Coventry Joint Strategic Needs Assessment (JSNA) 2023 - Print version

What is the Coventry Joint Strategic Needs Assessment (JSNA)?

Introduction

Welcome to the Coventry Joint Strategic Needs Assessment (JSNA) 2023. The JSNA brings together evidence about the health and wellbeing of Coventry residents, to help leaders across health and care understand and work together to improve the health and wellbeing of the people of Coventry.

Health is more than the healthcare system: it is not just about NHS hospitals, doctors, or nurses. Instead, health is about people’s lives. Indeed, people’s health is determined by their economic and social circumstances, such as:

• their communities - whether they have access to a good network of family and friends.
• their prospects - whether they have access to good jobs and education; and
• their environment - whether they live in a good neighbourhood with access to green spaces.

These social circumstances determine people’s health and well-being, and therefore, are known as social determinants of health.

This JSNA contains a full range of evidence to provide decision-makers with an understanding of local people and communities. It contains a lot of numbers and statistics because these are essential to show the trends of how things have changed, as well as comparisons with other places. However, because health is about people, this JSNA also contains a lot of evidence from local people and local community groups.

About this JSNA

The Health and Social Care Act of 2012 places a duty on Health and Wellbeing Boards to produce a Joint Strategic Needs Assessment.

In April 2018, the Coventry Health and Wellbeing Board authorised a move towards a place-based approach to the JSNA, with the production of a citywide JSNA profile and JSNA profiles for each of the city’s eight Family Hub reach areas.

Since the production of the last JSNA, there have been huge external influences on the health and wellbeing of our residents. The COVID-19 pandemic shone a light on inequalities within our communities and has fundamentally altered our lives. There have been changes to what we value, our communities and how they function, our ways of working and to our economy. The data within this profile reflects these changes.

This JSNA is produced in 2023 by Coventry City Council with cooperation from partners across the Coventry Health and Wellbeing Board and ideas contributed by community organisations and residents.

Each JSNA profile is structured as follows:

• Demographics and Community
• Prospects
• Environment
• Health and Wellbeing

For each topic area covered, the JSNA explores:

• Why is this important?
• What is the local picture? How does it compare?
• What is happening in the city? What else can be done?

In addition to the JSNA profiles, detailed statistical data and evidence are available in the citywide intelligence hub [/citywideintelhub]. The hub provides tools to compare different measures and indicators of all kinds.

Executive summary

Demographics and community

Coventry is a diverse and cohesive city with a relatively young population, with a median age of 35 years compared to the UK median of 40 years. In recent years, the city has experienced an 8.9% growth in its population, from 316,915 in 2011 to 345,300 residents on Census Day 2021. This is higher than the rate in the region (6.2%) or England (6.6%).

In 2021, just over one-fifth (22%) of the city’s population are children and young people aged under 18, 65% are of working-age (18-64), and the remaining 13% are aged 65 and over. The city’s population has grown particularly amongst younger adults, alongside the growth and success of the city’s two universities in attracting students locally and internationally; as well as better-paid jobs in certain sectors of the local economy. Despite this, growth in older people is expected to accelerate and outpace other groups within 10-15 years as Coventry's 55-59 age group experienced the greatest growth of any age group. This means there is a need to focus on preventative health amongst the working age population now to help manage future demand on health and care services.

Over the past decade, the city has become increasingly ethnically diverse, with a larger percentage of school children from an ethnic minority than all residents in Coventry as a whole, it is likely Coventry will continue to become more diverse.

Although the city is cohesive, people do not feel they have influence over local decisions. The city’s diversity and cohesion are assets to Coventry, however there is some indication that overall feelings of belonging, may have reduced over the last few years.

Prospects

Following Brexit and COVID-19 pandemic-related lockdowns, the economic outlook for the city remains challenging and uncertain. While spending and other economic activity rapidly bounced back in 2021-22, employment has not yet returned to pre-pandemic levels. Additionally, rapid inflation in 2022 threatens the city’s recovery, with rapidly increasing energy prices and cost-of-living impacting the finances of households and businesses alike.

A growing proportion of the city’s residents are gaining qualifications, two-fifths of the city’s working-age population is highly qualified. Around 40% of Coventry working-aged residents have a higher-level qualification (NVQ4 or above) in 2021, up from 30% just six years ago, suggesting better graduate retention; 7.6% have no qualifications, however, this is a reduction from 10% in 2018 and has halved over the past decade.

Education standards remain consistent with national averages with 89.3% of primary and 86% of secondary students attending a good/outstanding school; the city continues to have a slightly higher than average percentage of young people proceeding from school to a sustained education, employment, or training.

The percentage of Coventry neighbourhoods that are amongst the 10% most deprived in England reduced from 18.5% to 14.4% between 2015 and 2019. These pockets of deprivation limit people’s opportunities to succeed in life; and transforming life chances require addressing the social inequalities that are established right from the earliest years. The latest available data, for 2020/21, suggest that 23% of Coventry children aged 0-15 live in relative low-income families compared to 19% nationally.

Digital Exclusion adds another dimension to inequalities of access to healthcare and should be a consideration. Digital exclusion impacts healthcare both directly and indirectly. Directly by residents not having the opportunity, skills, and confidence to access healthcare digitally, and indirectly as digital exclusion leads to poorer opportunities across the wider determinants of health, such as employment, education, and housing.

Environment

Coventry residents have good access to services which are generally considered an asset that is enjoyed; however, residents’ satisfaction with their area is lower than the national average. Most people live within a 20-minute walk of a general or grocery shop, public transport links, parks, pubs, GP surgery, health centre and a place of worship, providing opportunities to socialise, exercise and enjoy their lives. However, this masks pockets of dissatisfaction which could be further explored through a more detailed understanding of local needs.

Average house prices are a little lower than the West Midlands regional average, however, rental prices appear to be slightly higher, both prices in Coventry are increasing. An increasing rate of house building within Coventry is planned, if these plans were to come to fruition it may facilitate further population growth with families and other households moving into these houses.

Threats to health and wellbeing are exacerbated by the increased costs associated with keeping homes warm, dry, and ventilated sufficiently over the colder months of the year and potential intermittent shortages in energy supply. Cold homes are recognised as a source of both physical and mental ill health, increasing the risk of heart attack and stroke, respiratory illness, falls and accidents.

The West Midlands Combined Authority has set a priority for the region to become net zero by 2041, and the City is working on a revised Climate Change Strategy focusing on a green future for a changing city and setting out how Coventry will remain within its carbon budget. This will require, amongst other things, retrofitting existing homes to ensure that they are up to modern insulation standards.

Green spaces bring communities together, reduce loneliness and mitigate the negative effects of air pollution, excessive noise, heat, and flooding. There is opportunity to work with communities to protect and improve existing green space and create new ones in areas most in need, and to implement nature-based interventions for health, such as green walking or green social prescribing.

Health and wellbeing

The unprecedented COVID-19 pandemic fundamentally changed all our lives and impacted on health and wellbeing on a global scale. The pandemic had many impacts, not all directly on residents’ physical health. The restrictions due to the pandemic and the lockdowns, may have had an impact on different aspects of health, not least mental health. COVID-19 caused severe illness and deaths and put a pressure on the health system. A total of 9,246 COVID-19 patients have been admitted to University Hospitals Coventry and Warwickshire (UHCW) up to end of April 2023. Many people experience ongoing symptoms of COVID-19 for a prolonged period, and many of these will need to access health services. Coventry delivered hundreds of thousands of COVID-19 vaccines that protected many from severe illness or death and protected the health service. However, many remain unvaccinated.

The overall health and wellbeing in Coventry is below average, with residents living in more deprived parts of the city not only living shorter lives, but also spending a greater proportion of their shorter lives in poor health than those living in less deprived parts of the city. The life expectancy at birth of the average person in Coventry is 78 years for males and 82 years for females (2018-20). However, this masks significant health inequalities across the city – of 11 years and 8 years respectively. Healthy life expectancy for Coventry, the years residents spend in good health, are 61 and 64 years for males and females respectively; this has decreased and remain below the regional and England averages.

There are significant inequalities across Coventry’s neighbourhoods and the extent of the inequality is relatively large compared to other areas. Inequalities in health arise out of inequalities in society. These inequalities are not inevitable and reducing inequality in society has been shown to lead to improvements in wellbeing, better mental health, better community and social relations, reduced levels of violence and better educational attainment. As a Marmot city, the city is working to address the ‘causes of the causes’ by resourcing and delivering of universal services at a scale and intensity proportionate to the degree of need.

Making things fairer requires improving the health of all social groups, in a way that reflects each group’s assets and needs. This is called a “social gradient” approach. Examples of where a social gradient approach can be adopted include hospital accident and emergency, where vulnerable groups are more likely to be users of emergency admitted care services, and less likely to take up vaccinations and screening services.

Community groups are best placed to address health challenges, because they are trusted and have the networks understanding and legitimacy to do so. However, their resources are limited, and capacity is stretched. The public sector must, therefore, change how it works with communities, by shifting to an ‘enabling’ leadership style; pooling engagement resources and building capacity, in line with the city’s One Coventry approach.

Demographics and communities

Population

Why is this important?

It is important to understand how Coventry’s population and demographics is changing so that local communities and organisations can ensure that the city has the right services to meet the needs of its people.

What is the local picture? How does it compare?

Coventry’s population is growing, changing and increasingly diverse, it is the seventh fastest growing local authority in the West Midlands region. Coventry has a population of 345,325 people; this is an increase of over 28,000 residents since 2011 and makes it the second-largest Local Authority in the West Midlands region. Coventry's population has increased by 8.9% over the past ten years, exceeding England's overall growth of 6.6% and the West Midlands region's growth of 6.2%.

It is difficult to predict how Coventry's population will grow in the future which makes planning services more difficult as a result. Before the Census 2021 data was released, the most reliable source to understand population growth was the Mid-year estimates (MYEs) by the Office for National Statistics (ONS). These statistics showed that the population had been growing at one of the fastest rates in the country. However, the census data reveals that although the population is still growing faster than average, it is not growing as fast as we previously thought. This could be due to several external influences, such as Brexit and the pandemic which will have influenced numerous factors, like international migration. It is unclear whether this will increase back to levels before these influences.

Coventry residents are, on average 5 years younger than England and the rest of the West Midlands region. Coventry’s young population is partly due to the city’s two universities, which continue to lower Coventry’s median age. The median age has increased by one year to 35 over the past decade, however it still falls below the England and West Midlands region median ages of 40.

In 2021, just over one-fifth (22%) of the city’s population are children and young people aged under 18, 65% are of working-age (18-64), and the remaining 13% are aged 65 and over. An estimated 68,300 children under the age of 16 live in Coventry, which makes up 19.5% of the population compared to 18.5% across England overall and 19.3% for West Midlands.

With an estimated 42,900 residents, 13% of the city's population is between the ages of 18 and 24, compared to 8% in England as a whole. The young population is partly due to the city’s two universities; Coventry also has a higher proportion of residents between the ages of 25 and 39.

The total number of births to mothers living in Coventry has been on a falling trend over the past 10 years. In 2021 the total number of births was 3,948, down from 4,801 in 2011. This is a major factor behind a 9% decrease in the number of children aged 0 to 4 over the last 10 years. This is line with a decrease nationally, however Coventry’s decrease was larger than average for the region. In contrast, the number of children aged 5-14 living in Coventry has increased notably over the last 10 years, rising from 36,200 in 2011 to an estimated 44,100. This is a 22% rise compared to a 12% increase for England as a whole.

Despite the relatively young average age of Coventry citizens, it is important to consider the growing older population and focus on preventative health amongst the working-age population now to help manage future demand on health and care services. Between 2011 and 2021, Coventry's 55-59 age group experienced the greatest growth of any age group, increasing by 27.5%. In a decade, Coventry’s population is likely to be older on average than today as the large increase in 55–59-year-olds seen in the past decade continues to grow older.

The 2018-based sub-national population projections indicate that population will begin to "age" during the next ten years, as the number of citizens 65 and older is likely to start to increase at a faster rate than the average growth rate for all ages. This means there is a need to focus on preventative health amongst the working-age population now to help manage future demand on health and care services. The north-west Coventry neighbourhoods of Allesley Green and Lower Eastern Green have the highest proportion of residents aged 65+ with 29.1%.

Whilst there is a natural growth in Coventry's population, with more births than deaths each year, migration now accounts for a larger portion of the city's expansion. The largest movements of people are from and to other parts of the UK, with students attending the two major universities in the city contributing to this. Coventry also welcomes many new residents from other parts of the world and international migration is a key factor in population growth. More people have moved to Coventry from overseas annually in the last 10 years (less so in the last 2 or 3) than moved from Coventry abroad.

The city’s growth has not been evenly distributed; therefore, local organisations may need to review the location of their services. A significant percentage of Coventry's growth was accounted for by its three fastest-growing MSOAs, which make up more than a quarter of the city's total growth. The fastest growing are Whitley & Toll Bar End, Henley Green & Wood End, and Central Coventry, with corresponding population growth rates of 45%, 36%, and 27% respectively. Of Coventry’s 42 MSOAs, 20 had growth higher than England’s average. 18 had growth higher than Coventry’s overall growth of 8.9% with six growing by more than double Coventry’s average.

Being home to two large universities, Coventry University and the University of Warwick, students form a growing part of the city’s population. While the increase in the number of students living in Coventry is by no means the whole story of Coventry’s population growth, the growth of the universities has certainly contributed. Over the last 10 years, between the academic years of 2010-11 and 2020-21, the total number of students enrolled at the city’s two universities increased from 56,100 to 67,255. Not all live in the city of course, census data gives an estimate of about 36,000 university students living in Coventry in 2021, a 29% increase from about 28,000 in 2011.

Due to the COVID-19 pandemic some students may have chosen to live at home whilst they studied. Therefore, the total number of student residents in the city may be lower than it otherwise would have been. Census 2021 data estimates a total of 9,730 international university students living in Coventry.

What is happening in the city? What else can be done?

Grassroot organisations that support community cohesiveness could succeed more if they had more opportunities for developing their capabilities and exchanging knowledge. Peer support groups for our most vulnerable residents including those with protected groups and needs, such as those related to age, gender, culture, religion, sexual orientation, and health, are available in the city. These peer support groups are the foundation of many people's social networks and interactions, and for some people, they are their sole source of social engagement.

The council remains committed to engaging with communities, providing opportunities to collaborate and share ideas. The One Coventry Plan 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. Coventry City Council’s ‘One Coventry Plan’ sets out a vision and priorities for the city, based on its commitments to the people of Coventry and the things that residents find most important. It is more focused on the needs and aspirations of communities. Building on key Council and partnership strategies, the One Coventry Plan sets out three interconnected priorities:

• Increasing the economic prosperity of the city and region
• Improving outcomes and tackling inequalities within our communities
• Tackling the causes and consequences of climate change

Although the city is cohesive, people do not feel they have the opportunity to get actively involved in improving their local area. The Household Survey 2022 found that just under four in ten residents (38%) agree there are opportunities to get actively involved in improving their local area, in line with 2021 findings. Residents aged 65+ are significantly more likely to agree with this statement compared to the survey average (47% vs. 38%).

At ward level, those in Binley and Willenhall (24%), Foleshill (24%), Longford (20%) and Upper Stoke (27%) are significantly less likely to agree that there are opportunities to get involved in local improvement. Furthermore, there is a sense of negativity or resignation, with 49% saying that even if given the opportunity, they would probably not get involved to make improvements to their local area.

There is some appetite for residents to become more actively involved in their communities. In the Household Survey 2022 residents were asked whether they would take a more active role in the community in the future when the opportunity arises, with 51% of respondents suggesting they would be likely to get involved in some way. Indicating a sizeable opportunity for community participation.

Diversity

Why is this important?

The growth of new communities can change the age and ethnic profile of the city, which can have an impact on demand for local services such as schools and GP surgeries and is influenced by many complex factors, such as living and working conditions, social inclusion, ethnicity, socioeconomic position, education, and cultural factors.

What is the local picture? How does it compare?

The city is becoming increasingly diverse with 45% of the population identifying as being part of an ethnic minority group compared to 26% in England as a whole. We use ‘ethnic minorities’ to refer to all ethnic groups except the White British group. Ethnic minorities include white minorities, such as Gypsy, Roma, and Irish Traveller groups, as well as those who identity as White Irish and ‘White Other’ (often people who have moved here from other European countries).

In the 2021 Census, 45% of Coventry’s population identified as an ethnic minority, an increase from 33% in 2011. In England it was 26% and in the West Midlands region it was 28%.

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.

With a larger percentage of school children from an ethnic minority than all residents in Coventry as a whole, it is likely Coventry will continue to become more diverse.

According to the latest school census in 2022, 55.9% of Coventry’s school children are from an ethnic minority group up from 39.7% in 2012. The largest ethnic minorities in school children are Black African (11.4%), non-British white (10.2%), and Asian Indian (8.9%).

Some areas are more diverse than others, which should be a consideration when reviewing service provision. For example, in Brownshill Green 92.1% of residents were born in the UK, while in Coventry Central only 50.5% of residents were. Therefore, local organisations may need to review the services they provide to serve the residents’ needs in different areas.

As it becomes more diverse, the city remains cohesive, but Coventry Household Survey data indicates that overall feelings of belonging, and cohesion, may have reduced over the last few years. Most residents said that their neighbourhood is a place where people get on well together, 63% agreeing so in the 2022 survey. It is notable though, that this has reduced from 88% in 2018.

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%. Those in Bablake (70%), Earlsdon (72%), Wainbody (65%), Woodlands (68%) and Wyken (67%) wards are significantly more likely to have a strong sense of belonging at neighbourhood level.

All residents were subsequently asked if the COVID-19 outbreak has changed their sense of belonging to their local community. Only a minority of 13% feel a stronger sense of belonging to their local community after Covid-19, a small difference compared to the previous year (15%). Three-quarters (75%) suggest that they feel the same sense of belonging to their community as before Covid-19. Therefore, there is minimal evidence of the pandemic having transformed community relations.

Coventry has a greater and increasing diversity of languages, which could act as a barrier when accessing and having an awareness of services available to residents. In 2021, 82.5% of Coventry’s residents had English as a main language, compared to 86.1% in 2011. In England 90.8% of residents have English as their main language and 91% in the West Midlands region. Within Coventry, Polish (2.3%), Panjabi (2.3%) and Romanian (2.1%) are the three most popular main languages spoken aside from English.

There are 16 languages that at least 1,000 Coventry residents speak as their main language and more than 100 languages and dialects spoken in the city in total. In Foleshill West just over a quarter of households have no people with English as their main language.

Whilst Coventry is becoming increasingly diverse with a wider range of languages spoken, the number of people who cannot speak English well has fallen in the last 10 years. This may be a positive sign for cohesion and integration. In the 2021 Census, people who did not report English as a main language were asked to report how well they could speak English. In Coventry, 16.9% could not speak English well and 2.6% could not speak English at all. This is an improvement from 2011 where 18.7% could not speak English well and 3.3% could not speak English at all.

Religion can also provide some insight into the diversity of Coventry, the number of people who are not religious has increased. 30% of residents are recorded in the Census 2021 as having ‘no religion’, an increase from 23% in 2011. Being religious is more prevalent in Coventry than the national average however, 37% of people across England have no religion. While Coventry has a lower proportion of Christian residents than the national average, 44% (England 46%) down from 54% in 2011; most other major religions are more commonly followed in Coventry. 10% of Coventry residents are Muslim, an increase from 7% in 2011; 5% are Sikh and 4% are Hindu.

The number of residents born outside of the UK has increased, highlighting the increasing diversity of the city. In 2021, 72.1% were born in the UK, 10.5% in Asia, and 10.1% in the EU. In Coventry, the top three non-UK countries where residents of Coventry were born are India with 4.5%, Poland with 2.6%, and Romania with 2.4%. In 2011, it was 4.2%, 2% and 0.3% showing that Coventry has become more diverse in the last 10 years, with the greatest increase being amongst people born in Romania.

Newly arrived communities are an important part of Coventry’s social fabric, economic development, and economic growth. This group includes students, people fleeing conflict and economic migrants. 14.2% of Coventry’s residents – approximately 49,100 people, around 1 in every 7 Coventry residents arrived in the UK since 2011. Central Coventry and Lower Stoke & Gosford Park have the largest concentration with 39% and 34% of residents arriving in the last ten years. Movement in and out of Coventry by international students will contribute to this population churn.

Coventry has a long history of providing safety to those fleeing conflict and persecution and has been recognised as a City of Sanctuary and International City of Peace and Reconciliation for many years. In the past 8 years, 778 people have been resettled in Coventry under the national Vulnerable Persons Resettlement Scheme (VPRS), Vulnerable Children Resettlement Scheme (VCRS), and more recent UK resettlement scheme (UKRS). As of March 2022, there were 1,368 asylum seekers receiving support in Coventry. This is the 4th most of any local authority in England with only Birmingham, Liverpool and Southwark supporting more. The true number of asylum seekers residing in Coventry is estimated to be 2,000 people – the highest proportion of asylum seekers per head of population in the West Midlands region. The number of Ukrainians living in Coventry under one of the UK support schemes is likely to vary as the Russian invasion progresses, but as of September 2022 was approximately 200.

Migration has been very high in the last year, nationally and to Coventry. International migration has contributed to the growth of the city over recent years, with a significant proportion of these not being asylum seekers and refugees or students. While there is uncertainty in measuring international migration due to challenges collecting accurate data, the number of foreign nationals living in Coventry and newly registering for a National Insurance Number (NINo) gives an indication of this and how the trends in movement have changed over recent years. After fluctuations and a significant dip due to the pandemic, 2022 saw 17,135 NINo registrations in Coventry, the highest number since records started in 2002. A series of unprecedented world events throughout 2022 and the lifting of restrictions following the coronavirus (COVID-19) pandemic led to record levels of international immigration to the UK.
The main drivers of the increase were people coming to the UK from non-EU countries for work, study and for humanitarian purposes, including those arriving from Ukraine and Hong Kong. Registrations in Coventry increased from 5,523 in 2011 to a peak in 2016 at 9,177 but fell from 8,433 in 2019 to 4,191 in 2020 due to restrictions during the COVID-19 pandemic; and bounced back to 8,140 in 2021.

The national profile of NINo registrants, whom we may call ‘economic migrants’, has changed a lot. While Coventry welcomes people from a wide range of countries, in the three years before the pandemic people from Romania and India made up 40% of registrations. The number moving from Poland was the 3rd highest, although this has been on a gradually falling trend since it was the highest in number 10 years ago; it is now outside the top 20.

At the peak of EU migration to Coventry in 2016 EU nationals made up 70% of NINo registrations, this fell to 54% in 2019, to 29% in 2020 and 12% in 2022. There was a significant increase in registrations amongst people from Asian countries, most notably India (reaching 7,221 in 2022), that drove the increase in total registrations in 2022; there is also a notable increase amongst people from Nigeria (2,138 in 2022).

The changing profile of economic migrants in recent years will need to be considered so that any specific health needs are provided for. Barriers to access should be delivered by a culturally competent health and social care workforce, one that makes use of the rich community assets in the city.

For the first time, the 2021 Census asked residents aged 16 and over about their gender identity and sexual orientation with two voluntary questions. As the questions were voluntary, varying response rates across different areas need to be considered when making comparisons.

In Coventry, 3.2% (8,761) identified as LGB+ (“Gay or Lesbian”, “Bisexual” or “Other sexual orientation”), 88.0% identified as straight or heterosexual, it is important to note that 8.8% did not answer the question and therefore assumptions cannot be made about their sexual orientation.

Gender identity refers to a person’s sense of their own gender, whether male, female, or another category such as non-binary; this may or may not be the same as their sex registered at birth.

In Coventry, 0.8% (2,182) indicated that their gender identity was different to their sex registered at birth. 91.6% of residents indicated that their gender identity was the same as their sex registered at birth. It is important to note that 7.6% did not answer the question and therefore assumptions cannot be made about their gender identity or how well the question was understood or defined.

The City of Culture Performance Measurement and Evaluation report sets out that over 700 events formed the programme, and these were hosted in all neighbourhoods across the city. It is estimated that these engaged 1 million people: 398,924 tickets were issued for events, an estimated 137,000 attended unticketed events and it is estimated that audiences for digital content were over 510,000 engagements. The report states, “77% of the programme, excluding commercial events was co-created with local residents and communities. Including the commercial programme, 64% of the whole programme was co-created.”

What is happening in the city? What else can be done?

Partners across Coventry must consider appropriate messaging to address local anxieties, stakeholder groups are essential in addressing issues in specific neighbourhoods. Coventry City Council has supported the coordination of place-based stakeholder meetings that welcome individuals and groups to represent their community and address local issues. Organisations can share local expertise, advertise their services, and investigate possible collaborations through these groups. There are currently 6 stakeholder groups across the city, these being: Canley, Foleshill, Hillfields, Radford, Spon End and Willenhall.

The public sector has a responsibility to change how it works with community groups across and between sectors. There is an appetite across local and voluntary organisations for more joined-up working to improve awareness and communication of the activities and networks available in the city. A key theme running through various engagement activities stresses the need to galvanise partnerships and facilitate a more integrated approach for the wider health system. This includes listening and responding to ideas and solutions from residents at a grassroots level. One of the objectives of the One Coventry Plan is to coordinate Coventry's response to how the city tackles challenges and opportunities by having a more consistent approach.

There are barriers around communication and awareness in the city, but there are also examples where working together has improved matters. The city has a wealth of voluntary and community groups responding to and addressing specific issues. There are lots of partnerships in the city that have been established organically to reflect and meet the needs of particular groups, these partnerships create opportunities to share ideas and resources between sectors. An example of this has been the Community Centre Consortium, 11 community centres from all over the city have joined forces to exchange knowledge, best practices, and funding requests. They can speak with one voice to outside funders, pool and organise resources and coordinate efforts by cooperating rather than competing with one another.

It is important for Coventry to deliver effective integration support to newly arrived communities to provide a solid foundation for newcomers to rebuild their lives, and subsequently become socially and economically independent. Whilst the overarching goal of One Coventry Together Strategy is to provide all newly arrived communities with the support needed to succeed from day one of arrival, Coventry has a duty of care for the thousands of refugees and asylum seekers who call the city home.

Prospects

Why is this important?

Understanding Coventry's economic, cultural, educational, and early childhood prospects can help us better understand the effects these factors have on the wellbeing of the local populations. A person's lifelong health, happiness, and productivity are affected by preventable health inequalities that can arise during pregnancy, childbirth, and the early years.

Best Start in Life

Why is this important?

“Giving every child the best start in life is crucial for securing health and reducing health inequalities across the life course. The foundations for virtually every aspect of human development – physical, intellectual, and emotional – are laid in early childhood. What happens during these early years, starting in the womb, has life-long effects on many aspects of health and well-being”. - Sir Michael Marmot

What is the local picture? How does it compare?

Coventry appears to perform better than the national average at birth, when a few statistics relevant to child development in infancy are assessed; however, these are not the only factors to a child’s development. Avoidable differences in health emerge by the time a child reaches the age of five. At birth and in early years, Coventry appears to be better than the national average when a few statistics relevant to child development in infancy are assessed. However, by the age of five, fewer achieve a good level of development than in other similar places.

In 2020/21, 73.8% of Coventry newborns received breast milk as their first feed, better than both regional (68.3%) and national averages (71.7%). The prevalence of breastfeeding is also measured using data collected by health visitors when a baby is 6 to 8 weeks old, in Coventry it has remained around 50% in recent years, meaning that half of babies remain at least partially breastfed by that age. While there is some uncertainty because of missing data for a small minority of babies, we can say the 2021/22 rate of about 51% is higher than the England average of 49.2% and it has been better for the last few years, although the gap has narrowed due to an increasing trend for England overall.

In 2021/22, 9.3% of new mothers from Coventry were smoking at the time of delivery. While it would be good to reduce this further, this has been on a downward trend from 15.1% in 2010/11. It is the same as the England average (9.1%) but lower than the regional average (9.8%) and the average amongst Coventry’s statistical neighbour areas.

Infant mortality rates in Coventry are higher compared to England but similar to the regional rate. The infant mortality rate in Coventry is 5.7 per 1,000. This is like the West Midlands (5.6) however more than for England (3.9). The child mortality rate (1-17 years) in Coventry, whilst low in number, is 15.0 per 1,000, which has remained persistently high compared to both the West Midlands (11.0) and England (10.3) since 2012.

In 2021 the percentage of all babies born at low weight (under 2500g) in Coventry was 8.1%, higher than the national average of 6.8%, but similar to the regional average of 7.6%. This could be due to a relatively high number of babies born to Coventry mothers being premature, leading to a higher number of babies born at low weight; for the three years 2018-2020 1,255 Coventry babies were born prematurely, a rate of 99.7 per 1,000 compared to the national average of 79.1.

By the age of two, the number of Coventry toddlers at the expected level of development is above the national average. At the age of 2-2 ½ health visitors should assess all children in terms of communication, motor, problem-solving and personal social skills; 85.1% of those assessed in Coventry were at the expected level in all domains, compared to 81.2% across England overall and 79.0% across West Midlands overall.

In Coventry, uptake of funded early years childcare for all children aged two, three and four has increased. The 2-year-old up take has increased to 74.8% in 2022, compared to 72% nationally and 67% regionally. This is because of Early Years initiatives and a campaign to reach vulnerable families post Covid. Similarly, the 3- & 4-year-old take-up increased from 86% to 88% but was still below national at 92% and regional 93% averages.

By the age of five, fewer children achieve a good level of development (61.1%) than nationally (65.2%). A child’s level of development is assessed at the Early Years Foundation Stage (EYFS) on early learning goals in the prime areas of learning: personal, social and emotional development; physical development; and communication and language and the early learning goals in the specific areas of mathematics and literacy. These figures also represent a lower proportion than the West Midlands average (63.7%) and lower than the average amongst Coventry’s statistical neighbour areas (62%). A comparison to 2019 shows a widening of the city gap with national from 2% points to over 4% points.

Inequalities in reaching a good level of development within Coventry have already established themselves by the age of 5. Amongst disadvantaged children, 46.3% achieve a good level of development, compared to 63.4% for non-disadvantaged, a 17-percentage point gap.

Comparing rates by ethnic group, children of Asian ethnicity in Coventry have the highest rates at 66.4%; furthermore, this is higher than children of Asian ethnicity elsewhere, across England it is 64.9% and Coventry’s rate is highest of all its statistical neighbour areas for this group. This is compared to 49.4% for children of ‘Other‘ ethnicity, 59.2% for children of ‘Mixed’ ethnicity, 60.8% for children of White ethnicity and 61.5% for children of Black ethnicity – these rates are lower than their counterparts across England and lower than the average for these groups living in statistical neighbour areas. While it is important to support the most vulnerable groups, it is essential to support all groups in a targeted way.

Data from an oral survey of 5-year-olds indicates that the dental health of children in Coventry is worse than regional and national averages. In 2021/22 over a third of 5-year-olds surveyed had experience of visually obvious dentinal decay, 34.2% compared to 23.8% across the West Midlands region overall and 23.7% across England overall. This is the third highest prevalence out of all local authority areas in the West Midlands.

The number of children in care remains above national average but is similar to statistical neighbours. In Coventry 89.5 children out of every 1,000 are in care. This is higher than England's rate of 70 but is more in line with statistical neighbour average rate of 89. This has been on a slightly increasing trend in recent years. Coventry has seen an increase in the number of unaccompanied asylum-seeking children, the city has a higher proportion of these children in care than all comparators. If these children were excluded, then a trend of reduction would be shown over the last few years.

The percentage of children under the age of 16 who live in absolute poverty is greater when compared to the rest of England. In Coventry in 2021/22, 21.4% of children under the age of 16 live in homes with ‘absolute’ low incomes, compared to 21.4% throughout the West Midlands and 15.3% in England. The percentage of children living in ‘relative poverty’ in Coventry is 26.7%, amounting to an estimated 18,267 children. This compares to 27.0% throughout the West Midlands and 19.9% in England. This has been an increasing trend in Coventry, and elsewhere, since 2014/15.

The extent of ‘child poverty’ can be measured in other ways, the End Child Poverty campaign attempts to model the number of children who live in households with a relatively low income (less than 60% of the national median household income), calculating income after the costs of housing are taken away. Rates are higher when calculated this way. For 2021/22 they estimate that 31,458 of Coventry children (0-15) live in poverty, which amounts to over one-third of all children living in Coventry, 39.6%.

What is happening in the city? What else can be done?

There is clear evidence that good parenting is crucial to a child’s development and to their future life chances. Coventry Parenting Steering Group, through the creation of the Parenting Strategy aims to raise the level of awareness about the importance and impact of parenting on children’s outcomes. So that “More Coventry children and young people grow up within supportive families and communities”.

Effective Early Help has a positive impact on the lives of children and young people and is a high priority in Coventry and nationally. Early Help services want to offer the right help, at the right time to improve outcomes for children, young people and their families and to prevent the need for high demand on statutory services. Early Help is a way of working that supports children in the early years of their lives, and as well as when a problem emerges at any stage in their lives. Effective Early Help also has a positive impact on public finances in a context of significant financial pressures, by reducing the demand for higher-cost services.

Coventry Early Help Partnership is committed to providing a range of help to children to ensure that they can benefit from what’s on offer to guarantee them the best start in life. Services such as the Family Hubs and Coventry Family Health and Lifestyle Service are essential in doing this throughout the city. There are 8 Family Hubs located throughout the city, each of which provides a variety of services aimed at supporting families, children, and young people.

The city’s family hubs help coordinate early intervention and support. Health visitors, social workers, midwives, police, and other professionals have been brought together to identify vulnerable families and put together a coordinated package of help. This helps to ensure that families have access to the support they need, including addressing maternal isolation, accessing activities to improve their children’s life chances, and providing help with finances.

There are ambitions for joint working between the public sector and voluntary sector. Family hubs and the out-of-hospital programme aim to work collaboratively with community groups, whilst community and voluntary groups aim to grow their impact –working with the public sector is seen as one way to do so.

Coventry Family Health and Lifestyle Service also provide a range of services and support. Support and services such as Healthy Child Programmes, Health Visitors, Family Nurses and Infant Feeding programmes. The Family Nurse Partnership (FNP) is a voluntary programme for young first-time mothers (and their partners), aged 19 years or under. Nurses provide regular home visits building a supportive and trusting relationship which enables new parents to provide good care for their baby and toddler and plan their future.

There are ambitions to strengthen the availability and accessibility of general information and advice to parents. MAMTA is a Child and Maternal Health programme delivered by Foleshill Women’s Training and commissioned by Family Health and Lifestyles Service, to provide strategic leadership and representation of ethnic minorities and to ensure service offers meet the needs of ethnic minorities and are accessible to all. MAMTA delivers health messages to families, to reinforce health and wellbeing messages from maternity and health visiting services in a way that reflects the socio-cultural influences and drivers of behaviour, that at times, may differ from white British communities.

Given the diversity in the city, it is crucial to ensure the needs of all communities are met. As part of the Special Educational Needs and Disability (SEND) Local Offer there are several targeted parenting programmes like the support offered by Communication and Interaction (including Autism) Support Service and the EYSS (Early years support service) SEND offering parent/carers of children with complex needs city wide support.

There is also a range of parenting support offered to parents universally, for example, Health Visiting and School Nursing, as well as online parenting support. Health visitors work closely with others to develop services and make sure people know about them. The community teams offer friendly support and advice, by working closely with GPs, midwives, school nurses and the wider local community.

The libraries throughout the city offer a range of valuable resources, such as community support and information through the Rhyme time sessions offered to 0–4-year-olds. Children are also helped with literacy and language development skills that come from the freely accessible books and intervention schemes such as Book Start Baby and Book Start Treasure.

Education and skills

Why is this important?

Poor work chances, social isolation, and difficulties with mental and physical health are just a few of the social disadvantages that people could potentially face later in life because of low educational attainment and low expectations. By supporting high levels of educational attainment and boosting expectations, these barriers can be removed so that children and young people realise their full potential.

There have been significant disruptions to education over recent years due to the COVID-19 pandemic, forcing schools to close and move to digital classrooms. It is fair to say that this has had an impact on education and some children’s school readiness as a result. Therefore, the Department of Education are reluctant to directly compare attainment statistics between 2019-2022, we have included some for your information here.

What is the local picture? How does it compare?

89.3% of the city’s primary school pupils attend a good or outstanding school – a slight decrease in recent years but in line with national averages. The Office for Standards in Education, Children’s Services and Skills, also known as Ofsted, inspects services providing education and training for learners and regulate services that care for children and young people. According to Ofsted’s ratings, Coventry's primary schools saw improvements from 42% in 2013 to 95% in 2019, but a decline to 89% in 2022.

The number of pupils with Special Educational Needs (SEN) has been increasing, as it has for England overall. In 2021/22 there were 11,054 of pupils with SEN in Coventry, making up 18.2% of all pupils compared to 16.5% for England overall. This is divided into two types, those with a Statement or an Education, Health & Care (EHC) plan; and those with SEN support. Between 2015/16 and 2021/22 the proportion of all pupils with a Statement or EHC plan increased from 2.3% to 3.3% and those with SEN support increased from 13.3% to 14.9%, this trend is similar to that for England overall.

Over this time, increases were seen most amongst children with ‘Speech, Language and Communications needs’ (SLCN) (from 1,679 to 2,709), ‘Autistic Spectrum Disorder’ (from 1,137 to 1,614) and ‘Social, Emotional and Mental Health’ needs (from 1,323 to 1,640). There was a reduction in the number of pupils with ‘Moderate Learning Difficulties’ (from 2,863 to 2,473). These trends by type of need are similar to the national trends, although Coventry’s increase in SLCN of 61%, is proportionally higher than the national increase (35%).

Coventry's total attainment performance at the end of year 6 (key stage 2) fell short of the national average in 2022, and the percentage achieving the expected standards has fallen since 2019. 54% of Coventry students at the end of year 6 met the expected standard in reading, writing, and maths combined, compared to 59% for England as a whole. In Coventry, 62% of students in 2019 achieved the standard in each of the three subjects. However, progress in maths amongst Coventry primary school pupils is positive. The average Coventry child outperforms pupils with similar prior attainment nationally in maths.

There are many factors that impact attainment and there are inequalities between some groups of pupils. Like the gender gap nationally, girls in Coventry tend to do better academically than boys. In 2022 60% of Coventry girls achieved the expected standard at key stage 2 compared to 48% of boys. Only 40% of disadvantaged pupils achieved the standard compared to 61% of those non-disadvantaged.

86% of the city’s secondary school pupils attend a school that is rated good or outstanding by Ofsted, this is a significant improvement from 74% in 2019, and now equals the England average.

The number of pupils achieving at least a ‘standard pass’ at the end of key stage 4, that is grades 9-4 in English and Maths, is below the national average. In 2022, 65.1% of Coventry students received a "standard pass," or grades 9–4 in English and Maths, compared to 69% across England overall. This is a fall in Coventry from 68.2% in 2021, although at higher levels than in 2017 (58.3%), 2018 (60.2%) and 2019 (59.4%).

The average attainment 8 score, which is an average score used to measure an individual student's progress across their 8 best performing subjects taken at GCSE level, for pupils in Coventry was 46.2, slightly worse than the England average of 48.9 and down from 48.0 in 2021.

Grading using summer exams returned in 2022 following 2020 and 2021 when exams were cancelled due to the COVID-19 pandemic and alternative methods of awarding grades were in place.

Inequalities in attainment persist into key stage 4, the gender gap at the end of primary is still present in key stage 4 attainment. The average attainment 8 score amongst female pupils was 48.9, better than 43.4 amongst male pupils. Overall attainment levels for disadvantaged pupils are significantly lower, with an average attainment 8 score of 37.7 compared to 49.8 amongst non-disadvantaged pupils in Coventry. Attainment 8 scores indicate that the overall attainment levels of white pupils in Coventry are lower than those for other ethnic groups. Further analysis is needed to understand these inequalities.

By Key Stage 5 (16- to 18-year-old) our attainment is slightly below the national average, but in line with other areas similar to Coventry. Coventry’s average point score is in the middle of Grade C, the same as our statistical neighbours, but slightly below the national average which is towards the top of Grade C.

Free school meals eligibility in Coventry continues to increase and now officially stands at 24.8% over all school years in 2022. However, this metric is disguised by the universal infant free school meals in Reception, Year 1 and Year 2. The maximum free school meals eligibility rate in any one class year in Coventry is currently 30%, which could be more indicative of the real eligibility rate. This is very high, considering that the eligibility criteria for free school meals is an annual net income of £7,400 after any benefits – suggesting a very high rate of severe deprivation amongst young families in Coventry.

The city continues to have a slightly higher than average percentage of young people proceeding from school to a sustained education, employment, or training. In 2022 the annual trend of improvement continued, with fewer young people not enrolled in any form of education, employment, or training (NEET). It is estimated that 310, 16–17-year-olds in Coventry are NEET or whose activity is not known. This is equivalent to 3.9% of that age group and is lower than the regional (5.0%) or England (4.7%) rates.

A growing proportion of the city’s residents are gaining qualifications. Two-fifths of the city’s working-age population is highly qualified. In 2021, 40.7% of Coventry’s working-age population is qualified to level 4 or above, which means they have a foundation degree or above. This has increased by about 15 percentage points over the past decade and the city is the second highest within the West Midlands.

7.6% of the city’s working-age population has no qualifications at all. This is a reduction from 10% in 2018 and has halved over the past decade.

A lack of qualifications may make it more difficult for someone to find more fulfilling work in the city or reduce their chances of getting positions based in Coventry as the city's jobs become more competitive and demand higher-skilled workers.

Adult education offers opportunities across the city for adults to engage and learn. The Adult Education Service in Coventry offers a choice of courses in a wide range of subjects. Each year thousands of people take the opportunity to learn a new skill, gain a qualification, find out more about something they are interested in, or simply make new friends. Data from the last academic year (2020/21) suggests Adult Education delivery in Coventry is doing reasonably well in serving Coventry’s communities. Wards with higher levels of deprivation have higher volumes of learners such as St Michaels (12%) and Foleshill (12%). However, there could still be community groups and areas of the city that are under-represented, and we need to continue to ensure our Skills Providers have good reach across the City.

What else is happening in the city? What else can be done?

The Coventry Skills Strategy seeks to ensure Coventry residents have skills that match the needs of local employers, not only for now, but also for the vacancies of the future. The strategy aims to build aspiration throughout all educational levels, with Coventry’s young people inspired to learn, seeing clear pathways to the jobs they strive towards. Ensuring that the learning and skills provision meets the needs of all Coventry’s communities and is fully inclusive.

Schools and colleges play a pivotal role in raising the aspirations of young people. 30 out of 33 of Coventry’s schools and colleges (including special schools) are engaged with the Coventry and Warwickshire Careers Hub (CW Careers Hub). The CW Careers Hub supports schools' ‘Careers Leaders’ to create a high-quality careers plan that will increase employer engagement, embed careers into the curriculum and inform students and parents of their options.

There is also the ESF-funded Coventry and Warwickshire; ‘Collaborate to Train’ project, a partnership between WCG (formerly Warwickshire College Group), Coventry City Council Job Shop, Coventry College, Coventry University and Solihull College & University Centre. The project helps small and medium enterprises (SMEs) access the right training to support the future of their businesses including; accessing apprenticeships, work experience placements, supported internships and advising on effective school engagement. The project has now entered its second phase after the first phase supported over 400 SMEs.

Adults out of work can be supported by Coventry Job Shop who are working with public sector and community partners to promote skills that lead to good quality employment. The Job Shop provides a wide range of support to all Coventry residents, of all ages, who are looking for work. They work with partners across the city and actively work with employers to generate opportunities for local people. It offers a range of support with searches for employment, training, apprenticeships and work placements, to guidance and reviews of CVs.

Community groups across the city are working together to provide better opportunities and outcomes for children. Having a healthy balanced meal is vital for children going to school and concentrating, there is lots of food-based provision for children throughout the holidays through initiatives such as Holiday Activities and Food programmes (HAF) as well as Magic Breakfasts. HAF provides free activities, experiences and food for eligible children and young people in the Easter, Summer and Christmas school holidays, whilst Magic Breakfasts are healthy school breakfasts to children at risk of going hungry. HAF also has information available to support families particularly to help with the cost of living and food help for families.

Economy

Why is this important?

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.

What is the local picture? How does it compare?

The global economic context is currently challenging and will likely impact Coventry and its residents. Growth in the local Coventry economy has slowed since 2016, following several years of strong growth, putting the city in a more difficult position to face the challenges of the pandemic and the cost-of-living crisis. Total annual GDP in Coventry, the value of all economic activity within the city, was at £11.094 billion in 2021, and had grown by an estimated average of 0.4% per year since 2016; this is lower than the growth across England overall (2.8%) and in the overall economy of the West Midlands combined authority area (2.0%). In 2020 Coventry GDP fell by 4.2% which is associated with the impact of the pandemic, and recovered in 2021, increasing by 4.5% - leaving Coventry with slightly higher GDP than before the pandemic, but recovery across the region and nation overall was better.

The city is home to some world-class business clusters which gives Coventry a competitive advantage. Business sectors in the city and region include advanced manufacturing and engineering (particularly in aerospace and automotive industries); energy and low carbon; connected autonomous vehicles; business, professional & financial services; and digital, creative, and gaming. According to the Centre for Cities, in 2018 Coventry had the second highest rate of published patent applications out of 63 UK city clusters and has regularly been amongst the highest in the annual list, indicating a high amount of innovation amongst Coventry businesses. This also translates when looking at productivity, in Gross Value Added (GVA) per hour worked, in 2020 the city ranked 14th highest out of 60 UK cities.

There has been a growth in average annual earnings in recent years closing the gap between Coventry and the national averages. The median earnings of all in full-time and part-time work increased by 8% amongst Coventry residents in 2022, higher than the national average of 7% and the average in the West Midlands Combined Authority Area (WMCA) of 4%.

In 2022 median earnings were 26% higher than in 2016, compared to 21% growth in the WMCA area and 20% across England overall. The gap between average earnings in Coventry and the rest of the region has gotten smaller in recent years and now shows that average earnings for Coventry residents are slightly higher than the national average, at £33,887 for full-time workers compared to £33,208 across England overall. However, increases in 2021 and 2022 are below inflation levels so real incomes are falling.

Whilst average earnings have been improving, average household income is lower in Coventry than other areas. Coventry’s median gross household income in 2022 was estimated at £30,237 compared to the UK median of £36,440. Income is one of the measures used in the English Indices of Deprivation 2019. Coventry ranks as relatively more deprived in the income domain, compared to other types of deprivation and local authority areas. Coventry ranks relatively worse for income deprivation affecting children and older people.

Despite growing opportunities, innovation and improvement in average earnings, the employment rate has fallen. This is likely due to the disruption during the COVID-19 pandemic and slow growth in the national economy in 2022. 72.1% of working-age residents were in employment in 2022, a slight recovery from 2020 (71.4%) and 2021 (71.5%) but lower than the 73.0% in 2019. Up until 2019 employment rates had been on an increasing trend for a few years. They remained lower than the national average of 75.8%; however, this has historically been the case, partly due to Coventry being home to two large universities. Coventry’s employment rate is not exceptionally low and is like that of other university cities. The unemployment rate in 2022 was 4.9%, equating to 9,400 residents: down from 5.5% in 2021 but higher than the pre-pandemic 2019 level of 4.3%.

Economic inactivity rates have gradually increased since 2019, up to then it had been in a decreasing trend. Economic inactivity refers to people who are neither in work nor unemployed, they are not actively seeking work for various reasons. This includes full-time students, those looking after a home, people living with long-term illness, retired people, and others. In 2019 it was 22.8% and by 2022 it was 24.3%, higher than the national average of 21.3%. Coventry has consistently had higher than average rates due to the relatively high number of economically inactive students, however, the increase in inactivity since 2019, is not due to inactive students of which there has been a reducing number. Increases in economic inactivity have been driven by increasing ‘involuntary’ economic inactivity, for example, people who are long-term sick; an estimated 28,300 form this group who the Centre for Cities call the ‘hidden unemployed’, to add to the 9,400 Coventry residents who are unemployed (not employed and actively seeking work).

Coventry was UK City of Culture between May 2021 and May 2022; this had a positive impact on Coventry’s economy. The Baseline Report provides an indication of the investment secured by June 2021, as a result of being awarded the UK City of Culture 2021 in December 2017. This equates to over £172m and estimated an impact of £51m of Gross Value Added (GVA) generated from capital works completed or underway through this investment.

The city’s year as the City of Culture, however, happened during a period of continued significant national and international challenges. In May 2021, as the City of Culture year launched, COVID-19 pandemic-related restrictions remained in place. Into 2022, the end of the year in the spotlight coincided with the rapid rise in the cost of living.

The City of Culture had a positive impact on tourism and attracted many to visit the city. Coventry tourism in 2022 had recovered to better than 2019 pre-pandemic levels. A tourism economic impact assessment commissioned by Destination Coventry using the ‘STEAM’ model, gives visitor numbers to Coventry and the economic impact of tourism for 2022, compared to previous years.

There was a very large dip in tourism in 2020 due to the restrictions of the COVID-19 pandemic, the recovery in 2021 didn’t quite bring the city back to pre-pandemic levels,19% down on visitor figures and 17% down on economic impact compared to 2019, 2022 data now shows tourism continued to increase and has grown beyond 2019 levels. The positive impact of Coventry’s year as UK City of Culture is indicated by comparing the 2022 increase on 2019 to other areas; the 10.2% increase in visitor numbers and 26.3% increase in economic impact in Coventry was higher than the 5.5% and 7.3% increases experienced by the WMCA area.

In 2022 it is estimated there were 11.05 million visitors to Coventry, which were made up of 9.70-million-day visitors and 1.35 million visitors who stayed for at least one night. This is increased from 10.03 million visitors in 2019, made up of 8.79 million day visitors and 1.24 million visitors who stayed for at least one night. The 2022 economic impact of tourism is estimated at £750.86 million with the sector supporting 7,354 full-time equivalent jobs, up from 594.36 million and 6,760 in 2019.

The Coventry Household Survey 2022 asked a representative sample of Coventry residents about their engagement in cultural events or attractions. Two-thirds (66%) had engaged in at least one type of cultural activity at least three times in the last year (not including pubs, the cinema or home crafting; participation would be higher if these were included). This represents an increase in cultural participation, doubling from 32% when people were asked in 2021 – this was clearly impacted by the restrictions of the COVID-19 pandemic. 2022 data shows an increase on pre-pandemic cultural participation - in 2018 52% of respondents said they had engaged in such activities.

The ‘cost of living crisis’ is impacting the local economy and Coventry residents’ economic wellbeing and their health. The impact of this cost-of-living crisis on communities across the city is yet to be fully realised, as people across the city face rapidly rising energy, fuel, food, and housing costs. The crisis is likely to cause problems with debt and will cause a general reduction in real incomes; unemployment may increase in future, making challenges worse. Financial insecurities are causing high levels of anxiety and other mental health challenges, as well as being a significant cost barrier to maintaining physical health for vulnerable groups. The deeper and immediate impacts of the cost-of-living crisis include real risk to health and wellbeing for a significant minority of Coventry residents. Disabled, long term sick, and the severely deprived are the most vulnerable with the spike in the cost of food and energy. The cost-of-living crisis is also having wider impacts that affect Coventry households well into middle incomes in terms of savings for security of housing, university, and retirement.

The national inflation rate started to increase in 2021 and continued throughout 2022 reaching 9.6% in October 2022 and by March 2023 prices were 8.9% higher than they were 12 months previously.

Higher prices have a disproportionate impact on lower income households, although this will also affect those on middle income. The inflation rate for food and non-alcoholic drinks is much higher, in March 2023 prices rising by 19.2% in a year. While the Treasury’s published forecasts predict inflation to slow, to 2.5% in 2024, energy prices are not going to come down quickly and prices are increasing faster than wages, so standards of living have fallen a little. The Centre for Cities estimate how inflation rates vary between 63 UK cities; in March 2023 Coventry residents are estimated to be facing a 10.7% inflation rate, ranking in the middle compared to other cities, ranging between 9.3% and 11.7%. They estimate that Coventry residents were £98 a month poorer in January 2023 than in the previous years.

There has been a noticeable increase in residents’ anxieties towards money, this in part can be attributed to the cost-of-living crisis. 17% of residents say they feel money worries almost all the time, a 5-percentage point increase compared to the 2021 findings. A further 23% are now worried about money quite often. There has been a corresponding reduction in the proportion of those that never feel worried about money (25% in 2022 vs. 32% in 2021). Those living in Foleshill (31%), St. Michaels (33%) or the Wyken (25%) wards are significantly more likely to feel worried about money almost all the time compared to the total average (17%). By age, those under the age of 35 are significantly more likely to feel worried all the time (22%), whilst those 44-64 (12%) of 65+ (8%) are significantly less likely to when compared to the survey average. Those with a disability are also significantly more likely to worry about money almost all the time compared to those with no disability (23% vs. 14%).

An emerging impact of the cost-of-living crisis is shown by the responses recorded regarding household food consumption. Just over two thirds (69%) of residents’ state that in the last 12 months they and their household always had enough of the kind of food they wanted. This is significantly lower than the 78% recorded in 2021. A quarter (26%) said they have had enough to eat, but not always the kind of foods they wanted, a significantly higher number than that of 2021 (19%). In 2022 4% indicate that sometimes they and other household members did not have enough to eat, up from 2%. The final 1% stated that often they and other household members didn’t have enough to eat. While this is a minority, there are clearly health and wellbeing risks for those experiencing this food scarcity.

Before the cost-of-living crisis began, fuel poverty was more prevalent in Coventry than in the region or England, in 2021 Coventry had the 4th highest fuel poverty rate of all local authority areas in England. An estimated 28,525 Coventry households are estimated to be fuel poor, amounting to 20.8% of all households in the city compared to 13.1% for England overall. The city’s rate in 2021 was the 4th highest of all local authority areas in England. Using another measure of fuel poverty, defined by having to spend at least 10% of household income on energy costs, we can model how the recent sharp increases in energy have affected Coventry households. It is estimated that in October 2021 12% of Coventry households were fuel poor, this trebled to 36% in October 2022. This modelling shows that in October 2022 the most affluent wards in Coventry had more fuel poverty than the most deprived wards did in October 2021, illustrating that the cost-of-living crisis touches a wide section of society.

There remain significant pockets of multiple deprivation in the city. People from more deprived populations are more likely to live shorter lives, as well as live a greater proportion of their life in poor health. The English Indices of Deprivation 2019 is the key measure for comparing levels of deprivation between areas. It measures a variety of aspects of deprivation: income, employment, health and disability, education, housing and services, living environment and crime; bringing them together to form the Index of Multiple Deprivation 2019, enabling us to know the neighbourhoods where people experience the highest levels of multiple deprivation. Depending on the way it is measured, Coventry ranks between 64th and 81st most deprived local authority area of 317 in England, so at least amongst the most deprived quarter of places in England overall. 14.4% of the city’s neighbourhoods are amongst the 10% most deprived areas in England and over a quarter, 25.6%, are amongst the most deprived 20% of areas, the most deprived ‘quintile’, a particular focus for the health system for tackling health inequalities (the ‘Core20’).

Those coming to the UK as asylum seekers and refugees are likely to have less access to employment, have worse quality housing, live in more deprived areas, and have worse mental and physical health. The city’s refugees and asylum seekers are nearly twice as likely to reside in the 10% most deprived neighbourhoods than the wider population. Research shows that newly arrived communities are at increased risk of poor mental health, particularly asylum seekers. Respondents to engagement undertaken for Coventry City Council’s “One Coventry ‘Together’: Newly Arrived Communities & Migrants’ Strategy’ felt that most of Coventry’s asylum seekers and refugees had poor mental health. This reflects a key finding of the Coventry Migrant Needs Assessment 2018 [https://www.coventry.gov.uk/downloads/file/28132/migrant-needs-assessment-2018] that there is an under-provision of specialist mental health services and access for vulnerable migrants.

Digital accessibility and inclusion are increasingly important. Internet and digital technologies have transformed our lives on a global scale. Particularly since the COVID-19 pandemic and subsequent lockdowns. The availability of high-speed internet, is an important consideration for residents and businesses when considering living, working, or investing here, and is an asset for the city; but there is some room for improvement in terms of achieving ultra-fast broadband speeds in all homes.

Coventry is the top-ranked local authority in the West Midlands region for gigabit broadband coverage. The telecoms regulator Ofcom measures access to, and the performance of, fixed broadband and the mobile network in its Connected Nations reports. As of May 2022, gigabit availability covered 96.4% of residential premises in Coventry with 93.7% covered by Full-Fibre, up from 91.5% and 75.4% respectfully in January 2021. This compares favourably to the national average; across the UK, 68% of homes can receive gigabit with 37% of homes able to receive Full-Fibre. Furthermore, 99.5% of residential premises have access to decent fixed broadband - defined by the UK government as a data service that provides fixed download speeds of at least 10Mbit/s and upload speeds of at least 1Mbit/s. Decent broadband can also be accessed through the mobile network using 4G services. As of May 2022, 89.65% of all premises have a reliable signal for 4G services while indoors from all four network operators (EE, O2, Three & Vodafone), an increase from 83.06% in January 2021.

Despite Coventry having high levels of gigabit availability, this does not mean residents will be able to afford a home broadband connection. There is no single measure of digital exclusion, however it is possible to measure the risk of digital exclusion. The Digital Exclusion Risk Index (DERI) tool, developed by Greater Manchester Combined Authority, models the likelihood of digital exclusion for all small neighbourhoods (LSOAs) in England by creating an overall score based on a collection of metrics. For each area they give a score between 0 and 10 where 0 represents a low risk of exclusion and 10 a high risk. Coventry’s average score is 3.44, slightly better than the West Midlands Combined Authority (WMCA) area overall which scores 3.55 on average, Coventry being the 2nd best scoring of the 7 areas across the WMCA. Coventry’s 2021 DERI scores range from 6.12 in the Manor Farm area to 1.36 in the Gosford and Gulson Roads area. However, caution should be taken when using the DERI indicator, as it is weighted by connectivity levels in terms of infrastructure, not actual residential connections to broadband, which may underrepresent the risk of digital exclusion in Coventry.

What else is happening in the city? What else can be done?

Coventry City Council has launched a new digital inclusion programme, #CovConnects, which aims to ensure all Coventry residents have equal opportunities to digital technologies, skills, and services in a way that is meaningful to them. #CovConnects follows a Community Based Model for Digital Inclusion and Health Participation based upon the 100% Digital Leeds model. This approach works with community partners to understand the barriers within communities related to digital exclusion, works together to co-design and create sustainable interventions and supports, which meets the needs of our diverse communities. This has led to a complex and varying programme working across communities with the public, private and VCSE sector to help reduce digital inequalities within the city. #CovConnects is now part-funded by the ICB to pilot digital health inclusion interventions to help us understand the role digital plays within healthcare and to pilot community interventions within the Leeds model to improve access to healthcare for Coventry residents.

Community-based Digital drop-ins are now taking place within community venues, where residents can access informal digital skills support, such as using a device for the first time, setting up an email address, staying safe online and accessing online services. Support is offered by Adult Education Digital Skills Tutors, who are supported by digital champion volunteers providing bespoke, person centred supports for what the learner would like to know.

An increasing network of National Databank distribution points across the city is gifting data to residents who cannot afford to stay connected. #CovConnects piloted distributing pre-loaded sim cards with 6 months of data, texts and calls via the National Databank from the Customer Service Centre and Community Support teams in October 22 as part of the wider Cost of Living programme. This has now been rolled out to Libraries, Family Hubs, Job Shop, Through Care and Migration teams. There is also an increasing network across community partners as Databank distributors, which is integral to ensure support is available within trusted locations for our diverse communities. As of August 23, there are 34 Databank hubs across sectors in Coventry.

The #CovConnects Device Bank has been created to ensure VCSE organisations and Council services can access digital devices for digitally excluded residents. Organisations and services can apply for devices to be either used in community spaces or gifted directly to digitally excluded residents as part of the Device Bank. #CovConnects programme provides wraparound, holistic digital inclusion supports in addition to the devices, ensuring the barriers experienced by residents and communities are addressed in a person-centred manner, across skills, support, access, confidence, and connectivity. The #CovConnects Device Bank utilises recycled Coventry City Council devices but has also received substantial investment from the WMCA Connected Services programme, whereby brand-new Chromebooks, laptops, PCs and mi-fi units are available.

#CovConnects has partnered with Barclay’s Digital Eagles to deliver digital champions for organisations across the city to help support residents gain the confidence to access digital tools, technologies, and services. The programme will train frontline staff and support them ongoing to enable residents to access digital services and supports. This growing network across sectors will ensure there is an infrastructure across the city for residents to access support in a person-centred manner to help them gain the confidence and skills to get online.

Community assets are crucial to health through the opportunities and services they provide directly and indirectly, through a sense of empowerment and control. In Coventry we respond to the needs of our communities through our integrated services community prototypes and other placed-based partnerships, rooted in and driven by place, working creatively with shared resources to make positive change.

The One Coventry approach to community involvement highlights the work taking place in communities along with new approaches to engagement and collaboration. Work has been undertaken to develop prototype areas throughout the city, trialling new ways of working and ensuring the needs of the community are met. The prototype areas work on putting support and services in place for people at the right time. It focuses on harnessing community action and intelligence shaping interventions that suit the community. The first pilot was undertaken at Moat House Community Centre and has since been further developed in Tile Hill, Canley, Hillfields and Spon End.

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. A new monitoring tool for 2023 onwards has been developed in partnership with the Institute of Health Equity (UCL) and Coventry stakeholders, reflecting the Marmot approach of ‘building back fairer’ as part of Coventry’s COVID-19 recovery. The new 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.

Community and voluntary groups are working together in the city to ensure support is in place for those who need it. The Coventry Food Network is an example of this, established as a result from the pandemic. Coventry Food Network is a food partnership which brings together several public, private, voluntary and community sector partners to address food poverty and its causes in Coventry by taking a city-wide collaborative and strategic approach towards a unified Coventry Food Network and Strategy. Since 18 March 2020, the Council has been working closely with a range of partners, to create and deliver a system of food provision. Some of the initiatives that have evolved from this partnership are:

• Established 15 social supermarkets/grub hubs throughout the city to provide nutritional food and support to those residents in greatest need.
• Support the delivery of the Household Support Fund by providing emergency food provision to vulnerable residents who needed additional support with accessing/affording food.
• Supported the delivery and developed a model to support those who were clinically extremely vulnerable (Shielding) re: food and basic support.
• Procured food and distributed food parcels to children eligible for free school meals provision during school holidays.
• Continue to support and enhance the offer of healthy, nutritious food to children and families eligible for free school meals through the HAF programme.

It is important to embed access to affordable food into policy and strategy documents when commissioning services and into the Council’s work on addressing health inequalities. For example, targeted support for low-income households supporting them into work higher paid roles; improving the knowledge households have around food through education and practical work; tackling barriers people face in terms of accessing food, understanding the reasoning behind healthy eating, how to cook, budget and how to lead a healthier lifestyle; support the Healthy weight objective to counteract childhood obesity.

The Council have refreshed two strategies which will help to shape the city’s economy, improving outcomes and tackling inequalities. These being the Economic Development Strategy for 2022-2027 and a new Skills Strategy 2022-2030. The two strategies work in harmony to increase the economic prosperity of the city by providing a framework for sustainable growth, whilst continuing to build upon the success in ensuring all communities have the right skills and opportunities to benefit from this growth.

The aim of the new Economic Development Strategy 2022-2027 is to make sure Coventry has a strong and resilient economy where inclusive growth is promoted and delivered, businesses are enabled to innovate and grow, and new local jobs are created for residents. The strategy sets out how the Council will aim to help deliver this through attracting and securing private and public investment, developing first-class infrastructure, and working directly with businesses to ensure they can grow in a sustainable way.

Environment

Localities and neighbourhoods

Why is this important?

The quality of the built and natural environment, such as the local neighbourhoods, access to local shops, services, parks, and green spaces, affect the health and wellbeing of everyone.

What is the local picture? How does it compare?

Coventry is the fourth most densely populated of the West Midlands’ 30 authorities, only Birmingham, Sandwell and Wolverhampton are more densely populated. Coventry has around 25 people living on each football pitch-sized area of land (3,501 people per square kilometre). Only Birmingham (4,275), Sandwell (3,995) and Wolverhampton (3,798) are more densely populated.

In Coventry, the least densely populated area is Brownshill Green with 426 people per square kilometre, over 20 times fewer people per square kilometre than the most densely populated area, which is Hillfields with 10,867 people per square kilometre.

Coventry has good access to services which is generally considered an asset that is enjoyed by residents in the city; However, residents’ satisfaction with their area is lower than the national average. Coventry residents live within a 20-minute walk of a general or grocery shop, public transport links, parks, pubs, GP surgery, health centre and a place of worship. In the 2022, the Coventry Household Survey found that 66% of Coventry residents were satisfied with their local area compared with 81% nationally. There has been a reduction in satisfaction from 70% in 2021 and 84% in 2018. Despite this, half of residents (51%) did not think their area had changed much in the last two years, 28% felt it had got worse and 10% suggested their local area had got better.

There are 2,000 hectares of green spaces in the city which is over 20% of Coventry’s total area. There are 430 green spaces that have no entry restrictions. Many of the parks in Coventry received Green Flag Awards in 2021, with Allesley Park, Caludon Castle Park, Coombe Abbey Park, Longford Park and The War Memorial Park all continuing their long run of inclusion in the scheme. However, Coventry trails behind the regional average for green space provision by population and there is considerable variation across the city.

Whilst many areas of the city overall benefit from a good supply of green spaces, some residents have no access to nearby green spaces or outdoor sports facilities. Residents in Henley and Wainbody enjoy access to over 100 hectares of green space contrasting with Upper Stoke, Lower Stoke, Radford, and Foleshill who have access to levels below the average of 62.3 hectares.

Air pollution is the largest environmental risk to the public’s health and has a harmful impact on the health of people living, working, and studying within Coventry. Met Office data, quoted by the Centre for Cities, counted 24 days in the year November 2021 – November 2022 that had poor air quality in Coventry, this ranks 17th highest out of 63 UK cities. Air quality particularly affects the most vulnerable, having a disproportionate impact on the elderly, pregnant, children, and those with cardiovascular and/or respiratory disease. Research suggests that long-term exposure to particulate air pollution contributes to death rates at a similar level as obesity and alcohol.

Like many towns and cities throughout the UK, roadside pollution levels, especially those resulting from Nitrogen Dioxide (NO2) emissions from traffic and Particulate Matter (PM), are a concern. NO2 levels measured across various roadside locations in Coventry have been improving. However, poor air quality affects different communities disproportionately, some areas in Coventry do not achieve the EU and international standards.

Nitrogen dioxide (NO2) is one of the pollutants of concern, and ‘diffusion tubes’ are deployed to measure levels at various roadside locations in Coventry, in 2022 75 locations were measured. Most locations of measurement in Coventry did not exceed the limit of an annual mean concentration of 40 µg/m3; only two did, both located near to each other on Holyhead Road; this area has often been where the highest measurement have been made over the last 10 years. In general, across all locations that have taken measurements, including the areas that have consistently seen the highest levels, annual mean levels of NO2 have been falling as a trend.

In 2019 there was a spike with most locations experiencing an increase even though it had been falling annually up to then. Levels then fell significantly in 2020, likely related to reductions in activity and traffic during the COVID-19 pandemic. Levels increased again across all sites in 2021 but dropped a little again overall in 2022. So, while the pandemic was likely a big factor behind reducing levels in 2020 and 2021, the 2022 data reveals an underlying downward trend, levels in 2022 were lower than in 2019 and in previous years measured.

The World Health Organizations' former guideline level for annual nitrogen dioxide up to September 2021 was 40 µg/m3. A more stringent 10 µg/m3 limit has since been introduced with the increasing recognition of the hazards of air pollution, and this will be reflected in future reports. None of the 75 sites measured in 2022 had an annual mean of less than 10 µg/m3, no location of measurement in Coventry meets these standards. Maps below show mean annual NO2 levels across Coventry’s diffusion tube sites in 2019 (left) and 2022 (right). They show green sites that have annual mean concentration of nitrogen dioxide of less than 30 microgram per cubic metre (µg/m3); amber sites between 30-39 µg/m3; and red sites with 40 µg/m3 or above.

Fine particulate matter (PM2.5) is another pollutant that has a significant effect on health. In Coventry overall the 2021 concentration of PM2.5 is estimated at 7.6 micrograms per cubic metre (µg/m3), slightly higher than the regional average (7.3) and national average (7.4). Related to this measure, the UK Health Security Agency estimates the fraction of annual deaths that can be attributable to particulate air pollution; for Coventry in 2021 this is estimated at 5.7%, slightly higher than the regional average (5.5%) and national average (5.5%).

What is happening in the city? What else can be done?

‘Green exercise’, or taking physical activity in green or natural environments, may provide additional benefits to people’s overall wellbeing. Increasing scope for physical activity through active travel and easier access to high-quality green spaces, improving air quality and housing (warming, cooling, and ventilation) and making healthy food more readily available locally will potentially help mitigate the risks of a range of health issues, including obesity, cardiovascular and respiratory disease, some cancers and diabetes and poor mental health, whilst also reducing Coventry’s greenhouse emissions.

Green spaces can also bring communities together, reduce loneliness and mitigate the negative effects of air pollution, excessive noise, heat, and flooding. There is opportunity to work with communities to protect and improve existing green space and create new ones in areas most in need, and to implement nature-based interventions for health, such as green walking or green social prescribing.

Coventry has a strong history of supporting “Friends of” groups and community-based organisations in maintaining, developing, and improving green spaces. As well as site-specific friends of groups and the Coventry Tree Wardens, there are several sports clubs and the city’s allotments are self-managed by Coventry and District Allotment and Gardens Council.

Green corridors form an important element of the landscape within Coventry, however there are some barriers to accessing these spaces that need to be addressed. Further work is required to address perceptions of anti-social behaviour, personal safety, dog fouling and access issues relating to volumes of traffic, busy roads, and safety concerns for cyclists. Further investment is also required to improve the quality and facilities of some green spaces.

The Council is committed to an ambitious plan to plant 360,000 trees one for every member of Coventry’s population over the life of the strategy: a tree for every citizen. Coventry has membership of the Trees for Streets National Street Tree Sponsorship Scheme, from the urban tree charity Trees for Cities, funded by the government’s Green Recovery Challenge Fund and City Bridge Trust.

Cleanliness of the city is important to residents. A large proportion of the responses to One Coventry engagement placed a focus on the need for Coventry to become a “greener city” and a “tidier/cleaner” city. “Clean city of Coventry - littering is the main issue. to build the economy and green city. The city should start from a clean platform.”

A more holistic approach to health could be used by identifying food growing spaces in the city – both active and those with potential to deliver environmental, social and health benefits. This would support future demand for allotment provision, community gardening and urban forestry and food production which has proven health benefits.

Initiatives to reduce air pollution and facilitate more active transport overlap considerably as they are both functions of mobility and there is opportunity for closer working across health, air quality improvement initiatives and transport to better meet the needs of Coventry residents. In Coventry, the main air quality issues identified and being addressed by the Local Air Quality Management (LAQM) process relate to residential properties that are near major arterial routes in the city, which experience high levels of congestion. Currently identified hotspots include sections of Holyhead Road, Walsgrave Road, Foleshill/Longford Road, Stoney Stanton Road and at certain junctions along the A45.

Change is needed in how people and goods travel to, from and around Coventry. Current levels of car travel will simply not be sustainable in the future; Therefore, the Coventry Transport Strategy sets out plans to create a city where it is easy, convenient, and safe to walk, cycle and travel on public transport, and where most people do not need to use a car to access the services that they need for day-to-day life. focuses upon encouraging local trips to be made by walking and cycling rather than the car, with significant investment in a new high-quality cycle route between Coundon and the city centre, and on an engagement programme with schools, businesses and local communities building on the successful work already done in the Walsgrave corridor.

Coventry City Council is working with the West Midlands Combined Authority, the UK Government and National Express West Midlands on a pilot project to make Coventry the UK’s first all-electric bus city. Funding has been provided by the UK government, and Coventry City Council is working closely with National Express to ensure the necessary infrastructure is installed by 2025.

Green Space Strategy aims to protect the cities green spaces, from large parks and playing fields to allotments, churchyards, and riverbanks. The strategy has already seen success in investment in children’s play, more spaces being managed positively for wildlife, greater community involvement with 30 friends or volunteer groups now working with the park service, the achievement of five Green Flag Awards, the delivery of large-scale investment in War Memorial Park and Coombe Country Park supported by external funding and achieving a national award for the wildflower planting on key highways verges and within selected parks. These achievements, along with other factors, have led to a significant increase in the use of green spaces in Coventry, reflecting the national picture.

Housing and homelessness

Why is this important?

Historically, housing is only considered in relation to health in terms of support to help vulnerable people to live healthy, independent lives and reduce the pressure on families and carers. However, it is now recognised that good quality housing for all leads to better health and wellbeing, as it indirectly affects early years outcomes, educational achievement, economic prosperity, and community safety.

Conversely, rough sleeping and homelessness significantly impacts on a person’s mental and physical health, and the longer someone experiences rough sleeping, the more likely they will develop additional mental and physical health needs, develop substance misuse issues and have contact with the criminal justice system.

While average house prices are a little lower than the West Midlands regional average, rental prices appear to be slightly higher. Both rent and house prices in Coventry are increasing. The median house price in Coventry for the year ending September 2022 was £214,500, lower than the West Midlands regional average of £225,000 and the England average of £275,000; but comparable to the average for the West Midlands metropolitan area, £210,000.

Over the last year the median house prices in Coventry increased by £12,000 (6%) whereas they increased by £3,000 on average in the West Midlands metropolitan area; and fell regionally (-£5,000, -2%) and nationally (-10,000, -4%). Over the last five years Coventry house prices have increased by 6% a year on average, similar to the level of increase elsewhere.

Dividing median house price by median earnings from employment amongst Coventry residents gives us a measure of affordability, the ratio in 2022 was 6.2. This shows houses in Coventry to still be more affordable than other parts of the West Midlands metropolitan area, as well as the West Midlands region (7.1) and England (8.3). While this statistic indicates that houses have become less affordable over the last 10 years, the ratio reduced in the last year, it was 6.5 in 2021.

The median monthly rent for all types of houses in the year ending September 2022 is estimated to be £725, lower than the national average (£800), the same as the average for the West Midlands metropolitan area, but higher than the average across the whole of the West Midlands region (£695). This has increased from £695 in a year, a 4% increase.

There has been an increase in private renting and a reduction in home ownership amongst Coventry residents over the last 10 years. Census 2021 data shows 24.7% of households are privately rented, up from 20.6% in 2011; and 57.4% of households are owner-occupied, down from 60.6% in 2011. 17% of Coventry households are socially rented, the same as in 2011. More households in Coventry privately rent compared to national (20.5%) and regional averages (17.9%) and less are owner-occupied compared to England (61.3%) and West Midlands (62.8%). The changes in tenure are similar to the trends across the region and the country overall.

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.

Threats to health and wellbeing are exacerbated by the increased costs associated with keeping homes warm, dry, and ventilated sufficiently over the colder months of the year and potential intermittent shortages in energy supply. Cold homes are recognised as a source of both physical and mental ill health, increasing the risk of heart attack and stroke, respiratory illness, falls and accidents. The percentage number of inadequately energy efficient homes in Coventry (based on an EPC rating of less than C, i.e. D - G), is estimated to be around 60% compared with 60% nationally, ranging from 37% of households in areas in Woodend, Henley and Manor Farm to up to 84% in Upper Stoke Central (Barras Heath) and along Hipswell Highway and Ansty Road (Ravensdale).

For Coventry, this equates to around 12,000 social rented homes and between 70,000 owners occupied or privately rented homes in need of improvements / retrofits to make them energy efficient to an EPC C rating standard. Whilst there are programmes running regionally and locally to meet this aim, core funding levels constrain the scale and pace of delivery. There is opportunity to incorporate other needs such as health within the process, to better understand the scale and format in which this programme could be delivered across Coventry equitably and what public health and community schemes could be delivered to raise greater awareness of how to stay warm or cool and increase community resilience.

An increasing rate of house building within Coventry is planned, if these plans were to come to fruition it may facilitate further population growth with families and other households moving into these houses. Some of the house building is earmarked for areas outside the city boundary (given cooperation with neighbouring authorities); while this part of it wouldn’t directly add to population estimate of Coventry itself, it would still have an implication for local needs and services.

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.

The homelessness rate in the city rose higher in 2021/22 than in the previous year. This is projected to further increase in 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.

Rough sleepers tend to be complex cases, often requiring more than one specialist service involved in their support to relieve homelessness. It is difficult to understand the true extent of numbers rough sleeping in Coventry at any given time. The Council’s Rough Sleeping Outreach Team routinely report between 5 – 30 new cases per month (average of 15 per month). Currently, around 50% of cases known to the outreach team move on to secure long term accommodation and support, with a further 40% not engaging and around 10% being sectioned, passing away, imprisoned, or reconnected with another Local Authority. Approximately 25% of new cases are thought to be non-UK nationals and 10% thought to have no recourse to public funds.

What is happening in the city? What else can be done?

Community based interventions such as Green Doctors and Warm Banks have been set up to support vulnerable people during the winter months. A range of organisations have worked in partnership to provide support and advice in managing the rising energy bills and making homes more energy efficient.

Investment in additional frontline resources to support more residents facing homelessness is needed. Through the Housing & Homelessness Strategy 2019-24 the council worked with partners to improve the use of existing homes. The introduction of the “Let’s Rent” scheme, whereby the Council provides guarantees for making rent payments and supports the vetting of prospective tenants. The Council also introduced an improved Homefinder system in September 2021, to make applying, searching, and bidding for social / affordable housing easier for residents.

The council have 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.

The Integrated Care System (ICS) commissions a GP service dedicated to providing healthcare to single people aged 18 or over who are experiencing homelessness and sex workers resident in the city. There are normally around 600 registered patients. The service works in partnership with a range of partners in the city to encourage patients to access healthcare in a timely manner and reaches out for support to enable a patient to complete treatment.

The Family Health and Lifestyle Service provides ongoing support from health visiting teams plus a range of local services that help with more complex issues. Supporting families facing homelessness, Drug and alcohol related problems, complex family circumstances and support with domestic violence

People with lived experiences have a unique and essential role to play in helping to prepare people to accept and receive support. Coventry has had success in working with people and volunteers with lived experiences of drug and alcohol misuse who are members of the city’s Multiple Complex Needs Boards. As experts by experience, these volunteers worked closely with the police and the Council to influence the city’s approach to working with a variety of people.

The Ayriss Recovery Coventry (The Arc CIC) is a drug and alcohol outreach/support service in Coventry. The Arc is made up of experts by experience – that is, people with first-hand, lived experiences of things such as rough sleeping or misusing drugs and alcohol. They understand on a deeper level what it is like for those accessing their services and can use their empathy and understanding to build connections between local services and people who are rough sleeping or misusing drugs and alcohol. The Arc CIC is one of the founding partners of the STEPS for Change Street homelessness hub in Coventry City Centre, a drop-in facility where rough sleepers and those at risk of homelessness can seek support from a variety of partner agencies.

Crime

Why is this important?

Being a victim of crime, and being worried about crime, impacts on a person’s perception of their quality of life in the neighbourhood and has a negative effect on a person’s mental and physical wellbeing.

What is the local picture? How does it compare?

The proportion of Coventry residents who feel safe during both the day and night remains significantly lower than the latest LGA national polling figure of 95%; and Coventry people feel less safe than four years ago. Over three quarters of residents feel safe during the day (77%) in their local area, with only 11% reporting feeling unsafe this remains unchanged from 2021. However, it is a significant reduction from 2018 when 94% reported feeling safe during the day. Safety during the day is significantly lower amongst those living in the Foleshill (55%), Henley (69%) and Upper Stoke (69%) wards when compared to the survey average.

When considering safety after dark in their local area, fewer than half (45%) of residents feel safe, a slight increase since 2021 (41%) – but a significant worsening on 2018 levels when 74% reported feeling safe at night. The sense of safety after dark expressed by Coventry residents is below that recorded nationally by LGA polling (76%). Residents living in Longford (34%), Henley (29%), Lower Stoke (29%) and Upper Stoke (25%) wards have a particularly low sense of safety after dark.

Recorded crime has been on an increasing trend in Coventry. Coventry’s total recorded crime rate in 2022 was 122 per 1,000 residents, compared to 93 for England overall. However, whilst it is increasing, Coventry’s overall crime rate and its violent crime rate does not rank particularly highly when compared amongst other local authorities in the West Midlands and groups of other similar places across the country.

A total of 42,021 crimes were recorded by the police during 2022, an increase of 8% since 38,990 cases recorded in 2021. This was after a much larger annual increase of 35% from 28,814 in 2020. It had been on a slowly increasing trend for a few years before 2020. Recorded crime has also been increasing recently for England overall, but the increase in Coventry has been greater.

While theft offences have continued to increase, in the last 3 months of 2022 the increasing trend in recorded crime has plateaued, albeit at a notably higher level than a few years ago. Total recorded crime in 2022 was 51% higher than levels in 2018 and violence against the person offences were at more than double 2018 levels (122% increase). This increase was driven by increases in ‘violence without injury’ offences and ‘stalking and harassment’ offences; ‘violence with injury’ offences increased at a slower rate, 34% higher. Total recorded crime in England dipped a little during 2020, perhaps due to the pandemic and lockdowns – whereas it increased a little in Coventry. While some types of crime, like theft-related offences, did dip during the pandemic, violent crime continued to increase.

Violence against the person offences have been increasing notably in Coventry since 2016; the violent crime rate was lower than the national average then but it is now higher, at 49 per 1,000 residents compared to England at 35. The top three of all offences in Coventry in 2021/22 were Common Assault and Battery (accounted for 11.6%), Assault Occasioning Actual Bodily Harm (ABH) (6.0%) and Harassment (5.5%).

There has been a reduction in First-time entrants to Youth Justice System. Coventry has seen more of a marked decline compared to the current family group and national comparators. This has given the opportunity for the Service to have an earlier offer to children at risk of entering the youth justice system. The first-time entrants to youth justice system (rate per 100,000 young people aged 10-17) has reduced to 112 in 2021/22 from 230 in 2020/21.

What else is happening in the city? What else can be done?

Nationally, there is a focus on implementing a ‘public health approach’ to tackling violent crime. A ‘public health approach’ treats violence like an infectious disease. It suggests that policymakers should use scientific evidence to identify what causes violence and find interventions that work to prevent it from spreading. A ‘public health’ approach involves multiple public and social services working together to implement early interventions to prevent people from becoming involved in violent crime.

The police have a key role in the Coventry Serious Violence Reduction Partnership. Several key interventions aimed at reducing risks relating to serious violence involve the police as a key partner. The Community Initiative to Reduce Violence is designed to engage individuals and provide them with an exit pathway from gangs, violence, and county lines. Police are partners in Early Help services, Youth Justice Diversion, Horizons, and the Edge of Care Team.

There have been many interventions implemented by the youth justice service, for example the “Through Our Eyes initiative”. Through Our Eyes started in 2021/22, a quarterly feedback group led by a local charity, Guiding Young Minds, and the local Youth Commissioner. These sessions see children open to Coventry Youth Justice System give feedback on their experiences, self-assess the service, and discuss issues individually/collectively to improve the Service. The sessions are facilitated externally to encourage and facilitate more honest feedback.

The Council has been working with West Midlands Police as part of an effort to tackle crime and anti-social behaviour in the Coventry area. An initiative led by West Midlands Police, Operation Advance as part of their commitment to working even more closely with communities, following the introduction of a new local policing model in 2023. During Operation Advance there were community clean-ups, knife sweeps, e-bike education, work with beggars and nighttime economy checks on pubs, clubs and hotels in the city where the Ask Angela Scheme is being highlighted to offer a way of supporting customers who feel vulnerable and who can discreetly ask for help. Elsewhere the Council has also been working in the St Michaels area of the city to cut back trees and shrubs to make it lighter and shrub beds have been planted with new colourful plants, and to work with residents to continue to improve our services.

Health and wellbeing

Life expectancy

Why is this important?

Life expectancy and healthy life expectancy are extremely important summary measures of overall health. The Marmot Review, Fair Society, Healthy Lives, demonstrates clear and significant links between avoidable differences in health outcomes and deprivation, where people experiencing multiple deprivation not only living shorter lives, but spend a greater portion of their shorter lives with a disability or in poor health. As a Marmot city, Coventry has adopted and embedded the principles of Marmot, tackling the social conditions that can lead to health inequalities, and working to improve the areas in which people are born, grow, live, work and age.

What is the local picture? How does it compare?

Overall health in the city is below average, life expectancy has remained below the regional and national averages. Life Expectancy has decreased in the most recent data, this in part could be due to the inclusion of COVID 19 data. Life expectancy is a statistic giving a high-level picture of the health of Coventry residents and should be used with care in understanding likely life spans for people; excess deaths due to the COVID-19 pandemic will have a negative impact on life expectancy statistics but this may not have a permanent impact. Whilst this data includes 2020 and the pandemic will have undoubtedly affected mortality statistics, life expectancy increases had already stalled before 2020.

Life expectancy for females in Coventry is 82.0 years and for males is 78.0 from 2018 to 2020. This is below the national average of 83.1 for women and 79.4 for men.

Healthy life expectancy, which is the number of years a person can expect to live in good health, is at 64.0 years for females and 61.1 for males. 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.

The gap between healthy life expectancy and life expectancy is referred to as the ‘window of need’. It is the average number of years that a person can expect to live with poor health, during which they will be likely to need support from the health and care system.

In Coventry, females can expect to live almost a quarter of their lives in poor health (18 years) whilst males can expect to live 16.9 years in poor health. However, this difference has narrowed slightly in recent years with the window of need for women reducing marginally.

There are significant health inequalities across Coventry’s neighbourhoods that affect certain communities disproportionately. Males living in less deprived areas of the city can, on average live up to 10.7 years longer than those living in the most deprived areas of Coventry; and for females the gap is 7.8 years. This is not too dissimilar to regional averages of 7.9 years for women and 9.7 for men. The extent of inequality for Coventry men is the second worst of all West Midlands districts. People in more deprived parts of the city not only live shorter lives, but also spend a greater proportion of their shorter lives in poor health compared to those living in less deprived parts of the city.

Premature mortality (deaths amongst residents aged under 75 years) is higher than the national average for both males and females. The premature mortality rate by causes considered preventable is higher than both national and regional averages. Premature mortality is defined as deaths from causes considered avoidable, treatable, or preventable given timely and effective healthcare or public health interventions. Coventry’s premature mortality rates by all causes and causes considered preventable for both males and females rank slightly better than average compared to Coventry’s near neighbours.

GP patient register data gives estimates of the prevalence of a number of key health conditions amongst Coventry’s population. Many of the estimates are for all ages and we should be mindful that prevalence of certain diseases is heavily influence by age and age structure of populations. This means simply comparing these headline prevalence rates with national averages is not insightful. Also, recorded prevalence is influenced by diagnosis rates. In 2021/22 7.1% of Coventry patients aged 17+ were recorded as having Diabetes. This amounts to 24,627 people and has been on increasing trend for many years, as it has nationally, in Coventry from 5.7% (16,514) in 2010/11. 4.3% of Coventry patients aged 18+ were recorded as having CKD (Chronic Kidney Disease), this amounts to 14,648 people. 2.1% of Coventry patients of all ages have Coronary Heart Disease and 12.0% have Hypertension (high blood pressure). 1.5% of Coventry patients of all ages have COPD (Chronic Obstructive Pulmonary Disease).

What else is happening in the city? What else can be done?

Preventable deaths can be avoided by addressing the social conditions that lead to poor health, such as people’s prospects and opportunities; housing and environment; as well as behavioural and lifestyle changes. These are explored throughout this JSNA.

Health protection

Why is this important?

Health Protection is a term used to cover a set of activities within public health. It is defined as protecting individual, groups, and populations from single cases of infectious disease, incidents and outbreaks, and non-infectious environmental hazards such as chemicals and radiation. Monitoring health protection coverage helps to identify possible drops in immunity before levels of disease rise.

What is the local picture? How does it compare?

The unprecedented COVID-19 pandemic fundamentally changed all our lives and had impacts on a global scale. Not only did it have direct health impacts, but it also had many indirect and varied impacts on several aspects of life. From 23 February 2020 to 30 April 2023, there were out of a total of 123,095 cases amongst Coventry residents, where an individual tested positive and officially reported the result, and 20,795,205 across England overall. Using Census 2021 population data to calculate the rate of Coventry cases per 100,000 population it is 35,856.39 compared to 36,781.97 nationally. These official cases do not represent all cases of course, not all people who had COVID-19 in this period will have taken and a test or reported its result and some people were asymptomatic so were unaware they had the virus. Therefore, these figures do not count total prevalence and make it difficult to conclude from differing case rates, it may be a result of different testing and reporting rates.

The Office for National Statistics (ONS) conducted a COVID-19 infection survey with the purpose of measuring total prevalence and its change over time; the highest national prevalence was the estimate for the week ending 2nd April 2022 with 7.6% of all people having COVID-19 at that time; in Coventry the peak was at 8.1% in the week ending 19th March 2022, equating to 27,800 Coventry residents with COVID-19 at that time. It may have been higher in the early weeks and months, but we are unable to make any conclusions as this survey did not start until May 2020, however ‘national lockdowns’, the first of which began on 26th March 2020, will have suppressed transmission and therefore prevalence of the disease.

By the time of the peak in cases in Spring 2022, when no restrictions were in place, the vaccination programme was well established and the number of patients seriously ill in mechanical ventilation beds at University Hospitals Coventry and Warwickshire (UHCW) and deaths due to COVID-19 were at relatively low levels, indicating the successful protection provided by vaccinations. The number of cases has fallen to much lower levels since then, but not to zero, the last ONS infection survey measure for the week ending 13th March 2023 estimated prevalence at 2.7%.

COVID-19 caused severe illness and deaths and put a pressure on the health system. A total of 9,246 COVID-19 patients have been admitted to UHCW up to end of April 2023. This hit its highest point at the peak of the winter wave in January 2021, when 286 beds at UHCW were occupied by COVID-19 patients, and 43 COVID-19 patients were occupying mechanical ventilation beds. Up to the end of March 2023 a total of 1,025 Coventry residents died where COVID-19 was named as a cause on the death certificate, this is out of a total 9,909 deaths in that time. Therefore, COVID deaths have made up 1 in every 10 (10.3%) deaths between 2020 and March 2023. In 2020 and 2021 COVID deaths made up 1 in every 8 (12.8%) of all deaths, 796 out of 6,225. Data from the Care Quality Commission suggests at least 200 care home residents in Coventry died due to COVID-19.

Deaths rates for COVID-19 are higher in older people. To compare overall death rates, we calculate age standardised COVID-19 mortality rates. Coventry’s 2020 rate was 130.25 per 100,000 population compared to 126.57 for England overall, and in 2021 Coventry’s rate was 129.40 compared to 116.69 for England. Therefore, after adjusting for Coventry’s younger population, death rates due to COVID-19 were higher in Coventry than the national average. We know death rates are higher amongst people living in more deprived areas, this may explain Coventry’s higher rate. Coventry’s COVID-19 age-standardised mortality rate per 100,000 population is not especially high compared to other areas in the West Midlands metropolitan area, ranking 5th highest out of 7 – rates in Walsall, Birmingham, Wolverhampton and Sandwell were notably higher, between 176 and 205 in 2021.

Many people experience ongoing symptoms of COVID-19 for a prolonged period, and many of these will need to access health services. People whose symptoms, covering a wide range, continue for more than 12 weeks are said to have post-COVID-19 syndrome or ‘long COVID’. The Office for National Statistics (ONS) estimates the prevalence of self-reported long COVID at 2.92% of all people living in private households in March 2023, this would equate to 9,700 Coventry residents suffering with long Covid at that time.

Coventry delivered hundreds of thousands of COVID-19 vaccines that protected many from severe illness or death and protected the health service. However, many remain unvaccinated. At the end of April 2023, 253,947 Coventry residents had received their 1st dose of the COVID-19 vaccine, an uptake of 69.3% of residents aged 12+, lower than England at 77.9%. 236,022 have received their 2nd dose, an uptake of 64.4% lower than England at 74.4%, and 176,528 had received dose 3 or a booster. These uptake rates may be underreported due to the population data used by the NHS, but still Coventry’s uptake is lower than England’s. There is a strong link with deprivation, with increasingly lower rates of vaccine coverage in areas of higher deprivation, and ethnic minority groups have lower rates in Coventry. There is a double impact, the harm from COVID-19 itself has been unequally distributed across the population. Also, 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.

The pandemic had many impacts, not all directly on residents’ physical health. The restrictions due to the pandemic and the lockdowns, may have had an impact on different aspects of health, not least mental health. The ONS conduct an annual survey where they ask people about their personal wellbeing, it indicates increased levels of anxiety amongst Coventry’s population during the pandemic. The % who gave a score indicating high levels of anxiety increased from 20.6% in 2019/20 to 26.9% in 2020/21.

Responses to questions in the Coventry Household Survey 2022 also indicates 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. This is not relatively high; the West Midlands rate is 13.3% and it is 12.7% for England overall. 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.

Childhood vaccination take up rates in Coventry are relatively low and have decreased. The Health Index for England developed by the Office for National Statistics (ONS) brings together 56 statistics that measures broad range of aspects of health, and we can compare Coventry’s level and progress overall and for each measure against England’s. It is a good tool for understanding which health aspects Coventry has the biggest challenges with– rates of childhood vaccination are highlighted as the city’s worst performing aspect. With 100 denoting the England level in 2015, Coventry’s Health Index Score for child immunisations declined in 2020 to a low level (79.4) compared to 2019 (94.8).

Many of the uptake rates continued to deteriorate into 2021/22. Uptake rates in Coventry are below the 95% threshold for several different childhood vaccinations. The rates are lower than the national and regional averages and often lower than average compared to similar areas. Three examples are: DTaP/IPV/Hib for one-year-olds at 90.3%, a vaccination offered to babies to protect them against five serious childhood diseases; the rotavirus vaccine at 88.5%, which protects against gastroenteritis; and MMR for 2-year-olds has an uptake rate of 88.5%. However, some rank slightly better including HPV vaccine dose 1 for 12- to 13-year-olds and Meningococcal ACWY Conjugate for 14 to 15-year-olds vaccines.

The coverage of screening for cancers such as breast cancer, cervical cancer, and bowel cancer across at- risk populations are below the national average, moreover Coventry performs worse than similar areas with screening rates relatively low compared to the city’s’ CIPFA statistical neighbour’ areas.

Coventry has high rates for some communicable diseases; the COVID-19 pandemic may have also led to delayed diagnosis and initiation of treatment. The incidence of Tuberculosis (TB) in Coventry, at 15.8 new cases per 100,000 population in 2019-21, remains notably higher than national and regional averages, but is decreasing. However, nationally it is estimated that the COVID-19 pandemic will have led to delayed diagnosis and initiation of treatment which may contribute to increased morbidity, mortality, and disease transmission. There are some local populations with higher rates of TB, for example, some of the city’s newly arrived communities from countries with high rates of TB, as well as vulnerable groups facing severe and multiple disadvantages including rough sleepers, people who misuse drugs and sex workers. HIV remains an important public health concern in Coventry, there are a larger number of HIV diagnoses in males. In 2020, the diagnosed HIV prevalence rate in Coventry was 3.10 per 1,000 population age 15-59 years, which is higher than the 2.31 in England. Coventry has the 4th highest rate in the 16 similar local authorities. In Coventry between 2018 and 2020, 46.5% all HIV diagnoses were made at a late stage of infection compared to 42.4% in England.

There is some indication that sexual health is an issue in Coventry, with higher rates of Sexually Transmitted Infections (STIs) than national and statistical neighbours. For Coventry the indicator new sexual transmitted infections (STI) diagnoses per 100,000 decreased in 2020 and 2021 but was still at a higher rate than the West Midland and England averages. The highest rates of STI diagnoses most commonly occur within areas of Coventry where the city’s two Universities are located in the city centre and Gibbet Hill area. Higher-than-average rates are recorded in areas of greater deprivation in the city’s north eastern ‘corridor’, the south east and the Canley / Tile Hill areas.

Teenage conception rates are still higher than the national average but have fallen significantly. In Coventry in 2021, there were 18.6 conceptions per 1,000 people under the age of 18. This is higher than England’s 13.1 and the West Midlands’ 15.2. However, this is an improvement from 25.8 in 2019 and a significant improvement since a peak of 68.1 in Coventry vs 43.2 for the West Midlands and 39.7 for England in 2008.

Ensuring communities understand and trust public health messages, and that they are accessible and culturally appropriate is vital. 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. During the pandemic the Community Resilience Team created 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 several videos.

Community members now have a platform and a chance to participate directly in shaping how the council and communities engage with each other. This helps to facilitate a community-led response to communications and messaging surrounding several topics.

There is increasing recognition of the key role that places and communities play in our health. C groups are best placed to address health challenges, because they are trusted and have the networks understanding and legitimacy to do so. Health and care providers need to shift to an ‘enabling’ leadership style, supporting communities to maintain their health and well being by pooling engagement resources and helping to build capacity by sharing skills and facilities with the communities we serve. The One Coventry Plan is designed to work with our communities to ensure that they are able to address their health needs and to reduce inequalities.

Since 2021, Coventry was successfully awarded funding 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.

A community-informed and culturally competent approach to healthcare is essential to increasing screening and vaccination rates. Asylum seekers and refugees typically have worse health than the wider migrant and UK-born population. During migration they are vulnerable to environmental threats – e.g., trafficking, and sexual exploitation – and may have experienced gender-based violence – e.g., torture, sexual violence, FGM, and conflict - that lead to health problems. They, and other newly arrived communities, can also spend long periods of their journey with limited access to healthcare which presents challenges in the form of poorly-managed long-term conditions – e.g., diabetes, and hypertension – and untreated communicable diseases such as TB, HIV and STIs. Newly arrived communities are at increased risk of poor mental health too potentially suffering with anxiety, PTSD, and depression. Therefore, newly arrived communities need healthcare on arrival and information and guidance about the NHS, what services are available, and about their health care rights. The impact of language and cultural barriers cannot be understated so services should be culturally appropriate, and trauma-informed.

Building on existing health and wellbeing infrastructures having a collaborative partnership approach, bringing together residents’ experience and partners’ skills and assets, should be taken to strengthen health and wellbeing in communities. An example of this is Vaccinating Coventry – a partnership group with membership from a range of council teams 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 minority ethnic 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.

The Integrated Care System has an opportunity to improve population health and wellbeing in its broadest sense, with a wide range of partners working together to improve health outcomes and tackle health inequalities, starting with the root causes by addressing the wider determinants of health. The development and implementation of the Integrated Care Strategy sees the importance of working together at all levels and as locally as possible. Much of the activity to integrate care and improve population health will be driven by organisations working together in places, and through multi-disciplinary teams working together in neighbourhoods, adopting new targeted and proactive approaches to service delivery, informed by a shared understanding of the needs of our population. The ICS brings together a wide range of partners – local government, NHS, voluntary and community sector, housing, Healthwatch, universities and others, to lead the system’s activity on population health and wellbeing and drive the strategic direction and plans for integration across Coventry and Warwickshire.

Demand and access

Why is this important?

The demand for health and care services is expected to increase as the city’s population grows and ages. To manage this growth there is a need to shift the emphasis to proactive and preventative care. This means ensuring people have better general health regardless of where they live, requiring fewer visits to hospital and shorter stays if they need inpatient care; and remodelling urgent and emergency and planned care so that it can cater to the expected increase in demand.

What is the local picture? How does it compare?

Coventry has good access to health services, with most residents being able to reach a pharmacy within a few minutes. Over 95% of Coventry residents could reach a GP or pharmacy within 10 minutes by public transport in 2020 (data on recently reduced bus services is not available yet.) 51 of 97 pharmacies in Coventry are currently listed as being open on a Saturday. This is particularly important as many community pharmacies are often located in deprived areas with high population density and inflexible work patterns. This means that they are an important first point of contact for patients seeking ad-hoc health advice alongside picking up regular prescribed medicines or purchasing over the counter medicines. Nonetheless, physical proximity is not the only metric for physical access. Pavements and pathways in the wider areas around healthcare facilities can be inconsistent with regards to accessibility for people with low mobility, mobility scooters, and prams. There are also challenges for the severely deprived or even homeless to access healthcare due to no provisions to accommodate their pet or an unwelcoming atmosphere in the waiting area.

We can understand satisfaction with GPs in Coventry by examining responses to the national GP patient survey by Coventry patients annually between 2019 and 2023. It shows reducing satisfaction levels amongst Coventry GP patients in the last two recent years, most notably between 2021 and 2022. The pandemic didn’t appear to have an impact on overall satisfaction levels with responses to three key questions not changing significantly between 2019, 2020 and 2021 but satisfaction has deteriorated since. When asked ‘Overall, how would you describe your experience of your GP practice?’, 71% of Coventry respondents in 2023 said good or very good, the same as England overall – but down from 81% in 2019 and 83% in 2021.

When asked ‘Generally, how easy is it to get through to someone at your GP practice on the phone?’, 59% of Coventry respondents in 2023 said easy or very easy, better than 50% for England overall – but down from 70% in 2019 and 73% in 2021.

When asked ‘How satisfied are you with the general practice appointment times that are available to you?’, 58% of Coventry respondents said satisfied or very satisfied, better than 53% for England overall – but down from 65% in 2019 and 69% in 2021. While satisfaction is reducing, as it is across England overall, this data does indicate that access to GPs, in terms of getting through to the surgery by phone and getting the appointments patients want, is better than the national average in Coventry.

In the winter of 2022/23, the NHS was facing significant challenges, with waiting lists and waiting times in A&E and for Ambulances high. There are indications that it is worse than average in Coventry. We can examine snapshots of three statistics, published by the BBC, to get a flavour of how the local hospital trust, University Hospitals Coventry & Warwickshire (UHCW), is doing and if the pressures were better or worse. For UHCW Trust in the week beginning 16th January 2023 29% of Ambulances were waiting 30 minutes or more to hand over their patients to A&E, compared to 20% for England overall and to 12% in the equivalent week in 2020. For UHCW Trust for the month of December 2022, 42% of patients were waiting longer than the target time of four hours in A&E, compared to 40% for England overall and to 23% in December 2019. For UHCW Trust for the month of December 2022, 49% of patients were waiting longer than the target time of 18 weeks for routine treatments, compared to 42% for England overall and to 18% in December 2019.

The impact of the pandemic means that performance reports show there are less people satisfied with social care. This is most likely because of the restricted way we have had to operate during periods of the pandemic. Understanding more about customer experience and how this can improve is increasingly important.

The delivery of Adult Social Care in Coventry focuses on approaches that promote well-being and independence to prevent, reduce or delay the need for long-term support and to enable people to achieve their outcomes. In performance terms, this means that we would expect to see a relatively smaller number of people in receipt of ongoing social care, and where ongoing social care is required that this is mainly provided in people’s own homes. We would also expect that the short-term services we have in place to enable people to be independent are successful in reducing demand for ongoing Adult Social Care.

In comparison to other local authorities, Coventry continues to have low rates of new requests for Adult Social Care but has seen an increase in requests for support. In 2022 there were 11,316 new requests for support (an increase of 14% on 2021's figure of 9,902). 6.5% of requests resulted in a long-term service (an increase on last year's 5%) however there was a reduction in those that received low level support in 2022 (18%) compared to 34% in 2021.

Coventry has a higher rate of safeguarding concerns per 100,000 population in 2021/22 (1962) compared to 2020/21 for England (1121) and West Midlands (1038). Coventry has a comparable number of enquiries started in 2021/22 (301) with England (343) and West Midlands (217) rates per population. The high number of concerns stated compared to England and West Midlands has meant that Coventry’s conversion rate (15%) is lower than England (34%) but comparable to the median West Midlands conversion rate (15%).

Responses to the Census 2021 indicate that 27,400 Coventry residents provide some level of unpaid care, this amounts to 1 in every 12 (8.5%) residents aged five and over. This is made up of 4.0% providing up to 19 hours or care per week, 1.9% providing 20-49 hours per work and 2.6% providing 50 or more hours per week. Over the 10 years since the previous census in 2011 the number providing unpaid care has fallen a little (after accounting for changing age structure of the population) – particularly due to the proportion providing less than 20 hours of care falling from 6.1% to 4.0%, the proportion providing more than 20 hours increased, from 4.0% to 4.5%.

What is happening in the city? What else can be done?

Improvements can be made to fairer, more inclusive access to services for people. Physical proximity is not the only metric for physical access to pharmacies and services. Pavements and pathways in the wider areas around healthcare facilities can be inconsistent with regards to accessibility for people with low mobility, mobility scooters, and prams.

Improving people’s awareness of support groups and available activities can be a more efficient and effective way to help them meet their health needs. However, these groups need support to build their capacity and to ensure their sustainability. The city has a range of peer support groups, where people use their own experiences to help each other. Coventry’s Adult Social Care and Communities Directory gathers information and advice in one central place so that information can be accessed easily and quickly.

Digital inclusion the move of services from face-to-face and telephone based to online services has caused significant concern to many residents, particularly those who are not used to using digital services or do not have regular access to the internet. COVID-19 significantly increased trends for online and remote primary healthcare, specifically the NHS 111 service and remote GP appointments. This increased access for some sections of society; however, it did not preclude a significant reduction in overall access to primary healthcare during and after the pandemic. There is significant scope to improve digital access to healthcare, and awareness of digital access options for healthcare. Nonetheless, physical health cannot be supported with online services only. Therefore, a balanced approach to providing access to primary healthcare using digital access where beneficial, plus physical access vis both GPs and pharmacies is preferred.

Access to services, particularly booking an appointment with a GP practice is of importance and concern to residents. Engagement undertaken by Coventry and Warwickshire Integrated Care Partnership (ICP) found that access to services particularly booking an appointment with GP practice, receptionists becoming a barrier to accessing services, difficulties in face-to-face appointments and ordering prescriptions and dentistry was problematic. Public perception of services also plays a large part, with several respondents expressing concern that services will not be able to cope with them if they were to
attempt access, meaning they were choosing to not even try to make contact to get support.

Additional support services for 16/17-year-olds transitioning into adult services is also a concern due to the lengthy waiting times to support this age group. Once referred to mental health services they receive their initial assessment, however they then usually have a long wait to commence therapy.

Although Kooth and other online facilities are available and very supportive, this still isolates them from the direct contact and intervention they require.

Lifestyles

Why is this important?

Individual behaviours, such as eating enough fruits and vegetables, smoking, alcohol consumption, and physical activity can affect health. These lifestyle behaviours are strongly influenced by the environment in which people live. For example, people living in a ‘food desert’, with limited access to affordable and healthy food, are more likely to eat unhealthily; an unsafe environment is likely to discourage people from walking or cycling; and social and cultural influences, including friendship groups, advertising and media, play an important role in determining people’s lifestyles.

These lifestyle risk factors – poor diet, physical inactivity, excessive alcohol consumption and smoking – are all linked to ill health and premature death. Having a combination of the risk factors contributes to greater ill health. People facing poorer social circumstances are more at risk of having multiple risk factors, exacerbating avoidable differences in health.

What is the local picture? How does it compare?

Seven in ten Coventry residents (71%) consider that their general health is either very good (29%) or good (42%) and the proportion rating their health as bad has decreased. Compared to the 2021 Household survey, the proportion who rated their health as good (either very good or good) has decreased marginally from 73% to 71% in 2022.

Under one in ten (7%) consider it to be bad, which leaves just over a fifth (22%) of residents who consider their general health to be fair. The proportion rating their health as bad has decreased from 8% in 2021 to 7% but is 6% more than the 1% recorded in 2018. As may be expected, younger residents, namely those aged under 35 (79%) or 35-44 (81%) are significantly more likely than the survey average to say they have good general health, whereas those aged 55-64 (64%) or 65+ (47%) are significantly less likely to feel they have good health.

Whilst smoking rates continue to fall, those living in a very deprived area (IMD Decile 1) are much more likely to smoke. Between one-in-nine and one-in-seven adult Coventry residents are current smokers, using two different data sources – but both sources show smoking prevalence to be falling.

The local Coventry Household Survey 2022 asked residents and 11% said they currently smoke cigarettes down from 12% in 2021 and 18% in 2018. The other data source, the national Annual Population Survey (APS) for 2021 estimates smoking prevalence in adults in Coventry at 13.7%, not significantly different to the overall rates for the West Midlands region at 13.8% and for England overall at 13.0%. This has been on a generally reducing trend from 18.8% in 2013; although there was a blip in 2020 when smoking prevalence appeared to increase to 17.1%, maybe related to the pandemic, before falling again in 2021.

In the 2022 Coventry Household Survey, 7% said they use e-cigarettes, on the increase from 2021 (4%) and 2018 usage (5%).

The estimated number of deaths in Coventry that are attributable to smoking has remained relatively high however, it may take some time for this to fall. The latest smoking attributable mortality rate per 100,000 for Coventry was 234.7 for 2017-19, contributing to an estimated 1,112 death over those three years. This is significantly worse than the England average of 202.2 and the West Midlands average of 203.8.

The consumption of alcohol overall in Coventry, at population level, appears not to be disproportionately high compared to other places, however hospital admissions for alcohol related conditions in Coventry is significantly worse compared to England. This may be related to the city’s demographics. The last time data was collected that allows some tentative comparison, in the Health Survey for England for 2015 to 2018, 29% (+/-6% points) of Coventry respondents said they don’t drink compared to 16% for England overall and 21% (+/-5 points) said they drank more than 14 units of alcohol a week compared to 23% for England overall. The Coventry Household Survey asks residents about drinking habits; while responses indicate a small increase in alcohol consumption at population level between 2018 to 2022, changes are not large. In 2022, 34% of

respondents said they don’t drink alcohol, compared to 42% in 2018. Of those that do drink alcohol, in 2022, 25% said they drink more than 2-3 units on 2 or more days per week compared to 26% in 2018. Due to sample sizes of the survey, small changes do not imply real change at population level.

Alcohol is causing disproportionate harm to health in Coventry. Hospital admissions for alcohol-related conditions in 2020/21 shows Coventry’s rate of 649 per 100,000 is significantly worse than the England average rate of 494 and the West Midland average rate of 564. Coventry’s rate is also higher than average compared to its statistical neighbour areas. Rates of deaths related to alcohol are also higher than average; in 2021 the ‘alcohol specific mortality’ rate was 19.4 per 100,000 compared to the West Midlands 15.8 at and England at 13.9. Alcohol-related hospital admission and deaths are much higher amongst men in Coventry, they make over two-thirds of the admissions and deaths. Moreover, the problem is relatively bigger amongst Coventry males with rates higher than the national average for males whereas admission and mortality rates amongst females are not significantly higher than their counterparts elsewhere, on average.

The importance of eating healthy food remains well recognised by the majority of residents and being able to cook from scratch every night is becoming more challenging for some, both due to time pressures and by not having everything needed in their kitchen to do so. Just over a fifth (22%) of residents surveyed said they eat at least 5 portions of fruit or vegetables a day. Nearly two-thirds (62%) of residents surveyed said they eat at least 3 portions.

In 2022 survey residents were provided with a series of statements relating to eating habits. The responses give a few insights: the importance of eating healthy food remains well recognised by the majority of residents (93%); being able to cook from scratch every night is becoming more challenging for some, both due to time pressures and by not having everything needed in their kitchen to do so (although a majority of 81% still state that they have what is needed) and the proportion who stated that price is the most important factor when buying food has significantly increased to 64% compared to 57% in 2021, a potential impact of the cost-of-living crisis. 29% said they eat takeaways at least once a week.

Levels of physical activity in Coventry are still relatively low compared to the West Midlands and England. Responses to the Active Lives Survey in 2020/21 gives an estimate that 59% of adults in Coventry take part in 150 minutes of moderate intensity activity per week, which is the level amount of physical activity recommended by the chief medical officer. This is significantly lower than the West Midlands (63%) and England (66%) averages, and lower than average amongst similar areas. Activity levels fell during the pandemic nationally and Coventry was no exception, this explains the drop in 2020/21; while activity rates in Coventry have remained lower than national averages, the data indicates slowly increasing rates in recent years until the pandemic year of 2020/21. National data indicates that activity levels were falling before the pandemic hit, among young people aged 16-34, the pandemic accelerated this. The drop in Coventry’s rate in 2021/22 may have been influenced by having a relatively young population.

At reception, Coventry’s obesity rate is similar to the England average; but by year 6, the city’s obesity rate is higher than the England average. 1 in 5 reception year (aged 4-5) Coventry children were measured as overweight in 2021/22, doubling to 2 in 5 children in year 6 (aged 10-11). There is a clear link with deprivation at age 4-5 and age 10-11 with successively higher rates of obesity in areas of higher levels of multiple deprivation. The general trend over the last seven years is of increasing proportions of 10-11 years being overweight or obese. The chart shows that in 2021/22, 41.1% of Coventry children in year 6 were measured as overweight or obese. Amongst reception year children aged 4-5 the prevalence is 22.0%, so weight problems increase as children get older. The prevalence of obesity amongst Coventry children, the higher weight threshold (BMI in the highest 5% of the reference population from 1990), is 10.4% in reception year and 26.7% is year 6.

The proportion who are overweight or obese is higher amongst adults, an estimate of 68% of Coventry adults are overweight and this has been on an increasing trend in recent years, and 26% are obese.

The Health Index created by the Office for National Statistics allows us to compare Coventry in Lifestyles to England overall and to see how Coventry has made progress in the years before the pandemic compared to England. The index includes 3 domains Healthy People: Healthy Lives and Healthy Places. The Healthy Lives domain includes the behavioural risk subdomain which is built on seven lifestyle indicators: smoking; sexually transmitted infections; sedentary behaviour; physical activity; drug misuse and alcohol misuse. The index shows overall that Coventry’s health in this area is worse than the England average for 2015 – 2020. However, there are a couple of indicators, drug misuse and smoking, where Coventry is performing better than the England average in 2015.

What is happening in the city? What else can be done?

To address health inequalities and establish an environment that promotes and preserves good health, it is important to acknowledge that lifestyle factors are rooted in socioeconomic conditions. Therefore, a citywide integrated working approach is needed. This could include addressing limited access to affordable food by improving public transport connections to and from places where people can find reasonably priced and nourishing food; lowering risky behaviours by changing social norms and connecting people to peer support groups, such as encouraging them to use health check services, sexual health check services, stop smoking services and improving their access to drop-in sessions for psychological therapy and child clinics in the neighbourhood.

There is a raft of both national and locally based initiatives, strategies, policies, plans and partnerships taking effect at pace to encourage healthy lifestyles and providing opportunities for organisations to work closer together to better meet the needs of Coventry residents. This could also include creating integrated strategies that combine air quality improvements, active travel plans, investment in transportation infrastructure, and physical activity promotion.

One of the priorities for the Integrated Care Strategy is to prioritise prevention and improve future health outcomes through tackling health inequalities. Prevention will be embedded and resourced across all plans, policies, and strategies for the population, supporting a reduction in inequalities and improvement in health and wellbeing outcomes. This includes addressing the impact of the wider determinants of health across the life course, ensuring residents live in affordable and good quality homes, have access to good jobs, feel safe and connected to their communities, utilize green space, and are enabled to use active travel. The strategy aims to deliver a whole system, all-age, person-centred approach to mental health and wellbeing, that is driven by access to physical and mental health and social care in the same place at the same time, with no wrong door, and where prevention is at the heart of it.

Priorities around improving access to parks and green spaces, reducing loneliness and social isolation, hyper-local community interventions showcasing services to improve health and wellbeing have been identified to support and promote communities’ health and lifestyles. Areas of deprivation have had funding through Sport England's Priority Place project to support local activities and improve physical activity levels. The Council is working with school nurses and health visitors to support children and families around healthy eating, being active and wellbeing, including supporting healthy behaviours alongside the buggy workout programme for new mums. Coventry’s Family Health and Lifestyle service is participating in a study with Newcastle University to test a series of different interventions with parents following on from a child’s participation in the national child management programme. This study is due to end in 2023.

The Be Active Be Healthy Service promotes healthy nutrition and physical activity to families across Coventry. The Be Active Be Healthy (BABH) team deliver a range of healthy lifestyle and exercise programmes designed to reduce the risk of obesity among children by supporting families to reduce weight, increase physical activity and adopt healthier long-term behaviours. The team works closely with schools and early years settings to promote a healthy food environment and to maximise opportunity for physical activity.

Conclusions

Demographics and community

Harnessing the city’s growth and diversity

• The city must be prepared for a growing, changing and increasingly diverse population. Due to uncertainty in understanding future population growth, a deeper analysis of Coventry demographics and its population estimates, and projection may be useful. With the anticipated growth in older people, there is a need to focus on preventative health amongst the working age population.
• Some areas are more diverse than others with population growth concentrated in certain parts of the city, which should be a consideration when reviewing service provision.
• Utilising community assets to help address specific needs and present opportunities for local residents to actively get involved.
• Grassroots organisations promote community cohesion and could achieve greater success with additional funding for expanding their capabilities and exchanging knowledge.
• The public sector has a responsibility to change how it works with community groups across and between sectors. There is appetite across local and voluntary organisations for more joined-up working to improve awareness and communication of the activities and networks available in the city.
• Partners across Coventry must consider appropriate messaging to address local anxieties, stakeholder groups are essential in addressing issues in specific neighbourhoods.
• It is important for Coventry to deliver effective integration support to newly arrived communities to provide a solid foundation for newcomers to rebuild their lives, and subsequently become socially and economically independent.

Prospects

Helping people to access opportunities and thrive

• Giving every child the best start in life is crucial for securing health and reducing health inequalities across the life course. Therefore, investment in effective early help has a positive impact on the lives of children and young people and is a high priority. This can be aided by strengthening the availability and accessibility of general information and advice to parents.
• Schools and colleges play a pivotal role in raising the aspirations of young people and can continue to raise aspirations by improving awareness of the significant and growing opportunities in highly paid jobs available in the city, which require people with the right skills and qualifications.
• It's important that residents aren’t left behind in being able to access digital opportunities.
• Community assets are crucial to health through the opportunities and services they provide and indirectly, through a sense of empowerment and control.

Environment

Connected, safe and sustainable communities

• There is opportunity to work with communities to protect and improve existing green space and create new ones in areas most in need, and to implement nature-based interventions for health, such as green walking or green social prescribing.
• Initiatives to tackle climate change present opportunities for public services, and the private and third sector to work closer together to bolster community resilience and address inequalities in the wider environmental determinants of health.
• A more detailed understanding of local needs should be developed through the place-based JSNA profiles, to address pockets of dissatisfaction with local neighbourhoods, and issues such as access and affordability of housing and local air quality.
• A joined-up approach is essential for tackling the city’s homelessness and rough sleeping problem, recognising the intersection of severe and multiple disadvantages faced by people.
• Partners should look to provide more opportunities for people to shape services, including involving people with lived experiences.
• Green corridors form an important element of the landscape within Coventry, however there are some barriers to accessing these spaces that need to be addressed. Further work is required to address perceptions of anti-social behaviour, personal safety, dog fouling and access issues relating to volumes of traffic, busy roads and safety concerns for cyclists. Further investment is also required to improve the quality and facilities of some green spaces.

Health and wellbeing

Healthy and independent for longer

• As life expectancy is below average and health outcomes are worse in more deprived areas, a targeted approach of appropriate support to each group is essential to improve health and wellbeing for all groups.
• Further study may be useful to understand the impact of COVID-19 in Coventry and it differs from the national picture overall.
• A more detailed analysis of causes of death in Coventry, and their contribution to health inequality may be useful. As well as an analysis of the diseases and causes of ill health and disability.
• Ensuring communities understand and trust public health messages, and that they are accessible and culturally appropriate is vital.
• Building on existing health and wellbeing infrastructures having a collaborative partnership approach, bringing together residents’ experience and partners’ skills and assets, should be taken to strengthen health and wellbeing in communities.
• In line with the shift to focus on prevention, a community-informed and culturally competent approach is essential to increasing screening and vaccination rates.
• Digital Access adds another dimension to inequalities of access to healthcare and should be a consideration.