Ten years as a Marmot city

1. Positive Progress

Marmot as a philosophy.

Participants advocated that the Marmot approach was a fundamental way of working, a philosophy rather than a strategy. The vision is that proportionate universalism drives all work in the city to tackle inequalities and improve lives. Being a Marmot place meant collective ownership, with lots of smaller parts moving in a positive direction. In this way, participants highlighted that the Marmot Principles should not necessarily be aligned to defined milestones. Partners advocated for “living” the Marmot Principles as a culture and value-base, working together to embed equity in all policies. At times, teams may not recognise that their work has been contributing to the Marmot approach, even when it does.

“It’s not a strategy, it’s a philosophy.”

The city

Participants described how the contexts and geography of Coventry influenced the role of Marmot in the city. It was felt that work through the Marmot Partnership could have a significant impact due to the small geographical footprint of the city, relative to larger city neighbours. A city of sanctuary, peace, and reconciliation, Coventry is also home to a transient population, with high migration into the city. Participants described places in Coventry that hold strong identities and pride, though also wanted residents to feel belonging to a cohesive city of Coventry.

‘It works because of the size of the city. It’s possible to make an impact. It’s possible to feel the impact and see it’.

‘The city is quite a forward and dynamic place.’

‘Diversity of the city is an asset.’

Success stories

Specific examples of collaboration to support communities were highlighted. Over the years, the Marmot Partnership has also strengthened its connections with more council service areas such as Planning and Transport. Notable successes were reported for the Marmot Principle to give every child the best start in life. The Family Health and Lifestyle Service was a leading example of service integration and co-production, as well as Child-Friendly Coventry, Start for Life, and the creation of eight Family Hubs around the city. Marmot Partners have also acted together on pressing issues that were brought to the Marmot Partnership. These included highlighting the rights of children from marginalised communities, leading a city-wide approach to access to free school meals, and a call to action on homelessness to support the needs of children and families living in temporary accommodation. Coventry’s unique commitment via the Job Shop to support people who face the biggest barriers to employment, education, and training was also praised as a success story, as well as ongoing work to form Businesses Committed to a Fairer Coventry and promoting an equitable social value agenda.

Pride in Coventry

In all workshops, participants were proud of the commitment in Coventry to improve lives and reduce inequalities. Some participants actively moved to professional roles in Coventry because of this ethos or took this ethos with them when they moved elsewhere. Participants were also proud to have led the way as the flagship Marmot city, inspiring other places to follow. Participants perceived the passion and shared sense of purpose to be a unique and valuable attribute of the city, driving progress on the Marmot Principles.

‘Marmot is a recognised brand.’

‘People take the knowledge of the Marmot approach and enthusiasm with them’.

2. Challenging Contexts

National picture

During ten years as a Marmot city, there have been significant national and global challenges including austerity, Brexit, rises in the cost of living, and COVID-19. These challenging contexts made it increasingly difficult to reduce inequality. Although Coventry’s deprivation ranking improved between 2015 and 2019, which is the latest available data, some communities may not have felt any improvements because of the difficult and overpowering national contexts. Marmot Partners also had challenges trying to plan and deliver long-term change, when funding opportunities were often shorter- term. National programmes and policies, for example, free childcare places, did not always align with local ambitions for proportionate universalism, which made goals harder to achieve.

'Coventry is fabulous at coming together really quickly’.

Limited funds and resources

Partners spoke about the impact of changes in government-funded initiatives that had been experienced by front-line services and the impact on service delivery. Examples included reductions in capita spend and changes to external grant funding. Partners reflected on the importance of using proportionate universalism to allocate monies within their financial envelope and remodelling services to ensure those who are facing the biggest health inequalities continue to have access to help and support. Partners recognised that the impact was felt across voluntary, community, and social enterprise organisations, including those funded to deliver training and pre-employment support activities. The impact of changes to universal youth provision because of central government funding cuts was also highlighted.

COVID-19: challenges and opportunities

Soon after the Coventry Marmot Evaluation was published in February 2020 (3), COVID-19 brought extraordinary new challenges. Organisations needed to find the balance between business as usual and reacting to pressing issues and government guidelines, with some areas of work being paused. Some services in Coventry were unable to deliver services face-to-face, which may have added pressure to other services that retained face- to-face service delivery. Time to reflect and think about the issues had also reduced. People had to work reactively, focussing their resources on responding to the challenges of the pandemic. However, it was felt that COVID-19 also brought opportunities to collaborate more creatively and work more flexibly. Social and health inequalities were being talked about more than ever before in the media, and sectors such as healthcare became more engaged with the social determinants of health. Partners were motivated to work together and find new ways of collaborating remotely. At points of crisis, COVID-19 also demonstrated that processes can be amended for the better and gave teams more autonomy to make effective choices. Despite initial motivation to maintain new ways of working, workshop participants highlighted that some of the flexibility that was welcomed during COVID-19 had not always been maintained.

‘COVID changed everything and highlighted inequalities. People who hadn’t thought about it (inequalities) started talking about it. It was in the mainstream press’.

‘Organisations took services to people during COVID. More people engaged, some barriers were removed, they didn’t have to travel in, didn’t need childcare’.

‘Many people who hadn’t experienced inequality are experiencing it now’.

3. Creating, Measuring, and Sharing Impact

Creating impact

Participants reflected that the Marmot approach had been successfully targeted at the strategic level. There were examples of proportionate universalism and the Marmot approach being embedded systematically. For example, contracts are increasingly being reviewed through a health inequalities lens and that where possible, services have a universal offer and a targeted offer proportionate to need. In recent years, the Partnership has been strengthened by involving more teams and organisations, with growing awareness about how more teams and services can align with the Marmot Principles. Moving forward, participants said that the Marmot approach should be promoted widely, reaching more frontline services and teams. Strong awareness of Marmot may ensure that the approach drives work early on and that issues are fed back to the system. Finally, and importantly, partners shared reflections on how the Marmot Partnership should involve Coventry residents to tell local stories. Engaging and working with the public in activities related to the Marmot approach can support the right action and improve outcomes on the principles.

‘We are a Marmot city, doesn’t matter where you work, you’re in.’

Sharing success

The successes of Coventry as a Marmot city must be shared and celebrated. Promoting positive achievements can help attract people, organisations, and opportunities into the city, and motivate more people to become involved. Participants felt it was important for Marmot Partners to collate stories and share them through regular communications and media. Getting the word out about Marmot could happen in organisational training and inductions, and by talking about Marmot in daily work and conversations. Participants also appreciated coming together to reflect on the Marmot workshops. Building in regular time to reflect as partners could help people stay committed to driving this important change.

Measuring progress

Understanding what is working to improve the Marmot Principles is essential for change. The Marmot Monitoring Tool was a positive recent development that has collated measures around the Marmot Principles. In addition, qualitative data and stories are needed to understand what is happening for people in Coventry, especially because of the difficult national contexts. Partners talked about how local evidence of impact is held by individual agencies. There are current challenges with organisations not being able to access data that could otherwise help them work more effectively to support communities. Bringing together data and reports from across organisations could better help the Partnership to see the bigger picture, share learning, and plan. Working with the NIHR Health Determinants Research Collaboration (HDRC) Coventry is an important development. The HDRC is increasing and coordinating research about health determinants as part of the city’s move to tackle inequalities.

Summary

As a Marmot city, Coventry is working hard to make sure Coventry is a happy, healthy place for everyone to grow, live, work and age in.

In recent years, there have been some real challenges, including COVID-19 and rises in the cost of living, that have made progress harder. The Marmot Partnership has continued to come together to collectively act on tackling health inequalities. Partners are proud to be putting the values and philosophy of the Marmot approach into work across the city. Moving forward, partners want more people to know about Marmot and be involved in driving positive change. Developing evidence about what works to reduce health inequalities, including through the Health Determinants Research Collaboration, is essential to make a difference locally and beyond. Coventry is committed to being a Marmot city, and the successes are to be shared and celebrated.

Next steps

The reflective workshops have contributed important insights into Coventry’s journey from the past, present, and for our future. Coventry is proudly shaping its next phase as a Marmot city. Next steps include:

• Increase awareness of Coventry’s flagship status as a Marmot city among communities and people in all professional roles. Be proud of Coventry’s commitment to making things better and fairer.
• Encourage more partners to be involved in championing Coventry’s approach as a Marmot city. By engaging widely across the city, health equity can become embedded in all policies, services, and decisions.
• Identify more ways for Marmot Partners to share their positive stories with others across the city. Regularly share updates about progress and new developments in tackling health inequalities across organisations and communities.
• Build the evidence about “what works” in tackling the social determinants of health. With the Health Determinants Research Collaboration, work with local partners to evaluate and understand what can make a difference in Coventry.