthcoming NICE guidance will cover strategic approaches to reducing unintentional injuries among the under-15s. (For more details see section 7.)
3.3 The technical efficacy of safety equipment has been demonstrated and, in most cases, has improved since the research studies included in the evidence reviews were undertaken.
3.4 The evidence did not cover all the home safety equipment available. For example, there were no evaluations of interventions involving the installation of carbon monoxide alarms.
3.5 There was limited evidence on residential care homes. While some elements of the recommendations may apply, residential care homes are already subject to a range of legislation. This includes The Care Homes Regulations 2001 (HM Government 2001) and 'Children's homes: national minimum standards, children's homes regulations' (DH 2002).
3.6 PHIAC considered it very unfortunate that many injury prevention schemes do not include an integrated and robust evaluation process. This limits the evidence available on their impact.
3.7 Children and young people learn by taking risks and challenging themselves when playing and in other activities. Many areas of the home – and activities that take place there – pose an inherent risk. Safety equipment and education help to keep children safe.
3.8 PHIAC acknowledged that interventions need to take into account a household's everyday circumstances and routine practices – and how receptive families are to safety messages.
3.9 PHIAC believes that it is important to raise awareness of safety issues.
3.10 Safety equipment has to be correctly used and maintained to be effective.
3.11 The cost-effectiveness modelling that underpins the recommendations is based on very limited data. It should not be regarded as a definitive analysis of cost-effectiveness. Rather, it explores the factors most likely to affect whether or not interventions to prevent unintentional injuries in the home represent good value for money. The analysis indicates that, from a public sector perspective, the cost effectiveness of such programmes is dependent on a number of factors (see the 'Cost effectiveness' section in appendix C for details).