Q. How can we get (and keep) Britain cycling? A. Reducing risk of non-collision incidents will help make cycling more enjoyable.

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1 Evidence presented to All Party Parliamentary Cycling Group: 5th December 2012 Q. How can we get (and keep) Britain cycling? A. Reducing risk of non-collision incidents will help make cycling more enjoyable. Rob Benington Injury Prevention Manager / Avonsafe Co-ordinator

2 1. Contents Summary Cycling is good for the population. NHS Bristol encourages more people to cycle more often and for longer. But risk, fear and anxiety inhibits participation. In order to understand the risks fully we need to look not just at the STATS19 (police data), but also at Hospital Episode Statistics (HES). HES data shows that many more cyclists are seriously injured in non-collision incidents (NCIs) than in collisions recorded by the police. We assume people discuss these incidents with others, helping to construct a narrative about cycling being more hazardous than is suggested by police data. Our approach to cycle advocacy should aim to reduce risk of NCIs as well as collision injuries. Reducing the risk will help keep cyclists on their bikes, make cycling easier and more enjoyable, and so help challenge perceptions of cycling as being hazardous. There is a growing body of evidence about how to achieve these benefits. Statement In 2011, STATS19 recorded, and the Department for Transport reported 3,085 killed or seriously injured (KSI) cyclists in the UK 1. In the same time period, in England alone, hospitals report admitting 17,653 cyclists to a hospital bed 2. Injury requiring treatment in an Emergency Department (without admission) will usually be included in the police definition of serious, and during 2010, 17% of all attendances at Emergency Departments in England resulted in admission 3. There is a discrepancy between the numbers of cycling injuries captured in STATS19 and Hospital Episode Statistics 4, particularly relating to non-collision cycling injuries. But more significantly, the sample of cycling injuries recorded by police is biased, and not representative of the population of injured cyclists 5. In England in 2011/12, 69.7% of injuries to cyclists that required admission to hospital resulted from non-collision incidents 6 but only 3-4% of all non-collision incidents are recorded by STATS19 7. STATS19 is used extensively in the improvement of road safety in relation to roads, road users, vehicles and traffic movement 8. As a result, the current focus of cycle safety interventions emerges from a poorly constructed needs analysis that is over-reliant on a single source of biased data. The disproportionate focus on collisions that results has pervaded cycling and road safety culture and risks adversely affecting our ability to reduce the more numerous non-collision injuries that make cycling less attractive to new starters and that may be helping shape perceptions of cycling as a hazardous activity. Research into noncollision incidents is still in its infancy, but a growing body of evidence 9 is enabling interventions to be piloted, for example the Think TwICE campaign commissioned by NHS Bristol 10. Collision injuries tend to be more serious than non-collision injuries and on average they result in a longer stay in hospital 11. We need to retain efforts to reduce collision injuries, (and STATS19 can helpfully facilitate this work) but non-collision incidents also result in fatalities and life changing injuries their potential severity should not be underestimated. Implementing the recommendations that follow will help achieve appropriate balance. 2

3 Recommendations for further action Data sources The Public Health England and/or Department for Transport should be asked to consult with local road safety practitioners to establish what help, advice and guidance they would require in order to better reduce the numbers of non-collision cycling injuries. The Department for Transport should be requested to advise all users of STATS19 data to report hospital admission data alongside cycling injury data recoded by the police. Estimates of numbers treated in Minor Injury Units and Emergency Departments where appropriate may also be available and should be included alongside STATS19 data where available and relevant. Reducing non-collision hazards Causes of non-collision injury to 0-18 year olds are under researched and this knowledge gap needs to be filled urgently. The Department of Transport should be requested to identify to partners (including large employers) to pilot and test whether changes in employment policies and working practices (for example inclement weather policies and travel to work policies) can reduce the risk and injury rate amongst cycle commuters, particularly during periods of freezing weather, (See reference 10 that links to a case study). Rail and tram lines and kerbs are an identified hazard, and in some instances pose an obvious barrier to cyclists movement. Detailed design guidance on designing kerbs, rail and tram lines to reduce hazard posed to cyclists should be commissioned and published. 3

4 Evidence and References 1. Police recorded 3,085 killed or seriously injured (KSI) cyclists in the UK Department for Transport (June 2012) Reported Road Casualties in Great Britain: Main Results hospitals report admitting 17,653 (English) cyclists to a hospital bed. NHS The Information Centre Hospital Episode Statistics Online siteid=1937&categoryid=211 17% of all attendances at Emergency Departments in England resulted in admission Studies into the attendance/admission ratio report a wide variation in rates of admission which vary by age of patient, gender, cause of attendance, and other factors. Examples of the % of people attending emergency departments who are subsequently admitted to hospital include: 17%. The Nuffield Trust for Policy and Research Studies in health Services (2010) Trends in Emergency Admissions in England in : Is greater efficiency breeding inefficiency? 4

5 Male 23.6%; Female 27.2% (All ages). All years %. NHS Scotland Emergency Department Activity June 2011 July % - Ormel, et al (1999) 4. There is a discrepancy between the numbers of non-collision cycling injuries captured in STATS19 and Hospital Episode Statistics 5a) "Road Casualties Great Britain 2006" reported that Hospital Episode Statistics (HES) for England showed 7,065 admissions to hospital of pedal cyclists, whereas STATS 19 recorded only 2,092 seriously injured pedal cyclists. The Department for Transport found that almost all the difference was due to HES having 4,268 pedal cyclists who had not been involved in a collision (e.g. people who just fell, or were thrown, from a bicycle which had not collided with any other vehicle), whereas STATS 19 had recorded only 101 (one hundred and one) such casualties. From : Benington, R (2012) An introduction to non-collision cycling injuries. NHS Bristol. The numbers of casualties have changed since 2006, but the patterns in the data remain. 5b) 3,085. Total number of cyclists killed and seriously injured in the UK in 2011 and recorded in STATS19. (DfT, June 2012). 12,301. Total number of admissions to hospital bed of cyclists from noncollision cycling injury in England during ,358. Estimate of number of cyclists in England seeking treatment for noncollision cycling injuries in Emergency Departments and Minor Injury Units in England during Calculated using admission/attendance ratio (17%) discussed at 3). 5. The sample of cycling injuries recoded by police is not representative of the population of injured cyclists The Department for Transport is clear: Non-collision cycling incidents should be reported to the police. The STATS19 requirement is clear that all accidents involving non-motor vehicles such as pedal cycles and ridden horses on 'public roads' (see 2.4) should be reported, regardless of motor vehicle or pedestrian involvement. Department for Transport, STATS20 5

6 But there are reasons why single vehicle crashes or non-collision incidents may be under-reported and under-recorded, and why sampling bias exists in the STATS19 sample of cycling incidents: Incidents occurring on Cycle path/track with no lawful access for motor vehicles and Footpath or bridleway with no lawful access for motor vehicles are specifically excluded from STATS19 records by STATS20; Awareness of the need to report falling off your bike to the police may be low; Issues of desire to establish justice between a victim and a perpetrator are less likely to be present; In single vehicle crashes there are fewer issues of fault or blame to establish and investigate; Insurance claims, and therefore the insurance companies requirement that incidents are reported to the police, is less likely to be present when only one person is involved; The reduced likelihood of being able to claim for damages reduces the motivation to report the incident to the police; Police are unlikely to be called to attend an incident involving only one person unless injuries are very serious or there are other complicating factors and the vehicle involved is easy to clear from the highway following the incident. 6) 69.7% of injuries to cyclists that required admission to hospital resulted from non-collision incidents. Total number of cyclist admissions 17,653. Total number of cyclist admissions caused by non-collision incidents 12,301 = 69.7%. 6

7 7. only 3-4% of all non-collision incidents are recorded.... 7a) Levels of reporting for various road user groups and types of accident. Reported in: European Transport Safety Council (2007) Social and Economic consequences of Country Czech Republic Car Occupants Motorcycle Riders Cyclists Pedestrians Driversions Vehicle sions Vehicle Colli- Single Colli- Single All Passengers All All All Denmark France Germany Great Britain Hungary Netherlands Norway Sweeden Switzerland road traffic injury in Europe. 7b) The largest study conducted to date into non-collision incidents in the UK found that around 4% of victims believed the police were aware of the incident. Severity of injury Number % of sample of which police aware Killed 1 0% (The report appears to be genuine) Admitted to intensive care unit 3 33% Admitted to hospital bed 48 8% Treated in Emergency Department or Minor injury Unit % Treated at home % Injured but no treatment necessary No injury No response 1 n/a Totals 828 4% Benington, R. (2010). The causes and circumstances of non-collision cycling incidents - Interim Results (Summer 2010). NHS Bristol 7

8 but it is this data set that is used extensively in the improvement of road safety 1.3 The STATS19 reports are analysed nationally by reference to a great variety of characteristics and attendant circumstances and the results are used extensively for research work and for guidance in the improvement of road safety in relation to roads, road users, vehicles and traffic movement. The data also form the basis for annual statistics on road accidents and casualties published by DfT, the Scottish Executive (SE) and the National Assembly for Wales (NAfW). Local authorities also publish similar statistics. 1.8 It is because of the many various uses to which this data is put that the need for accuracy and prompt return is paramount. Cont. Department for Transport (2005) Instructions for the completion of Road Accident Reports (STATS20). 9) There is a growing body of evidence about the causes and circumstances of non-collision cycling incidents. Benington, R (2012) An introduction to non-collision cycling injuries. NHS Bristol. Benington, R. (2010). The causes and circumstances of non-collision cycling incidents - Interim Results (Summer 2010). NHS Bristol Infrastructure and cyclist safety TRL Report PPR580 Nyberg, P., Bjornstig, Ulf, Bygren, L-O. (1996) Road characteristics and bicycle accidents Sc and J Soc Med Vol 24 No 4. Ormel, et al (1999) Enkelvoudige fietsongevallen Onderzoek_Enkelvoudige_fietsongevallen.pdf Paul Schepers, Karin Klein Wolt (2011), Single-bicycle crash types and characteristics. Ministry of Infrastructure and the Environment, Center for Transport and Navigation Paul Schepers; Berry den Brinker (2011) What do cyclists need to see to avoid single-bicycle crashes? Ministry of Transport, Public Works, and Water Management, Centre for Transport and Navigation, The Netherlands b Vrije Universiteit Amsterdam, Faculty of Human Movement Sciences, The Netherlands Paul Schepers (2012) Does more cycling also reduce the risk of 8

9 Contacts and Links Author Rob Benington Injury Prevention manager Directorate of Public Health NHS Bristol BS1 3NX Tel: Links Avonsafe webpages Downloads for reports into non-collision incidents are at The link to Bristol s Better by Bike survey into non-collision cycling incidents is at: 9

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