Prioritising prevention and wider determinants to protect the health and wellbeing of people and communities
What are our overall aims by 2028?
A system wide commitment to supporting prevention is embedded, recognising value for money in prevention and early intervention.
Prevention is the first step in every clinical pathway and opportunities for primary, secondary and tertiary prevention are maximised across all pathways.
Prevention is explicitly embedded and resourced across all plans, policies and strategies for our population. 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, utilise green space and are enabled to use active travel.
Resources are allocated to reflect our focus on prevention and the wider determinants of health – this will include a systematic shift in resources ‘upstream’ towards prevention, with Place based Health and Wellbeing Partnerships acting as the delivery vehicle for the wider determinants of health.
We work as a system to manage all aspects of health protection, taking appropriate measures to protect the most vulnerable.
What’s our starting point?
Our system Population Health Framework not only recognises the interplay between wider determinants of health, people’s health behaviours and lifestyles, the communities in which people live and the health and care system, but also demonstrates the shared commitment across partners in our system to work collaboratively to address all these vital dimensions of health.
Our Population Health, Inequalities and Prevention Board is responsible for developing and embedding the strategic approach to prevention across the system, as well as strategically aligning prevention, inequalities and PHM work. The Board will continue to play a central role in developing the local prevention agenda across the next five years.
Our Local Authorities – Coventry City, Warwickshire County and our local District and Borough Councils – have Health and Wellbeing Strategies in place that are rooted in the wider determinants of health, including a focus on connected, safe and sustainable communities and prevention of ill-health. The nature of wider determinants means that the scope of work being undertaken is broad and encompasses several workstreams.
What are some of the key links to other parts of the plan?
Through the national Quality and Outcomes Framework (QOF) delivered by local GP practices, existing pathways and Local Authority funded public health prevention services, prevention is already a fundamental part of health and care delivery to our population. This is reflected across this plan.
Population Health Management – embedding PHM will enable us to better understand health inequalities and target prevention initiatives to reduce them.
Health Inequalities – we will use the Core20PLUS5 methodology to ensure that prevention is prioritised in our more deprived communities.
Collaboration and Integration – Integrated Neighbourhood Teams will focus on supporting people to stay healthier for longer within their local communities through a focused and joined-up approach to prevention
Improving Access to Services - Mental Health and Children and Young People – our new Mental Health and Children and Young People Health and Wellbeing Strategies will focus strongly on prevention and early intervention.
What will we be focusing on in the next 2 years?
Updating the Coventry and Warwickshire Health Protection Strategy, setting out our partnership approach and key deliverables relating to identified priorities, including emergency planning, infection control, antimicrobial resistance, screening and immunisations and air quality, and incorporating learning from the Covid-19 pandemic.
Implementing the updated Health Protection Strategy through the Coventry and Warwickshire Health Protection Committee.
Working in close partnership with UK Health Security Agency colleagues to ensure a coordinated response to the above challenges, particularly emergencies and outbreaks.
Working in partnership through the Health Protection Strategy Group and Health and Wellbeing Boards to deliver the Coventry and Warwickshire Antimicrobial Resistance Strategy, including focusing on reducing inappropriate antimicrobial prescribing across primary and secondary care, with System Prescribing Leads playing key leadership roles.
Offering all people admitted to hospital who smoke NHS funded tobacco treatment services, including in adult inpatient and maternity settings, and long-term users of specialist mental health services. Aligning the offer with local community smoking cessation pathways and Place based provision.
Using national funding to employ an NHS Long Term Plan Prevention Project Lead. Working alongside the ICB Health Inequalities and PHM Teams, the Prevention Project Lead will play a vital role in embedding prevention across the system, including by leading on the implementation of the NHS England modifiable risk factor high impact actions relating to tobacco dependency, obesity and alcohol, and supporting the reestablishment of the Prevention Subgroup of the Population Health, Inequalities and Prevention Board.
Using data from our local Diabetes Prevention Programme as a test bed for Health Equity Assessment Tools, in turn supporting us to target prevention initiatives to reduce health inequalities.
Ongoing CVD prevention work in the north of Warwickshire to promote detection, diagnosis and optimal management of individuals with hypertension, Atrial Fibrillation (AF) and high cholesterol, and to increase the number of individuals being treated to target for hypertension, started on direct oral anticoagulants for AF and lipid lowering therapies (statins) for high cholesterol.
In Coventry, continuing to address the wider determinants of health, including the cost of living crisis and fuel poverty, through the Coventry Green Futures Programme and the ‘One Coventry approach’ aligned to the One Coventry Plan.
In Warwickshire, implementing the county-wide Homelessness Strategy, including supporting implementation of the health chapter, through joint working across health partners and local government.
In Warwickshire, implementing the Warwickshire Tackling Social Inequalities Strategy, including working with the charity Children North East to trial and embed a ‘poverty proofing’ approach across key services in the NHS and Local Government.
Building on learning from the approach taken in Warwickshire to integrate a ‘Health in All Policies’ approach as part of the County Council’s overall approach to strategy development, embedding a ‘Health in All Policies’ approach across the system, whereby organisations adopt policies that promote health and wellbeing and address social needs.
Maintaining effective coordination across relevant health and care partners through the Newly Arrived Communities Strategic Health Group to ensure migrant, refugee and asylum seeker populations receive appropriate physical healthcare, tailored mental health support and access to all services.
Working collaboratively to maximise vaccination uptake via a variety of campaigns, especially relating to patients with respiratory disease and childhood vaccines such as MMR (measles, mumps and rubella), and improving uptake across our Core20PLUS5 populations.
Continuing to deliver on Place priorities through the Place based Health and Wellbeing Partnerships.
Financial resource to focus on PHM architecture to better enable patient identification for secondary prevention.
Uncertainty around long-term funding to support NHS Long Term Plan prevention priorities, and need to shift financial resource to align to prevention and health inequalities.
Time lag of return on investment for prevention in a financially pressured environment.
Delivery and programme management workforce constraints; for example, embedding smoking cessation in NHS settings at a time of consistent and significant pressure on acute services
QOF does not recognise or reward good prevention in primary care specifically within post pandemic demands.
Obtaining robust and accurate data to support return on investment for prevention approaches.
Making best use of digital capability to enable prevention.
Clinical and care professional leadership voice should be reflected within prevention and secondary prevention plans.
Key Metrics and Deliverables
Deliver on Core20PLUS5 approach through CORE20PLUS5 workstreams reflected in the local Health Inequalities Strategic Plan – Health Inequalities Strategic Plan Maturity Matrix in development to provide a mechanism to self-assess and provide assurance on progress in delivering the Strategic Plan (see Health Inequalities section).
Deliver on objectives of the Health and Wellbeing Boards as detailed in the Health and Wellbeing Strategies.
Increase healthy life expectancy for everyone living in Coventry and Warwickshire.
Reduce the under 75 mortality rate from cardiovascular diseases.
Reduce the overall smoking prevalence in adults
Increase the percentage of patients aged between 25 and 84 years with a CVD risk score greater than 20 percent on lipid lowering therapies to 60%.