Gypsy, Roma and Traveller communities in the UK experience significant healthcare inequalities, resulting in poorer outcomes and shorter life expectancy. To address these entrenched issues, ARC East of England researchers have developed a Community of Practice that brings together community members, healthcare professionals and researchers to co-create practical, actionable solutions.
New research has identified a number of barriers contributing to the inequalities Gypsy, Roma and Traveller (GRT) communities face in healthcare access, treatment and outcomes. The study reveals that GRT communities often encounter stigma and discrimination due to their ethnicity when accessing healthcare, resulting in low levels of trust and delays in receiving timely treatment and care. In response to these findings, the study has co-produced actionable steps to promote equitable and reliable healthcare for GRT communities. This research is part of the ARC East of England’s Inclusive Involvement in Research theme, aiming to improve inclusive practices with GRT community members.
Researchers from the University of Essex, in partnership with Oblique Arts, One Voice 4 Travellers, Gate Essex, COMPAS and healthcare professionals, have developed a Community of Practice to explore barriers to healthcare access faced by GRT communities. The group identified potential solutions to overcome these challenges and developed innovative approaches to engage with GRT communities in shaping health research, policy and practice to reduce inequalities.
Professor Ewen Speed, Principal Investigator of this study, shares the background to this research:
“Research evidence from Friends, Families, Travellers states that ‘in the UK, GRT communities experience a life expectancy 10–12 years lower than the general population.’ Much of the reason for this is around inequalities in accessing healthcare services.”
Professor Ewen Speed, Principal Investigator
In addition, there is comparatively limited knowledge about the healthcare needs of GRT communities in the UK. For example, the census data underestimates the true size of this population due to underreporting driven by fears of discrimination and mistrust of government organisations. This study recently submitted evidence to the United Nations (UN), highlighting that the GRT community’s right to health is not being upheld in the UK. The UN has acknowledged this and has asked the UK to comply with their recommendations. This research marks a significant milestone in advocating for the healthcare needs of this community.
“This study gained an understanding of all perspectives involved in making healthcare fair. We learnt that, although there have been numerous attempts to address the inequalities faced by this group, these efforts have often been scattered, localised, and short-term. The GRT communities want barriers to access to be recognised and responded to.
Sally Burrows, Researcher in this study
"They want greater understanding, less discrimination and improved communication with healthcare providers so that access to healthcare is fairer and can genuinely improve the health and wellbeing of their communities.”
Sally Burrows, Researcher in this study
The study developed a Community of Practice through working with 45 GRT community members, 23 health practitioners and community workers, and 18 local, regional and national decision-makers, with representation from eight GP surgeries, six councils and four NHS Foundation Trusts. Through the Community of Practice, the project team identified a number of practical potential solutions to overcome systemic and structural barriers to accessing healthcare for GRT community members. These solutions can be categorised into three key areas: raise awareness of GRT community members’ rights and needs, improve communication and understanding and establish consensus on reasonable adjustments.
The first area includes raising awareness that GP practices are legally required to accept patients who want to register with them, whether for a permanent or temporary period, and encouraging healthcare professionals to accurately record patients’ ethnicity to ensure healthcare services are tailored to and informed by their specific needs. The second area, the Community of Practice recommends a commitment to cultural competency training and positive engagement with GRT community groups to improve communication and cultural awareness. It is also encouraged to use more appropriate translation services for both verbal and written communication, ensuring clear and effective understanding between healthcare professionals and patients. The study also highlighted lower literacy levels within the GRT community, which can make completing written forms particularly challenging. Finally, the third area focuses on building trust between healthcare professionals and the GRT community members by establishing guidelines for reasonable adjustments for GRT patients, establishing dedicated service-level agreements tailored to GRT community member needs and increasing the representation of GRT community members working within and alongside health services.
By participating in the Community of Practice, GRT community members reported that their own understanding of the complexities of the health system had improved and that they had become more sympathetic to health professionals and their efforts to improve access to care. One community member said:
“It was really good to hear from the people who came up from different organisations, especially from the medical side of things, because I hadn't quite realised the degree of difficulty that the medical profession are under trying to put anything in place really about that one, yeah.”
Anonymous, Community member
The findings have already made a significant impact locally, regionally and nationally. Hertfordshire Partnership NHS Foundation Trust has prioritised improving healthcare access for GRT communities. Mid-South Essex and North East London NHS Foundation Trust are collaboratively developing a GRT Health Policy alongside an e-learning tool designed to raise awareness of issues around different GRT communities' cultural contexts. They are also ensuring that GRT community members are routinely included in Equality Impact Assessments. Additionally, a community member from the Community of Practice has been commissioned to deliver training sessions to future social workers at Anglia Ruskin University.
The study has launched an implementation framework, entitled 'Whole System Action Plans', comprising nine whole-system plans that propose high-impact, short-term actionable steps. To support the dissemination, the group has co-produced a poster highlighting some key issues and solutions and hosted an event at the University of Essex, where they welcomed 90 attendees to share their findings and facilitate discussions on addressing the healthcare challenges faced by the GRT community. You can watch two recordings of the event below. Additionally, the team created a video featuring members of the GRT community to raise awareness of these challenges.
To hear more about the study, get in touch with the research team: Professor Ewen Speed, esspeed@essex.ac.uk, and Sally Burrows, sally.burrows@essex.ac.uk.
Access the 'Whole System Action Plans' here
Watch the event here:
Part one:
View the accessible transcript here
Part two:
View the accessible transcript here
Acknowledgement
This project was supported by the NIHR through the Research for Patient Benefit scheme, see award (NIHR 204503)
