Community engagement is about everyone in Scotland having a right to take part in decisions about their health and wellbeing. But for some groups this is harder than for others. As part of Gypsy Traveller History Month, Community Engagement Officer Gillian Ventura tells us how important it is for this resilient community to have their voices heard.
Lockdown has been hard for everyone. Staying home, staying safe, doing your bit. It’s a struggle being cooped up when you’re in house with a garden. Imagine doing it when you can’t get things delivered to the place where you live. Imagine doing it when you’re part of a community where family is everything, but you can’t be within two metres of loved ones whose home you could touch if you just stretched out your hand. Imagine doing it when the land your home sits on is no guarantee of permanent residency.
As family and kinship are central to Gypsy / Traveller culture, the reality of lockdown has been particularly challenging. It can be difficult to maintain a two metre distance in a pitch which requires space for at least two caravans to accommodate one family.
“Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.”
Yet lockdown has simply highlighted the many struggles and inequalities that this community face. Helping to get those struggles voiced at the highest levels is part of my job as one of Healthcare Improvement Scotland’s Community Engagement Officers.
Taking time to engage
There are around 20,000 Gypsy / Travellers living in Scotland. Among them are groups as diverse as Romany Gypsies, Scottish Gypsies / Travellers, Irish Travellers and European Roma. Some will have arrived in the UK as asylum seekers and refugees, fleeing persecution. They all consider travelling and a nomadic identity as an important part of their traditional and contemporary culture. Recognised in law as a distinct ethnic group, they also have the worst health outcomes of any ethnic group, primarily due to poverty and discrimination.
Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.
I’ve been working with the Travelling community at the Swinhill site in Larkhall for two years now, supporting the work of NHS Lanarkshire’s Keep Well Team, nurses Heather Craig and Sandra Kelly. Gypsy / Travellers face a range of health problems at an earlier age than the general population and it’s important to reach them so they can get the right healthcare and support. They typically live 10 – 12 years less than “settled” people. They have higher rates of anxiety and depression and their suicide rate is six times higher than the general population – this increases to seven times for young Traveller men. Infant mortality is three times higher. Around 42% of Gypsy / Travellers are affected by a long-term condition, compared to 18% of the general population. People from Gypsy / Traveller backgrounds also engage later with health services and can often experience barriers accessing primary care as a result of living in unauthorised areas or moving frequently, having low levels of literacy and experiencing discriminatory attitudes.
“The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level.”
The key to engaging the community has been the site manager, Roy Overend. Roy has been at the site since 2003, and thanks to the great relationships he’s built up with the residents and the Gypsy / Traveller community in Lanarkshire, he’s helped us engage with them and understand the complexities of their community. The on the ground work done by Heather and Sandra has also been vital: by carrying out health checks, monitoring blood pressure, diabetes, addressing issues with mental health and wellbeing etc, they have built a rapport with the community. At first it was just the women from the site that went along, now the guys are coming as well. They all see the benefits and the advice they get opens the door for me to be able to do work around things like Realistic Medicine and What Matters to You.
What matters to them
Through the What Matters To You work, we found that the main issue for the community was accessing primary care services, in particular getting registered with a GP service when they are travelling, which is part of their culture. This work was shared with the Travelling Community Network and also with Scottish Government, to help raise the profile of the issues that matter to the community. Through this, we’re linked in to the Improving the Lives of Scotland’s Gypsy/Travellers (2019-21) action plan, launched by Scottish Government at the end of last year. The five key priorities are: provide more and better accommodation, improve access to public services, better incomes in and out of work, tackle racism and discrimination and improve Gypsy / Traveller representation.
The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level. One lady from the community within Lanarkshire assisted the Scottish Government Person Centred Care Team to develop GP Registration Cards. The Keep Well team worked with the community to promote the cards within Lanarkshire and the wider partners working with Gypsy Travellers.
The Blue GP Registration Cards are a pocket sized card promoting the right to register at GP practices. I’ve been encouraging their use by the community, asking them to keep a card in their pocket or bag so wherever they are, they know they can access GP services. Helping improve healthcare here is all about teamwork, and it doesn’t matter that people don’t know which organisation we’re from or who we work for. It’s about working together to ensure the community gets the health and social care support they need. We’re simply the people who can help them do that.
What matters to me
But this is not a quick job. Gypsy / Travellers enjoy and are proud of how they live – it’s the discrimination and lack of respect and resource that they get annoyed about the most. This lack of understanding from “settled” people can make it harder to engage with them – why should this time be any different? Yet building relationships, persevering, and, most importantly, understanding their culture will, over time, pay off, ensuring better health and social care not just for them but for everyone using local healthcare systems. At a time when Gypsy / Traveller culture is being compromised due to lack of site provision, it’s important to me that their voices are heard.
Gillian Ventura is a Community Engagement Officer with Healthcare Improvement Scotland