Agenda item

Briefing Note of the Consultant in Public Health (UHCW NHS Trust and Coventry City Council), R Chapman

The Board received a Briefing Note of the Consultant in Public Health, UHCW NHS Trust and Coventry City Council, R Chapman which provided an update on the progress of 3 areas of work:

• Homelessness and health
• Substance misuse
• Domestic abuse

Homelessness, domestic abuse and drug misuse are interconnected issues affecting the most vulnerable in society and were the focus of significant partnership working in Coventry.

In March 2024, the Health and Wellbeing Board received a report in relation to Homelessness and Health highlighting the health inequalities faced by people experiencing homelessness. 

Since the previous report to the Board, a number of projects and interventions had started to take place with the support of the Coventry Care Collaborative including:

• Completion of initial NICE baseline self-assessment
• Secondment of a researcher from Warwick University as part of the HDRC to support a research piece into health and homelessness in the city
• Inclusion of homelessness as a specific priority area in Marmot 2.0 and initial planning partnership meeting focusing on health inequalities.
• The production and publication of the Homeless and Rough Sleeping Strategy and the delivery plan.
• Development of an operational steering group to look at practical interventions in terms of health and homelessness and steer delivery of agreed operational actions.

Much focus in the past 2 years relating to substance misuse had been the implementation of the Drugs and Alcohol Strategy and ensuring positive engagement from key partners within the local system.  Key achievements to date had been strengthened partnership relationships; inter-organisational pathway development and the local response to understanding and managing drug related harms and deaths.  The priorities for the next 3 years had been recently reviewed and one area to receive more focus was around prevention and reducing harm from the impacts of alcohol use on individuals, families and the wider community.

In November 2024, Coventry and Warwickshire held the first Prevention Summit.  Alcohol was identified as a local priority for the wider work on prevention. In Coventry, there was a disproportionate amount of harm caused by alcohol use and alcohol related mortality and hospital admission rates were higher than the national average.

Another significant piece of work that had been completed was the re-procurement of drugs and alcohol treatment services.  The current provider, Change Grow Live (CGL), had been successful in maintaining the contract and the new service model had a much stronger focus on building a more vibrant long term recovery offer for Coventry.

Domestic Abuse and preventing harm from domestic abuse was one of Coventry’s key priorities following the commencement of the Domestic Abuse Act 2021.  Coventry had continued to prioritise tackling and preventing domestic abuse.  The current strategy was overseen by the Domestic Abuse Local Partnership Board.

Current priorities included Domestic Abuse Housing Alliance (DAHA) and Safe and Supported accommodation subgroup that co-ordinated the whole housing approach for groups of domestic abuse including their children, workforce development, Data task and Finish Group and ongoing needs assessments for the safe accommodation duties and wider strategy refresh for 2026.

Since March 2020, Coventry had seen an increase in demand for domestic abuse services.  Commissioned domestic abuse services had seen a 30% increase in case load numbers since July 2021.

The Housing and Homelessness team had seen a significant increase in approaches due to people fleeing domestic abuse, since changes had been brought in via the Domestic Abuse Act 2021 relating to priority need.

Over the past 3 years, there had been a change in the complexity of need for victim-survivors of domestic abuse including: substance misuse, mental health, disabilities, as well as language need and no recourse to public funds.  A snapshot from Change Grow Live, on 30 September 2024, identified there were 280 victims of domestic abuse accessing structured treatment programs out of a total number of 1024.  Of these 280 service users, 95 had housing issues.

The Victims and Prisoners Act 2024, included the Duty to Collaborate, which introduced new responsibilities for PCC’s, local authorities and ICB’s to collaborate in the commissioning of community support services for victims of domestic abuse, sexual abuse and serious violence.

Members of the Board, having considered the Briefing Note and Presentation, asked questions and received information from officers on the following:

• Progress with homelessness and health was being measured by an action plan with timescales which were monitored.  A Complexity and Vulnerability Forum had been established at UHCW and officers were looking at how to capture data on individuals as they came through the hospital which would help to monitor and measure success.
• UHCW and the ICB had signed up to the Armed Forces Covenant however, some armed forces veterans did still end up homeless.
• A series of case studies would be shared by officers illustrating learnings and success stories.
• The health and homelessness strategic steering group would report back to the Care Collaborative.
• Homelessness data was captured via the new electronic patient records at UHCW.
• CGL delivered a wide range of training packages on substance misuse.
• The new model was developed and based on evidence and national strategic outcomes over the past 2 years focused on in-reach and out-reach and an agreement to support whole families.
• There were vast differences in substance abuse between Coventry and its statistical neighbours.
• For many years previously, alcohol misuse had not been funded in the same way as other substance misuse; one of the reasons the model had been changed to look into alcohol and how people use it.
• The completed needs assessment for drugs and alcohol in 2022 was city wide in Coventry and a young person’s assessment was undertaken which allowed a focus on the needs of young people.
• A specific group had been set up to help young people with substance misuse.
• The Drugs and Alcohol Needs Assessment 2022 had been citywide and part of had been a focus on young people including an assessment.  An early help substance misuse group had also been set up to focus on the needs of young people.
• Work on alcohol misuse was at an early stage in Coventry and success was currently below average. 
• Access to primary and secondary healthcare had been identified as a priority to support young people and families suffering alcohol misuse.  The young persons service was not just related to drug and alcohol misuse, but wider, with early interventions and substance misuse among young people had increased and alcohol decreased however, substance misuse was more complex ie. Multiple drugs being taken.
• Mental health remained a barrier and identified as a gap in support in both young people and adults.
• A significant level of consultation had been undertaken to develop the service at CGL however, the biggest concern had been accessibility of the service to allow more flexibility and longer hours.  More focus had also been placed on working in GP surgeries and sessions in churches.
• Coventry had always invested in perpetrator interventions and perpetrator or behaviour change intervention called Choose to Change was available.  The priority was always safety with perpetrator intervention.  Parallel support for victims and children was also available.
• A Needs Assessment was being developed in relation to sexual violence/abuse.

Members of the Board requested the following:

Homelessness and health

·  Progress outcomes for homeless and health to be shared with Board members.

·  Lead for homelessness pathways (UHCW) - possibility of funding pathways for continuation of the post to be investigated.

·  Steering Group to include University colleague with speciality in health and homelessness.

·  Case studies to be shared with Members.

Drugs and Alcohol

·  Investigate specific training packages for Fire Service employees.

·  Comparison data on substance misuse compared to statistical neighbours to be circulated to Members.

·  Availability of additional venues for outreach to be investigated.

·  Visit to CGL to be arranged for Cllr Caan and key partners.

Domestic Abuse

• Relate to be invited to respond on deliverables for the Make a Change programme.
• Sexual abuse/exploitation to be included in the Work Programme for 2025/26.

The Health and Wellbeing Board were recommended to:

Homelessness and Health

1. To continue to support the work and future projects in relation to health inequalities and homelessness.
2. In particular, for organisations to support work on healthcare pathways and services that meet the needs of this group.

Substance misuse

1. Support the refreshed strategic priorities and their delivery through the Drugs and Alcohol Partnership Steering Group

2. Specifically provide organisational support to strengthening alcohol misuse identification and routes into treatment to reduce the harmful impact of alcohol on the residents of Coventry.

Domestic Abuse

1. Support the ongoing needs assessment and the requirement for data as this will assist us in understanding the diverse needs within the city.

2. For organisations to review the offer of support available to their workforces, such as having a domestic abuse policy in place and clear guidance on how victim survivors will be supported in the workplace.