Coventry Health and Wellbeing Strategy 2023-2026 - Print version

Chair's foreword

I am delighted to present the Coventry Health and Wellbeing strategy.  Our strategy has been refreshed up to 2026 to reflect the changes to our short-term priorities, the learning from the pandemic, and alignment to plans and strategies across the health and care system. It highlights the improvements in health and wellbeing that have been achieved in the city since 2019 but also recognises the challenges and that more needs to be done to prevent ill-health and reduce inequalities, build resilience in communities and integrate services.

Since we published our previous strategy, for 2019 to 2023, there have been significant changes to the way health services are planned and commissioned and the refreshed strategy reflects this.  Our Strategy has an increased focus on working together with communities which will be crucial to our success. Making the most of our strengthened system partnerships that have worked together so effectively during the pandemic will help work towards our high-level ambitions.

Councillor Kamran Asif Caan
Chair of Coventry Health & Wellbeing Board

Background

The Health and Wellbeing Strategy is one of the vehicles for determining that the health needs of the local population are being identified and agreed. It is a statutory requirement of the Health and Wellbeing Board and should set out the priorities for improving the health and wellbeing of the local population, reflecting the local Joint Strategic Needs Assessment.  The Strategy should inform any joint commissioning arrangements with the NHS and local authority, including the Better Care Fund Plans.

Both the local authority and the Integrated Care Board must have regard to the relevant Health and Wellbeing Strategy. In addition to the development of a strategy, the Health and Wellbeing Board needs to develop and Pharmaceutical Needs Assessment and this is published separately.

This refresh of the Coventry Health and Wellbeing Strategy draws on significant engagement with communities and sets out the council’s ambition to ensure more residents of Coventry are fulfilling their ambitions, living healthier lives for longer and living in safer, connected and sustainable communities.  It builds on the continued lessons from being a Marmot City and embeds The King’s Fund population health approach. There is also a recognition that, along with partners, this strategy must address the wider determinants of health and reduce health inequalities in Coventry.

Since the launch of this strategy, the world has seen unprecedented change due to the Covid-19 pandemic, both in the context of health security and the economic landscape.  One of the biggest lessons learnt from the pandemic response has been the ability to capitalise on strengthened partnerships to deliver outcomes.  With the advent of Integrated Care Systems as a result of the legislative changes within the Health & Care Act (2022) there are greater opportunities to build on collaborations to improve population health & integrate care.

To ensure the Health & Wellbeing Strategy remains relevant and focused, this refresh was developed to review the progress of the strategic ambitions, short term priorities and to align with the One Coventry approach which aims to continue to improve the city of Coventry and the lives of those who live, work and study here.   The performance measures, key facts and opportunities and challenges will also be reviewed as part of the review and refresh.

A wide range of factors shape individual behaviours and influence health outcomes, including biological, social and community influences, individual lifestyle factors, living and working conditions, and socioeconomic, cultural, structural, and environmental influences. The Dahlgren & Whitehead diagram below displays these relationships:

Figure 1: Dahlgren & Whitehead diagram of the wider determinants of health

Residents’ health may be influenced differently by these determinants depending on where they live in Coventry, as shown below in the ward diagrams of Figure 2.

Figure 2: Levels of deprivation in Coventry

The Kings Fund model of population health aims to improve the health of a population through improving the physical and mental health outcomes and wellbeing of people within and across a defined local, regional or national population, while reducing health inequalities.  [1] [#_ftn1]  This model has been adopted across Coventry and is very much embedded in the One Coventry approach and is aligned with the policy objectives which have shaped Coventry as a Marmot City.  Taking action on the four key pillars of this framework continues to guide our approach to achieving our long-term vision for change (see Fig 3). 

Figure 3:  The Kings Fund model of population health & Coventry Health & Wellbeing strategic ambitions

What do we know about health and wellbeing in Coventry?

Population

• Coventry continues to be a growing, changing and increasingly diverse city.  Data from the JSNA suggests that in 2021 the city’s recorded population was over 345,000, making it the second largest local authority in the West Midlands region and 25th largest in England.  Coventry prides itself on being a diverse city and continues to welcome many new residents from other parts of the world. Recent data indicates that migration is a significant part of this annual population change. 
• In Coventry, the population size has increased by 8.9%, from around 317,000 in 2011 to 345,300 in 2021. This is higher than the overall increase for England (6.6%), where the population grew by nearly 3.5 million to 56,489,800[1] [#_ftn1].
• Coventry is a young city compared to the rest of England, with a higher proportion of residents between the ages of 25 and 39. This younger population can also be attributed in part to the city’s high concentration of university students, with 20-year-olds being amongst the most prevalent age group, along with 13% of the population between the ages of 18 and 19.   Understanding the sociodemographic profile of an area is important when planning services, as different population groups may have different health and social care needs and are likely to interact with services in different ways.
• In the 2021 census, 45% of Coventry’s population identified as an ethnic minority, up from 33% in 2011, which is higher than both the regional (28%) and national average (26%)
• Of the ethnic minority population, Asian Indian formed the largest group making up 9% of Coventry’s total population compared to 3% in England and 5% in the West Midlands. Within Coventry, Foleshill West, Foleshill East, and Hillfields had the largest percentage of their population identifying as an ethnic minority with 80% or more doing so.
• According to the latest school census in 2022, 55.9% of Coventry’s school children are from a minority group, this is an increase from 39.7% in 2012 (Coventry City Council, 2022c). Amongst the school-aged population our largest minorities are Black African (11.4%), non-British white (10.2%), and Asian Indian (8.9%) children.

Health Inequalities

• The city is relatively deprived, ranking 46th most deprived borough in England, with 14.4% of the city’s neighbourhood amongst the 10% most deprived areas in England.
• Overall health in Coventry is below the national average and there are significant health inequalities that continue to impact the lives of those most deprived in the city.  Life expectancy for both men (78.0 years) and women (82.0 years) is lower than the England average, with people living more of their later years in ill health and a significantly higher prevalence of preventable deaths.  Healthy life expectancy refers to the number of years a person can expect to live in good health.  In Coventry, this is 64.0 years for females and 61.1 for males.  Compared to the national picture, healthy life expectancy for Coventry males is lower than the national (63.1) and regional (61.9) averages whereas for Coventry females it is slightly higher (62.6) and (63.9). The trends show little change in recent years for women, but it has fallen a little for men. Such data is important for us to take action on the cumulative effect of the prevalence of risk factors, the prevalence and severity of disease, and the effectiveness of interventions and treatment.

Mental Health and Wellbeing

• Loneliness affects many people in Coventry. Findings from the Coventry Household Survey, conducted in 2021, show that 16–24-year-olds score highest on loneliness, with the survey showing that the younger you are, the more likely you are to be lonely. The survey also highlighted that women, carers, disabled and unemployed people are more likely to be lonely.
• Responses to questions in the Coventry Household Survey 2022 also indicate a detrimental impact on mental wellbeing. A series of seven questions about respondents’ wellbeing were asked using the Short Warwick and Edinburgh Mental Wellbeing Scale (‘SWEMWBS’). Respondents can score from 1 (very low wellbeing) to 35 (very high wellbeing); the average score has reduced from 26.4 in 2018 to 22.94 in 2021 and 21.75 in 2022. Further to this, we can broadly categorise respondents’ level of mental wellbeing according to their score; in 2021 28% gave a score that suggests ‘possible’ or ‘probable’ depression, up from 10% in 2018, and only 18% gave a high mental wellbeing score, down from 43% in 2018. These are not clinical diagnosis of course, just an indication to the extent of the impact on wellbeing of the pandemic. 
• The proportion of Coventry adults diagnosed with depression according to GP registers, has been on an increasing trend. Mental ill health is of growing concern, in 2013/14 it was 6.5% which increased to 11.9% in 2021/22, amounting to 40,743 residents.
• The 2021 Coventry & Warwickshire Adult Mental Health and Wellbeing Needs Assessment set out a few key findings: 
  • there are high levels of poor wellbeing and mental ill health.
  • there is difficulty in accessing or understanding available services or support. 
  • there will growing demand in the future, either due to better diagnosis and recognition of mental health issues and/or a general increase in poor mental health.
• Feelings of belonging and cohesion may have reduced over the last few years according to the 2022 Household Survey.  56% of adults said they felt a sense of belonging to Coventry, down from 83% in 2018; and 54% felt they belonged to their immediate neighbourhood, down from 77%.  

Equality, Diversity and Inclusion

• The Census 2021 has confirmed Coventry’s status as one of the most diverse cities in the UK, with 45% of people identifying as being from an ethnic minority group.  The different communities making up the city’s population reflect a broad range of backgrounds and needs.  It is therefore imperative to monitor how Council services are being used, using this latest Census data, to ensure that these diverse needs are being appropriately and adequately met by the Council. 
• Coventry City Council acknowledges the importance of the principles of diversity and inclusion underpinning everything we do and recognises the importance of ensuring that our workforce at all levels, including at senior leadership level, is more reflective of the communities we serve and that we deliver services which meet the needs of all of our diverse citizens of Coventry.  A commitment to this work is reflected in our status as an early adopter of the RACE equality code kitemark which is an accountability framework designed to provide organisations across all sectors and sizes, with the opportunity to address race inequality in the boardroom and at senior leadership level.
• Employees with disabilities can face significant challenges in the workplace & as part of the council’s commitments in the Workforce Diversity & Inclusion Strategy (2021-2023), a series of career development programmes have been launched to equip staff who have a disability, identify as neurodiverse or have a long-term physical or mental health condition to develop leadership skills that will enable them to thrive regardless of their role or position.
• Living with excess weight has health implications across the life course, as well as the burden it places on their families, social care and the NHS.  Across the West Midlands, the prevalence of children at a healthy weight (particularly in year 6) is declining and getting worse at 57.1%.  Obesity prevalence is strongly linked to deprivation, with the rate of obesity in children living in the poorest areas more than double that of those living in the least deprived.  Child obesity levels in the city are higher than the England average, with around 22% of Reception children and 41.1% of Year 6 children classed as overweight & obese in 2021/22.  These figures for Year 6 particularly are increasing and getting worse.  A similar trend is also reflected with the adults in the city with 68.4% classed as overweight or obese.  58.6% of adults in the city are physically activity, which is below both the regional and national average.   These trends come at a significant time given the links between excess weight & COVID-19 severity, along with a range of other chronic diseases.

Education and Skills

• Education standards have increased with 94% of primary and 74% of secondary students attending a good/outstanding school.
• The number of pupils achieving a “strong pass” and “standard pass” at the end of Key Stage 4 is below the national average. In 2022, 46.6% of Coventry students earned "strong passes" in English and Maths at grades 9–5, compared to 44.78% 50% of students in England. In 2022, 65.1% of Coventry students received a "standard pass," or grades 9–4 in English and Maths, up from 64.9% in 2021. This is lower than the 69% national average. For 16–18-year-olds (at key stage 5), Coventry’s average point score is in the middle of Grade C, which is slightly below the national average which is towards the top of Grade C.
• Nearly 19% of Coventry neighbourhoods are amongst the 10% most deprived neighbourhoods in England; 10% of the population has no qualifications at all, limiting their ability to gain rewarding employment. To transform life opportunities and increase everybody’s probability of a successful life needs every child to achieve a good level of development by the age of five; social inequalities are already established from the early years of life. 

Housing and Homelessness

• Where we live can have a significant impact on our wellbeing.  Despite improving local housing systems, the city still has high levels of homelessness; highlighting a need to work together with partners to improve the use of existing homes and empty dwellings.  
•  Household overcrowding is more prevalent in Coventry than national and regional averages. Census 2021 counts 10,196 Coventry households as overcrowded, having fewer rooms than a minimum standard for the number of occupants. This amounts to 7.7% of all households, so overcrowding rates in Coventry are higher than West Midlands (5.4%) and England overall (6.4%). However, overcrowding has reduced since 2011 when it was at 9.5% of households.
• The homelessness rate in the city rose higher in 2021/22 than in the previous year. This is projected to further increase in 2022/2023, the cost-of-living crisis is a factor here. The number of households accepted under a main homelessness duty increased from 722 in 2020/21 to 800 in 2021/22. There was a 14% increase in case demand on homelessness prevention and relief services in 2021/2022 compared with 2020/2021, the Council, obtained secured accommodation for 1,167 households, compared with 1,083 in the previous year. 
• Due to the increase and projected further increase in demand for homelessness support in 2022/2023, the Council has invested in additional frontline resources to support more residents facing homelessness issues and has revised and uplifted contracts for delivering additional support with providers, including The Salvation Army, St Basils, and P3 Charity, for households which are not eligible for a statutory homeless duty.

Employment and Economy

• A protective factor for health is having meaningful employment. Reducing avoidable health disparities will involve tackling the unequal distribution of money, wealth, and power by improving opportunities and skills.
• The city’s advanced manufacturing sector is growing, helped by the increase in the city’s highly skilled and highly qualified working-age population.
• Young people who are not in education, employment or training (NEET) are at greater risk of a range of negative outcomes, including poor health, depression or early parenthood. Across the city, NEET rates are decreasing in the city and getting better at 3.9% which is better than the regional and national average.  The percentage of people of working age in employment in Coventry is 69.2% which is amongst the lowest across the West Midlands & below the England average at 75.4%
• The local economy has experienced significant challenges in recent years with the COVID-19 pandemic, inflation, labour shortages, and new regulations and document requirements for UK-EU trade post-Brexit all of which have slowed economic recovery. This had a major impact on the local labour force, with the claimant count rising from 7,525 (3.0%) recorded in January 2020 to 16,490 (6.6%) in December 2020 (the peak during the pandemic). 

Fuel Poverty

• A household is said to be in fuel poverty if their fuel costs are above average, and when having paid for fuel, they are left with an income below the official poverty line.  In figures, released from 2020, Coventry was one of the worst affected authorities in the country, with 20.3% of households in fuel poverty. Some areas of Coventry have fuel poverty rates of over 50%.  Delivering a sustained recovery from the COVID-19 pandemic and global economic challenges is one of the priorities of Coventry’s economic development strategy which will contribute to achieving the One Coventry objective of “Improving Outcomes and Tackling Inequalities in Communities”.
• The impact of the cost-of-living crisis continues to affect households across the city.18.7% (13,670) children live in low-income families and the impact of fuel poverty has had a significant impact on spending behaviours particularly around food choices with price being the most important factor as highlighted in the Coventry Household Survey 2022.  Data from this survey also noted that people living in Foleshill (31%), St Michael (33%) or Wyken (25%) wards are significantly more likely to feel worried about money almost all the time compared to the total average (17%).  In addition, those with a disability are also more likely to worry about money almost all the time compared to those with no disability (23% vs 14%).
• Smoking is the leading preventable cause of illness & premature death.  Despite the continued decline in smoking prevalence across the West Midlands, 16.4% of adults in Coventry still smoke, which is higher than the national average at 15.4%.   
• Lifestyle questions around smoking behaviours is a component of the Coventry Household Survey (2022) and suggests that those aged 35-44 are significantly more likely to say they currently use e-cigarettes (9%) compared to the survey average of 7%.

More information about health and wellbeing in Coventry can be found in our health and wellbeing profile (Joint Strategic Needs Assessment) and our review of population health needs.

Taking action: An update on wider determinants of health

2023 marks a decade since Coventry became a Marmot City and the population health approach is very much embedded into ways of working throughout Coventry.  The city is now embedding the One Coventry Plan, which rather than being a programme or project is a different approach to working with and for our communities. The One Coventry plan highlights a continued commitment to strengthen the Marmot City approach through encouraging healthy lifestyle & providing quality healthcare[1] [#_ftn1].  Since the publication of the strategy, the following developments have been made:

• Coventry City Council is amongst 10 local authorities that have been awarded funding from the National Institute for Health and Care Research (NIHR) to create a Health Determinants Research Collaboration (HDRC) within Coventry over the next 5 years[2] [#_ftn2].  This is an opportunity to build on the evidence base around the wider determinants of population health and health inequalities and develop a new research culture and capability in the authority.
• The Marmot Partnership (previously Marmot Steering Group) continues to bring together key stakeholders from across the system to provide an ongoing strategic focus on health inequalities[3] [#_ftn3].   A new monitoring tool for 2023 onwards has been developed by the Marmot Partnership.  This strategic monitoring tool aims to support the work of the Partnership by understanding what local action is needed and where in the system, what has been effective and share good practice and influence partners strategic priorities to improve health equity.  The monitoring tool uses the eight Marmot policy objectives as the overarching themes to bring together activities, and a new set of indicators to measure the progress made in reducing health inequalities for those living in Coventry.  The Health and Wellbeing Board will be updated annually on Marmot activity and any progress made against the indicators and outcome measures in this monitoring tool. System partners will also be provided with evidence of progress made on the Marmot Priorities key priorities to influence the strategic prioritisation of resources.

Businesses Committed to Fairer Coventry

Developed between Public Health, Employment and Skills, and Business and Economic development colleagues the ‘Businesses committed to a fairer Coventry’ campaign aims to work with Coventry businesses to consider how they can implement fairer work practices for their employees.  This addresses the well understood link between poor quality work and inequalities.

The Marmot review for industry ‘The Business of Health Equity’ (2022) sets out the important role that businesses play in the health and wellbeing of their employees by providing good quality work and opportunities to develop skills and improving health equity. Legal and General in partnership with the Marmot team at the Institute of Health Equity chose Coventry to hold a round table event in March 2022 to launch the review and stimulate discussions. January 2023 saw a national network for businesses launched to share information and learning in the drive to tackle health inequalities.  ‘Businesses committed to a fairer Coventry’ is our local response to the review (see infographic below). The campaign pilot will commence June 2023.

Taking action: An update on our health behaviours and life

Our health behaviours are important drivers of health. These modifiable behaviours include smoking, alcohol consumption, diet and exercise. Prioritising the prevention of illness is one of the key commitments across both Coventry and Warwickshire and we are addressing this through aligning and co-ordinating prevention programmes across the local authority and NHS system to maximise impact and tackle barriers to healthy lifestyle choices. Within the Integrated Care System, the population health & inequalities prevention board was established to address this area of public health.

Physical activity

• Prevention of ill-health and promotion of wellbeing continues to be at the heart of every NHS and local government pathway and in Coventry, this is reflected in the collaborative approach with the voluntary and community organisations promoting physical activity & active travel through events such as the Wellbeing For Life festival. Sport & physical activity plays a key role not only in improving our mental & physical wellbeing, but in creating opportunities for people to make new connections, reduce social isolation and bring communities together. Across the city there are a wealth of free and low cost opportunities for residents of all age to participate in sport & physical activity.
• In 2022, Coventry was successful in securing funding through the Commonwealth Active Communities Fund. The aim of the funding is to tackle inactivity in local communities and engage underrepresented groups by delivering physical activities in parks and green spaces, care homes and with street closures. This investment has created further opportunities for local organisations in the city to reduce isolation and loneliness by delivering more physical activity opportunities in a community setting as part of Coventry Moves on your doorstep. The Public Health team continues to work closely with the Sports Development team in the Council on this agenda.
• Social prescribing in Coventry has created further opportunities for residents to make choices about their lifestyles to improve mental and physical health and self-esteem through participating in a range of wellbeing activities including sport & physical activity.
• Coventry continues to host a number of exciting citywide events to showcase local physical activity opportunities. Sports Fest is in its 11th year and most recently had over 15,000 residents taking part in sport and physical activity during the festival which is the highest attendance the event has ever had.

Taking action on childhood obesity

As a Marmot City, we are committed to ensuring that every child has the best start in life, and we are continuing to take action to support families to make healthy lifestyle choices. Supporting research into the prevention of ill health forms a key part of this and Coventry is part of a NIHR study to test the effectiveness of the MapMe intervention alongside the current NCMP invitation letter.

Childhood obesity in Coventry remains higher than the England average and is most prevalent in the most deprived areas of the city which mirrors the national picture of obesity and socioeconomic status. This research provides a unique opportunity to understand motivations and barriers around accessing weight management services for children.

Alcohol and substance misuse

• Liver disease is one of the top causes of death in England and people are dying from it at younger ages. In Coventry, the hospital admission rate is increasing and getting worse at 52.4 (per 100,000) which is higher than the regional and national average.
• The government’s new 10-year drug and alcohol strategy ‘From Harm to Hope’ sets out an ambition to address substance misuse by breaking drug supply chains, delivering a world-class treatment and recovery system and achieving a generational shift in demand for drugs. A new Supplemental Substance Misuse Treatment and Recovery Grant (SSMTRG) has been issued to Local Authorities to enhance the delivery of treatment and recovery systems.
• The following is a summary of projects in the city that have been invested in as a result of this funding:
  • Creating a dedicated criminal justice team within Change Grow Live (CGL) (Coventry’s commissioned adult drug and alcohol treatment service) and employing a substance misuse worker embedded in the Caludon Centre
  • Employing an additional worker within Positive Choices (Coventry’s commissioned Young People’s risky behaviour service) to focus on supporting individuals engaged in County Lines activity
  • Employing a worker within the Housing and Homelessness team of the City Council to coordinate the multiagency Vulnerable Persons Forum
  • Introducing the use of long-acting opiate substitute therapy
  • Distributing additional naloxone (an intervention to reverse the effects of opiate overdose)
  • Providing additional residential rehabilitation placements

Sexual Health

Coventry and Warwickshire Partnership Trust offer an Integrated Sexual Health Service (ISHS) which help with providing care and advice on sexually transmitted infections and contraception in the city. Increasing sexual health testing continues to be a priority in Coventry, particularly as data from 2021 indicates that detection rates for chlamydia and HIV testing are decreasing in the city[1] [#_ftn1]. There is a commitment across Coventry & Warwickshire to work with communities to continue to shape services with a focus on reducing inequalities and improving engagement, which include:

• Provision of free & confidential services (including for under 16s) which include clinic-based appointments and drop-in, outreach services in the community and fully comprehensive HIV care.
• Provision of free condoms and Chlamydia screening for 13–25-year-olds living in Coventry through the C-Card scheme.
• Provision of free postal STI kits that can be ordered by Coventry residents.

Taking action: An update on an integrated health and care system

The Coventry & Warwickshire Integrated Care System was formalised following the statutory reforms in the Health & Care Act 2022 along with the establishment of the new Integrated Care Board (ICB) and Integrated Care Partnership (ICP).  The local authority has worked with these new partnerships to ensure a commitment to prioritise prevention and improve future health outcomes through tackling health inequalities across Coventry. 

Embedding action to tackle inequalities at both strategic and operational levels is the key focus of local authority public health and an integral part of ICS work.  A strategic plan has been developed with the ICS to support the realisation of these actions.[1] [#_ftn1]

One of the key actions for the integrated care partnership is the development of the Integrated Care Strategy, which sets out the 5-year ambition to improve population health and wellbeing in its broadest sense, with a wide range of partners working together to improve health outcomes and tackle healthcare inequalities.  For more information on the Integrated Care Strategy, visit https://www.happyhealthylives.uk/integrated-care-partnership/icp-strategy/. [https://www.happyhealthylives.uk/integrated-care-partnership/icp-strategy/]

The Integrated Care Board is developing a five-year Coventry and Warwickshire Integrated Health and Care Delivery Plan as the health and care system shared delivery plan for the Integrated Care Strategy. It is recognised that delivering the vision set out in the Integrated Care Strategy will require the combined efforts of health and care system and wider partners in the ICS, with key activity being driven through the two Health and Wellbeing Strategies and aligned delivery plans.  The focus of the Delivery Plan is predominantly the ‘integrated health and care system’ quadrant of the population health model but will link into the work of the wider system.

Taking action: an update on the places and communities we live in and with

There is increasing recognition of the key role that places and communities play in our health. For example, our local environment is an important influence on our health behaviours, while there is strong evidence of the impact of cultural factors, social relationships and community networks, including on mental health. Our One Coventry Plan is designed to work with our communities to ensure that they are able to address their health needs and reduce inequalities.

The built environment has a significant impact on population health and as Coventry is ranked amongst one of the fastest growing cities outside of Greater London, considerations to this growth are continuing to be supported by new, high-quality infrastructure to combat congestion and transport issues as identified in the Coventry Local Plan. This plan sets out the blueprint to facilitate the provision of new high quality public green spaces, investment in the city’s education system and enhance the health facilities and opportunities required to support all aspects of the city’s population. A refresh of the Local plan is underway and due to be published in 2024[1] [#_ftn1].

The evolution of the digital environment has increased opportunities to access services remotely and whilst there are significant advantages to this, there are residents who are at a greater risk of digital exclusion. Lack of access to digital devices as a result of a low income, limited internet connective at home or lack of confidence using digital services can lead to missed/delayed appointments in relation to health, education & employment. The #CovConnects programme is Coventry’s local response to tackling action on digital exclusion. This programme is part funded by the ICB inequalities fund and aims to support residents on their digital journeys, working in partnership with organisations to improve access for all through access to devices, training sessions and many more.

The legacy of Coventry and Warwickshire Year of Wellbeing

2019 marked a pivotal opportunity to raise the profile of promoting positive action to improve wellbeing across Coventry & Warwickshire. The partnership across both Health & Wellbeing boards inspired the Health and Wellbeing Concordat to ensure organisations do all they can to address key challenges very much aligned to our priorities including: the rise in ill-health, physical inactivity, loneliness and social isolation. The commitment to prioritising population health & wellbeing has continued beyond the 2019 campaign through legacy initiatives such as Wellbeing For Life[2] [#_ftn2].

Coventry City of Culture

Since the publication of the 2019-2023 strategy, Coventry had a year in the spotlight as the UK City of Culture, which provided an opportunity to address the multiple and intersecting inequalities in the city through increasing cultural access for those communities and neighbourhoods that historically have benefitted the least from public investment in arts and culture. This iconic year boosted jobs and opportunities as a result and yielded more than a million people attending 700 events in person & online.[3] [#_ftn3]

Low-income family tracker project

Supporting families to give their children the best start in life is one of the commitments within the One Coventry plan and a key part of this is providing information about relevant tools and services to facilitate this. An example of this work is the Low-income family tracker project. This pilot initiative aims to identify and contact families with low-income to understand whether they could be supported to apply for additional benefits to which they are entitled to; and to prevent homelessness. This work will target support to people who need it most now and uncover hidden pockets of poverty; and identify families who are struggling and who may never have engaged with the Council and its partners before.

• Let’s Talk Coventry: Valuing communities and residents is one of the central themes within the One Coventry plan and one of the tools that has been used to engage and empower communities is the online engagement platform Let’s Talk Coventry. This platform has been successful in increasing residents’ understanding of issues and consultations taking place across the city. It continually gives residents the opportunity to feedback on proposed plans, find out about more about council services and surveys, share ideas and join in with discussions.
• The Community Resilience Team aim to empower, engage, and enable our communities to take action in their community by providing support and advice to individuals, voluntary organisations, and communities to identify and build on already existing strengths and skills within neighbourhoods.

The team strengthens communities through collaboration by establishing trusting relationships and creating strong partnerships from within the community. Several partnership networks have been established as a result; Community Centre Consortium, Community based stakeholder networks, Community Messengers, and Coventry Food Network Operations Group to name a few.

The Community Resilience Team champions community action through supporting a vibrant voluntary and community sector across the city, actively supporting, and writing funding bids, securing developer support, securing significant amounts of external funding for the city and providing guidance on how to ensure community groups are sustainable. This has become increasingly important with support surrounding the cost-of-living crisis and securing funding for warm spaces and restarting groups after the impact of COVID-19.

As a result of a collaborative approach the team has been able to work with communities around system change collaborating with health partners to increase voluntary sector support and gain an understanding of the barriers and needs of individual communities. The Community Messengers played a pivotal role in this.

There is a need to share resources and community intelligence therefore the team has explored ways in sharing community intelligence and building lasting relationships and ongoing conversations using digital tools such as the council’s online engagement platform Let’s Talk Coventry.

Community Messengers were a pivotal part of the community-led response to communications and messaging around COVID-19 during the pandemic. Over 200 community champions reflected the diversity across the city, consisting of faith, voluntary and community networks, sharing messages in a way that resonated with communities and neighbourhoods and provided feedback and intelligence regarding their lived experience during this critical period. During Coventry City of Culture 2021, the strength of the Community Messengers programme was extended to help to support with developing and collaborating on cultural projects which helped to create meaningful participation opportunities for community members. Following the current transition out of the emergency phase of the COVID pandemic, the Community Messengers group continues to meet. The agenda now focuses on issues and challenges raised by the active and diverse community sector working with the Coventry City Council Community Resilience Team.

Family Hubs bring together services for families with children aged 0 to 19 years or 25 years for those with special educational needs and disabilities. Following a competitive process, Coventry is amongst 14 local authority areas to receive additional funding to fast track the delivery of these services as trailblazer sites, with a particular emphasis on perinatal mental health, parent-infant relationships, and infant feeding services. There are a range of services and digital programmes across the life course which are already supporting families with parenting education to equipment them with skills and support to enable them to thrive.

Healthy Communities Together: Coventry was successfully awarded funding in 2021 to deliver the Healthy Communities Together (HCT) programme. This programme is funded by the National Lottery and aims to support local areas to develop effective and sustainable partnerships between the voluntary and community sector, the NHS and local authorities to improve health and wellbeing, reduce health inequalities and empower communities.

Community Prototypes: Community prototypes and place-based partnerships are enabling the city to draw upon lessons learnt from the collaborative response to the COVID pandemic and enabling a practical response to the cost-of-living crisis. The vision is to increase earlier identification of issues and opportunities for prevention or early help, and to enable the delivery of integrated support and services, through a locality approach which focuses on improving the quality of the lives of local residents, building community capacity and making the most effective use of city-wide resources. The first community prototype commenced in the Wood End and Henley Green locality, followed by a second in Canley and Tile Hill. In addition to the community prototypes, the council is also working in partnership with Citizen (social housing provider) and other partners to develop more place-based, collaborative approaches in the Spon End and St Michael’s localities.

Review of strategic ambitions and priorities

The three strategic ambitions for the health and wellbeing of the residents of Coventry are:

• People are healthier and independent for longer
• Children and young people fulfil their potential
• People live in connected, safe and sustainable communities

In our previous strategy, the following short-term priorities were agreed following insights from the JSNA and engagement with communities and key partners:

• Loneliness and social isolation
• Young people’s mental health and wellbeing
• Working differently with communities

These priorities align with and support the delivery of key national & local policies & programmes. These include the NHS Plan, The One Coventry plan, the ICS strategy. All of these prioritise integration, prevention, collective action & stronger communities (see figure 4).

Figure 4: Mapping of key strategies

In Autumn 2021, a review was undertaken to understand progress against the short-term priorities of the strategy and to ensure that the priorities were still relevant given the impact of the Covid-19 pandemic and on-going economic pressures on our city and residents The review of the Health and Wellbeing Strategy priorities was informed by evidence from a range of sources, including needs assessments that had been conducted as well as survey data, workshops with stakeholders, a senior partner workshop, learning from the current Strategy priorities and feedback from public consultation. The following is a summary of the progress against each of the short-term priorities:

Loneliness and social isolation

Loneliness and social isolation were chosen as a priority due to growing awareness of the negative impact they can have on the quality of life and well-being of those who experience them, with demonstrable negative health and social effects. To take forward this priority, a multi-agency working group has been established. As part of this programme of work, a mapping exercise was conducted to understand current resources and assets in the city which included initiatives such as:

• Connecting for Good
• Chatty Cafes
• Work by Moat House Community Trust to identify and support vulnerable individuals
• Work by Operation Shield to provide personalised support for clinically and extremely vulnerable individuals.
• Social prescribing services have worked in partnership with primary care networks and wider referral partners to provide 1:1 link worker support connecting people to community services, groups and activities
• Social Isolation Summit: This summit was hosted by Grapevine in July 2020 and focused on reflecting on the impact of the pandemic from a community perspective and how to develop community connectedness going forward.[1] [#_ftn1]

Young people’s mental health and wellbeing

Delivering a mental health system that is underpinned by prevention, building resilience, early intervention, recovery and self-care for children and young people was selected as a key priority for Coventry’s Health and Well-being Board in 2019. Since the publication of the strategy, the following is a summary of the progress of activities:

• Kooth, a new online virtual support offer for emotional wellbeing and mental health commissioned
• Establishment of mental health surge working group to monitor and review referral data into mental health services
• Developed and implemented two mental health support teams in schools
• Coventry and Warwickshire Mind adapted their offer during the Covid-19 pandemic. This has seen a move to a digital platform for delivering services and support.
• Wellbeing for Education Return training programme launched locally

Working differently with communities

Adopting a place-based approach to addressing needs has allowed for different approaches to be used in a way that works for the diverse communities that Coventry serves. The following is a summary of progress since the last strategy:

• Community Messengers network established
• Healthy Communities Together Programme
• 14 new Social Supermarkets/ Food Hubs supported and set up in response to the pandemic
• Migrant Health Champions established

Where do we want to focus now?

Utilising the review process and feedback from the engagement process, it was agreed that the existing short-term priorities of the Health and Wellbeing Strategy were correct & but that there were a number of areas that need to be intensified. These are as follows:

Tackling loneliness and social isolation for all: Social isolation is detrimental for an individual’s physical and mental health and therefore having strong social networks and positive social relationships is good for our health and wellbeing. Engagement with residents has highlighted the impact of social isolation not just on our older residents, but the wider community. Coventry has a real opportunity to build on our community assets to improve social connections.

With Coventry’s diverse population, the experience of isolation may have a new slant, particularly with different communities coming into the city as a result of continued migration and civil conflict. With this comes the challenge of working in the overlap of the priorities and being responsive to their needs and ensuring there are the relevant services in place to meet this need.

• Improving mental health for all: Nationally, the Covid-19 pandemic has impacted significantly on many people’s mental health, as monitored by ongoing surveillance reporting. Throughout our engagement with residents in developing this strategy, many raised specific concerns around the mental health of children and young people as well as older adults, as well as the importance of ensuring equity of access to services.
• Focus on employment and homelessness as a prevention opportunity: Despite growing opportunities, innovation and improvement in average earnings in the city, there has been an increase in the number of residents unemployed and economically inactive. Understanding the impact of the pandemic & the cost-of-living crisis on communities (across the life course) is therefore a key priority given the increased risk of further exacerbating wider inequalities.
• Strengthen work with communities: The city’s diversity and cohesion are assets to Coventry, however there is some indication that overall feelings of belonging, and cohesion, may have reduced over the last few years. A commitment to strengthening work with communities is paramount, as there is a real opportunity to build on the work delivered during the pandemic and continue to unlock the power of local assets by improving the connectivity between the Health & Wellbeing board and communities and the Health & Wellbeing board and place-based working.
• The need for co-production to achieve the priorities and the importance of engaging with the community to influence and design solutions. There is a call for stronger links, information sharing and partnership working across a range of services. The One Coventry Plan asked, “what will the Coventry of 2030 look and feel like to you?” and a majority of responses pointed to a need for more communication, collaboration, and engagement.

[EV1] [#_msocom_1]

Figure 5: Our short-term priorities

How will we measure success?

Our ambition for Coventry is to ensure everyone can enjoy good health and, that we reduce health inequalities. To achieve this, we are committed to developing a new performance framework that is shaped by the core pillars within the population health framework and ties into the Coventry & Warwickshire Strategy & the One Coventry performance framework. The Health and Wellbeing Board will continually review the activity to achieve the priority objectives and will consider any additional steps that need to be taken to ensure effective progress.

The following principles, which form part of the Coventry and Warwickshire Health and Wellbeing Concordat, will continue to underpin the way we work as Health and Wellbeing Board partners:

Working through the relevant Partnership Boards across our population health framework, we will develop a reporting framework and schedule to update the Health and Wellbeing Board on the progress of action plan development, and the key measures of success relating to these priorities. In addition, we will continue to monitor and respond to the changing local and national context, to ensure that our approach remains relevant and impactful for the citizens of Coventry.

How will we measure success?

Our ambition for Coventry is to ensure everyone can enjoy good health and, that we reduce health inequalities.  To achieve this, we are committed to developing a new performance framework that is shaped by the core pillars within the population health framework and ties into the Coventry & Warwickshire Strategy & the One Coventry performance framework.

The following principles, which form part of the Coventry and Warwickshire Health and Wellbeing Concordat, will continue to underpin the way we work as Health and Wellbeing Board partners:

• Prioritising prevention: we will tackle the causes of health-related problems to reduce the impact of ill health on people’s lives, their families and communities. We will seek to address the root causes of problems, listening to local people’s priorities and acting on their concerns.
• Strengthening communities: we will support strong and stable communities. We will listen to residents to understand what they want from the services we provide and encourage them, to lead change themselves where possible.
• Co-ordinating services: we will work together to design services that take account of the complexity of people’s lives and their overlapping health and social needs. We will focus on the best way to achieve good outcomes for people, reducing the number of interactions people have with our services and avoiding multiple interventions from different providers.
• Sharing responsibility: we value the distinct contributions of all organisations that are represented on the Health and Wellbeing Board. We will maintain partnerships between the public sector, voluntary and community sector, local businesses and residents, recognising that we share a responsibility to transform the health and wellbeing of our communities. We will pool resources, budgets and accountabilities where it will improve services for the public.

Working through the relevant Partnership Boards across our population health framework, we will develop a reporting framework and schedule to update the Health and Wellbeing Board on the progress of action plan development, and the key measures of success relating to these priorities.  In addition, we will continue to monitor and respond to the changing local and national context, to ensure that our approach remains relevant and impactful for the citizens of Coventry.