Quality standard


This quality standard covers preventing unintentional injury in children and young people under 15. The term 'unintentional injury' is used rather than 'accidents' to recognise that injuries are the result of events that can be prevented. For more information see the topic overview.

Why this quality standard is needed

The likelihood of unintentional injury is affected by a number of factors, including personal attributes (such as age and any medical conditions), behaviour (such as risk‑taking) and the environment (such as poor‑quality housing). The physical, psychological and behavioural characteristics of children and young people make them more vulnerable to injuries than adults.

The 2007 Audit Commission and Healthcare Commission report Better safe than sorry found that unintentional injury was a leading cause of death among under 15s. Although child mortality from all causes, including unintentional injury, has decreased over the past 20 years, the Overview of child deaths in the four UK countries (Royal College of Paediatrics and Child Health 2013) found that injury is still the most frequent cause of death in children. Analysis of UK death registration data from 1980 to 2010 found that 31% of deaths in children aged 1–4 were from unintentional injuries.

A 2013 report from the Child Accident Prevention Trust said that children and young people from lower socioeconomic groups are more likely to be affected by unintentional injuries. It estimated that each year over 108,000 hospital admissions (estimated cost to the NHS £131 million per year) and around 2 million attendances to A&E (estimated cost £146 million per year) for children and young people under 15 are because of unintentional injury[1]. The costing report for the NICE guideline on unintentional injuries highlighted that an 11% national reduction in unintentional injuries for children and young people (under 15) could save £26.4 million, which could offset the cost of implementing the guidance.

Approaches to preventing unintentional injuries include education (providing information and training), altering products or the home environment (child proofing) and enforcement (regulations and legislation).

The quality standard is expected to contribute to improvements in the following outcomes:

  • unintentional injuries in children and young people in the home

  • preventable child deaths related to unintentional injury in the home

  • hospital admissions

  • A&E attendances

  • health and wellbeing of children and young people.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Improvement areas

Reducing deaths in babies and young children

1.6 i Infant mortality* (PHOF 4.1)

Alignment across the health and social care system

* Indicator shared

Table 2 Public health outcomes framework for England, 2013–16


Objectives and indicators

1 Improving the wider determinants of health


Improvements against wider factors that affect health and wellbeing and health inequalities


1.3 Pupil absence

2 Health improvement


People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities


2.7 Hospital admissions caused by unintentional and deliberate injuries in children and young people aged 0–14 and 15–24 years

4 Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely while reducing the gap between communities


4.1 Infant mortality* (NHSOF 1.6i)

Alignment across the health and social care system

* Indicator shared

Coordinated services

The quality standard on preventing unintentional injury in under 15s specifies that services should be commissioned from and coordinated across all relevant agencies involved in preventing unintentional injury in children and young people (under 15). A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to children and young people who are at risk of unintentional injury.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing high‑quality services that can prevent accident and unintentional injury in children and young people are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, public health and social care practitioners involved in assessing and caring for children and young people who are at risk of unintentional injury should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in protecting children and young people from unintentional injury. If appropriate, health, public health and social care practitioners should ensure that family members and carers are involved in the decision‑making process about preventing unintentional injury.

[1] Child Accident Prevention Trust (2013) Tackling inequalities in childhood accidents.