How can we bridge the gap? – health inequalities for Gypsy, Roma and Irish Travellers

18th November 2018

On 1st November I attended the annual conference of the Traveller Movement, a registered charity who aim through their work to campaign against discrimination, promote inclusion and assist community engagement and participation for Gypsy, Roma and Irish Traveller communities.

I attended because at this year’s Challenge 2020 conference I facilitated a workshop titled ‘Public Engagement Mission Possible’ where one of the re-occurring questions from our audience was ‘how do NHS engagement staff engage with seldom heard groups in a climate of austerity?’. This got me thinking in more detail about these ‘seldom heard’ groups so I started some research into who these groups are. In doing this I came across several charities working with the Gypsy, Roma and Traveller communities (GRT) and this sparked my interest. During my time here I had rarely heard or seen many examples of work with these communities. I wanted to find out what I was missing. Coincidentally the annual TM conference was just a few weeks away so I booked myself a place to educate myself.

I was struck by the energy and dedication in the room from the people who make this event happen. There was a packed agenda for the day and speakers from Ireland and Scotland sharing difficulties faced across the borders. I particularly enjoyed hearing from Brigid Quilligan of Kerry Travellers Health & Community Development Project, Professor Colin Clark from University of West Scotland (UWS) Sociology and Social Policy and Derek Campbell Regional Director of East Midlands for the Independent Office for Police Complaints. After lunch I attended a workshop where the topic was ‘Health – barriers to accessing healthcare for Gypsies, Roma and Irish Travellers’ (GRT). From this session I want to share some statistics which drive home the struggle faced by these communities and the impact of the barriers that they face:

The NHS does not include Gypsy, Roma or Traveller ethnic categories in their data dictionary
Baker, M, (2005) Leeds Baseline Census 2004-20005 Gypsies and Travellers. Leeds Racial Equality Council

42% of Gypsies and Travellers are affected by a long-term condition, as opposed to 18% of the general population
Parry, G., Van Cleemput, P., Peters, J. , Moore, J., Walters, S., Thomas, K and Cooper, C. (2004): The Health Status of Gypsies & Travellers in England Report of Department of Health Inequalities. Sheffield:  The University of Sheffield.

GRT live on average 10-12 years less than the general population (1), in some areas even 25 years less. (2)"- Baker, M, (2005) Leeds Baseline Census 204-2005 Gypsies and Travellers. Leeds: Leeds Racial Equality Council
- Leeds Community Healthcare, NHS Trust (2018) Gypsy and Traveller Community and a Queen’s Nurse tackle health inequalities in Leeds.

The suicide rate in the Traveller community is six times higher than in the general population and seven times higher among young Traveller men
All Ireland Traveller Health Study 2010

The workshop was convened by Dr. Margaret Greenfields Professor of Social Policy & Community Engagement & Director at the Institute for Diversity Research, Inclusivity, Communities and Society (IDRICS) Faculty of Society & Health Buckinghamshire New University. Here we heard first hand from those working in their communities fighting against the inequalities. Some felt that their efforts over many years have been in vain as policy still dictates that accessing healthcare services is harder to begin with if the very nature of their culture is that there is not always a fixed abode. Negotiated stopping was a subject which had been mentioned previously and it was suggested that this would have a positive impact on health. Suggestions around the room about how to tackle the issues were around education – getting into universities and speaking to the politicians and healthcare professionals of the future. Another suggestion was simply but effectively sharing stories and looking at influencing change one person at a time from within the communities and from outside. A point was made and seconded that typically men do not talk openly about their health issues with people from outside of their community and women are often the key to getting the initial dialogue going and gaining trust. As with other disadvantaged groups one of the first steps that can be taken towards improvement is to open dialogue. To get out and talk to the people who need support and find out how to make it happen.

One example highlighted just one of the issues faced is where a GP handed out printed information to a patient who could not read. There was a discussion around identifying champions and focusing on CCG’s and GP practices. There was an interesting case study that showed some positive change in Durham talked about by Patrice Van Cleemput. In Durham area GP’s had added the ethnicity code which is currently missing from the NHS data dictionary, to allow data to be collected so that the success of interventions could be measured as opposed to being invisible. This highlighted an increase in anxiety and depression amongst GRT groups and this data was presented to the local CCG. As a result of this two health trainers were brought in to deliver what was needed in the home environment. To read more about the situation in County Durham there is an independent evaluation by Patrice Van Cleemput from March 2017– Gypsy and Traveller Health Project.

On the subject of working with GP’s and CCG’s a suggestion around the steps needed to change was to:

  • Get the data
  • Show the need
  • Get CCG’s on-board and get funding
  • Get the service provision needed to address the gaps.

Another positive case study that we heard about was from Alice Young from Julian House a charity whose vision is ‘a just society where socially excluded people are supported and empowered to build sustainable, independent lives’. Julian House work with Gypsy, Roma, Traveller and Boaters communities to build networks to promote fair access to healthcare. From their service report in May 2017:

The service has now been running for just over 2 years and is continuing to reach out to GRT&B communities and individuals, supporting people with specific health and welfare issues as well as developing its Outreach programmes, both on land and water.

A number of successful joint working partnerships have been established with other agencies, thus enabling them to increase engagement with these marginalised communities.

The Travelling Community Support has become embedded within BANES and the surrounding local authorities and is well known of, through word of mouth and through social media.

This work was commissioned as a result of a report Bath and North East Somerset Gypsy, Traveller, Boater, Showman and Roma Health Survey 2012-2013prepared for Bath and North East Somerset Health Authority by Margaret Greenfields with Liz Lowe.  The research study/needs assessment was the first and they believe still the only review of Boater health in the UK. The updated report to this.

It was interesting to find that funding for the report by Margaret Greenfields and Liz Lowe was from a statutory sector joint funding consortia (including the local CCG, Local Authority and Public Health source) on the back of earlier work undertaken in the area. More recently the funding for this work is from Virgin Care in BANES.

However, despite these two positive stories there is still a lot more needed to tackle the problem.

A recent news article from the Independent reported that the Health and Social Care Secretary Matt Hancock is to announce a green paper focused on prevention that aims to stop people from slipping into poor health. The paper, entitled 'Prevention is better than cure' will argue for a shift towards primary and community care services, which help people stay well. The Independent quotes Matt Hancock: "… focusing on the responsibilities of patients isn’t about penalising people. It’s about helping them make better choices, giving them the all the support we can, because we know taking the tough decisions is never easy.

I look forward to reading the green paper and finding if there is any mention of providing more support for some of the most disadvantaged communities.

From the statistics given to us at the conference and from reading reports and studies it seems clear that work has to be done to ensure that the public sector equality duty is adhered to and that the need of those with protected characteristics are met.  Unfortunately, the NHS England panel representative had had to pull out but it will be interesting to see their take on this on this in the future.

One of the discussion points in our workshop was around cultural awareness training and a point was made that it can’t be just a tick box exercise. A comment was made that ‘to be seen as equal in society we shouldn’t have to provide specialist training’. What was loud and clear from attending the GRT conference was that members of these communities are not asking for special treatment, they are seeking equality.

The Research and Communities team at Civica is working on a programme of awareness and promotion of seldom heard and disadvantaged groups over the coming year.