Coventry Director of Public Health Annual Report 2020/2021

Directors of Public Health along with their teams and the wider Council have been responsible for spearheading the local response to the Pandemic and have developed Local Outbreak Management Plans to outline all aspects of the approach taken including community testing, local contact tracing, supporting self-isolation, controlling local outbreaks and ongoing surveillance, working with Public Health England and local partners and engaging local communities. These responsibilities are supported by West Midlands and Warwickshire Strategic Coordination and Recovery Groups and local Health and Care infrastructure.

This partnership is reflected in the diagram below which shows the number of services and partners involved in the overall response.  

Outbreak response partnership

 

The approach taken has been influenced and led by ‘One Coventry’ values which focus on working together with Partners to improve the City and people’s lives by being open, fair, and transparent, involving the right people, embracing new ways of working to continuously improve the services we offer, engaging with our residents and empowering our employees to enable them to do the right thing and putting diversity and inclusion at the heart of all we do.

The COVID-19 pandemic has served to shine a light on the engrained health inequalities that exist in Coventry. It became evident within the first months of the response that certain groups of people including Black and Ethnic Minority groups, those living in poor, overcrowded, or insecure housing, older people, and those with disabilities were more likely to suffer greater morbidity from infection than the overall population. Our approach as a Marmot City means we are well placed to address these inequalities with a specific focus on engaging with and supporting our most vulnerable and hardest to reach communities. This report will focus on the engagement elements of this response.

Focus on engagement

Ensuring communities understand and trust public health messages, and that they are accessible and culturally appropriate, has been central to the communication and engagement strategy in Coventry throughout the pandemic. Through our Health and Wellbeing Strategy there was already a strong commitment to working more closely with our communities in an honest and transparent way. We have built on this commitment during the pandemic and engaged and actively involved communities in the development and onward dissemination of key messages about COVID-19 and the Test and Trace programme in an effective and appropriate way.

Early in the pandemic a multi-agency engagement and participation cell was established to lead and co-ordinate activity. One of the key focuses of the cell was health inequalities, aligned to our status as a Marmot City and addressing the findings of the PHE disparities review (and subsequent emergent recommendations specifically for BAME communities) and the targeting of culturally sensitive messages to those communities most at risk. We have used learning from other areas of the country e.g., Leicester and Liverpool, and profiling tools such as Acorn to develop our comms and engagement approach, especially with hard-to-reach communities. We have utilised expertise in Behavioural Science from our local Universities to review campaign messages and offer ways in which we widen our reach and appeal with certain messages. As well as looking at communities within Coventry, we have also worked collaboratively on  campaigns for businesses and other settings such as schools within the City. Communications have been developed to support businesses to operate in a COVID safe way and guidance based on national good practice and local lesson learned have been disseminated across all sectors.

A cornerstone of this approach was involving trusted community leaders in Coventry including the Director of Public Health, Council Leader, Chamber of Commerce, local NHS leaders and Cabinet Members to reinforce national messaging, encourage compliance, and understand the barriers to adherence in communities. Public perceptions of the threat of the virus have continued to shift throughout the pandemic. Our communications have had to evolve to match this changing environment to ensure that central communications about pandemic interventions are tailored to meet local need and feedback received from the community about how messages are being understood.

The overall approach to communications and engagement taken in Coventry is described below through a focus on key groups: communities, workplaces, schools and extremely vulnerable communities.

Working with communities

Community Messengers

In the Summer of 2020, CRET called out to communities to recruit a network of community messengers. Coventry has a very diverse and active voluntary and community sector with many small and well-connected groups. It is also blessed with many community leaders and “go-to” people in local neighbourhoods. The call-out was successful in recruiting more than 200 community messengers who consisted of existing faith, voluntary and community networks in the city. The number of messengers has now grown to 320.

The messengers perform two main functions

1. they help to disseminate into their community the “stay safe” messages
2. they collect and feedback community intelligence which is then used to influence a number of things such as improving our communication materials, focusing our interventions and deploying our local teams of  COVID-19 advisors.

Young people were included through a partnership with The Positive Youth Foundation, a charity that supports young people in the Coventry area (and who chair the Coventry Youth Partnership), and a series of focus groups held with young people and the council’s communications team helped the development of specific messaging for young people, including a number of videos.

How is the Community Messenger work delivered?

A webinar is held every week where CRET team members facilitate the webinar with the Director of Public Health or member of the senior team giving an update on COVID-19 situations and responses, and then time for discussion and sharing community intelligence back which is passed on to the relevant group/team e.g. Vaccinating Coventry group, the LFT testing team or COVID-19 advisors.  A bulletin is then created and sent to all messengers weekly (with urgent updates in between if they’re needed), which are then used by the messengers to share with their networks.   

The updates are long and detailed but crucially the messengers themselves identify what is useful for them and decide what to share - they pick and choose the items they want.

One messenger does a weekly email for her neighbours in her street, and she rewrites the information we provide into her style. She says she needs to think about what we’re saying before she sends it on.

The community messengers have actively involved friends and family in their work, recruiting messengers themselves to share communications. The exact number of messengers is difficult to estimate, due to people recruiting their own friends and colleagues, but we have 320 on our list so far.

The culture of this work is about working together as equals – CRET has purposefully designed the approach so that each community messenger can do as little or as much as they are able – all help and support is appreciated.  
 
The messengers also provide peer support to each other and have worked together on a number of issues – such as the development of shared videos and jointly writing to travel companies to ask for extra signs on buses around wearing face coverings. They have taken ownership and many messengers have become powerful advocates for public health and have stated they want to continue working in this way for other programmes.

An example of how it worked

When a walk-in test centre was set up in Foleshill, a ward with high levels of deprivation, it led to a backlash from the community.

They thought we were stigmatising them by putting the centre there, although the decision to make it a walk-in test centre was because of low levels of car ownership there. We hadn’t explained why we’d made the decision, but the feedback helped us address the problem and to explain fully.

Working with community and faith groups

Alongside the messengers’ network, voluntary and community groups worked with the council to share communications. Webinars to brief community centres and places of worship were held when there was a change in guidance (such as when Coventry went into tier 2 restrictions) and CRET regularly provided phone advice as well as sending the weekly update email to voluntary and community sector groups.

This work is considered just as important as engagement with community messengers.  Community centres and places of worship are supporting people through these difficult times by providing social supermarkets and other crisis support and they’re an excellent way to get “stay safe” messages out as they are hubs in their communities.

Additionally, CRET has given advice on practical ways in which venues can be open safely and have supported the places of worship and community centres across the city very practically by giving away hand sanitiser, signage and masks.

There have been many benefits to this network approach.  As they’ve begun to link up and provide peer support to each other, they’ve seen the value of working together and now want more - we will continue to give support.

Together, the community messengers, community and faith groups have created some excellent resources which have been used during the response. 

These include:

• Community Messengers' vaccination videos:
  • Sharon’s story
  • Tracey’s story
  • Gordon
  • I worked Amrik and Guro
  • Jo
  • Martin
  • Joyce
  • Khaled
• Teenagers from Positive Youth foundation supported us by creating some videos:
  • Ava - English (subtitles can be switched on)
  • Own your space
  • Know your tier (Arabic)

Food Network

Over the last 18 months, the Council has been working closely with a range of partners, in particular, the Coventry Food Network, to create and deliver a system of food support to vulnerable residents as a result of the Covid-19 pandemic. The Coventry Food Network (CFN) is a multi-faceted food partnership and consists of representatives from public, private, voluntary and community sectors. It is a space to openly debate and discuss food-related issues, initiate new projects, and propose the direction of travel for tackling food-related issues throughout the city.  
A number of initiatives have been delivered to provide emergency food to residents in need:

• Emergency food provision for vulnerable residents, including those who were clinically extremely vulnerable
• Free School Meals (FSM) provision during school holidays
• Supported the delivery of the DfE Holiday, Activities and Food Programme 2021 (HAF).  On an individual basis, a number of the food hubs/social supermarkets successfully bid for funding to deliver the HAF programme to children and families in their local area.
• The COVID Winter Grant Scheme (CWGS)/The COVID Local Support Grant (LCSG) – the Coventry Food Network supported the Council to deliver the scheme locally.  The CWGS operated from 1 December 2020 and has been extended to 30 September 2021.
• Integrated Services – Social Supermarkets/Grub Hubs and Wrap Around Advice Services – aiming to embed the provision of wrap around services within the social supermarket/grub hubs. It is recognised that access to food is only one factor in providing a pathway out of poverty and the provision of wrap-around support in tandem with food, is key to affecting this.

Additional grant funding

CRET built on their participatory approach by submitting a bid with the Migration team within the council to the Ministry of Housing Communities and Local Government Community Champions fund, and were successful in securing funding to set up two interventions:

1. Small Grant Scheme
2. Community Champions

The first was a small grants scheme to support small grassroots community organisations to support BAME community and disabled people to better engage and get the “stay safe” messages out as well as encourage community lateral flowing testing and vaccine take up. This has been purposely targeted at smaller community organisations in touch with those hardest to reach – it launched mid-February 2021 and 39 small grants have already been awarded. The groups awarded funds worked hand in hand with CRET, like community messengers in the delivery of messages.

The second element was run by the Council’s Migration Team and supported medium to large community organisations/charities in the city to host a community champion who would work to engage and support key target groups. There are currently 14 host organisations hosting community champions. CRET worked closely to support these organisations (who also became community messengers to link up the work). Additionally, the Migration team established a range of outreach programmes of work to engage and support migrants and asylum seekers in the city.

In all of these initiatives, the true measure of success is more than engagement.  Our community messengers and the community and voluntary groups are not simply passing on messages - they are taking part actively.  For example, complaining to big business where they see failures, recruiting people in the network to help and the voluntary and community groups are peer supporting each other as well as working collectively with us. These are ways of working together with many benefits that will continue long after the pandemic is over. 

Vaccinating Coventry

Engagement as detailed above was also deployed to assist the work of Vaccinating Coventry – a partnership group with membership from a range of council teams (Public Health, Migration and CRET, COVID-19 advisor teams, communications), NHS partners (CCG communications and engagement teams, primary care network and GP and Pharmacy representatives, Healthwatch), with a focus on improving vaccine uptake inequality across the city.  While vaccine uptake across Coventry and Warwickshire has been good, early in the vaccination programme data started to reveal areas of Coventry with much lower uptake, particularly among BAME groups and those living in more deprived areas. The work of the group is linked tightly with wider COVID-19 prevention inequality work, focused upon access to testing, understanding of and adherence to national guidelines. An action framework was developed for the group addressing four key work themes:

Understand and Act
Build upon knowledge and understanding of the variation in uptake at small geographical levels and among different population groups. Acting on barriers was key and, as a system, we needed to address issues of hesitancy and access, and in particular provision of additional vaccination sites particularly in areas of higher deprivation and in areas where we know uptake of the vaccination may be lower.

Listen
We are listening to questions and concerns our communities may have about the vaccination and what they think may be helpful in addressing these – key feedback to date has related to concern about safety, needing more information about the vaccine itself, and about vaccines in general and what to expect (including side effects) and concerns among younger women of child-bearing age.

The community messengers have been vital in helping us to “listen” more effectively. They have provided valuable feedback about what’s really going on in neighbourhoods. The messenger network tells us about the latest false news and disinformation that’s being shared on social media about the vaccine. These are things that we wouldn’t see in our social media feeds and it helps us make sure we’re myth-busting and addressing safety concerns when we need to.

Engage
A wide range of engagement is being undertaken across the city, some focusing on vaccination, and some on the wider national roadmap/recovery, and what this means for us locally. Regular open community engagement sessions have been hosted by the CCG and the Council for: Black African and Caribbean Communities, South Asian Communities, and groups for younger women, including a number of bilingual events. Vaccine understanding/engagement sessions have been held for our community messengers, migrant health champions and welfare callers (contact tracers), City of Culture staff, and provider of Cook and Eat Well sessions in the city, alongside a number of sessions for care providers in the city. We continue to engage and are currently working on a programme of engagement for younger people.  We have also built questions into our contact tracing processes to gather information, and talk to individuals, about vaccination.

Communicate
A broad shared portfolio of communications assets has been developed by partners within the CCG, Acute Trusts and in the Council. The communication and engagement strategy for vaccinations (joint NHS and Council) is being guided by the intelligence and understanding we are gaining from our communities and where we understand the areas of highest need are, this will continue to evolve as the vaccination programme evolves.
    
Engagement has supported the four elements above – for example, community intelligence gleaned from community messengers, champions and the funded groups has been fed in to better understand barriers and plan additional pop up centres.  Additionally, many communities group and organisations across the city have sent volunteers to help as marshals for community pop up vaccination clinics. Some community messengers have also physically brought members of their group to be vaccinated together – leading by example.

To provide additional access to vaccinations for some of our higher-risk communities, with lower uptake of vaccination, we have worked alongside our NHS partners to offer an outreach/mobile vaccination programme (using both outdoor and community centre sites) to offer vaccination outside of the "static sites" to support particular population groups, including:

• Homeless communities
• Individuals with mental health problems and learning difficulties
• Asylum seekers in hotel accommodation
• People in areas of highest deprivation in the city including the centre, Hillfields and Foleshill areas

Case Study

Engagement with the community messengers was crucial in the role out of the vaccination pop-ups in the City. Early on in the process, we received valuable feedback from the Community Messengers to say that it was important to give ample notice to the relevant communities prior to a pop-up vaccination clinic event being held. One example of this was the pop-up clinic in Hillfields, whereby advanced warning enabled the Community Resilience Team to reach out to their contacts in the area two weeks prior to the clinic running. In doing this we were able to achieve the following outcomes:

• Over 300 Community Messengers were informed of the pop-up vaccination site through warming up messages, save the date and reminders.
• We reached out to the specific Hillfields stakeholders list (30 contacts)
• We contacted the Chairman of Coventry Muslim Forum who asked the places of worship to let their congregations know about the clinic the day before in Friday prayers. On the day, he attended morning worship, announced that the pop-up was on and escorted people to the clinic.
• Organised for Community Champion Grant Awardees in the area to attend the pop-up clinic. Having a friendly and “known” face at the event encouraged others to attend that were previously worried or anxious about having the vaccine. They were also able to address issues and concerns about being asked for legal paperwork or if they were registered with a GP etc. They also supported cases where translation may have been needed.

This clinic was highly praised for the engagement work that was done prior to and during the event. It made a noticeable difference in the number of people who attended and the involvement from members of the community was very impactful.

We have also started an employer programme of work, linking up employers either with local vaccination sites which can offer block “walk-in” opportunities for employees or the offer of an on-site vaccination clinic. Alongside this, we will continue to link up with events teams to provide opportunities for people to get vaccinated (e.g. provision of a vaccination clinic at Godiva Festival).

Key lessons learnt from Community Engagement

• Provide as much detailed information as you can, but let people choose the information they want to share in their own ways
• Make senior leaders visible, so people know their work is valued – the fact that senior leaders find time to attend most webinars to talk to community messengers is greatly appreciated and respected by the network
• With all engagement arrangements make sure to set a culture of openness and mutual respect - ‘we are all in this together’
• Share information with established hubs in neighbourhoods like community and faith centres
• Provide effective, clear communications collateral for communities to share via the social media channels they use
• Listen and act on the valuable feedback you’re getting from communities
• Support communities to tell their stories in their own words – like the videos produced by young people and the community messengers
• Find ways of overcoming barriers to engagement, e.g. there was a tension between the peaks and troughs of NHS staff capacity to delivery outreach and having enough time to engage with local communities – advocated for longer lead-in times for outreach clinics.