Coventry is a young, diverse city, with a quarter of its population under the age of 19. As a Marmot [1] city, Coventry has adopted and embedded the principles of Marmot’s suggestions for tackling the social conditions that can lead to health inequalities, and is working to improve the areas in which people are born, grow, live, work and age.

The Marmot Review into health inequalities in England was published on 11 February 2010. It proposes an evidence based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age and which can lead to health inequalities.

There are eight Family Hubs operating in local authority venues across the city, serving local communities. They focus on delivering early help to children aged 0-19 (and up to 24 for young people with SEN) and their families, across the whole of Coventry.

Public Health commissioned the Family Health and Lifestyles Service which went live in September 2018, and this brings together seven existing health services, offering an exciting opportunity to provide a more seamless service to families.

Services include:

• Health Visiting
• School Nursing
• Family Nurse Partnership
• MAMTA – Child and Maternal Health Project, which offers BAME families support during antenatal and postnatal period
• Stop Smoking in Pregnancy
• Infant Feeding
• Family weight management services

The new service creates a healthy lifestyle offer that can be woven throughout the universal service, utilising universal checkpoints to address family lifestyle needs and provide targeted, specialist support where appropriate.

In Coventry, figures for accident admissions for 0-14-year olds were above the national average and there was recognition from both the Children and Young People’s Partnership Board and the Safeguarding Board, that more strategic approaches were needed to tackle unintentional injuries to children and young people.

Harbir Nagra, Programme Manager, Public Health says:

‘I’m working on developing the new Family Health and Lifestyles service with the South Warwickshire Foundation Trust which offers support to 0-19 years. I am also leading on the implementation of a five-year Parenting Strategy for the city which launched in July 2018. It’s a multi-agency approach, involving a number of key partners such as Education, Police, Health, Family Hubs and Parenting Practitioners and the Voluntary Sector.’

The Child Accident Prevention Trust (CAPT) became involved in March 2017, through their Department of Health improving Capacity and collaboration (ICC) project. CAPT’s role was to support Coventry City Council’s Public Health Team in workforce development within their commissioned services, upskilling practitioners to be competent and confident in opening up accident prevention conversations with parents, and working more closely with local communities.

Harbir says:

‘Our partnership with CAPT has been extremely useful in getting us to think about topics from different angles.  For example, during Child Safety Week, we extended our spread of activities across schools, libraries and community organisations. Having the CAPT picture books, such as As I grow and change I can, as well as other resources to disseminate among partners, was really useful. CAPT provided support and advice through meetings and emails guiding us to refine and shape our thinking around child safety.’

To support staff in having home safety conversations with parents, a pilot training event was delivered to 20 staff from early years services. Topics included effective ways to talk to parents about child accident prevention and the use of home safety check lists.

‘Staff thought the training was really helpful. For some it contained new information and for some it was a useful refresher that reinforced key safety messages,’ Harbir says.

Following the success of this first event, training was then rolled out to a wider audience – in line with the restructuring of services towards 0-19 years old. This involved going back to the Safeguarding Board and asking them who they felt would benefit from the training. Around 200 staff took part in workforce training including Health Visitors, School Nurses, the Family Nurse Partnership (which works with young mothers), as well as staff from Housing services, Fire service and Police. So far 12 courses have been delivered.

Ian Evans, CAPT’s training and consultancy manager prepared questionnaires for staff to fill in before and after training to measure what they had learnt from the training.

During training, the idea of a home safety checklist for Health Visitors to use during visits to families was raised. In recognition of the amount of paperwork Health Visitors already had to manage, it was decided that Health Visitors would create a self-assessment form on home safety, which Health Visitors could give to parents.

Harbir says: ‘I attended some of the training to encourage staff to think creatively about opportunities within their calendar of events.  For example, midwives recognised opportunities during ‘Maternity March’ (a campaign that takes place at the local hospital) and other staff thought about safety issues around hazards at Christmas or how to prevent falls during bad weather.’

Through the Improving Capacity and Collaboration Project, CAPT supported Coventry to tap into the links which voluntary organisations have already developed with local communities. Grapevine, a local charity ran a number of ‘Ideas Factories’ in areas of the city where they had strong community partnerships or identified areas of need. The aim was to empower parents to take local action to prevent accidents in the home.

‘Grapevine started by encouraging parents to think about the accidents they had as children, the impact these had and why it’s important to keep children safe. Parents were then empowered to come up with pledges for actions they could take themselves – for example sharing links to CAPT’s website campaigns on social media, writing blogs about child safety or holding a meeting in their own neighbourhood,’ Harbir explains.

Ian Evans, from CAPT facilitated two community-based workshops in two wards of the city, in February 2019.

Harbir says:

‘Our relationship with CAPT has been very valuable in helping us understand our local situation, to understand the national picture and what other areas are doing. Considering national data alongside local intelligence in communities is key to informing action planning. A strategic multiagency action plan has been developed by partners to address unintentional injuries. A whole systems approach is needed to reduce injury in childhoodand continue to raise the profile of childhood accidents’.

[1] Sir Michael Marmot chaired a review of health inequalities in England, which published a report in 2010, proposing an evidence-based strategy to address the factors which determine health and the conditions which contribute to health inequalities.