Interpretation of the East Anglian trends is made more difficult by the change in England in 1987 of the system for the collection of hospital admission data. The fact that the rates for the East Anglian region seem to decline before this change and other considerations suggest that the observed trends, although partly reflecting the disruption of the coding during the changeover in systems, may not be entirely artefactual. The possible roles of diagnostic transfer and changes in the delivery of care, asthma treatment, admission and readmission policies, and the severity and prevalence of asthma in changing admission rates are considered. The changing trends in admission rates for East Anglia and Wales reflect recently published trends for mortality from asthma in England.

BackgroundUnintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a ‘natural experiment’ for evaluating the scheme’s impact on hospital admissions for unintentional injuries.MethodsControlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision.Results57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (−0.33% (−0.47% to −0.18%)) but did not decline in control areas (0.04% (−0.11%–0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended.ConclusionsA national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.

BackgroundInjuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The ‘Safe at Home’ (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness.Materials and methodsCost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0–2, implementation); T2 (years 3–4) and T3 (years 5–6). Analyses were conducted for T2 versus T1 and T3 versus T1.ResultsTotal cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH.ConclusionSAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.

Safe At Home (National Home Safety Equipment Scheme) is an £14 million initiative to help families keep their children safe and to reduce accident rates in the home. Working with locally based delivery partners the scheme is providing home safety equipment to over 60 000 of the most disadvantaged families in areas with the highest accident rates. The equipment which is provided with a fitting service includes safety gates, fireguards, window restrictors, cupboard locks, corner cushions, cord shorteners and bathmats. The scheme is not just about equipment. Over 2 years it will provide 500 000 families with information and support that will help them to create a safer environment. Safe At Home is also rolling out a comprehensive training programme for delivery partners, with over 3000 training places being offered throughout the scheme. There is a websitehttp://www.safeathome.rospa.com/. Other developments include a DVD with training notes and discussion points which is used as part of a facilitated session. An accompanying height chart, highlighting the key risks and prevention advice left with each family is a practical aid that backs up the information in the DVD. A picture based resource is also available for use in family information sessions.

BackgroundHome accidents are a leading cause of death and injury in the UK. Falls among older people lead to over 4 million hospital bed days each year. Almost 1 million children require emergency care following home accidents. Partnership working is vital to address this key public health issue.DescriptionThe Safer Homes Programme provided a package of consultancy, training and intervention across 30 local authority areas with higher than average hospital admission rates for accidents. The programme helped partners, who included local authorities, home improvement agencies, charities, Fire Services and NHS, to develop strategic plans and business cases. It trained local practitioners to plan, implement and evaluate community interventions including home safety checks, falls and burns interventions and advice to vulnerable families.ResultsOver 740 staff received the home safety training. The community interventions and advice given to families reached over 166,000 people. An independent evaluation by ICF International found increased home safety awareness among staff; improved partnership working and the development of clear injury prevention strategies. Training increased confidence of staff to raise awareness among client families. Families demonstrated practical safety improvements and behaviour change. One area reported a 12% drop in hospital admissions due to falls.ConclusionsThe programme raised the profile of accident prevention among local partners at a crucial time of change as well as making homes safer within their local communities. Learning about effective strategic development and local delivery of interventions has been shared between partners and more widely to improve practice.