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The following section uses Hospital Episode Statistics and Police casualty reports along with bicycle travel data to assess recent trends in bicycle safety rates in England and Wales. HES data for 2001/2010 show that emergency admissions have been rising for pedal cyclists involved in collision crashes. At the same time the length of stay associated with these injuries appears to be declining (Figure 4 below). This latter trend may merely reflect changes in admission and discharge patterns over time and so may not reflect a real decline in the burden of injury.

Overall these data suggest that cyclists have not seen the same continuous decline in crash injuries seen for other road users such as car drivers over recent years 94_{. Travel by bicycle appears to have risen slightly over the decade but} appears to be accompanied by a rise in injuries suggesting no detectable improvement in safety as suggested by studies describing a “safety in numbers” effect. The latest figures suggest that there was a further 4% increase in cyclist casualties in 2011 compared to 2010 155 a first quarter estimates for 2012 show that increases are continuing with 4160 cyclists injured in the first quarter of 2012 a 10% increase on the same period in 2011 338.

Figure 4 Total Bed Days And Emergency Admissions For Pedal Cyclist Collision Crashes 2001 - 2010 And Pedal Cycle Travel. Sources; HES Online 2011 And The National Travel Survey 2010 47_.

Another way of visualising recent figures is shown in Figure 5 below. This graph shows cyclist injury, fatality data from police records and cycling exposure data from the National Travel Survey (2009) standardised by comparison to a reference period (1994-1998). Deaths amongst cyclists have declined over the decade but the small numbers each year mean that comparisons are unreliable due to chance variations. It appears that as above, injury numbers have followed a similar pattern to cycle exposure with recent increases in both cycle participation and injuries after initial declines from the reference period. This further suggests that progress towards the target reduction in injury rate per distance travelled has not occurred and that even declines in absolute numbers may have stalled.

Police recorded 16195 cyclist casualties on the roads in England and Wales in 2007 with 2564 (16%) killed or seriously injured. This amounts to around 5% of all deaths on the country’s roads despite cycling accounting for only 1% to 3% of all travel 68 156. In the year to October 2010 the number of killed or seriously

- 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000

Hospital Activity As A Result Of Collision

Crashes Involving Pedal Cyclists (HES 2001 -

2011) and Total Cycle Travel (DfT 2010)

Bed Days

Millions of Kms Cycled

Emergency Admissions

injured rose slightly to 2770. The numbers killed or seriously injured has declined by 26% on the 1994-98 average but the past two years have seen small rises 157. Cycling injuries are accounting for a steadily increasing proportion of all road injuries owing to continued improvements in the safety of other modes 158.

Figure 5 Changes In Cyclist Numbers Killed, Killed And Seriously Injured, All Severities Of Injury* And In Distance Cycled Per Person Per Year** Compared To Baseline (1994-98 Means).159

A possible “safety in numbers” effect, with more cycling and walking leading to less than proportional increases in casualty numbers, has been demonstrated by a study using data giving distanced travelled by cycling and walking and collision crash injuries 160_{. The study used a variety of datasets from the US} Europe and the UK (1950 to 1999) to compare the rates of injuries amongst vulnerable road users with contemporary survey data estimating cycling exposure. The data suggest that increasing numbers of people cycling does not lead to proportionate rises in injuries. Areas where more cycling and walking occurs have relatively lower rates of injuries suggesting that the risk for each individual goes down the more fellow cyclists there are who take to the same

0 20 40 60 80 100 120 S ta n d a rd is e d ; 1 9 9 4 -9 8 = 1 0 0

Cyclists Deaths and Injuries (Police Reports) and

Distance Cycled Relative to The Average For

1194-1998

Killed

Killed and Seriously Injured

All severities

Miles per person by Bicycle (National Travel Survey 2009)

roads. Recently a similar effect has been found for non-collision crashes in the Netherlands 161.

An analysis of trends in cyclist deaths in London between 1992 and 2006 demonstrated no increase in fatalities during a period which saw a significant rise in estimates of bicycle travel, both in absolute terms and relative to motor vehicle mileage 162. These findings are consistent with a protective effect for individual cyclists from increases in overall bicycle use but the fact remains that in the absence of good quality exposure data and with many non-fatal injuries going unreported, the overall burden of injury from bicycle collisions with other road users remains too high.

Such studies as those discussed above have been cited by some authors as reason for rejecting legislation to mandate helmet wearing on the assumption that compulsion may reduce participation and thus drive up risk to individual cyclists 163 164. The impression of a reduction in head injuries as a result of increasing use of cycle helmets may merely reflect reducing exposure as cyclists give up or reduce the amount they cycle, in some cases as a result of legislation 64

. Curnow points to similar declining rates in head injury that have been observed in pedestrians (who don’t use helmets) over the similar time periods. Self-imposed or parentally-enforced reductions in exposure to road danger, if similar for cyclists and pedestrians, may confound these apparent improvements in safety. Moreover, it has been suggested that relatively large shifts away from motor vehicle use towards cycling may be required before measurable improvements in safety rates can be achieved 165. Absolute reductions in injuries would also presumably occur were cyclists to reduce their cycling in response to collision risk and outside of London, cycling continues to decline in many areas as a proportion of all travel 47.

Overall, bicycle travel in the UK remains more dangerous per unit of distance than other modes, crash rates relative to exposure do not appear to be declining as they are for other modes of travel and collision crashes appear responsible for greater severity of injury than loss of control crashes and may result in longer hospital stays.