Coventry Director of Public Health Annual Report 2020/2021

The COVID-19 pandemic has made the past year one of significant global challenge. Internationally, there have been some 219 million people infected with COVID-19, and over 4.5 million deaths due to COVID-19. In the UK, there have been over 7 million infections and over 150,000 deaths.
In Coventry, COVID-19 led to 682 deaths by September 2021  and long-term health problems affecting the day-to-day activities for thousands of residents. COVID-19 lockdowns and restrictions have disrupted the daily lives of all 379,000 residents in the City. To put this in perspective, more residents have died from COVID-19 than from the City’s darkest hour during World War II when much of the centre was devastated during the night of the Coventry Blitz on 14/15 November 1940.

Understanding changes to the health and wellbeing of residents over the past 12 months as a result of COVID-19

Alcohol

• Alcohol and drug misuse increased during lockdown
• National surveys suggest greater alcohol use amongst health staff
• Drug offences increased by 41%
• Reduced services meant less opportunity for prevention/early intervention

Business

• Lockdown and reduced trade impacted on business revenue amd household income
• Total business rates rateable value in Coventry has reduced by £2m

Children

• Increase in newly looked after children - 304 children in 2020-2021 - the highest in the past six years
• Closed schools mean less opportunity to identify children experiencing or at risk of abuse

Deaths

• COVID-19 accounted for 668 deaths since 21 March and almost one fifth of all Coventry deaths in 2020/21
• Excess deaths were greater than the 5-year average in Mar-Apr 2020, Oct 2020 and Jan- Mar 2021 but have been below average since Apr 2021

Education

• Schooling was disrupted as a result of lockdowns and disruption continues
• In June 2021 309 positive cases in Coventry schools resulted in 3.935 people self-isolating

Footfall

• City centre footfall was 84% lower in Apr-Jun 2020 compared to Apr-Jun 2019
• Footfall has since recovered to around 80% of 2019 levels.

Green

• Visits to parks in Coventry increased in spring and summer 2020 and spring 2021 as lockdowns shifted activities from city centres, shops and retail to outdoor activity

Homelessness

• 350 individuals who were street homeless/rough sleeping were housed temporarily as part of the national 'Everybody In' scheme
• 250 have moved into permanent accommodation
• Ending of the scheme, street homelessness may increase once again

In-patients

• UHCW had 262 Covid inpatients on 19 January 2021 putting immense capacity on the healthcare system
• This has now improved with 11 inpatients on 30 June 2021
• Unmet need resulted in emergency admissions at UHCW in June 2021 at 137% of the average in June 2019

Jobs

• 71.3% of Coventry residents were economically active in employment in 2020, down from 73% in 2019.
• Impact of the pandemic has been cushioned by income support and job retention schemes and may get worse as these schemes come to an end

KPIs

• Increase demand for services - from waste collections to business support to social care - have led to challenges for the local authority
• 70% of One Coventry Plan metrics improved or stayed the same in 2020/21 down from 79% the previous year

Life expectancy

• Early, national analysis suggests life expectancy and healthy life expectancy has stagnated - with life expectancy reducing in the most deprived areas
• Full impact of the pandemic on life expectancy is likely to continue for several years

Mental Health

• Survey 2,500 residents of Coventry and Warwickshire shows spending more time at home and remote working improved mental health
• News and social media had the biggest negative impact
• Service data shows greater unmet need among older adults and black adults

NHS test and trace

• In January 2021 test and trace was localised improving on the number of contacts reached, and ensuring people are supported to isolate
• Jan to June 2021 the Council contacted 4,779 people to offer advice and support to isolate

Police

• 9.5% increase in overall crime, with the number of crimes in the city increasing month on month through 2020/21
• Increases in assault, harassment, hate crime (+55%), domestic abuse (+37%) mirror regional and national trends

Quarantine and isolation

• Between 28 May 2020 to 30 June 2021 25,503 residents were asked to isolate and identify their close contacts
• Since 20 February 2021, 161 people returning from red/amber countries asked to quarantine and test on return to identify and contain mutations and variants

Recreation

• 2021 household survey showed 76% of residents spent some time on active recreation with 52% spending at least an hour a week
• Percentage of residents spending no time on active recreation has decreased from 41% in 2018 to 24% in 2021

Screening

• Suspension of screening services during first lockdown are expected to have on going impacts
• In Coventry and Warwickshire the pause resulted in 679 missed bowel screenings, 811 cervical screenings and 538 breast cancer screenings every week and a 4% drop in dementia diagnoses

Travel

• Movement around workplace areas, retail, recreation areas and around half transit stations remains half of normal levels
• Traffic has returned to 95% of normal levels according to the Council's own data. This may illustrate permanent changes in commuting patterns.

Unemployment

• Unemployment in Coventry increased from 4.6% in 2019 to 5.9% in 2020
• Male unemployment increased from 4.2% to 6.3%, female unemployment decreased from 6.5% to 5.3%
• Contrasts with national and regional data

Vaccinations

• Flu vaccine uptake in the 2020/21 season for Coventry was 78% for 65+ and 50% for under 65 at risk (70% and 44% for 2019)
• Childhood vaccinations have also increased eg. MMR1 coverage at 24 months for Coventry and Rugby CCG improved from 89% in 2019/20 to 92% in 2020/21 Q4.

Wellbeing

• National surveys show COVID-19 reduced wellbeing with 1 in 10 people reporting low satisfaction in April 2021 up almost 50% from 2019.
• Especially impacted those with an underlying health condition, young adults, self-employed or unemployed and women

XYZ

• Further detail on Health and wellbeing impacts of COVID-19 are available:
• One Coventry Plan annual performance report
• Director of Public Health annual report
• Coventry and Warwickshire mental health needs assessment
• Coventry Household Survey

 

 

 

Direct impact of COVID-19

Hospitalisations due to COVID-19

Between 1 April 2020 and 31 March 2021, 2,591 patients were admitted to University Hospitals Coventry and Warwickshire (UHCW) due to COVID-19. At the peak of the winter wave in January 2021, 286 beds at UHCW were occupied by COVID-19 patients, and 43 COVID-19 patients were occupying mechanical ventilation beds. This placed severe pressures on the hospital’s capacity to respond to other illnesses, accidents, and emergencies.

Deaths due to, or involving COVID-19

The following table sets out the number of people in Coventry who died with COVID-19 mentioned as one of the causes of death on their death certificate as certified by their doctor.

In 2020/21, COVID-19 accounted for nearly one-fifth of all deaths in Coventry. Over 90% of COVID-19 deaths are “due to” (caused by) COVID-19, and fewer than 10% are “involving” COVID-19 (where COVID-19 is a contributing factor to the death).
Data from the Care Quality Commission suggests 200 care home residents in Coventry died due to COVID-19. This is greater than the figure in the table above which shows place of death because some care home residents died elsewhere (for example, in hospital).

Inequalities

National data shows that COVID-19 has had a disproportionate impact on some ethnic groups. This trend was not as evident in the data for Coventry but higher case rates were seen in some of the most deprived areas of the City. 

In terms of ethnicity, of the 23,205 cases:

• 4,020 Asian (17.3%) – compared to around 16-22% of the city’s population
• 1,446 Black (6.2%) – compared to around 5-13% of the city’s population
• 611 Mixed (2.6%) – compared to around 2-7% of the city’s population
• 754 Other (3.2%) – compared to around 1-2% of the city’s population
• 1,310 White Other (5.6%) – compared to around 7-10% of the city’s population
• 10,490 White British (45.2%) – compared to around 45-67% of the city’s population
• 4,574 Unknown (19.7%).

Vaccinations

Covid-19 vaccines have weakened the link between catching Covid and getting seriously ill.

January 2021

• 1000 people were catching Covid every week in Coventry
• On an average day, 250 beds at UHCW were taken up Covid patients
• 40 people very seriously ill with Covid on a ventilator
• Even with a national lockdown

August 2021

• 1000 people were catching Covid every week in Coventry
• On an average day, 40 beds at UHCW were taken up Covid patients
• 8 people very seriously ill with Covid on a ventilator
• With minimal restrictions in place

 

On 8 December 2020, Coventry’s University Hospital Coventry and Warwickshire (UHCW) became world-renowned when Margaret Keenan became the first person in the world to receive a  COVID-19 vaccination outside of a clinical trial.
As of 12 August 2021, 224,473 Coventry residents have received a first COVID-19 vaccine dose. This represents 70% of the city’s adult population (age 18 years and over)  A total of 178,626 (56%) people have received both COVID-19 vaccine doses.
Vaccines are highly effective against getting infected and people having severe infection.  Far fewer patients are being admitted to hospital with COVID-19 since the rollout of the vaccination programme commenced.  On 26 January 2021, there were 220 COVID-19 patients at UHCW including 36 on mechanical ventilation, whereas on 9 August 2021 there were 29 patients in hospital including 2 on mechanical ventilation.  Vaccinations have significantly reduced the likelihood of COVID-19 patients becoming severely ill and requiring hospitalisation.

Overall, 90% of people over 50 years of age and 79% of people over 30 years of age have received their first COVID-19 vaccine dose of the COVID-19 vaccine, but in some parts of the city these figures are lower. In parts of Foleshill, St Michael’s, and Lower Stoke, under 50% of adults have had their first vaccination dose. We know that vaccination uptake has been lower in deprived neighbourhoods, so we are working collaboratively with the City Council, NHS, business and community partners to address this, with the goal to increase uptake and reduce the risk of disease or severe illness and death where vaccination is lower.

Wider health impacts of COVID-19

Throughout the pandemic, many aspects of life that are key to good health and wellbeing have been impacted. These factors, such as employment status, living environment, personal relationships, and having a voice in decisions that affect you, are known as the wider determinants of health.

Nationally, Public Health England (PHE) reports  that, based on analysis of waves of a YouGov survey conducted during the pandemic:

• Half of people who had a worsening health condition in the seven days before the survey did not seek advice for their condition. The most common reason given was to ‘avoid putting pressure on the NHS’
• Self-reported mental health and wellbeing has worsened compared to before the pandemic
• More people were helping others than  had been before the pandemic
• There have been increases in snacking, cooking from scratch, eating healthy meals, and eating with family
• More people have attempted to quit smoking than before the pandemic

Together, these changes will have a mixed impact on overall health and wellbeing. Locally, preliminary findings from the Council’s latest household survey (a representative sample of Coventry residents), conducted in February 2021 found:

• Just under three-quarters said their health was good, a decrease from 2018
• A smaller proportion of residents reported smoking cigarettes or e-cigarettes than in 2018
• A similar proportion of residents reported eating the recommended level of fruit and vegetables
• A smaller proportion of residents reported eating takeaways
• A greater proportion of residents consumed alcohol at least once a week

Residents reported a mixture of positive and negative impacts of the pandemic on their lives. Compared to before the pandemic, fewer residents were worried about their relationships with people they live with, their job, or their connectedness to their local community; but there were greater concerns about their finances, physical and mental wellbeing, and lifestyles.

At the end of the first lockdown (July 2020), Coventry City Council worked with Warwickshire County Council on a joint Coventry and Warwickshire COVID-19 health impact assessment. The assessment sought to identify key factors that may affect the population’s health and wellbeing as a direct result of COVID-19.

Key findings include:

• An integrated recovery: the analysis shows that health and wellbeing have been deeply impacted by changes across the wider determinants of health; health behaviours and lifestyles; the health and care system; and the places and communities we live in. The implication is that recovery must be connected across all four parts to have the biggest chance of success and
• The double impact – the harm from COVID-19 itself has been unequally distributed across the population. The analysis shows that the wider impacts from the pandemic and lockdown did fall more heavily on the communities most directly affected by the disease – with the burden falling disproportionately on communities in areas of greater deprivation who have less ability to mitigate against the impact of the pandemic.

Economic, social and wider impacts of COVID-19

Businesses and economy

The pandemic has had a detrimental impact on the economic wellbeing and vitality of cities around the world – and Coventry is no exception.
During 2020/21, footfall in the retail area of Coventry city centre was at unprecedented low levels; footfall in 2020/21 (April 2020 to March 2021) was 60.7% lower than it was the previous year 2019/20. This led to significant reductions in trade for some businesses. This finding is not unsurprising given that for much of the year the City was under lockdown restrictions that required retail and hospitality to close for prolonged periods. The drop in footfall in Coventry was in line with other cities in England as a whole.

Jobs, employment and unemployment

The full impact of the pandemic on the economy has been cushioned by Coronavirus job retention schemes and self-employment income support schemes. As a result, data for Jan-Dec 2020 suggests that 181,400 residents (71.3%) remain economically active in employment, compared to 73.7% for West Midlands and 75.4% for Great Britain. This is a decline from 73% in Jan-Dec 2019.

There appears to be a gender divide in this with the pandemic affecting male employment more than female employment. Male employment declined from 78.7% in Jan-Dec 2019 to 73.9% in Jan-Dec 2020; compared to a small increase in female employment from 67% to 68.6% in the same period. The decline in male employment diverges from regional and national trends, which only saw a small decline.
There has been an increase in unemployment from 8,800 in Jan-Dec 2019 to 11,300 in Jan-Dec 2020; an increase from 4.6% to 5.9%. This is bigger than the increase regionally and for Great Britain, from 4.8% to 5.3% and 3.9% to 4.6% respectively. At 5.9% the Coventry unemployment rate is now higher than average compared to a group of similar local authority areas (CIPFA near neighbours). Government support schemes will have mitigated the pandemic impact on unemployment, it is hard to predict what the full impact on unemployment will be once support schemes end. From Coventry workplaces there were 57,000 employments on furlough by April 2021 (Coronavirus Job Retention Scheme).
As with employment levels, there is a gender divide – male unemployment has increased from 4,600 to 6,300 (from 4.2% to 6.3%), while female unemployment has decreased, from 6.5% to 5.3%. This contrast regional or national trends, where female unemployment has also increased.

The Job Shop has worked hard to adapt our services and provide customers with the same levels of personalised 1 to 1 support.

Communities and wellbeing

Mental wellbeing

The Council works with partners to conduct the Coventry Household Survey, a biennial survey on the perceptions, opinions, lifestyles, and behaviours of a representative sample of Coventry residents.  The Coventry Household Survey asks people questions from the short version of the Warwick–Edinburgh Mental Wellbeing Scale (SWEMWBS). The SWEMWBS questions enable the monitoring of mental wellbeing in the general population and the evaluation of projects, programmes and policies which aim to improve mental wellbeing.

Between 2018 and 2021, Coventry residents reported a decrease in their overall wellbeing, with the median SWEMWBS score falling from 26 in April 2018 to 22 in March 2021.  The decrease in score is likely to be associated with the ongoing pandemic. Similar national surveys have seen a comparable reduction, so this is not isolated to Coventry.

Worsening mental wellbeing is particularly acute in parts of the city facing digital exclusion, particularly amongst the north-east of the city (Foleshill, Wood End/Henley/Manor Farm), plus parts of Tile Hill and Willenhall – areas of the city which are also generally more deprived as measured by the English Indices of Multiple Deprivation 2019.

Crime

Total recorded crime in Coventry increased in April 2020 to March 2021 to 31,309 from 28,592 in 2019/20. This is a 9.5% increase; a much larger increase than in 2019/20 which was only 0.8%. In 2020/21, Coventry ranked fourth out of the eight policing areas, accounting for 11.2% of the West Midlands force's total. Crime has increased throughout the year; however, this may be due to the reduction in recorded crime during the first lockdown experienced at the beginning of the time period. March 2021 recorded the highest number of offences in Coventry for the year.

The largest rises in crime categories are those with a marker for Domestic violence and Hate Crime. Within those two strands, Harassment and Common Assaults have seen the highest increases. There are many hypotheses as to why these types of crimes have risen, people spending more time at home is perhaps the most commonly held one.

There has been a 36.7% increase in domestic abuse reported in 2020/21. The number of reports increased from 7,463 in 2019/20 to 10,203 in 2020/21. In 2020/21, there were 6,237 crimes and 3,966 'non-crime' incidents reported over the 12 months.
The pandemic has created additional challenges for those suffering from domestic abuse. Lockdowns have resulted in victims being trapped with abusers and have increased the barriers to being able to report abuse. An increase in both the number and complexity of cases has been observed. The easing of restrictions can offer opportunities to engage with services but may also increase abusive behaviours due to a perceived loss of control of the abuser. The impact of the pandemic on domestic abuse will extend well beyond the pandemic itself, including the increased impact on children of victims.

Coventry City Council funds both specialist accommodation and a sanctuary scheme to keep people safe in their own homes. Our early response to the pandemic was to fund additional units of specialist accommodation to help cope with increased demand. We are now using the opportunities from the Domestic Abuse Act 2021 to commission additional support for victims and their children to include domestic abuse prevention, housing, mental health, counselling and specialist support to meet complex needs. In addition, we have developed a Domestic Abuse Champions network among staff and have implemented an early intervention pilot with the police where all calls regarding domestic abuse are followed up by trained workers. Our newly established Domestic Abuse Local Partnership Board will oversee our progress as part of our wider strategy to tackle domestic abuse.

Children’s social care

At the end of March 2021, 747 children were looked after by Coventry City Council. This is an increase of 46 children from March 2020, when there were 701 looked after children. Expressed as a rate per 10,000 children, Coventry’s rate has increased from 88.0 in March 2020 to 93.7 in March 2021.

There was a considerable increase in new children becoming looked after in July and December 2020 and the number of looked after children peaked at 754 in December 2020. Rates in Coventry reflect wider trends regionally and nationally and may be linked to increased isolation associated with pandemic-related lockdowns.

A total of 304 children became newly looked after during 2020/21. This is the highest number since 2015/16.

Adult social care

Adult social care providers provide a diverse range of services: care homes (nursing and residential), supported living settings (range of different types of accommodation shared by people with particular physical or learning disabilities), extra care provision for people living in their own flats in communal settings, and home care services for people living in their own homes. The challenge for these providers during the pandemic has been great, as they have been required to adapt their operating processes to allow for social distancing, alongside strict infection control measures (including PPE use). These providers also care for some of our most vulnerable people in the city and those who have been most affected by the COVID-19 pandemic.
Council partners and NHS partners have worked very closely together to support care providers and those they care for, throughout the pandemic, through ensuring regular and accurate communication, ensuring appropriate use of extra grant funding for infection control measures, providing access to the Council’s PPE stock (a PPE procurement and distribution system was established at the very beginning of the pandemic, ensuring flexible access to COVID-19 vaccinations (vaccinations provided in-home settings for those staff in care homes). There have been regular communications with care providers about national policy changes and associated locally agreed policy, alongside a number of opportunities for the concerns of providers to be listened to and acted upon.

We continue to intensively support care settings, who continue to operate with full COVID-19 secure measures in place, in anticipation of a difficult winter ahead, with cold weather, COVID-19 and other respiratory viruses likely to have a significant impact on the health of the individuals cared for.