Wiltshire JSA for Health and Wellbeing
2013/14
Section 2: health inequalities
Minority groups: Gypsies, Roma, Travellers and Boaters
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Related briefings in the JSA for Health and Wellbeing Briefing (and hyperlink) Ethnicity Entire section Health inequalities Disabilities Youth offending Community safety Housing
Section Demographics Health inequalities Children and young people Children and young people Children and young people Wider determinants of health Wider determinants of health
Outcome Frameworks Summary The Public Health Outcomes Framework for England, 2013-2016 1 outlines the overarching vision for public health as “to improve and protect the nation’s health and wellbeing, and improve the health of the poorest fastest”. One of the most important contribution the framework will make to addressing equality is in creating a robust set of outcome measures that enables services and the local people to whom they are accountable to “drill down” into the underlying data in order to identify areas where different groups do not receive equal access to, experience of and outcomes from, public health services.
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Changes/Comments New section taken from general minority groups section in 2012/13
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Executive summary Within Wiltshire there are groups at higher risk of poorer health outcomes relating to specific health and social care needs and wider determinants of health. This includes gypsies, Roma and travellers and boaters. According to the 2011 Census, 757 people in Wiltshire identified themselves as being of gypsy or Irish traveller ethnicity, this is 0.2% of the population 2. In 2011/12, Wiltshire had 102 children in primary or secondary schools whose ethnic group was Gypsy/Roma according to the January 2012 school census3. As at December 2013, Wiltshire Council owns 5 permanent residential gypsy and traveller sites and one transit site. This provides 90 residential pitches and 12 transit (28 day licence) pitches. In the next 12 to 18 months these will be transformed (dependant on planning permission being granted) to provide 100 full time residential pitches. However, the transit facility will be closed for the next 12 to 18 months to allow its use to accommodate residents of permanent sites during refurbishments4. The Wiltshire gypsies, Roma and travellers strategy group has commissioned a review of national and local evidence and literature review relating to health and wellbeing. This action-orientated project will highlight appropriate interventions and recommend priorities for action by the end of 2013/14. There are about 175 or so boats without moorings on the Kennet and Avon Canal at any one time between Devizes and Bath 5. It is believed that around 66% of these are people's homes. Boaters without permanent moorings experience a range of problems accessing local services because of their transient lifestyle. There are also tensions with local communities and the regulatory authority, i.e. the Canal and River Trust.
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Background Gypsies and travellers have a lower life expectancy compared with the rest of the population. This is associated with several factors including access to services, living conditions and health behaviours, as well as poorer educational outcomes and low employment.
Wiltshire As at December 2013, Wiltshire Council owns 5 permanent residential gyspy and traveller sites and one transit site. This provides 90 residential pitches and 12 transit (28 day licence) pitches. In the next 12 to 18 months these will be transformed (dependant on planning permission being granted) to provide 100 full time residential pitches. However, the transit facility will be closed for the next 12 to 18 months to allow its use to accommodate residents of permanent sites during refurbishments6. In north Wiltshire there are 23 family pitches on one site at Thingley near Chippenham. The capacity will increase to 31 pitches when the current refurbishment project is complete in late 2014. In west Wiltshire there are 7 family pitches on one site at Dilton Marsh near Westbury. This site is due to start a complete refurbishment in March/April 2014, but capacity will remain at 7 pitches. In south Wiltshire there are 3 sites and 1 transit site: • • • •
Lode Hill, Downton, Salisbury where there are 10 family pitches. The capacity will probably increase to 12 pitches when the current refurbishment project is complete in late 2014. Dairy House Bridge, Southampton Road, Salisbury where there are 18 family pitches awaiting refurbishment (planning permission dependant). Oak Tree Field, Odstock, Salisbury where there are 32 family pitches awaiting refurbishment (planning permission dependant). A transit site at Odstock Salisbury- where there are 12 pitches awaiting refurbishment (planning permission dependant).
According to the 2011 Census, 757 people in Wiltshire identified themselves as being of gypsy or Irish traveller ethnicity, this is 0.2% of the population 7. In 2011/12, Wiltshire had 102 children in primary or secondary schools whose ethnic group is Gypsy/Roma according to the January 2012 school census8. This was 0.17% of the school population which was similar to the South West (0.16%) but lower than in England overall (0.22%). Figure 1 shows the distribution of gypsies in Wiltshire by Output Area (OA).
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Figure 1: 2011 Census: ethnicity = gypsy or Irish traveller
Source: Office for National Statistics, 2011 Census
Consultation with the travelling community has raised concerns about access to and appropriateness of health services and maintenance of sites. There are a number of barriers to effective engagement with gypsies and travellers, such as expressed suspicion and fear of authorities and concerns that personal details would not be safe or would be shared with other agencies. There are some particular problems for this community relating to health services within Wiltshire that were raised during
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community engagement work carried out by Wiltshire Racial Equality Council in 2008/09: • • • •
Patchy access to health services in general, especially in the North and West of the county. Lack of information about services and healthy lifestyles in pictorial form. Lack of outreach mental health services. Problems accessing immunisation services for children.
Further work 9 was carried out in 2013 by the Wiltshire and Swindon User’s Network to look at diverse communities experiences with health, public and social care services. The main findings specifically in relation to gypsies, Roma and travellers were: •
Difficulties in accessing services, which require registration (e.g. GP service), for nomadic gypsy travellers due to frequently being on the move and having no fixed abode. Consequently, Romany Gypsies use Hospitals A&E service for minor health needs, which is not appropriate for them or the service.
•
The insular and closed nature of some communities (in particular gypsy/traveller) can prevent potential users from accessing and using mainstream services.
•
Unawareness of different communities’ cultural values and intricacies. For example gypsy traveller values surrounding high regard for hygiene and cleanliness which are important when providing personal care or outreach services.
•
Poor literacy levels within the Gypsy Traveller community even make it difficult for them to locate a service as they find it difficult to understand directions and signs.
The Wiltshire gypsies, Roma and travellers strategy group has commissioned a review of national and local evidence and literature review relating to health and wellbeing. This action-orientated project will highlight appropriate interventions and recommend priorities for action by the end of 2013/14.
South West The South West Public Health Observatory produced a report looking at the health and wellbeing of Travellers and Gypsies in 2011 10. The report: •
refreshed the literature review material pertaining to Traveller and Gypsy health;
•
used recent caravan count data to map Travellers and Gypsy populations in the South West to look at emerging trends;
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investigated, via a questionnaire, how much work, if any, is being done by Local Authorities and PCTs with regard to Traveller and Gypsy health;
The findings included: •
Work in this area is very limited and there are still vast gaps in research and data pertaining to the health of Traveller and Gypsy communities.
•
The lack of research makes it challenging to draw conclusions but the general consensus from the sources that are available is that the healthcare of Travellers and Gypsies is still worse than the national average.
•
Access to GP breastfeeding support, immunisations and injury prevention services are available to Travellers in almost half of local areas in the South West.
•
Areas that need to be improved are sexual health, dentistry, and drugs and alcohol services, all of which scored low on the questionnaire.
Resources In November 2010, the Secretary of State for Communities and Local Government set up a ministerial working group to tackle the poor outcomes Gypsies and Travellers experience across a wide range of social indicators. A progress report 11 was produced including 28 commitments from across Government that will help mainstream services work more effectively with the Gypsy and Traveller communities.
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Boaters Background Nationally, there are an estimated 5,000 to 10,000 people living on boats without permanent moorings on inland waterways owned or managed by the Canal and River Trust (CRT) 12 which is the navigation authority for the Kennet and Avon canal13. The canal runs through Bath and NE Somerset, Wiltshire, West Berkshire and Reading and about 40 miles of it is in Wiltshire. There are 2,000 boats in total on the Kennet and Avon canal including those on permanent and marina moorings. There are about 400 or so boats without moorings on the Kennet and Avon Canal at any one time and 175 are between Devizes and Bath 14. It is believed that around 266 (66%) of these are people's homes and there are an estimated 559 adults and children living in these homes 15. Only 14% of boat dwellers without moorings on the Kennet and Avon canal reported that they receive welfare benefits; 51% have an annual income below £20,000, and 40% are earning minimum wage or less. Some 68% have a postal address16. According to the Kennet & Avon Boaters 2011 survey, 78% are registered with a GP. Around 5% are aged over 60 and 7% said they had a disability. There is no security of tenure for boat moorings on any of the UK's navigation authorities, unless you are one of the 83 boaters on CRT residential moorings who hold a CRT Houseboat Certificate 17. Facilities on the Kennet and Avon canal On the Kennet & Avon canal between Bath and Hungerford there are 14 water taps; 7 Elsan disposal points; 7 pump outs; 16 rubbish disposal points; 3 recycling points and 1 toilet in Bradford on Avon. On other canals and rivers, CRT provide showers, sinks, toilets and launderettes, but there are none on the Kennet & Avon canal except in marinas which make a charge for these facilities. There is virtually no mobile signal on many networks, and no 3g internet signal except in a few places, between Froxfield and Pewsey. Other locations have better coverage but it is very patchy. Most boaters rely on text messaging to communicate. Issues Facing Liveboard Boaters Access to services, employment and benefits: • • • • • •
GP registration / Dental care. Access to school - difficulties surrounding ability to get children into local schools due to constant moving. Often means travelling long distances. Access to library services, e.g. limited internet access as a ‘guest’. Often no benefits claimed / live on low income. Problems with access to employment if forced to cruise wider network. Criminal Record Bureau checks problematic without permanent address.
Waste and sanitation •
Facilities poor or broken or abused by local community.
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Shower and laundry facilities do not exist on Kennet & Avon but do elsewhere on canal network. More recycling facilities needed. Private facilities expensive.
Transport: • • •
Bus pass - over 60s need a permanent mooring /frequency and cost/access. Vehicle parking – often on road and not near towpath, i.e. not secure. Poor condition of towpath, e.g. dog mess.
Local community: • • •
Hostility/ vehicle damage / property theft. Prejudice from local residents/parish councils. Anti social behaviour/ vandalism towards boats in some urban areas.
Other canal users: •
• • •
Many boaters believe hire boat companies should be made to take responsibility for damage caused by their boats and to address drunken / threatening behaviour – more instruction, lower speeds and collision advice required. Lack of canal dredging and maintenance. Volunteer towpath rangers who can be unknown or unchecked people. Engagement with the Canal and River Trust, who police canal life, considered aggressive and confrontational.
Wiltshire Voices Wiltshire Voices brings us the views of people who either do not or cannot participate in civic life. There are many reasons why these people do not take part but there is no reason why they should be ignored. Wiltshire Voices enables people to have a say in their own way. A short film about Boaters in Wiltshire has been made as part of the Wiltshire Voices programme: http://wiltshirevoices.wordpress.com/
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Challenges for consideration Addressing the lack of reliable baseline data on some groups e.g. people who identify themselves as lesbian, gay, bisexual or transgender, travellers and gypsies, and religious groups. Break down the barriers to effective engagement with gypsies and travellers, such as expressed suspicion and fear of authorities and concerns that personal details would not be safe or would be shared with other agencies. There are some particular problems for gypsies and travellers relating to health services within Wiltshire that have been raised: •
Patchy access to health services in general, especially in the North and West of the county, particularly those which require registration (e.g. GP services).
•
Lack of information about services and healthy lifestyles in pictorial form which would help with literacy issues.
•
Unawareness of different communities’ cultural values and intricacies. For example gypsy traveller values surrounding high regard for hygiene and cleanliness which are important when providing personal care or outreach services.
•
Lack of outreach mental health services.
•
Problems accessing immunisation services for children.
Boaters without permanent moorings experience a range of problems accessing local services because of their transient lifestyle. There are also tensions with local communities and the regulatory authority, i.e. the Canal and River Trust.
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Contact information Document prepared by:
Tom Frost Public Health Scientist Wiltshire Public Health Telephone: 01225 716791 Email:
[email protected] With input from: Frances Chinemana, Public Health Consultant, Wiltshire Public Health Mike Davies, Gypsy & Traveller manager, Wiltshire Council
1
Healthy Lives, Healthy People: Improving outcomes and supporting transparency, Department of Health, January 2012 https://www.gov.uk/government/publications/healthy-lives-healthy-peopleimproving-outcomes-and-supporting-transparency 2 2011 Census, Quick Statistics table QS209EW, ONS, January 2013 3 January 2012 School Census, Chimat. url: http://atlas.chimat.org.uk/IAS/dataviews/view?viewId=247 (accessed 15/1/13) 4 Information provided by email by Gypsy & Traveller Manager, 04/12/13 5 Mark Stephens, Kennet and Avon Canal Manager 6 Information provided by email by Gypsy & Traveller Manager, 04/12/13 7 2011 Census, Quick Statistics table QS209EW, ONS, January 2013 8 January 2012 School Census, Chimat. url: http://atlas.chimat.org.uk/IAS/dataviews/view?viewId=247 (accessed 15/1/13) 9 Diverse Communities, A study of diverse communities living in Wiltshire and their experiences with health, public and social care services, N Watts & M Fortune, Wiltshire and Swindon User’s Network, 2013. http://www.intelligencenetwork.org.uk/EasysiteWeb/getresource.axd?AssetID=55619&type=full&servi cetype=Attachment 10 Health and Wellbeing of Travellers and Gypsies in the South West, South West Public Health Observatory, October 2011. ISBN: 978-0-9569224-4-1 11 Progress report by the ministerial working group on tackling inequalities experienced by Gypsies and Travellers, Department for Communities and Local Government, April, 2012. ISBN: 978-1-40983430-4. url: http://www.communities.gov.uk/publications/planningandbuilding/mwgreporttravellers 12 The navigation authority for the Kennet and Avon canal is British Waterways (BW) - a public corporation which the Government transferred to a charity, the Canal & River Trust (CRT), on 2nd July 2012. For "British Waterways" now read "Canal & River Trust". 13 Estimate by National Bargee Travellers Association, based on estimate given to House of Commons Select Committee on the British Waterways Bill by petitioners against the Bill in 1993 14 Mark Stephens, Kennet and Avon Canal Manager 15 estimate based on observation, used in Kennet and Avon Boating Community research to identify impacts of British Waterways policy on boat dwellers without moorings: Interim Report 10 October 2011 16 estimate based on observation, used in Kennet and Avon Boating Community research to identify impacts of British Waterways policy on boat dwellers without moorings: Interim Report 10 October 2011 17 Figure quoted for 2010 licences by BW witness in BW v Davies court case to remove boat dweller , September 2010
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