• Making Every Contact Count (MECC): There is online training available at Making Every Contact Count - eLearning for healthcare (e-lfh.org.uk).
• ‘Embedding Public Health into Clinical Services toolkit’ Embedding Public Health into Clinical Services - eLearning for healthcare (e-lfh.org.uk) eLearning module - designed to support clinical leaders and service managers to guide their teams through the process of re-designing services to include prevention. It uses a five-step process and provides practical tools and resources to help identify the unique contribution the team can make, how to implement quality improvement initiatives and ultimately transform their service to have prevention within it. All key staff, such as Commissioners, should undertake this training, and the toolkit should be used when new business cases are being developed.
• NHS Prevention Programme advice on the most impactful interventions relating to the prevention and management of CVD, diabetes and respiratory disease.
• NHS Long Term Plan Prevention Health and care leaders have come together to develop a Long Term Plan to make the NHS fit for the future. The plan has been drawn up by frontline health and care staff, patient groups and other experts.
• The Hewitt Review (2023) assessed how integrated care systems (ICSs) in England could be better empowered to improve health outcomes, reduce inequalities, and shift focus from acute care to prevention. It called for greater local autonomy, less bureaucracy, and more flexible funding.
• The 2024 Darzi Report focused on reforming the NHS to boost productivity, embrace innovation, and improve patient outcomes. It emphasised digital transformation, workforce development, and integrated care to ensure a more efficient and sustainable health system.
• The 2023 Chief Medical Officer's report highlighted the importance of prevention and tackling health inequalities, with a focus on the health of young people. It called for action on mental health, obesity, and early-life health determinants to improve long-term outcomes.

Through our Prevention Framework, we aim to integrate a local approach to prevention across the entire health and social care system, enabling all ICS partners to collaborate more closely and compliment each other’s efforts.

We recognise that our health is influenced by various factors, including  education, work, living conditions, housing, and our lifestyle choices. There is also increasing recognition of the role of our communities and the social networks we belong to. The most significant impact on life chances and reducing health inequalities lies outside direct health and care services. Therefore, we emphasise the need to address all four aspects of the population health model, particularly the connections between them, in our approach to prevention.

Our holistic approach to health and wellbeing focuses on proactive measures that tackle the root causes of health issues. This is supported by population health management capabilities, which help identify target patient groups and enable integrated teams to design and implement tailored interventions based on specific needs.

We also recognise the important intersection between prevention and health inequality. Communities with the highest burden of long-term conditions often face poorer access to and uptake of healthcare. Health inequalities are driven by a higher prevalence of modifiable behavioural risk factors in certain population groups. Our prevention efforts must be informed by strategic work to address health inequalities and target those with the greatest need.

To effectively address these issues, we must work at the place  and  neighbourhood level, understanding population differences and adapting our approaches accordingly. This involves collaborating with communities to develop preventative interventions that best meet the needs and circumstances of specific groups. Aligning system-wide actions on health inequalities and prevention is crucial, with population health management (PHM) serving as a key enabler. However, it is important to understand the distinctions between the two and how they complement each other.

• Active Travel initiatives
• Active waiting lists / Healthy Hospitals
• Weight management services e.g. Tier 2, 3, 4, Diabetes Prevention Programme, pathways
• Locally commissioned services e.g. stop smoking, weight management, non-dependant alcohol consumption, drug and alcohol services, domestic abuse services, sexual health, NHS Health Checks
• Physical activity programmes and opportunities including funded programmes, referral programmes, Sports Partnership work, place-based interventions, hyperlocal interventions
• Mental Health Services and programmes including physical health checks, suicide prevention
• NHS Long Term Plan Prevention e.g. NHS Tobacco Dependency Programme
• Long Term Conditions Management e.g. CVD
• Screening programmes – such as, cervical, bowel and breast cancer
• Early Years programmes and Family Health services
• CYP focussed work programmes including violence reduction, diversionary activities
• Recovery Pathways e.g. cancer, cardiac, covid

Prevention is everyone’s business and there should be a system-wide and long-term approach to influencing and embedding this. Our health and care services need to transition from a culture where we treat illness, towards a culture that promotes health and wellbeing. A shift towards a culture of prevention will not only improve the health and wellbeing and reduce health inequalities for our residents and patients but also help secure the future of our organisations to meet the predicted increase in need and have a long-term financial benefit. 

We need a systematic approach, with strategic leadership, adopting a ‘health in all policies’ approach that embraces the contribution of every part of the health and care system, in our neighbourhoods, our places and at a Coventry and Warwickshire and even a regional level.  

Importantly, this means embracing the role that local communities play in prevention – recognising the significance of “the places and communities we live in and with” from our population health model.  We need to work collaboratively and flexibly, taking an asset-based approach built on a deep understanding of communities, rather than delivering a ‘one size fits all’ approach. Public services should work together with local communities to help build healthy communities, where the community assets that help keep people well and prevent ill health are mobilised and valued.  

Through our Prevention Framework we expect to develop high impact prevention interventions, in relation to the biggest health risk factors, which are co-produced with local communities and informed by our population health management capability and evidence about what works.  

Population health intelligence and performance data inform the system’s priorities and help to identify opportunities for intervention. We have a plethora of data about unmet health need, access to services, health inequality and service outcomes. We need to work collaboratively and to share data, where appropriate, to ensure evidence-based decisions are taken for the benefit of the general population. Joint Strategic Needs Assessments should be used routinely to inform service planning, and our developing Population Health Management capability used to enable design and delivery of targeted, proactive health and care interventions for at risk cohorts. 

We must also ensure that our prevention activity is developed with our communities, equally involving people who use services, alongside carers, families and communities, throughout the commissioning cycle.  

We will work through our Prevention Network to facilitate sharing of best practice across the system and raise awareness of local and national evidence and resources so that our activity is consistently evidence-based and supported by a culture of learning and evaluation. 

Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. In Coventry and Warwickshire there are significant inequalities in life expectancy and in healthy life expectancy, with people living in our more deprived communities spending a longer period of their already shorter lives in poor health. These inequalities are driven by significantly higher rates of premature mortality from avoidable conditions such as cardiovascular disease and respiratory illness, in turn driven by worse rates of risk factors such as smoking, poor diet, physical inactivity and obesity across the life course. Prevention is therefore a fundamental part of work to reduce health inequalities by addressing both the wider determinants of health and protective factors. 

But prevention activity will not automatically lead to reduced inequalities. We need to ensure that a focus on reducing healthcare inequalities is embedded in our prevention activity, and that this is informed by the knowledge and learning from our strategic system work to tackle health inequalities. This means focusing delivery particularly for specific groups that experience inequalities in healthcare access, experience and outcomes and using the Health Equity Assessment Tool (HEAT) to understand and address the inequalities impacts of planned services and interventions.  

It is commonly recognised that 80% of our health and wellbeing is driven by factors outside of health and care services. The wider determinants of health refer to a diverse range of economic, social and environmental factors that impact people's lives, including housing, education, employment, transport, and access to healthy food, for example. There is a clear link between wider determinants and health outcomes, which in turn creates health inequalities. It is therefore important that our prevention activity pays attention to the wider context in which people live and how this then impacts on their health behaviours and outcomes, and engages with wider system partners at a local level.  

This includes thinking about how we can create healthy communities and workplaces where individuals and families can make simple and easy positive lifestyle choices. For example, liaising with local businesses and organisations provides a great opportunity for embedding prevention within the workplace. A workplace culture that promotes positive health and wellbeing will not only benefit individuals but also the wider organisation through reduced sickness leave, and an engaged workforce with lower staff turnover. Businesses and organisations can also support staff to be active, eat well, reduce harm from alcohol and smoking and promote mental well-being. 

Prevention should also take a life course approach. There are a wide range of protective and risk factors that interplay in health and wellbeing over the life span and a life course approach considers the critical stages, transitions and settings where large differences can be made in promoting or improving health and wellbeing. This capitalises on the potential to deliver an inter-generational approach, with health improvements and a reduction in health inequalities from generation to generation. 

At an individual level we can pay attention to social context by embedding a personalised care approach, especially for those living with complex health conditions and comorbidities. This means that people are consistently empowered to be equal and active participants in their health and wellbeing by having more choice and control over the way that their care and treatment is planned and delivered based on what matters to them and their individual strengths, needs and preferences. 

We are committed to supporting the frontline professionals to embed prevention in their everyday practice and equipping them with resources and tools to do this. For health and care, we want to see prevention as the first step in every clinical pathway and to recognise that this is wider than what we define as secondary prevention. It’s a whole system approach that embraces the wider determinants of health and the contribution of all partners. 

Making Every Contact County (MECC) should be systematically adopted from commissioning to service delivery due to the fact front line staff interact with individuals every day. Leaders and managers can support MECC by ensuring staff keep up to date with the latest local versions of the MECC training offer. Clinical leaders and service managers can also be supported to guide their teams through the process of re-designing services to include prevention.