Gypsy, Traveller and Roma Communities

Baroness Chisholm of Owlpen Excerpts

Thursday 8th March 2018 Grand Committee

[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.