Coventry Joint Strategic Needs Assessment (JSNA)

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 on the finances of household 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.

Recommendations

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.
• Grassroot 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 heath 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.

Approach

Working together in our places and with our communities.

Health is determined by people’s social circumstances such as their communities, prospects and environment; and similarly, this approach to addressing and improving these circumstances must also be rooted in local people and communities. Growing this capacity in the communities require improving connectivity. This can be done by:

• distributing leadership – valuing the community leaders that are already working in this space as they have the trust, networks, understanding and legitimacy, and getting behind existing partnerships; 
• joining forces – getting the public sector to work together by pooling resources to build capacity and connections, investing resources to enable communities to maximise social action; 
• grassroots activities – making social action activities across the different sectors more visible; and 
• forging links – building links and generating connectivity by helping partners and communities share what they do, and helping them learn from, and build partnerships, with each other.