Baroness Whitaker
To ask Her Majesty’s Government what steps they are taking to address health issues in the Gypsy, Traveller and Roma communities.
Baroness Whitaker (Lab)
My Lords, I first want to give Her Majesty’s Government credit for commissioning the Traveller Movement to produce the report, Impact of Insecure Accommodation and the Living Environment on Gypsies’ and Travellers’ Health by Professor Margaret Greenfields and Mr Matthew Brindley. On International Women’s Day, it would be right to say that the report makes clear that it is the women who are most likely to report poor health, including mental health. My questions for the Minister are, now that it has been published for more than a year, what has been done to implement the recommendations, and how is progress being monitored?
The main findings were that the physical conditions of their environment were a key element of social determinants of health and thus had a measurable effect on the physical and mental health outcomes for Gypsies and Travellers. Sixty-six per cent of the sample reported bad, very bad or poor health, mental as well as physical, with those with the worst self-reported health living on unauthorised roadside sites, followed by those living on poor quality local authority sites. Thirty-nine per cent of the sample reported anxiety or depression, and the majority of those lived in conditions where they felt insecure because of planning status, threat of eviction or poor site conditions or had reluctantly accepted to live in bricks and mortar because there was no pitch available on a Traveller site. It is also notable that the majority of respondents rated their health as bad or very bad by their mid to late 30s and by their 40s a steep decline had begun.
Asthma and repeated chest infections, particularly among children, were noted in about half the interviews, but it was difficult for many at insecure sites to be registered with a GP. Chronic conditions, such as diabetes or kidney problems, were therefore inadequately treated and exacerbated. This was in contrast to those on secure sites, who were all able to access a local GP. Gypsies and Travellers who lived on private sites with planning permission felt that they had the best health. The experiences of racial harassment recounted to the interviewer are particularly heart-breaking, especially when the Gypsies and Travellers concerned had deep-rooted family connections to the area and had lived there for many generations.
The more secure a site, the fewer incidents there have been. It is not as if many Gypsies and Travellers did not engage in their local neighbourhoods when they did have stability through schools, councils and service providers. Respondents at two-thirds of the sites gave chapter and verse about this. Since they did much more caring for immediate household members or the wider family than the general population do, I think they did indeed have something valuable to contribute.
It is pretty well evidenced that improving the environmental health factors of existing sites and providing stability of tenure would improve health outcomes considerably. This would, of course, be cost effective in terms of reduced spend on ill-health and disability, as well as having a positive effect on children’s education, and it would deliver a measure of justice to those so heavily and unfairly penalised by the shortage of authorised sites.
Under the Health and Social Care Act 2012, commissioners of healthcare services have a duty to reduce health inequalities in access to services and outcomes. This, combined with the equality duty under the Equality Act 2010, should oblige local authorities responsible for accommodation to work with healthcare commissioners and health and well-being boards to sort out a fairer deal for Gypsies and Travellers. Will the Minister tell the committee how many local authorities have taken this role on board?
As local authorities have in the past been so slow to assume their responsibility for fair standards for their Gypsy and Traveller citizens, the report says, the duty once placed on local authorities to provide sites where a need has been identified should be reinstated. If the Welsh Government can do it—with a consequent drop in expensive disruption and protests—why cannot we?
At the very least, more robust data should be gathered by the MHCLG on the provision of new pitches on Gypsy and Traveller sites explicitly linked to health outcomes for people on insecure sites, monitored under Health and Social Care Act 2012 duties. Such monitoring should include the impact of the August 2015 Planning Policy for Traveller Sites’ change of definition, which can so damage the capacity of Gypsies and Travellers to obtain reasonable planning permission.
Non-governmental organisations, such as Friends, Families and Travellers, of which I have the honour to be president, also ask for the data to be disaggregated for Gypsies, Roma and Travellers. The amalgamation of data has skewed statistics for the different communities, who have different characteristics. There is no systematic monitoring because they are not yet included in the NHS data dictionary, so how can health outcomes be understood and resources properly targeted? Friends, Families and Travellers has asked Jeremy Hunt to include accommodation status in NHS data collection, so as to present a clearer picture of how homelessness impacts on health. Will the Minister tell me what is happening about this?
Time prevents me listing all the sensible recommendations of this report, but your Lordships’ Committee and the Gypsy and Traveller communities themselves are owed a progress report by the Government on what they are doing about them. I remind your Lordships that the inequalities of health among Gypsies and Travellers result in significantly decreased life expectancy—up to 12 years less for women and 10 years less for men—a miscarriage rate of 29% as opposed to 16% for the mainstream population, the highest maternal mortality rate of any single group and 17.6% of them having experienced the death of a child as opposed to 0.9% of their low-income peers, quite apart from increased chronic illness, a marked increase in incidence of mental ill-health and a lack of support in bereavement and suicide.
These are dark days for our cherished diversity. Gypsies and Travellers have never shared much in our much-vaunted tolerance, but now that the alarming increase in the racial harassment they experience is so clearly documented, what are Her Majesty’s Government doing to show that all our citizens are of equal worth?
The Lord Bishop of Derby
My Lords, I thank the noble Baroness, Lady Whitaker, for securing the debate and for her passion and leadership on this very important issue. I will make a contribution about Roma people, of whom there is a significant community in the city of Derby, where I am privileged to serve. I chair the Multi-Faith Centre, which brings together different faiths and cultures, and we have a particular project working with Roma people in the city. I will draw on that experience to highlight this element of the Question and to point to some things that we might want to consider more deeply.
My colleague the most reverend Primate the Archbishop of Canterbury has published a book, Reimagining Britain. One of the tables in it shows that Roma people and other groups are a barometer of many of our problems as a civilised society. That is what I want to explore. Your Lordships will know that Roma people are a migrant, unsettled people. They are reputed to have come from northern India more than 1,000 years ago and migrated into the Balkans and parts of Europe. What has been highlighted in our experience of trying to work creatively with Roma people in Derby is that while we have developed a way of handling society and health issues through what I would call settled systems, it is difficult for people who do not have a settled lifestyle to fit into such systems. Rather than thinking that they are old-fashioned people who need to settle down and fit into our settled systems, I think that they bring with them an important challenge that the Minister might like to comment on. My wife lives with me on the edge of Derby and works in London; she is a mobile, modern person. It is very difficult for her to make an appointment with the doctor, for instance, because the system is settled but she has a flexible lifestyle. Many of the Roma people are testing our systems, so we need to be creative. We need to be pushed towards greater flexibility in dealing with these people, not simply making them conform to things that might be too tight for them.
In my experience and that of my colleagues, the scale of deprivation among Roma people is enormously high. Literacy rates are low. There is a history of discrimination, so there is a mentality of not being confident about fitting in. There are high levels of unemployment and smoking. There are low rates of child immunisation and high infant mortality. In 2014 the European Commission said that poor health among Roma people is closely linked to social, economic and environmental factors. People such as the Roma are a barometer of the health of our society, and that is why it is worth taking them seriously and learning from them.
They come with difficult cultural norms. As a long-oppressed people with no real sense of home, there is fatalism and a tendency to live in the moment. We run a youth club for young people because they tend to congregate in open spaces, which is their lifestyle, and it is sometimes difficult to hire somewhere for those young people to meet. There is such an explosion of energy and engagement in the moment and we have somehow to see how that can be a part of our civilisation, something that can be seen to be creative rather than anti-social and not fitting in with our norms.
At our multi-faith centre we run the Roma Community Care project in partnership with Derby City Council. The Minister might like to reflect on how we can encourage local authorities to partner with voluntary energy to reach out and be alongside people to help with integration and to offer health services. We try to use Roma people. We train them within the project and try to develop self-help and development skills. Some things need to be done to put some flesh on engaging creatively with people who bring unsettlement into our settled system. First, as I have said, we need voluntary energy and local authority funding to bring schemes together. Secondly, we need mediators and champions, people who will engage with these communities and raise up people who can come back and engage with us. We need to make home visits, not just to meet people in our territories—our surgeries, our hospitals and in A&E departments—because in Roma culture, people will talk about their health only within the privacy of their own home. They are nervous about talking in what they think of as a more public place. We need to train and equip people from the Roma community as workers and volunteers, and we need outreach programmes.
One of the most interesting things we have learned is that in a culture with low rates of literacy, it is no good producing leaflets to help people access healthcare. Roma people communicate through conversation. Quite honestly, in a civilised society, is it not better to communicate through talking rather than by leaflet? That is why we need advocates—people to make the connection. There is an interesting challenge. Do our systems have enough space for conversation? You have to fill in a form online or ring up to make an impersonal appointment with some sort of machine. Roma people present a challenge that is not just a problem to be overcome but should make us think about our systems slightly more creatively. We have to encourage our professional services to engage with people such as the Roma more on their own terms, with proper cultural awareness.
Finally, the Roma are a very vulnerable people and we have high levels of trafficking in our city of Derby. We have had cases of child trafficking, sexual exploitation and forced labour where there have been prosecutions and Roma people are victims, because they are so vulnerable.
I hope we can look at our systems of housing and health—of connecting with these communities—to see how we can reach out to meet them. We should not just expect them to conform, but should look for a cultural engagement where we give a bit to bring people in and reach out, and they have to learn to give a bit to participate in what we are offering for a healthy society with healthy Roma people within it.
Lord Judd (Lab)
My Lords, I very much thank my noble friend Lady Whitaker for giving us the opportunity of this debate. I have to mention this: I always enjoy listening to the right reverend Prelate because he always speaks with the authority of engagement. He is not just telling people what they should do or theorising about it; he is actually involved in doing it, which is very challenging.
I put the record that I deeply appreciate the information I received from the Traveller Movement, which produced a very helpful briefing for the debate. I should also like to put on the record my appreciation of our Library. I always like it there. It does first-class work in making available helpful information on the issues before us. I just wish that more of us in the House would look at what it produces and value it, because it is of a very high standard.
It is a difficult time for a whole host of reasons. The shortage of money and the reduction of money for local authorities, when they are on the front line, is a real worry—yet another. My time in the Council of Europe—just short of 10 years, which I enjoyed tremendously—offered another illustration, on the issue of Gypsies and Roma, of how, to work satisfactorily, we had to look at it strategically as well. Therefore, there is a great need to work closely with our friends in Europe. Whatever happens as a result of all our late nights here on the legislation to prepare for leaving Europe, we will need to go on working closely with our friends and colleagues in Europe. We need to understand each other; of course, in some countries in Europe there are still situations that lead to more Roma and Gypsies coming to our country. In a way, that is a credit to this country.
My other point is that I am sure that we have—the right reverend Prelate already talked about this—an immense amount of work to do with our community in terms of understanding. Some schools are doing very imaginative work, but much more needs to be done. It should not just depend on an inspired teacher who happens to be interested in the subject and is therefore doing something about it. It should be integrated because this is part of our community; it should understand what being part of that community is. I never hesitate to make what could be said to be a rather idealistic point; I am glad it is said to be so. One of the things we must get right in British society is learning to celebrate and enjoy diversity. There are always situations and pressures from the unfamiliar by which people can feel threatened, but that is essentially because people are not well informed. Therefore, there is a terrific job to be done.
As the right reverend Prelate said so wisely, we need—he said “champions”; I would say emissaries—people who go out and help the Roma and Gypsies. The challenges for the Gypsy community are huge, but the challenges for the Roma are terrific. We must help them to better understand the society they are living in and to find their way about in it. We must help them to integrate, to the extent that they are in dialogue with the society of which they are a part, and help that society to understand. I would be lying in this Committee if I did not say that I sometimes feel quite distressed when I am going through a beautiful part of the country, or a very attractive country town, and suddenly see a mess. It is not nice and people can react in a host of ways. I do not believe that if we really had the right kind of communication we could not tackle that issue together with the Roma and Gypsies: we would help them to understand how other people see their lifestyle and what it is doing to them.
This debate is supposed to concentrate on health, and health issues are huge. Life expectancy is 10% below that of the general population; that is, 10 to 12 years less than the general population. Infant mortality is still deeply worrying, as is the high maternal mortality rate. There is low child immunisation. There are issues around levels of mental health problems, substance misuse and diabetes. There are very disturbing statistics on all these conditions on which we need to concentrate. If we are talking about what can be done and what the Government should be doing, my noble friend has asked very specific questions and I support her in saying that I hope we get specific answers to those questions. Information sharing is tremendously important, not just between the long-established settled community and Gypsies and so on, but between different parts of the settled community, which often react in isolation from each other. There needs to be much more integration.
We also need community engagement and to find ways to make mainstream services relevant and accessible. I liked what the right reverend Prelate said about his wife. Most of us have the same kind of experience with our GP at home, wherever we live, and our lifestyle here. Poor living conditions need to be addressed. I am very glad that my noble friend has given us the opportunity to concentrate on this issue for a few minutes, but we are good at talking about the issue; it is when things are actually happening that we should worry. At the moment, if viewed as history, or looked at from another planet, we do not have a very good story to tell about these underprivileged people and the kind of challenges they are enduring. We need to wake up and do something about it.
Baroness Bakewell of Hardington Mandeville (LD)
My Lords, I thank the noble Baroness for securing this important debate and setting out the issues so clearly. We all take healthcare for ourselves, our families and our children extremely seriously and want it to be available when we need it. This right has to be extended to the Gypsy, Roma and Traveller communities.
When elected to Somerset County Council, I was persuaded in 1995 by a colleague to chair a small working group looking into the needs of Gypsies, Roma and Travellers in the county. There was widespread support for the deliberations of this working group, including from the Traveller Education Service, social services and the various district and parish councils. We talked to many Gypsies and Travellers and found that it was all but impossible for them to access healthcare, due mainly to the need for a permanent address in order to register with a GP, as the noble Baroness said. There was also some suspiciousness on their part about having contact with officialdom and filling in forms. The county council at that time had a strong Gypsy and Traveller department, which looked after the six sites for Gypsies in the county’s ownership. Gypsies and Travellers arriving in the county from outside and camping in unregulated sites were provided with water bowsers and visited to ensure that their needs were met, especially if there were children present. We take the provision of water as a given, but many have recently realised just how difficult it is to live if their water supply is cut off.
Although the report of the working group was welcomed by some, this was not the case for everyone. I had the extremely unpleasant experience of attending a public meeting in part of the county where one vociferous gentleman stood up and said that the only thing to do with Gypsies was to stand them up against a wall and shoot them. Mercifully, his extreme and irrational hatred was not replicated by others in the room.
I wind the clock forward 13 years to 2008-09 when, as a member of the local district council, I took part in a piece of work run by the Centre for Public Scrutiny. A group of councils looked at health services available to communities on the margins. Two councils, of which mine was one, looked at the provision for Gypsies and Travellers, while two others looked at provision for sex workers and two others looked at provision for ethnic communities.
During our work in south Somerset, we visited two Gypsy sites. We talked to the teenagers, young women and mothers on the site. We found they had good access to maternity services, and midwives visited the site to do antenatal checks. They were all pleased with the level of support they got. As they lived on a permanent site, the young mothers and more mature women were registered with local GP practices and got good support, not only for themselves but for their children, although this did not seem to extend to dental care.
There was, however, little health support for Travellers who were often camping in woodland sites and on the corner of farmland, usually with the support of the local landowner or farmer. These were not permanent arrangements and, therefore, access to health care was very limited. Their children were unlikely to receive the usual inoculations that we take for granted for our children. Although Gypsies and Travellers need to access healthcare, they rarely, if ever, wish to access social services. It is part of their culture that they look after their own elderly relatives, while we in the settled community tend to call up services to help us with our infirm and elderly relatives.
The Equality and Human Rights Commission, in its report in March 2016, found that Gypsies and Travellers, compared with the general population, were more likely to suffer bad health, as has already been referred to. This includes lower life expectancy, high infant and maternal mortality rates, low child immunisation levels, chronic cough or bronchitis—even after smoking is taken into account—asthma, chest pains and diabetes. They also have higher rates of smoking. This is exacerbated by the fact that many Gypsies and Travellers remain, as I have indicated, unregistered with GPs.
Although variability in general health among different ethnic groups can sometimes be explained by an older age profile, this is not the case for Gypsies and Irish Travellers, of whom only 6% were aged 65 or above in 2011, and who had a low median age of 26. Improved life expectancy for Gypsy and Traveller communities appears to be associated with the availability of established site provision and access to medical care. Having a pitch on a permanent site is vital to accessing healthcare, to which every speaker has referred.
A recent report from the Department of Health noted that accommodation insecurity, the conditions of Gypsies’ and Travellers’ living environment, low community participation and discrimination all play key roles in exacerbating these poor health outcomes. It is suggested that these factors also hold the key to effectively addressing and improving health and well-being. The report calls for long-term, joined-up working at both local and national levels to address the wider social issues of Gypsies’ and Travellers’ ill health. Similarly, emerging evidence shows that the health inequalities of Roma people are close to those among Gypsies and Travellers. These include a high prevalence of diabetes, cardiovascular disease, premature heart attacks, obesity, asthma and mental health issues.
Poor familiarity with healthcare provisions and language barriers may make it difficult for this group of marginalised people to access services. Their culture may prevent some Roma people using support services for mental health issues, sexual health and drug and alcohol misuse. However, it is known that Gypsies and Irish Travellers have low rates of GP registration. While somewhat out of date, in 2004 16% were not registered, compared with 1% of comparators.
I have been looking at and involved in this subject for more than 20 years. We do not as a society appear to have moved forward in ensuring that this marginalised part of our nation has equal access to health care. What will the Minister do to allow these people to have access to the healthcare services the rest of us take for granted?
Baroness Wheeler (Lab)
My Lords, I, too, congratulate my noble friend on securing this important debate. I pay tribute to her strong advocacy and campaigning work with the Gypsy, Traveller and Roma communities over the years, most recently as the president of the Friends, Families and Travellers organisation, which plays such a key role in the network of community organisations fighting hard against injustice, discrimination and poor health outcomes suffered by Gypsy and Traveller communities across the UK.
It is timely, one year on from its publication, to seek a clear and unequivocal response from the Government to the key recommendations and call for urgent long-term and joined-up working contained in the excellent work undertaken by Professor Greenfields and Matthew Brindley on the health impact of insecure accommodation and poor environmental conditions, so ably summarised by noble friend in her speech. As the foreword to that document states:
“This report makes it clear that the conditions in which members of this group are born, grow, live, work and age contribute significantly to their poor physical and mental health outcomes … Tackling these wider determinants is crucial to breaking this cycle of deprivation and health inequalities”.
Noble Lords have today painted a bleak picture of this cycle of deprivation and poor health. Gypsies and Travellers have poor access to healthcare generally, with difficulty in registering with GPs and poor access to services as a result, including health screening, home visits, dental services and access to secondary health care. We have heard about the life expectancy of over 10% less than the general population, with other health issues such as high infant mortality rates, high maternal mortality rates, low child immunisation take-up, mental health issues, substance misuse and diabetes, which are all prevalent in the Gypsy and Traveller communities.
The Care Quality Commission report in 2016 on end-of-life care came to the stark conclusion that, overall, health commissioners and services in most areas have done little to reach out to the Gypsy and Traveller community. Can the Minister tell the Committee what the Government are doing to address this? Should not each clinical commissioning group have a lead or champion, as we have heard, for all the four groups vulnerable to poor health that were identified by the National Inclusion Health Board, which includes this key group we are discussing today?
As the debate has clearly demonstrated, there is much for all of us to learn and understand about the history, values, traditions, culture and vibrancy of the Gypsy and Traveller community—for example, its strong family networks and relationships and their carer responsibilities and commitments. The Greenfields study showed that 42% of respondents were carers involved in helping to care for immediate household members or wider family onsite or in the immediate vicinity. That is significantly above the rate found in mainstream populations and, as the study underlines,
“reflects cultural values common to Gypsies and Travellers and significant cost-savings to local authority and health services who would otherwise need to engage with delivering care to vulnerable individuals”.
Like the wider communities, many of the adults and disabled being cared for within Gypsy communities will have comorbidities, particularly relating to high levels of respiratory disease and diabetes, as we have heard, resulting from poor care and accommodation, all of which make life more challenging and difficult for the carer and the cared-for. On International Women’s Day, as has been said, it is right that we underline the key role of carers, the majority of whom are women, as well as the importance of the role that women play in the communities that we are talking about.
Like other noble Lords, I am very grateful for the expert and comprehensive briefings that we have received from the Traveller movement and the FFT and for the thorough House of Lords Library research brief. They not only set out the problems and the challenges that individuals and communities face but address the myths and assumptions that lead to the health inequalities and widespread discrimination that we are discussing today. Most prominent among such misunderstandings is Gypsies’ and Travellers’ long-established roots in their local communities—yet they are so often wrongly labelled by the local community as newcomers.
I look forward to the Minister’s response on the issue of local authorities’ duty of care to Traveller communities and the Greenfields report’s call for the reinstatement of their responsibilities to provide Traveller sites where a need has been identified, an issue raised by my noble friend Lady Whitaker. Does the Minister agree that that would address one of the root causes of unauthorised sites and encampments, which not only have an adverse and negative impact on the health and well-being of Traveller communities but stoke up local community resentment and misunderstanding and deepen community risks? The Government are not usually very fond of giving praise to the Welsh Government on health and related issues, but the application of such a duty in Wales has had very positive effects, as speakers in the debate have pointed out. Indeed, the Welsh Government’s updated 2016 delivery plan for the Gypsy and Roma community, Travelling to a Better Future, is an excellent strategic and cross-service approach to raising awareness and providing the joined-up services across health and social care and accommodation that are being called for today.
I referred earlier to the CQC report on end-of-life care support, A Different Ending. I am currently undertaking a fellowship with the Industry and Parliament Trust on the hospice and end-of-life care movement, so I was particularly concerned at the CQC findings on the huge barriers to good end-of-life care faced by Gypsy and Traveller communities. The cultural misunderstandings that we have heard about throughout this debate are often at the heart of the poor care that they experience, such as the failure by hospital services and staff to recognise the importance of extended family being able to visit a dying person while they are still alive, and as a family or a group in large numbers, not just filing in one at a time in accordance with hospital single-visitor rules. There are also negative experiences around parking caravans in hospital car parks while visiting for long periods, often met with aggression and threats to call the police, and the failure to recognise the need for the quick release and burial of the body in Traveller culture.
Case studies under Professor Greenfields’ research work on the bereavement experience of the Gypsy and Traveller communities highlight the appalling lack of appropriate psychological follow-up care provided to families, particularly in relation to post-natal bereavement or stillbirth or following on from the suicides of close relatives. By contrast, good end-of-life care experiences cited by the CQC included both hospital and hospice support for the person being able to die at home in their trailer and the welcoming of the whole family into one room on hospital or hospice facility sites. The CQC cites a project in Suffolk where hospices and Gypsy and Traveller communities work together to raise awareness of Gypsy and Traveller culture. There is much to learn here. What plans do the Government have to help to raise awareness among health and community services of the end-of-life care needs of Gypsy and Traveller communities?
No debate on the health and well-being of the Gypsy, Roma and Traveller communities can pass without reference to Rodney Bickerstaffe, the former UNISON general secretary who sadly died last year. He was president of the Labour campaign for Travellers’ rights in the 1980s and 1990s, spearheading the adoption of some key policy initiatives that were subsequently taken forward by the Labour Government in office. The most important of these was supporting the drive for more Travellers’ sites through the inclusion of Gypsy and Traveller accommodation assessment needs in regional spatial strategies, sadly later abandoned by the coalition Government. As a former employee of UNISON, I can testify to Rodney’s heartfelt and indefatigable campaigning and commitment to working to improve the lives and health of the Gypsy, Traveller and Roma communities, which he carried on through into his presidency of the National Pensioners Convention after his retirement from UNISON.
This has been an excellent debate on a crucial issue that needs urgent attention, and I look forward to the Minister’s response.
Baroness Chisholm of Owlpen (Con)
My Lords, this has been a fascinating debate, and I thank the noble Baroness, Lady Whitaker, for initiating it. It is exactly the sort of debate that we should have in this House, and I have certainly learned a lot along the journey of my briefings.
As the noble Baroness, Lady Whitaker, mentioned, Gypsy, Roma and Traveller communities are among the most disadvantaged in British society. They experience some of the poorest health in the UK, with life expectancy up to 10 to 12 years less than the general population. Some 39% of Gypsies and Travellers have long-term illnesses, compared with 29% in a comparison group. At the same time, as the noble Baroness, Lady Bakewell of Hardington Mandeville, said, they tend to be younger than the average population.
The situation is exacerbated by so many Gypsies, Roma and Travellers not being registered with GPs, as the right reverend Prelate the Bishop of Derby and other noble Lords mentioned. Poor familiarity with healthcare provisions and often language barriers may make it difficult for people to access health services. Other factors that have an influence are accommodation insecurity, the living environment, low community participation and discrimination.
So what have the Government done about it? All noble Lords talked about healthcare, and the poor health outcomes faced by Gypsies, Roma and Travellers are in many ways entrenched and difficult to resolve, but the Government have supported a number of focused developments to improve the system. The Inclusion Health programme published a number of resources from 2013 to 2016 on key issues affecting this group of people. These included guidance for services on planning and commissioning inclusive services and a report on the impact of insecure accommodation and the living environment on Gypsies’ and Travellers’ health. This was published in January 2016 and made a series of recommendations to government.
While there is still much to do, good progress has been made in the last two years in meeting some of these recommendations—for example, improved joined-up working between central government departments and between local authorities, police forces and Police and Crime Commissioners. Among other points, the National Inclusion Health Board emphasised the importance of identifying the health needs of these vulnerable communities, particularly through local joint strategic needs assessments, which could be met by the local authorities or by clinical commissioning groups; providing leadership at local level, including through joining up health and local authority interests, where public health has a pivotal role; and commissioning for inclusion, including by strengthening local arrangements and protocols to ensure services are accessible and welcoming.
Many noble Lords have mentioned good practices in that area. The noble Baroness, Lady Bakewell, mentioned a particularly interesting project going on in Suffolk and the right reverend Prelate mentioned what was going on in his area as well. There is another very good area practice taking place at the moment, in the Market Harborough medical practice in Leicestershire. Through local NHS funding arrangements and GP contract levers, it has delivered an enhanced care model for Gypsy/Traveller communities. This met the needs of people on two large Traveller sites close to the A6 motorway. The focal point, after registration of patients, was a nurse-led minor illness clinic. The medical centre takes a more relaxed position on appointments with Travellers; if they turn up without an appointment, rather than forcing them to make an appointment, staff will see them at the end of the clinic—an arrangement that works well and suits both parties, according to staff. Gypsy/Traveller engagement was costed into the design and delivery of services at this practice, which in turn built confidence with the GRT community through a named trusted professional. As the right reverend Prelate said, that is so important. They felt safe talking to a particular person, and, equally, that person was able to visit them in their communities.
The National Inclusion Health Board has produced practical advice for the professionals responsible for service design and provision. This is to support efforts to facilitate the social inclusion of these groups, notably around the lack of data, and to support local health staff to take account of the often complex needs of vulnerable groups when they are commissioning services.
The noble Baroness, Lady Whitaker, talked about registration difficulties experienced by Travellers. An Inclusion Health training guide was published in 2016. In November 2015, NHS England produced guidance for general practices to clarify the rights of patients and the responsibilities of providers in registering with a GP practice, and to facilitate better understanding about the process of registering with a GP. This guidance has now been complemented by the publication of a leaflet for members of the Gypsy, Roma and Traveller communities on how to register with a GP. I know that the right reverend Prelate the Bishop of Derby said that it was not always the answer to hand out leaflets but in this case the leaflet was co-produced in March 2017 by the Gypsy, Roma and Traveller communities for them to hand out within their own communities.
On accommodation and planning, the noble Baroness, Lady Whitaker, talked about the problems with roadside sites, as did the noble Baronesses, Lady Wheeler and Lady Bakewell of Hardington Mandeville, and the noble Lord, Lord Judd. The Government are committed to reducing the number of unauthorised sites by ensuring that local planning authorities plan and make provision for affordable, good-quality accommodation for Travellers, while recognising their distinct cultural lifestyle. Local authorities are best placed to make decisions about the number and location of such sites locally, having had due regard to national policy and local circumstances. However, a proposal has been made to implement more widely the negotiated stopping policy which is currently operational in Leeds and seems to be working very well. This allows unauthorised encampments that do not cause trouble to stay for a fixed period of time. The authority works with the unauthorised encampments and the local settled community to set out ground rules on noise, fly-tipping or on issues that some people in rural communities have experienced with unsettled communities such as problems with their dogs. The encampment is tolerated for a short period of time. This policy has also been found to increase community cohesion. Leeds has estimated that it has saved it £240,000 a year.
We expect that local authorities should identify a five-year—ideally a 15-year—supply of deliverable and developable sites for Travellers against locally set targets. This should be annually updated. As my right honourable friend the Secretary of State for Housing, Communities and Local Government said in a speech earlier this week, for the first time all local authorities will be expected to assess housing need using the same methodology, which will be a big improvement on the current situation.
Many noble Lords talked about educational problems. We have invested £137 million in the Education Endowment Foundation to identify what works to raise disadvantaged pupils’ attainment and to communicate this to schools. Between 2012 and 2014 the Department for Education funded two local authorities to trial a virtual head teacher for Gypsy, Roma and Traveller pupils, with responsibility for supporting schools to promote better pupil outcomes. The effective practice identified was disseminated to every local authority in 2017. In 2017, the Department for Education held a conference for local authority Gypsy, Roma and Traveller leads to identify and disseminate best practice in this area. The Department for Education has produced good practice case studies for schools working with Gypsy, Roma and Traveller pupils, and Ofsted has released a report specifically on the education of Roma pupils, which has recommendations for schools and local authorities.
What are the Government doing now? The noble Baronesses, Lady Wheeler and Lady Bakewell of Hardington Mandeville, and other noble Lords mentioned joined-up thinking. The Ministry for Housing, Communities and Local Government maintains close contact with Gypsy, Roma and Traveller stakeholder groups, while the Department for Education has established a Gypsy, Roma, Traveller stakeholder group. The DHSC, the Department for Education and the MHCLG—I hate acronyms—held a trilateral ministerial meeting to discuss Gypsy, Roma and Traveller issues in November 2017, and we plan to continue holding regular cross-government meetings.
The noble Baroness, Lady Whitaker, asked about the NHS data dictionary and how we will cope with it. We are scoping out with NHS England and NHS Digital the development of a unified information standard. This would mean that, if it were possible for the NHS data dictionary to identify Gypsy, Roma and Traveller communities as separate groups for the first time, the dictionary would set out standards for data collection in the NHS. If that standard was implemented, we would fully understand the extent of the inequalities experienced by Gypsy, Roma and Traveller communities by making it easier to determine their health outcomes and uptake of health services. It is in the scoping process; until that is done, it has not been decided how we will view the housing status of this group. We also have the added possibility of taking it from the 2011 census, which we obviously have at the moment, or waiting for the 2021 census to get a proper update of what is going on.
The Ministry of Housing, Communities and Local Government, working with the Department of Health and Social Care and the Department for Education, is funding up to six community-led pilot groups. These projects will improve educational attainment, health, and social integration for Gypsy, Roma and Traveller communities and will be delivered in 2018-19. These projects will be reported quarterly and there will be a full report at the end of the year. The Department of Health and Social Care has commissioned research to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services. This project is due to report back in 2018.
I again thank the noble Baroness, Lady Whitaker, for bringing forward the debate and all noble Lords for taking part. We all need to work with this community to enable it to have good healthcare, good education—particularly as far as girls and women are concerned—and the availability to keep their culture, which they should be able to celebrate and which has been honed over several centuries. As always, I will write to any noble Lords whose questions I have failed to answer and, as always, I seem to have run out of time. I thank noble Lords again for having taken part.