Since 2018, Coventry City Council has commissioned an integrated lifestyle service for adults offering support for smoking, weight management, physical inactivity and non-dependent alcohol misuse.
Reducing health inequalities is a priority for Coventry City Council. Coventry was one of the original Marmot Cities and the Council’s current draft One Coventry plan commits to:
- Strengthening our Marmot City approach to ensure it remains at the heart of what we do
- Working with NHS partners to encourage healthy lifestyles and provide quality healthcare to all communities across the city.
One of the goals of the One Coventry plan is to bring about ‘a reduction in inequalities, including health inequalities, between our most deprived and most affluent wards.’
Smoking is at the heart of these inequalities with much higher rates of smoking in the city’s deprived wards than in its affluent wards. Smoking cuts across all health inequalities in the city; for example, smoking prevalence is particularly high among adults with mental health conditions: 31.4 per cent locally compared to 26.3 per cent nationally.
There are around 31,000 smokers in the city, a population prevalence of 13.7 per cent compared to 13 per cent nationally. Rates of lung cancer, low birthweight, smoking-attributable hospital admissions and emergency hospital admissions for COPD are all above the national average.
Targeted support for adults and young people
Since 2018, Coventry City Council has commissioned an integrated lifestyle service for adults offering support for smoking, weight management, physical inactivity and non-dependent alcohol misuse. The service employs a team of health coaches and subcontracts pharmacies and GPs to deliver additional stop smoking support and the NHS Health Checks programme. The Council also commissions a healthy lifestyle service for children, young people and families, including an opt-out stop smoking in pregnancy service, health visitors and school nurses.
Both services have been commissioned for a nine-year contract term in order to embed pathways, encourage investment from other funders, stimulate innovation, and secure long-term service improvement.
The adult lifestyle service has an established engagement strategy with deprived populations and other target groups. The service generates referrals through an online presence, targeted promotion and close working relationships with key partners including primary care, secondary care and employers. Locality-based health hubs have been developed in key communities, enabling clients to receive in-person appointments or drop-in support. Health coaches also run weekly clinics at the local JobCentre Plus and the Council’s own Job Shop, supporting smokers who are looking for training or work.
The service recognises the value of harm reduction approaches and has adopted a ‘cut down to quit’ model with a particular focus on people with mental health conditions. Initial outcomes of this approach are measured by the number of people achieving a 50 per cent reduction in the volume of cigarettes consumed. Clients are encouraged to recognise and value the achievement of a significant reduction in their smoking in order to motivate a full quit attempt. E-cigarettes have also been introduced as an option to help smokers quit and the service is reviewing the impact of this change on service uptake in population groups who are less likely to engage with smoking cessation services.
The lifestyle service has a close working relationship with the NHS including engaging with inpatients in the local hospital as part of the Long Term Plan; supporting the Lung Health Check programme, which has generated many new referrals; and enhancing the impact of the NHS Health Check Programme with a seamless pathway into lifestyle behaviour change support.
The service for young people has been reshaped by a community consultation project in Bell Green, a deprived area with a high prevalence of young smokers. A key insight from young people was that they responded more to health messages with a focus on money, such as ‘don’t buy cigarettes for a month and you can afford trainers/a holiday/a PS5/branded clothes’ than to messages about harm. Advertising was also moved away from social media, where it had little impact, to bus stops, community centres, GP surgeries, and youth groups.
The number of smokers achieving a 4-week quit is in Coventry is significantly higher than the national average: 2,224 smokers per 100,000 achieved a 4-week quit in 2019/20 compared to the national average of 1,808 per 100,000.
The integrated approach enables multiple outcomes to be achieved and measured. People accessing the service achieve an average of 1.8 individual outcomes per journey, such as stopping smoking and a 5 per cent reduction in weight; or a 5 per cent reduction in weight and 150 mins a week of physical activity.
How the work is sustained
Coventry City Council commissions stop smoking services separately from Warwickshire County Council but the two authorities share a systems approach to tobacco dependency. Their joint tobacco dependency workstream reports into the Population Health and Inequalities Prevention Board of the Coventry and Warwickshire Integrated Care System.
Oversight of tobacco control work in the county is through the Coventry and Warwickshire Tobacco Control Partnership which meets quarterly, and a tobacco dependency steering group which meets monthly. Partners include the local authorities, trading standards, the NHS, commissioned providers, the integrated care system, and NHS England.
Smoking cessation is understood within the Council to be a core public health responsibility which delivers significant return on investment. Nonetheless the long-term decline in the public health grant has threatened the affordability of the service. The efficiencies of the health coaching approach have helped to mitigate this threat.
Procurement of long-term contracts has proved to be effective in establishing partnerships and pathways.
An integrated lifestyle behaviour change service is acceptable to the public and offers a flexible way of responding to emerging need and to changes in the local funding landscape. It can be delivered in a way that contributes to wider efforts to reduce health inequalities.
Targeted marketing campaigns aimed at specific population groups has more impact than generic health messaging.