Shared learning database

Sefton Council
Published date:
January 2014

Sefton families with a child aged 5 years and under are being offered free thermostatic mixing valves (TMVs). The valves regulate the temperature of water from the bath hot tap and can help prevent scalds at bath time.

Sefton's hospital admissions data showed us that burns and scalds were one of the more frequent causes of childhood injuries in the Sefton area, however our child injury prevention scheme didn't include any specific interventions for burns and scalds.

A literature review on the efficacy and cost-effectiveness of TMVs in reducing bath water scalds supported NICE Public Health Guidance 30, 'Preventing unintentional injuries among the under-15s in the home', which called for local authorities to develop local agreements with housing associations and landlords to ensure that permanent home safety equipment is installed and maintained in all social and rental dwellings.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim is to reduce accidental injuries in children and young people and to reduce inequities in health and well-being. In 2010/11 in Sefton, the rate of hospital admissions due to accidental injury for children and young people under 18 years of age was comparable to the regional level but significantly worse than the England average. In addition, local data suggested a social gradient in admissions for injuries.

The scheme aims to address the Public Health Outcomes Framework indicator on hospital admissions caused by unintentional and deliberate injuries among under-18s, as well as the NICE public health guidance on reducing unintentional injuries.

The aim of the scheme is to prevent injuries caused by contact with hot water in young children. Young children aged 5 or under are more at risk of being scalded by hot water from the bath tap because their skin is much thinner than adults and burns more easily.

The objective is providing an intervention which would help to reduce bath water scalds. The intervention involved supplying and fitting free thermostatic mixing valves (TMVs) in households that included children under the age of five.

Reasons for implementing your project

Local hospital data demonstrated that injuries caused by burns and scalds were one of the most common reasons for admission to Accident and Emergency. Sefton's Injury Prevention did not include any specific intervention in preventing injuries caused by hot water or burns.

An examination of hospital admissions data showed us that children under five years old made up around 80% of hospital admissions for hot water scalds - which are most often caused by bath water. Although the number of children affected was quite small, we could see that the severity, impact and cost of the injuries could be very high. It has been estimated that the costs of treating a serious bath water scald could start at around £41,000 but rises to twice that for a very serious scald that requires intensive care. In addition, apart from the financial cost, there was also a high emotional cost to the child and family.

A literature review highlighted the effectiveness of TMVs in reducing bath water scalds, which also supported NICE Public Health guidance on reducing unintentional injuries. As well as being efficacious , the installation of TMVs to baths was also found to be cost-effective. Unit costs associated with installation were calculated to be £13.68, while costs associated with treating bath water scalds ranged from £25 226 to £71 902.

How did you implement the project

A business case for the project was developed and presented to the Primary Care Trust (PCT) Board. The proposal involved supplying and fitting free thermostatic mixing valves (TMVs) in households that included children under the age of five and other vulnerable populations, such as those with learning or physical disabilities and the elderly.

Working in collaboration with Sefton Council, the Public Lead formed a steering group to oversee the programme. The project plan was agreed and referral criteria outlined along with a crib sheet for front line staff. The scheme would be targeted at Sefton's most vulnerable families which included families residing in our most deprived wards, child in need, children under child protection plan, children with learning or physical disabilities and young mothers aged 19 and under children.

The team worked in collaboration with other agencies to promote the programme and to recruit families into the scheme. The team created leaflets and posters to promote the scheme and displayed them in Children's Centres, GP surgeries, midwifery clinics, A&E departments, the Council's 'One-Stop Shop' and local parent groups. Local newspapers also covered the launch of the scheme.

Sefton recruited Sovini as its management company and Sovini was responsible for assessing applications. Initially, Sovini contacted those families who had expressed an interest in the scheme and conducted an initial visit to ensure that the home was suitable for the installation of TMVs to baths, whereupon a second appointment for installation was made. As with other social schemes, an ongoing challenge was ensuring that people kept their installation appointments.

Another major barrier to the scheme was the reluctance of the public to have the TMVs installed due to a misconception that the TMVs would lower the bath temperature for the whole household, as well as a lack of awareness of the scheme despite the on-going promotion campaign.

The team learnt from this experience and planned a re-launch of the scheme in September 2013, with a wider range of activities to raise awareness among families and professionals who work with them. They linked up with the local Home Safety Equipment Scheme so that TMVs could be requested along with other safety items, and they partnered with social housing providers so that they could promote the scheme to tenants whose homes were being refurbished.

Key findings

Progress was measured via monthly updates and quarterly meetings with stakeholders which included Children's Centres, Council staff and Sovini, who were responsible for installing the TMVs. Client satisfaction was measured after installation of the TVs by questionnaire.

The scheme was launched in late April and in the first month, 30 people applied to the scheme. As to date, 78 people have expressed an interest and there have been 24 TMVs successfully installed. Initial uptake of the scheme has been slow and latterly, the Christmas break has also affected installation as families have been reluctant to have the valves fitted. Close monitoring or the scheme is in place to allow the team to measure progress and apply remedial actions as required The full breakdown is as follows:
Application to scheme: 78
Missed appointments: 9
Wrong contact details: 3
Not required as one fitted already: 1
Valve did not Fit: 3
Changed mind: 3
No response: 35
Completed: 24

It is early days to assess outcomes as the scheme is still in its infancy. However, families have reported more confidence at bath time. There have been general satisfaction with the valves itself and there have been no complaints of the scheme.

There have also been some very enthusiastic responses. Some of the families have offered to promote the scheme by being featured in the local newspapers. The value of the scheme can also be measured by the numbers of self referrals as a result of word of mouth. In addition, some families who were not eligible for the scheme have chosen to install the TMVs at their cost , demonstrating the success of the media campaign to raise awareness of the dangers of hot water at bath time to young children.

Key learning points

- Use a variety of communication channels that will help you to reinforce your messages and give you the best chance of reaching your target audience. You can't just assume people will read and respond to leaflets and posters.
- Try to think creatively about different places and ways to promote your scheme to give families lots of chances to engage with it. At present, the CVS promote the scheme at all its workshops and events, including at commercial outlets.
- It is important to engage professionals who work directly with families, such as health visitors and Children's Centre staff, so that they can mention the scheme in face-to-face conversations with parents.
- Campaign materials should address common misconceptions about TMVs, for example that having one fitted will stop you from having hot baths.
- 'Piggy-backing' on another local initiative can be an effective way to reach the families you want to target. Potential partners include initiatives that provide home safety equipment or smoke alarm installation, or social housing refurbishment programmes.

Contact details

Koon Lan Chan
Public Health Development Manager
Sefton Council

Social services
Is the example industry-sponsored in any way?

A management company Sovini were recruited to assist with the delivery of the project.