Ministerial Working Group on Gypsy/Travellers minutes: December 2018

Attendees and apologies

Present

• Christina McKelvie, Minister for Older People and Equalities (Chair)
• Jamie Hepburn MSP, Minister for Business, Fair Work & Skills
• Joe FitzPatrick MSP, Minister for Public Health, Sport & Wellbeing
• Maree Todd MSP, Minister for Children & Young People

Apologies

• Kevin Stewart MSP, Minister for Local Government, Housing & Planning

Guest speakers (attending part of the meeting)

• Professor Alison McFadden, Director Mother & Infant Research Unit, School of Nursing & Health Studies, University of Dundee
• Susan Townsley, Doubledykes Travelling Person’s Site, Perth, assisted by her daughter Yvonne

Items and actions 

Welcome, introductory remarks 

Christina McKelvie welcomed Ministers and guest speakers to the fourth meeting of the Ministerial Working Group on Gypsy/Travellers, which will focus on health.

Focus on Health and Social Care

Christina McKelvie welcomed the guest speakers and invited Prof. McFadden to speak about her recently-published research on Gypsy/Traveller Health. (Slides from Prof. McFadden's presentation are at the bottom of this page).

Gypsy/Travellers experience poor health outcomes; misdiagnosis is common and many expect discrimination. These factors are interconnected with the wider social determinants of health.

Barriers to accessing health can be practical, including the emphasis on written information, and punitive approaches to missed or late appointments. Gyspy/Travellers can also be concerned about confidentiality, and fearful of authorities and action they may take against them (such as removing children).

Strategies which have been shown to work include:

• individual and collective advocacy, provided by third sector organisations
• collaboration between third and public sector organisations for effective delivery
• flexible services, for example Health Visitors working across boundaries
• specialist staff, alongside a strategic approach which embeds good relationships within the mainstream service
• supporting community participation, eg. training community members to become a link with health services
• tailored/dedicated services to meet specific needs
• outreach can be effective but can also mean only a partial service is provided, therefore this should only be a short term measure, or a way of linking with mainstream services

Health should be treated in the broadest sense, not just medical but social too. And where community members are involved in service design this is likely to lead to more effective and inclusive services: if we put those in greatest need at the heart of service design, our services will deliver better for all.

Short-term projects are common in work with this community and undermines trust and confidence in services; sustained investment and ongoing collaboration between services and with the community are crucial.

It takes time to build trust - 3-5 years - and so health services need to take a strategic approach to developing trust.

Gypsy/Traveller perspective

Susan and Yvonne told the group about:

• experiences of discrimination from health services, including a hospital which assumed they wouldn’t attend follow-up appointments because they were Travellers
• two years waiting for essential adaptations to a chalet to make it accessible to a wheelchair user
• dampness and mould in accommodation, contributing to health problems such as asthma
• reluctance of Gypsy/Travellers to visit the GP, particularly the  menfolk
• difficult experiences for those with low levels of literacy registering for GPs and making appointments, negative attitudes from reception staff and lack of privacy making it difficult to ask for help with forms

They also commented that:

• accessing health services is easier for people who are settled on sites (getting to know GP, midwives etc) but much harder for Gypsy/Travellers who are on the road
• Gypsy/Travellers living in bricks and mortar housing can be especially isolated and reluctant to access services
• discrimination against Gypsy/Travellers can be based on their address or even surname

Overview of current Scottish Government work on Gypsy/Traveller health

Joe FitzPatrick thanked the guest speakers for their insights.

There is a lot of good work underway across Scotland but it is inconsistent, and often down to committed individuals rather than a system that is working effectively for everyone.

Continuity and trust really matters: sometimes good work folds when the funding ends but there are other examples of where it has been mainstreamed.

We recognise the importance of working with the community to get it right, and are committed to doing this more. We intend to start the work in 3 interlinked ways.

We are already taking forward a wide range of actions across different areas of health policy to improve access to services for Gypsy/Travellers. This is a work in progress, which aims to show what we are doing but also to highlight areas that need more attention. We also need to make sure that if something isn’t working for this community we are prepared to change it.  

In addition, we have developed some new proposals for alternative ways of serving the community – based on the findings of Prof. McFadden’s research and practical experiences from places such as Pavee Point, Ireland – and we will work with the Gypsy/Traveller community to help shape and deliver these:

• Community Health Matters involves training community members for health advocacy roles so that they can become the first point of contact for Gypsy/Travellers wanting to find out about or access health services
• Mothers Matter focuses on maternal health and child health, including income maximisation for Gypsy/Traveller families
• Communication Matters aims to address health literacy by training community pharmacists to improve their communication skills by using validated tools and techniques

We will take forward work to re-engage and support healthcare professionals around this agenda, including working with a group of NHS Board practitioners and Healthcare Improvement Scotland to develop and deliver these proposals, as well as demonstrating their impact..

We will also develop actions to monitor progress and demonstrate the impact of change such as provision of Annual reports, audits and self-assessment against good practice by Health Boards supported by an outcomes planning tool and agreed datasets to collect relevant information.

Ministerial discussion

1. Acknowledge that we need to work harder to engage with Gypsy/Travellers and ensure that the services we offer are better at understanding and meeting their health needs.
2. There lots of activity planned in health, but we need to know whether this is making a difference and so we will develop a framework for supporting and measuring improvements in Gypsy/Traveller access to/experience of health services.
3. We don’t know enough about Gypsy/Traveller health in Scotland and will take action to improve our baseline data and to have a greater understanding of the health inequalities affecting this community.  
4. It is important not to lose sight of areas which we have not yet discussed, such as social care, and mental health.
5. There are some priorities in health that also apply across other areas of policy covered in earlier MWG meetings and should be covered in the MWG action plan. These include:

• staff training
• tackling discrimination (individual and institutional)
• improving data on Gypsy/Travellers
• better understanding of needs and solutions
• community development and participation
• raising awareness amongst the Gypsy/Traveller community of their rights and entitlements

Timeline for MWG actions

Christina McKelvie asked Ministers to provide an initial set of draft actions from their portfolio before Christmas recess. She will meet individually with Ministers in January, and a compiled list of draft actions will be discussed at the final MWG meeting in March.

 

Hilary Third
Secretariat to the Ministerial Working Group on Gypsy/Travellers
Scottish Government Equality Unit

Presentation slides: Prof. Alison McFadden - Engaging and building trust with Gypsy, Roma and Traveller people

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