Aims and objectives: Tackling inequalities in health is a major priority of the Government's Public Health White paper (November 2004). This project was set up to address inequalities in health experienced by an ethnic group in a district.
The aim of the project was to identify and address causes, which create inequalities in health for Gypsy-Travellers in Newark and Sherwood District.
Objectives of this project were:
(1). To identify and address inequalities in health experienced by Travellers. (2) To identify and remove barriers, which prevent Travellers from making full use of the health services.
Support for the change:
Due to their distinct socio-cultural lifestyle Travellers are an inaccessible ethnic group. Recently, Travellers in Newark have formed a group East Nottinghamshire Travellers Association (ENTA). For the past few years a health visitor and her GP practice have established a positive working relationship with this group. Therefore it was possible to involve Travellers throughout the needs assessment and development and implementation of the action plan in this project.
A multi-agency health steering group incorporating Travellers, the PCT, the GP, health visitors, county council, district council, children’s fund, youth services, supporting-people and Travellers education services has been set up. They have developed and are implementing and monitoring a five-year action-plan a stepped programme.
To sustain the project activities in long term, "reducing inequalities experienced by Travellers" has been adopted as one of the three local targets built into the Local Delivery Plan of the PCT.
Patient and public influence:
Survey and focus group discussion with Travellers provided insights into the barriers Travellers face and solutions for improving their access to health services.
Travellers have become active members of the multi-agency health steering group and have actively contributed to the development of the 5 years action-plan and particularly in:
• Development of a patient-held record card for use by health service providers to provide continuity of care for Travellers.
• Development of sets of audio-visual educational material for Travellers, covering education about health services and health promotion topics that affect Travellers.
• Development of educational packages on Travellers' culture and health beliefs for training health service staff.
Impact on the workforce:
A family worker, (-a new cadre from within the Travellers community), is being trained to work as a bridge between the health services and Travellers.
Three health visitors are receiving on-the-job training on effective working with Travellers communities.
Training on Travellers culture and health beliefs has been included in the development training of frontline workers in primary and secondary care facilities in the district.
Measuring the results:
This is the first time that Travellers health needs have been systematically been assessed. By using a unique postcode identifier, information pertaining to Travellers was obtained from the routine health statistics. This was then compared with the district average and other local information with various agencies.
Pooling their resources a multi-agency health steering group jointly made five years action plan. Travellers, health visitors, GP and other agencies' frontline workers jointly monitor implementation of the action-plan. The PCT and Nottinghamshire County Council have jointly appointed a family worker.
The PCT has adopted reducing inequalities experienced by Travellers as one of the three local targets into the Local Delivery Plan and have encouraged the GP practice to develop enhanced services for Travellers.
Improved performance:
Travellers were involved in planning and conducting the needs assessment. It showed that Travellers had disadvantaged health status across all key health areas of primary care, secondary care and health promotion. For example;
• Double the deaths rate (1,619, CI 1,110: 2.270) of the PCT average (707, CI 678:737).
• High death rates for smoking related conditions.
• High emergency-hospital admissions (50%) against the PCT population (32%).
• Poor uptake of; immunisation (MMR 56%: Meningitis C 52%), breast screening (29%) and cervical screening (37%).
Travellers were then involved in preparing a multi-agency 5 years action plan to address the identified needs, and they continue to be actively involved in implementation and monitoring of the action plan.
Reflecting diversity:
Health of the population in Newark and Sherwood district is average when compared to England, however some pockets of inequality remain within the district. Travellers are a distinct ethnic and culturally diverse group. However, because of the lack of specific ethnic coding they are invisible in Census and Health Statistics. As a result their health needs have never been addressed separately like other ethnic groups. Further Travellers experience social prejudice, which often reflects among health care providers.
The results of the needs assessment have shown that Travellers experience inequalities in health in all fronts. Their high mortality and morbidity need to be addressed by improving their access to and full utilisation of health services.
Educational packages on understanding Travellers’ culture are being delivered to the health service staff (receptionists, nurses, midwives and doctors) and managers (PCT and hospital). Similar actions have been taken by other agencies (e.g. county and district councils, police and fire departments).
Travellers are taking active part in health education and health promotion sessions to improve their understanding of health promotion services.
Sharing the learning:
The results of this project are being widely shared with health communities in North Nottinghamshire and stakeholders from other agencies by the Travellers Association and health steering group members.
The results of this project were presented at a National Conference (October 2004) on the National Study on Travellers Health Needs conducted by the Department of Health.
Presentations have been done through different forums in the region. The abstracts are being submitted for publications in journals (BMJ, Nursing Times and Health Services Journal) and for the annual scientific conference of the Faculty of Public Health to be held in 2005.
Outstanding features:
Travellers were involved throughout in the designing, planning and implementation of the needs assessment, and then in developing a multi-agency 5 years work-plan to address the identified needs. This has resulted in everyone’s enthusiastic involvement in implementing the plan of action.
