Gypsy Roma Traveller Health Needs Assessment - Kent County Council

Our case study links to all five inclusion health draft principles:

1) Commit to action on inclusion health

2) Understand the characteristics and needs of inclusion health groups locally

3) Develop the workforce for inclusion health

4) Developing integrated and accessible services for inclusion health

5) Demonstrate impact and improvement for inclusion health

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Yes

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5) Organisation/s: What organisation/s were involved?

Kent County Council Public Health

6) The challenge: What was the issue you were trying to solve? Include which Inclusion Health Group the initiative focused on and its level i.e. community/locality/system

Gypsy Roma and Traveller inclusion health group.

It is recognised nationally that Gypsy, Roma and Traveller communities have significantly poorer health outcomes than the general population of England and these inequalities in health are a result of interactions between adverse environments (living, working and social), lifestyle behaviours and poor access to health, care and wider support services. Kent has a higher percentage of Gypsy and Traveller people than the England average and many Roma communities. Nationally there is a lack of focus on Gypsy, Roma and Traveller communities in Joint Strategic Needs Assessments which results in these communities being overlooked when planning services.

In response to these issues the council’s Public Health Team carried out a Gypsy, Roma, and Travellers Health Needs Assessment (HNA) to update the previous HNA of 2015.

The aim of the Gypsy, Roma and Traveller Health Needs Assessment was to identify the health needs (including wider determinants) of the Gypsy, Roma and Traveller communities in Kent, to describe the current services and support in place to address these needs, and to identify the gaps in meeting these using evidence-based or best-practice approaches and make recommendations for future improvement.

7) The approach/solution: What did you do? What help did you receive? How did you go about delivery?

This HNA used an epidemiological and corporate approach described by Stevens and Rafferty to:

• Describe, and where possible quantify, the scale of health needs faced by Gypsy Roma Traveller communities across the life-course (epidemiological).

• Obtain stakeholder views on the needs for health and care services amongst Gypsy Roma Traveller communities and elicit views on the extent to which these needs are currently being met and barriers faced (corporate)

• Map current community, health and care services available to Gypsy Roma Traveller communities against evidence-based/best practice standards in order to make an assessment of met and unmet need.

The needs assessment has been carried out in two waves (wave 1 is now complete, wave 2 is planned to commence in summer 2023).

Wave 1

The aims of this wave was to:

1. Identify those stakeholders (commissioners, service providers, Gypsy Roma Traveller community advocates) who were key informants for the needs assessment and who can also facilitate access to Gypsy Roma Traveller communities in Kent

2. Build a picture of the Gypsy Roma Traveller communities within Kent from key stakeholders including an assessment of met and unmet health and care needs

3. Co-design Wave 2 participatory research to uncover Gypsy Roma Traveller community members' perception on their collective needs, as well as their attitudes towards these needs.

A mixed methods approach was used to describe the scale of health needs faced by Gypsy, Roma, and Traveller communities in Kent. A variety of stakeholders from health and social care, Kent County Council, Voluntary Community Sector Enterprise (VSCE) services, community advocates and other statutory services were interviewed to obtain views on the needs for health and social care services amongst Gypsy, Roma and Traveller communities and the extent to which these needs are currently being met and barriers faced.

The groups in scope for this HNA were the Romany Gypsies, Irish Travellers and Roma groups. These are ethnically and culturally diverse groups although share the tradition of a nomadic lifestyle. When referred to collectively in this paper, it is with the understanding that there are differences between these communities which are recognised and acknowledged; equally, there are aspects of similar shared experiences which are also recognised.

8) Insights and impacts: What evidence proves it worked? What difference it makes to the Inclusion Health Groups? How did this improve experiences, access and inclusion? How did this improve their health and help address health inequalities?

The HNA report highlights the significant health inequalities faced by Gypsy, Roma, and Traveller groups across Kent which are in line with what is known about the health needs of these communities nationally. These health inequalities result from longstanding inequalities in the wider determinants of health as well as inequities in access to preventative, screening, and treatment services. These are exacerbated by experiences of stigma and discrimination faced by these communities. Additionally, levels of health literacy, cultural and health beliefs shape the way community members view the need for services.

Findings suggest that action taken at individual, provider and system level will improve health outcomes for Gypsy, Roma, and Traveller people.

Kent County Councils HNA makes several recommendations covering the following areas:

• Instigating and monitoring Gypsy, Roma and Traveller ethnicity reporting in health, social care and Voluntary Community Social Enterprise (VCSE) services across Kent.

• Using policy levers and system leadership to develop a system-wide approach to addressing health needs.

• Increasing more joined up working between services and co-design with service users.

• Investing in developing trust and culturally competent services.

• Addressing health and mental health literacy through accessible information sources, peer support and adult education.

• Training trusted individuals in Making Every Contact Count (MECC) to support healthy lifestyles and uptake of preventative services.

• Identifying primary care champions, developing communities of practice and promoting inclusion health audits.

• Developing innovative solutions to support those living nomadic lifestyles attend screening and routine appointments.

• Investing in and training of community members to increase employment opportunities.

• Developing granular understanding of community needs though furthered in-depth research with community members.

The findings of the HNA have been shared with many groups across Kent and the Southeast Region. This has resulted in a raised awareness of the significant health inequalities faced by Gypsy Roma and Traveller groups and has led to the development of 'Provider Network Community of Practice' in which organisations across a range of statutory and voluntary sectors can share best practice. Other recommendations will be progressed through relevant KCC and Kent and Medway ICB workstreams.

Other impact:

We also plan to carry out the next iteration of this research:

Wave 2

The aims of this wave are to:

Conduct qualitative research with Gypsy Roma Traveller communities to:

a. Understand lived experience of this community

b. Provide a deeper understanding of the issues faced in relation to health and social care services, barriers to access and gaps in services.

c. In the absence of data to undertake a health and wellbeing survey to accurately capture the health needs of different subsets

d. Findings to be triangulated with Wave 1 to determine priorities and generate a final set of recommendations.

It is expected for Wave 2 (community engagement) to commence around Summer 2023. It was crucial for us to develop trusted relationships with stakeholders first and ensure we had gained knowledge and understanding regarding barriers and challenges with the community engagement before commencing with Wave 2.

Clinical Research Network Kent Surrey and Sussex

The CRN KSS underserved funding call has invited submissions of well developed plans from across the health and care system. The funding will support collaborative projects with strong potential to make a tangible difference in increasing access to health and care research for under served communities.

Subject to being successful in this funding, we plan to develop research capacity in the community; allowing trust to be built, relationships to develop and maximise efforts of Wave 2 community engagement (above).

Provider Network Community of Practice (Gypsy Roma Traveller)

A quarterly meeting whereby key stakeholders in Kent will come together to discuss successful engagement, best practice, what’s working, as well as challenges and barriers; offering a forum of support and shared learning for professionals working to improve the health and wellbeing of these communities in Kent (first meeting planned for end of June).

9) What people said: Any quotes or feedback from service users, staff, management or decision makers

The HNA has been positively received by many stakeholders and the Head of the KCC Gypsy Roma Traveller Resident Service said that the work offers “more of a raised awareness of the importance of forming strong partnerships with health colleagues, and other trusted partners to make improvements for residents (…) it will bring additional benefit which will result in better outcomes for residents.”

10) Tips for success: Approaches or links that make a difference or lessons learned.

There are several pockets of best practice in Kent where individuals and services have recognised and responded to specific needs of the Gypsy, Roma, and Traveller communities. This had both fostered trust and engagement with communities and supported better health outcomes.

‘Best practice’ has been derived from the triangulated recommendations from stakeholder engagement and previous work undertaken in Kent to understand the health needs and barriers faced by the Gypsy Roma and Traveller communities. This includes:

• Building trust with the communities in a sustainable and proactive way.

• Offering relevant information and ensuring information is relayed in an appropriate format for the audience.

• Using already established relationships and existing engagement.

• Investing in workforce training to ensure there is understanding about cultural differences and experiences.

• Offering a joined-up approach and exploring partnership working; utilising all contact with these communities where appropriate.

We are planning future work with the Gypsy Roma and Traveller communities to explore and co-create approaches to achieve the above.

However, ‘best practice’ services are often reliant upon the commitment of individuals and can be subject to short term funding. To succeed and be sustainable there is a need for system-wide recognition of inequalities faced and development of commissioned services and practices to address these.

11) What next: What are you doing next?

• Publish the HNA on the Kent Public Health Observatory website.

• Socialise findings and recommendations in relevant fora and explore opportunities for collaborative work with existing engagement in the system (especially where recommendations can be maximised).

• Subject to CRN KSS Underserved programme funding we plan to develop research capacity in the community; allowing trust to be built, relationships to develop and maximise efforts of Wave 2 community engagement.

• Undertake Wave 2, which consists of qualitative interviews with Gypsy Roma and Traveller community members to understand the lived experience of these communities and in the absence of data to undertake a health and wellbeing survey in order to accurately capture the health needs of different subsets. Findings will then be triangulated with Wave 1 (stakeholder engagement findings) to determine priorities and generate a final set of recommendations.

•Engagement work must be done sensitively and slowly in order to gain trust and ensure sustained work. Potential of health inequalities funding next financial year; this JSNA and CRN KSS funding (TBC) will be the groundwork to enable future sustained funding to support these communities.