Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, following the commitment to address health inequalities in the NHS Long Term Plan, published on 10 January, what steps they intend to take to tackle the health inequalities experienced by members of the Gypsy, Roma and Traveller communities.
Answered by Baroness Manzoor
During 2019 all local health systems will be expected to set out how they will reduce health inequalities by 2023/24 and 2028/29 including, where applicable, for Gypsy, Roma and Traveller (GRT) communities.
We are reviewing the collection of data within the National Health Service and working closely with NHS England to complete a scoping exercise to understand how information on protected characteristics is gathered in existing NHS datasets. The Department plans to complete an initial assessment later this year, which will form the basis for future decision-making on NHS data collection by ethnicity.
NHS England has produced guidance for general practices clarifying rights of patients and responsibilities of providers in registering with a general practitioner. It also co-produced a leaflet for members of the GRT communities on how to register. These will be kept under review.
The Department of Health and Social Care is also working closely with the Ministry for Housing, Communities and Local Government and the Department for Education on six community-led pilot projects, two of which are looking to improve health outcomes for GRT communities.
The Government commissioned research from the universities of Dundee and York examining how trust in healthcare services could be enhanced amongst Gypsy, Roma and Traveller communities. The report, Enhancing Gypsy, Roma and Traveller peoples’ trust: using maternity and early years’ health services and dental health services as exemplars of mainstream service provision, was published in September 2018. It has made eight key recommendations to the health sector and other key providers, which include increasing collaborative working with those that already have trusted relationships with GRT communities e.g. individuals from third sector organisations, individual health or other sector professionals; and suggested the introduction of literacy help-cards throughout the NHS. These are cards that can be presented to front line staff or receptionists to ask for discreet help with form-filling. A copy of the report is attached.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Lord O'Shaughnessy on 9 April (HL6732), whether they are taking account of the finding in the report by the Social Exclusion Task Force and Department of Health, Inclusion Health, published in March 2010, that lack of ethnic monitoring in relation to Gypsy, Roma and Traveller communities “makes it difficult to ascertain which services are making a difference, to whom, and by how much”; and what progress they have made with NHS England to investigate whether data collection in the NHS could include more of the protected characteristics listed under the Equality Act 2010 to provide better information about Gypsy, Roma and Traveller communities’ access to healthcare.
Answered by Lord O'Shaughnessy
The Department is in the process of reviewing the collection of data within the National Health Service and has commissioned NHS England to complete a scoping exercise to understand how information on protected characteristics is gathered in existing NHS datasets, including the NHS Data Model and Dictionary which currently use the 2001 census ethnicity categories. Subject to the publication of the 2021 Census White Paper, we plan to complete an initial assessment by the end of 2018, which will form the basis for future decision-making on NHS data collection.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether the NHS Data Model and Dictionary will include entries for (1) Gypsies, (2) Travellers, and (3) Roma; and if so, when.
Answered by Lord O'Shaughnessy
The Department is in the process of reviewing the collection of data within the National Health Service and has commissioned NHS England to complete a scoping exercise to understand how information on protected characteristics is gathered in existing NHS datasets, including the NHS Data Model and Dictionary which currently use the 2001 census ethnicity categories. Subject to the publication of the 2021 Census White Paper, we plan to complete an initial assessment by the end of 2018, which will form the basis for future decision-making on NHS data collection.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what information about Gypsies, Travellers and Roma community is available from the NHS’s Improving Access to Psychological Therapies programme.
Answered by Lord O'Shaughnessy
This information is not available as Roma, Gypsies and Travellers are not separately identified in NHS Digital codes used when recording ethnicity of patients.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what training is provided to Clinical Commissioning Groups about Gypsy, Roma and Traveller issues in general, and with regard to dementia in particular.
Answered by Lord O'Shaughnessy
Information on training provided to clinical commissioning groups (CCGs) is not held centrally, as it is for CCGs to determine their specific needs.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what data, if any, they collect in relation to the diagnosed mental health status, and self-harm and suicide rates among self-identifying Gypsies and Travellers within the secure estate; and how such recorded data compares with that of other ethnic groups whose ethnicity is recorded on NOMIS or is otherwise monitored.
Answered by Lord O'Shaughnessy
Data on people detained in the secure estate, including secure mental health hospitals, prisons and immigration removal centres, are collected in different ways across Government. Across the secure estate, data on ethnicity is collected through self-reporting which impacts the ability to provide ethnic breakdowns with confidence.
The Mental Health Services Data Set (MHSDS) collects data on people in contact with National Health Service funded secondary mental health, autism and learning disability services, including secure mental health hospitals. The MHSDS uses ethnicity codes which align with the 2011 Census and NOMIS ethnic groups and includes a category for ‘White (Gypsy or Irish Traveller)’. It does not collect data on suicide and self-harm rates of people identifying as gypsies or travellers.
Prison recording systems such as the Prison National Offender Information System (p-NOMIS) do not hold clinical data, although individual prisoners’ records may refer to aspects of it where relevant. An example is that a vulnerable prisoner being supported through the Assessment, Care in Custody and Teamwork (ACCT) process may have mental health needs that are noted in their ACCT documents, so that non-clinical staff are aware of them and will respond appropriately.
p-NOMIS records incidents of self-harm and all deaths of prisoners, including suicide. For ethnic monitoring it uses the same classifications as the 2011 census. The specific option for Gypsies or Travellers is ‘White (Gypsy or Irish Traveller)’. Anyone not identifying themselves as such may use another, such as ‘White (other)’ or ‘Other’. It is not possible to calculate rates of self-harm or suicide by ethnicity with confidence.
Data on people detained in immigration removal centres is recorded by nationality. Data is not routinely recorded on people who may identify as gypsy or traveller. The Office for National Statistics, which is the official source of suicide data for the United Kingdom, does not collect data on suicide registrations by ethnicity.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the recent study by the University of Essex, The Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the UK; and what monitoring they undertake or evidence they collect in relation to the impact of racism on the mental health and wellbeing of Gypsy, Traveller and Roma people.
Answered by Lord O'Shaughnessy
It is planned that The Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the UK will be examined as part of a wider piece of work to be undertaken by the voluntary, community and social enterprise (VCSE) Health and Wellbeing Alliance programme. This is to examine effective strategies to reduce racial disparities in mental health. The programme is overseen by the Department, NHS England and Public Health England, who work together with VCSE organisations to drive transformation of health and care systems; promote equality; address health inequalities and help people, families and communities to achieve and maintain wellbeing. It is anticipated that work will begin later this summer.
The impact of racism on the mental health and wellbeing of Gypsy, Roma and Traveller people is not routinely monitored.
The Department has commissioned NHS England to scope out whether data collection within the National Health Service could be improved to include more of the protected characteristics listed under the Equality Act 2010. The Government is committed to improving NHS data collection to better understand the extent of inequalities, determine health outcomes and uptake of health services for these communities. The initial scoping exercise is due to be completed later this year.
The Government is committed to ensuring that attention is focussed on developing national and local services to reduce unfair gaps in outcomes between ethnic groups. The Government’s ethnicity facts and figures online resource brings together information from across Government about how ethnicity affects people's everyday lives.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, what assessment they have made of evidence from the Republic of Ireland of the high rates of suicide and premature deaths among Irish Travellers in the All Ireland Traveller Health Study 2010; and what evidence, if any, they collect in the UK in relation to suicide rates among Gypsy, Traveller and Roma residents.
Answered by Lord O'Shaughnessy
No assessment has been made of evidence from the Republic of Ireland of the high rates of suicide and premature deaths among Irish Travellers in the All Ireland Traveller Health Study 2010.
There are no official statistics collected on suicide rates among Gypsy, Traveller and Roma residents in England. The Office for National Statistics, which produces official data on suicide rates in the general population based on registered deaths, advises that data would not be robust enough to produce any statistics on suicide by ethnicity.
Suicide prevention is a priority for this Government which is why we updated the National Suicide Prevention Strategy for England last year to strengthen its key areas for action.
The National Suicide Prevention Strategy makes clear that local authorities should tailor suicide prevention approaches to their local communities. Most local authorities now have a multi-agency suicide prevention plan in place. We expect local authorities to work with the National Health Service and other local services and professionals to ensure their plans are tailored to the demographics and associated risks of their local communities, including for groups such as Gypsy, Traveller and Roma residents.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the reply by Baroness Chisholm of Owlpen on 8 March (HL Deb, col GC117), when the scoping study to identify Gypsy, Roma and Traveller communities as separate groups will be completed.
Answered by Lord O'Shaughnessy
The Department has asked NHS England to scope whether data collection within the National Health Service could include more of the protected characteristics listed under the Equality Act 2010. This would identify Gypsy, Roma and Traveller communities as separate groups for the first time and provide a better understanding of these communities access to health services, their health outcomes and the extent of the inequalities that they face. The scoping work is underway and is due to be completed this year.
Asked by: Baroness Whitaker (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what is their assessment of the efficacy of the drug lanosterol in reducing cataracts.
Answered by Lord O'Shaughnessy
The drug Lanosterol is not licensed for human use in the United Kingdom.
The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for the licensing of medicinal products according to legislation set out in European Directive 2001/83 EC. The MHRA's primary aim is the protection of public health, for which an important objective is assessing the safety, quality and efficacy of medicines, and authorising their sale or supply in the UK for human use.
A medicine can only become licenced if an application is made to the MHRA for a licence, usually by the manufacturer, demonstrating that the product meets the required standards of safety, quality and efficacy. In their role as a regulator, the MHRA is not in a position to hold product licences or to solicit for new product licence applications.
There has been no evidence submitted to MHRA to support the use of Lanosterol in humans at present. There have been no applications for UK clinical trials or marketing authorisations for this product.
Under their terms of service, general practitioners and hospital doctors are allowed to prescribe any medicinal product, including any unlicensed medicinal product, which they consider necessary for the treatment of their patients and under their clinical responsibility. They should always satisfy themselves that the medicinal products or other substances they consider appropriate for their patients can be safely prescribed, that patients are adequately monitored and that, where necessary, expert hospital supervision is available. We would expect clinicians to also seek informed consent from their patients on the basis that there are risks associated with using an unlicensed medicine as well as potential therapeutic benefit(s). Patients should also be informed that the licensing assessment of the medicine for unlicensed use will not have taken place.