The introduction of European legislative and consumer crash testing requirements in the late 1990s has resulted in marked changes in the design of vehicle structures and restraint systems. This paper examines real-world accident data to evaluate the changes that have taken place in crash performance and the circumstances of injury. Comparisons are made between older cars, built between 1991 and 1996 and newer cars, built up to 2000. There has been a major improvement in the incidence of fatality with a reduction in risk of 24%. The collision partner in fatal crashes has now changed, so that collisions with roadside objects account for almost the same number of fatalities as car to car impacts. The collision severities of fatal frontal crashes have not increased in newer cars but the crash severity in fatal side impacts remains substantially above crash test speeds. There are still opportunities to increase the levels of crash protection further by the mitigation of higher speed side collisions and improving the protection in impacts with roadside obstacles. Rear seat belt use is low amongst fatally and seriously injured passengers and rear passengers are likely to receive the greatest benefit from belt reminder systems.