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Related to: Socio-economic Inequality, Ill Health and Disability, Mental Health and Illness, Ethnicity, Faith and Belief, Alcohol, Carers, Domestic Abuse, Education, Special Educational Needs, Hate Crime and Hate Incidents, Sensory Impairments, Smoking, Social Capital and Community Capacity, Substance Misuse, Education

Key Facts:

  • The Gypsy/Traveller count in July 2017 recorded 38 total dwellings in Bath and North East Somerset. 
  • According to the School Census carried out by the Department for Education, in B&NES in the financial year 2013/14, 0.01% of state primary and secondary children's ethnic classification was Gypsy/Roma, significantly lower than in the South West (0.16%) and England (0.25%).
  • Findings of a health needs assessment suggest that Gypsies and Travellers experience different needs to that of the population as a whole.
  • These needs are characterised by increased risk factors across a range of issues including mental ill-health, physical disabilities and lifestyle factors such as smoking. For example, Traveller and Gypsy Traveller women are more than twenty times more likely to experience the death of a child than the population as a whole.
  • These needs are often coupled with a reluctance to engage with public services, although satisfiaction with health services are reasonable.
  • In response to the 2016 B&NES Boaters Survey, peace and tranquillity was the reason given by the greatest proportion of respondents (83%) for living on a boat.
  • The vast majority of the respondents to the 2016 B&NES Boaters Survey said that one or two people lived in their boat (86%) and 19% said that there was at least one child (17 years or younger) living on their boat. 
  • Only 25% of respondents to the 2016 B&NES Boaters Survey said they had a home mooring.
  • 78% of respondents to the 2016 B&NES Boaters Survey said they use their boat as a permanent home.
  • Only 15% of the respondents to the 2016 B&NES Boaters Survey said they would consider alternatives to living on a boat such as living in similar accommodation on land.

Definition

Gypsies and Travellers are usually visibly identified as those living in caravans, but mobility is not their defining characteristic. Gypsies and Travellers comprise of many groups, each with their own lifestyle, culture and traditions. Only Gypsies and Irish Travellers are recognised as distinct ethnic groups under the Race Relations Act 1989. Information provided here also includes information relating to “New Travellers”, “Showmen” and people living on boats. The experiences of second or third generation New Travellers, Showmen and people living on boats although not distinct ethnic groups, are believed to be similar to those of Gypsies and Irish Travellers. 1

The definition of Gypsies and Travellers under the Housing Act 2004:

‘Persons of nomadic habit of life whatever their race or origin, including such persons who on grounds only of their own or their family’s or dependent’s educational or health needs or old age have ceased to travel temporarily or permanently, and all other persons with a cultural tradition of nomadism and/or caravan dwelling. It is crucial to recognise that this ethnic and cultural identity does not simply evaporate when a household moves into conventional housing.’ 2

What does the data say?

Gypsy/Traveller Count 3

The bi-annual count of Gypsy and Traveller caravans has been in place since 1979 and is one of the department for communities and local government's only consistent sources of information on caravan numbers. Sites and encampments are included in the return if the occupants are; traditional and ethnic Gypsies and Travellers or members of the non-traditional New Traveller group who live in caravans or other mobile dwellings.

The dwellings the Count includes are:

  • All mobile homes, caravans, trailers and other living vehicles on Gypsy and Traveller sites and encampments, whether or not they meet the strict legal definition of a caravan
  • Touring caravans on Gypsy and Traveller sites and encampments even if not lived in permanently
  • Tents, benders or yurts where these are the ‘permanent’ living accommodation of Gypsies or Travellers

Currently Bath and North East Somerset contains 6 identified sites/encampments all of which fall into the 'tolerated' category and 1 site with full planning permission for 1 unit on private land. There were a total of 38 dwellings counted in July 2017.

Figure 1- Gypsy/Traveller Bi-Annual Count Jan 2010 - July 2017

Overall numbers of recorded dwellings across all site types has been steadily falling since a peak in January 2012. Over the same period there has been an increase in the number of sites that have permission for Gypsy/Traveller dwellings.

2015 Overview of Gypsy, Traveller & Boater Health Needs within Bath and North East Somerset 4

In 2015 the Travelling Community Support (TCS) conducted an overview of gypsy, traveller and boater health needs within Bath and North East Somerset. 

The Travelling Community Support (TCS) - works to improve the overall quality of life for Gypsy, Traveller and Boater communities in B&NES. Primarily a signposting service, TCS also offers 1 to 1 support and advocacy for service users. To ensure this is effective TCS works with local services and organisations to support them in engaging positively with the travelling community. Travelling Community Support had been running for almost 12 months at the time of this report

Focus of Travelling Community Support (TCS) - Health is the principal focus of TCS. According to the TCS, recent surveys indicate that the average life expectancy of Gypsies and Irish Travellers is nearly 30 years less than that of the rest of the population.  The work of the TCS also suggests that many Boaters and New Travellers, whose health needs are often overlooked as part of the travelling community, suffer from a variety of long term health conditions (respiratory, spinal, etc.) either caused or heightened by their way of life. Also, that Gypsy, Traveller and Boater communities often have difficulties in accessing services and support that is accommodating of their way of life, resulting in health inequalities. 

Purpose of 2015 Overview:

  • To assess whether there is a need for a Travelling Community specialised support service in B&NES.
  • To compile a simple cost-benefits analysis of common health scenarios based on real-life experiences of TCS service users.  Identifying what currently happens in practice, and how this could be improved with the range of support and services offered by TCS.

Key findings of 2015 Overview

Sites and pitches

At the Carrswood View, Lower Bristol Road, Twerton site there were 8 permanent pitches and 5 transit pitches (tenants can stay for up to 3 months, then they must move elsewhere).

The Stoney Lane, Lower Bristol Road, Twerton site is a tolerated encampment on privately owned land.

At Queen Charlton, Keynsham there are 2 sites.

Along the Kennet and Avon Canal there were 380 boats without a home mooring on western end. 

Demographics

At the 8 permanent pitches at Carrswood View, Lower Bristol Road, Twerton, the majority of residents were New Travellers with approximately 10 adults and 5 children.

At the 5 transit pitches at Carrswood View, Lower Bristol Road, Twerton, there were Irish Travellers, English Gypsies and New Travellers, approximately 8 adults and 8 children.

It is unsure of numbers and makeup of the residents of the Stoney Lane, Lower Bristol Road, Twerton site.

At the Queen Charlton, Keynsham sites, there were approximately 9 adults and 6 children.

A large proportion of liveaboard boaters along the Kennet and Avon Canal were single/separated males of 40+. However the canal also acts as home to many young families, couples of all ages and young single men and women.

Overview of issues

According to the Overview report the issues associated with travelling communities in B&NES are similar to any other area of the United Kingdom:

  • lack of service provision
  • lack of understanding 
  • barriers to health and preventative screening programmes due to having no fixed ‘home’ address.

However, these issues are shaped locally by the large number of liveaboard boaters without a home mooring residing on the Kennet & Avon canal and the river Avon in B&NES.

Key issues in B&NES identified and tackled by Travelling Community Support are outlined below:

Health and wellbeing issues

  • Mental Health Issues, including Post Traumatic Stress Disorder.
  • Mobility problems.

Economic issues

  • Lack of money to pay for counselling.
  • Difficulties navigating the benefits system, including the Disability Living Allowance.
  • Long periods without any income due to mistakes and/or missed benefits appointments. 
  • Support with grants for white goods.
  • Non-payment of rent, council tax and credit union loans.

Accommodation issues

  • Threat of eviction and homelessness.

Issue with access to services

  • Poor literacy.
  • Support needed with GP registration.
  • Support required for accessing drug and alcohol services.
  • Support needed with accessing mental health groups and counselling.
  • Signposting required for domestic abuse survivors.
  • Signposting needed for debt and money management.
  • Support needed for accessing school places, including access to special needs schools. 

Issues experienced by liveaboard boaters

  • The Canal and River Trust changed its guidelines for continuous cruisers without a home mooring and has started to issue short term licences as a penalty for boaters non-compliant with the terms of these new guidelines.
  • Vulnerable boaters have found themselves without licences and feeling hounded by CRT enforcement.
  • Injuries affecting mobility, leading to severe depression and isolation/loneliness.
  • Confusion with benefits, leading to increased stress and poor health. 
  • Risk of homelessness.
  • The new CRT guidelines call for a specified range of travel which means liveaboard boaters must cruise much further than before.
  • Boat fires.

Key conclusions of 2015 Overview:

  • That there is an increasing need for a Travelling Community specialised support service in B&NES.
  • That engaging with TCS not only benefits Gypsy Traveller and Boater communities, but also means a decrease in the long-term costs for health, social care and council services, by enabling early intervention, preventing more expensive action later down the line.

Click here to see the 2015 Overview of Gypsy, Traveller & Boater Health Needs within Bath and North East Somerset, including the cost-benefits analysis of common health scenarios. 

What does the community say?

2016 Boaters Survey 5

Between May and July 2016 a Boaters Survey was carried out in Bath and North East Somerset. The aim of the survey was to find out more about people who live on boats on the canal and river in Bath and North East Somerset and their experiences and needs, especially relating to accessing basic utilities such as water, sewerage disposal, public transport and other amenities. The purpose of the survey was to help plan service and mooring provision between Dundas Aqueduct and Hanham Lock. This survey followed a previous boater survey in 2013 which examined boater demographics.

The survey was aimed at live-aboard boaters who spend time in the Bath and North East Somerset Council area, whether or not they travel to other parts of the Kennet and Avon Canal system or to other waterways. The survey was not aimed at holiday and leisure boaters, as there are plans for these groups to be consulted separately in an exercise tailored to their particular use of the canal and river.

102 people responded to the survey. 

Results

Question 1 - What do you like about living on a boat? - Peace and tranquillity was the reason the greatest proportion of respondents (83%) selected for living on a boat. This was followed by:

  • The waterway community (77%)
  • Being able to move to new places (77%)
  • The scenery along the canal/river (76%)

Only 15% selected artistic inspiration and 24% selected other. 

Question 2 to 6 - The type of boat - Questions 2 to 6 asked about the type of boat respondents had:

  • Q2) What type of boat do you have?
  • Q3) What is your boat mainly made of?
  • Q4) What is the size of your boat? (Length)
  • Q5) What is the size of your boat? (Beam)
  • Q6) Does your boat have a fully functioning engine that allows you to move it?

The majority of respondents said that they had steel (91%) narrow boats (84%) over 50 feet in length (67%), with a beam 7 feet or under (85%) and with an engine so they are capable of moving under their own power (99%). These responses can help guide mooring and facilities provision. For example, they indicate that there is a need to accommodate longer boats. 

Question 7 and 8 – People living in the boat - Question 7 and 8 asked about the people living in the boat:

  • Q7) How many people live in your boat?
  • Q8) How many people who live in your boat are children (17 years or younger)?

The vast majority of the respondents said that one or two people lived in their boat (86%) and 19% said that there was at least one child (17 years or younger) living on their boat. 

Question 9 to 11 –  Mooring arrangements - Question 9 to 11 asked about people’s mooring arrangements:

  • Q9) Do you have a home mooring?
  • Q10) If you answered YES to Q9: Is it a residential mooring (mooring with residential planning permission)?
  • Q11) If you answered YES to Q9: Is this mooring in Bath and North East Somerset (between Hanham and Dundas)?

Of the 102 respondents, only 25% had a home mooring, only half of these had that mooring within Bath and North East Somerset, and only 7 respondents stated that they had a residential mooring. 

Question 12 - Which of the following options best describes how you use your boat most of the time? – The vast majority of respondents said that they use their boat as a permanent home (78%).

This was followed by:

  • As a second home where I live for extended periods / as an alternative to my main residence (10%)
  • I use it to cruise the waterways in my leisure time (4%)
  • As a temporary home (3%)

Only 2% they used as a holiday home and 1% said they used it as a temporary home where I live when at work. 2% of respondents selected other. 

Question 13 to 16 – People’s cruising area - Question 13 to 16 asked about people’s cruising area and their use of the River Avon:

  • Q13) What is your cruising area?
  • Q14) Do you regularly cruise on the River Avon?

In terms of respondent’s cruising area, of the 102 respondents:

  • 24% stated it was between Bath to Devizes
  • 18% said it was the whole length of Kennet and Avon
  • 12% said it was between Kennet and Avon West of Devizes
  • 10% Devizes to Newbury
  • 8% canal and river in B&NES
  •  and only 2% said it was the river Avon.
  • But, the highest proportion of respondents 30%, selected other.

The majority of respondents (64%, 65 respondents) said that they regularly cruise the River Avon.

  • Q15) If you answered NO to Q14: What would encourage you to cruise the River Avon more regularly?
  • Q16) If you answered NO to Q14: Is there anything that puts you off cruising the River Avon more regularly?

There were 60 responses to Question 15, and 54 to Question 16, and a significant number of responses stated either that there was a lack of mooring opportunities or that the respondent was not confident there are mooring opportunities.

Others stated they lacked confidence in their ability/their boats on the river.

Some respondents commented on a lack of facilities e.g. water points and pump out. Finally, some respondents, conscious of Canal and River Trust monitoring their movements, stated they were not sure that Canal and River Trust would log them on the river (there have been instances of boaters being accused of “not moving enough” when the reality is that the boat has moved to somewhere it has not been logged).

Question 17 to 19 – Permanent serviced moorings - Question 17 to 19 asked about people’s interest in permanent serviced (water, electricity, sewerage etc.) moorings:

  • Q17) If permanent serviced (water, electricity, sewerage etc.) moorings were more readily available in B&NES would you consider taking one?
  • Q18) If you answered YES to Q17: Which type of locations would you consider taking a permanent serviced mooring?
  • Q19) If you answered YES to Q17: What do you consider to a reasonable price per month?

Of the 102 respondents, 59% (60 respondents) said that they would consider taking a permanent serviced mooring in B&NES if they were more readily available. Of the 66 respondents that answered question 18 about what type of locations they would consider taking a permanent serviced mooring:

  • 79% of respondents said they would consider one on the non-towpath side of the main canal
  • 18% said they would consider one in a small off line canal basin
  • and only 3% said they would consider one in a large marina.

62 respondents answered question 19 about what they would consider a reasonable price per month for a permeant serviced mooring, and whilst responses ranged between £50 to £500 a month most were at the lower end of this spectrum, with 30% giving a price of £100 a month or less, a further 33% giving between £100 and £200, and 25% between £200 and £300.

Question 20 - Would you consider alternatives to living on a boat such as living in similar accommodation on land (e.g. Tiny Homes)?

Tiny Homes definition provided - homes of between 100 and 400 square feet (10-40m2) floor area either on wheels or on a foundation.

Only 15% of the 102 respondents said that they would consider alternatives to living on a boat such as living in similar accommodation on land. 

Question 21 - To what extent to you agree or disagree that a lower cost of living is your main reason for living on a boat?

21% of the 102 respondents said that they strongly or tended to agree that a lower cost of living was their main reason for living on a boat. 

Question 22 - When cruising would you consider paying for short term serviced moorings where services were included (e.g. laundrette, showers, pump out, electricity hook up)?

64% of the 102 respondents said that when cruising they would consider paying for short term serviced moorings where services were included.

Question 23 – Factors important when choosing where to moor.

Respondents were asked - When choosing where to moor (whilst cruising) how important are the following factors:

  • Road access
  • Parking
  • Local shops
  • Public transport
  • Attractive scenery/surroundings
  • Schools
  • Health services
  • Employment
  • Avoiding flood risk
  • Services (sewage and rubbish etc
  • Safety and security

The five most important factors respondents said were very or fairly important when choosing where to moor were:

  • Attractive scenery/surroundings with 94% of respondents
  • Safety and security with 84% of respondents
  • Avoiding flood risk with 80% of respondents
  • Services with 77% of respondents
  • Road access with 64% of respondents

The majority of respondents also said that parking (59%) and public transport (57%) were fairly or very important when choosing where to moor.

Question 24 - What is your main mode of travel, aside from your boat?

The greatest proportion of the 102 respondents, 54% said that their main mode of travel aside from their boat is a car. A significant proportion, 17% said that a cycle was their main mode of travel aside from their boat.

Question 25 – Whether boats are owned or rented.

The vast majority, 96% of respondents said they owned their boat, 78% said they owned them outright, 16% said they owned them with a mortgage, and 2% said they had shared ownership of their boat. 

Question 26 - What would be the top three improvements you would like to see to the Canal and River network, and where would these be located?

There were 92 responses to Question 26, the main improvements highlighted were:

  • more/better moorings
  • towpath improvement
  • more Elsan (boat and caravan toilet cassette disposal)/rubbish/water/shower facilities
  • less towpath you can’t moor to (much is overgrown/eroded)
  • more dredging/maintenance
  • better understanding between different users
  • fewer boats/hire boats/”booze boats”
  • “looking after heritage”
  • enforcement of moorings to comply with law/basic rights of boaters to be respected/established
  • and disabled moorings.

To get the results in more detail see - B&NES Water Space Study, Boater Survey Consultation Report

2012 Health Survey 6

In 2012 a study was carried out locally into the health of  Gypsies, Travellers, Boaters, Showman and Roma in Bath and North East Somerest. The resulting report was the culmination of a specialist health project which was commissioned to run between late Summer 2012 and Spring 2013. The research was jointly commissioned by Bath and North East Somerset Local Authority Public Health Department/PCT and North Somerset PCT (as they then were).

The study utilised a mixed-methods approach. Trained community interviewers from the communities in question administered face to face surveys to 66 Gypsies/Travellers/Showmen and Boaters. In addition an e-survey was administered to 40 professional health staff. Follow up depth interviews were undertaken with 3 health care professionals and a further 3 Boaters and New Travellers in addition to a focus group with members of the Boater community.

In total, 66 very in-depth interviews were achieved with the following groups of service-users: 5 English Gypsies; 6 Irish Travellers; 1 Scottish/Welsh Traveller; 21 New Travellers; 2 Showmen; 30 ‘Boaters’ and 1 individual who classified themselves as ‘other’. Despite significant efforts to achieve a sample from the Roma population it was impossible to do so within the time scale as a result of geographical movement amongst this population within the survey period.

Whilst Boaters and New Travellers were willing to provide information across a full range of topics (including access to contraception; substance (mis)use and use/preference in sexual health services); for strongly held cultural reasons no Irish or Welsh/Scottish Travellers and no English Gypsies would respond to these elements of the survey.

Significant information was gathered from all communities included in the sample in relation to access to services (including emergency care and experiences of A&E services), health needs, barriers to registration with GP and other primary care services; prevalence of particular conditions and preferences and experiences of terminal care for members of their communities. Data was also collected on the strength of community networks/availability to support from peers during times of illness.

The ‘professional’ health workers e-survey was made available to a broad range of health professionals (including dental surgeons).

The e-survey explored subjects pertaining to degree of experience of working with different Gypsy/Traveller/Boater/Showmen communities, understanding and concerns pertaining to specific health conditions/barriers to engagement across the communities, questions around the relevance of ‘hand-held’ medical records, training needs for health care professionals and recommendations for engagement with the communities in question.

Demographics

According to the 2012 Health Survey, the demographics of boat dwellers (whilst including a percentage of young couples and women) tended towards middle aged and older males (often single). Other communities were significantly more likely to be co-residing as couples, often with resident children (average of 2 per household other than Irish Travellers who averaged 3 school age children per household). 7

From crude observations of other localities in which Boaters reside, the demographics of live-aboard Boaters is thought to primarily comprise of: 8

  • young single women (under 30)
  • young couples with children and without children under the age of five
  • older males

Accommodation and living standards

The 2007 West of England Gypsy and Traveller accommodation (and other needs) assessment concluded there are issues with adequate accommodation. 9

Respondents (all categories) reported living in their present home location for an average of 5.8 years ranging from 2 months to 20 years & 2 months.

The duration/average length of remaining in one location was greatest for Ethnic Gypsy/Travellers living either in housing or on authorised sites.

Of those respondents who replied to questions on numbers of enforced moves/evictions within a three year time period, Boaters averaged 4 moves and New Travellers 3 such movements.

The majority of respondents emphasised continual ‘semi-voluntary’ movement on a fortnightly basis to comply with Canal and River Trust (CRT) regulations or in the case of Travellers prior to accessing the local ‘tolerated’ sites, to avoid eviction/negative engagement with local authorities.

Respondents were also surveyed across a range of issues pertaining to the physical environment at their current location (access to water, heating etc) with the majority reporting a satisfaction rating of around 4-5/7 in terms of facilities.

The general physical environment was rated as being of a lower quality amongst English Gypsies (both sited and housed) than amongst New Travellers despite the generally lower availability of services for NTs and Boaters.

Unsurprisingly physical environment was lower for Boaters/Travellers than other populations overall given their residence (overwhelmingly) at unauthorized locations.

There was a low ability across all groups for access to open fires. Access to wood/coal is relatively low for boaters and given their dependence in the main on solid fuel for warmth this may be an issue in terms of bronchial health/arthritis etc. if there is intermittent ability to remain warm or carry adequate fuel for burners.

It is noteworthy that no single category of respondent reports being extremely pleased with their physical environment.

Boaters

All but one ‘Boaters’ were currently residing in live-aboard accommodation.

There was a high proportion of ‘Boaters’ without access to long-term moorings. This may reflect the significant shortage of affordable moorings (a theme which emerged again and again in interviews and during analysis of the data).

Only 6 Boaters (20%) had moorings. Most who responded (56%) reported a high degree of nomadism enforced by their circumstances/Canals and River Trust legislation, moving every 2 weeks.

59% of Boaters stated that they had adopted their current lifestyle as a result of the high cost of living in housing.

New Travellers

Four respondents were living in housing (one owner-occupier, two living in Registered Social Landlord (RSL) accommodation and one privately renting)

Six New Travellers living on sites/or in ‘temporary accommodation indicated that their accommodation did not fall easily into the categories of ‘unauthorized sites/roadside’ noting that they were ‘lying low’ or discreetly parked up. They failed to provide further information on their circumstances for fear of enforcement action.

Of those New Traveller respondents living on roadside/unauthorised encampments who provided duration of stay at their current location, the average length of residence was 25 months.

A significant proportion of New Travellers cited moving to a site to join family and friends/lifestyle issues.

Irish Travellers

All six of the Irish Traveller respondents were housed:

  • two owner-occupiers,
  • one in private rented accommodation
  • two RSL tenants.
  • one woman did not specify precisely which type of housing

Irish Travellers had been in their current property for an average of 39 months.

English Gypsies

One person lived in an owner-occupied house, another in private rented accommodation

Health

Members of these communities can have poorer health than that of their age/sex-matched comparators. 10

A West of England Gypsy and Traveller accommodation (and other needs) assessment was carried out in 2007. It brought together national and regional data and concluded that Gypsy and Traveller communities experience health outcomes significantly poorer than that found in the lowest socio-economic group in the UK population. It also revealed that there are issues with Travellers and Gypsies living on unregistered sites registering with GPs. 11

There is a higher occurrence of anxiety/ depression, respiratory problems (asthma and bronchitis), heart disease, diabetes and arthritis than in the non-travelling communities. 12

The extent of disability amongst families by ethnicity is speculative, but survey responses indicate that if all individuals who have a household member with a disability have recorded this fact, that:

  • 14% of New Travellers
  • 10% of Showmen
  • 32% of Romany families
  • 10% of Irish Travellers
  • 39% of ‘others’

are caring for someone with a disabling condition which impacts on their day to day activities. This is a significantly higher rate than is found amongst the ‘mainstream’ population, particularly given the younger age range amongst the communities surveyed. 13

A range of other research studies has found that the Gypsy and Traveller mortality rate is up to one and a half times that of the housed population. A recent Irish study found that fifty per cent of the Traveller population died before the age of fifty. 14

High rates of miscarriage, still-birth and perinatal death are also found amongst the community with women twenty times more likely to experience the death of a child than amongst other UK communities. 15

Travellers also exhibit high child accident rates associated with instability of sites and lack of access to health care. 16

Whilst there is an increasing body of evidence on the unequal health status of Gypsies and Travellers and increased rates of morbidity and mortality (e.g. Cemlyn et. al., 2009; Parry et. al., 2004) to the best of our knowledge this is one of the only UK’s study of the health status of ‘Boaters’ (itinerant Canal dwellers), and one of a tiny handful of studies which includes information on the health status and beliefs of New Travellers.

Smoking, anxiety and depression were revealed to be key health concerns for both service users across the communities as well as being identified by health care providers as issues they had encountered.

The main issues were:

  • smoking, reported by 35 respondents (53%),
  • nerves/depression/stress, reported by 17 respondents (26%)
  • eyesight problems (15 respondents – 23%).

Interestingly (and not unrelated we suggest to the age range of respondents as well as potentially living in smokey environments in boats/limited use of opticians) eyesight problems were particularly an issue for Boaters. 43% of Boaters cited eyesight problems as an issue which affects their family.

Injuries associated with residence on sites and in boats (e.g. saws, axes, muscular-skeletal pain) and arthritis/asthma were also somewhat over-represented amongst the populations surveyed.

Boaters in particular reported experiencing numerous injuries associated with their way of life (spinal injuries, falls, cuts and chainsaw accidents) as did some New Travellers.

It was noteworthy although unsurprising re the physicality of living on a boat that a relatively high number of Boater respondents reported mobility difficulties.

Smoking was the most significant issue for New Travellers, affecting 62% of them.

Depression and stress were also substantial amongst insecurely sited New Travellers and Boaters who were required to move on every 14 days. The stress of their lifestyle was linked during some comments in the focus group with higher rates of smoking and substance use amongst some Boaters and New Travellers.

Relationship with health services - 2012 Health Survey 17

Findings from this study has revealed that members of these populations are marginalised from mainstream health care and experience significant barriers to access to services as a result of their lack of secure accommodation.

There is a general absence of recognition of the needs of these communities by health practitioners who in the main fail to monitor their health status and access to services.

Overall 32.5% of respondents to the Professional/Practitioner survey reported having had contact with Gypsy/Traveller/Boater communities in their practice.

Around 37% of the health practitioner respondents indicated that they did have worries or concerns about delivering care to Traveller/Boater populations.

Overall whilst health professionals are generally interested in working with these populations and worried about their state of health, they identified a number of concerns and problems in helping them:

  • issues of ensuring continuity of care for mobile communities,
  • lack of understanding of culture/culture clashes over compliance with treatment,
  • challenges of working on sites/towpaths
  • issues of compliance with treatment
  • lack of confidence in dealing with Gypsies/Traveller/Boater populations
  • fear of visiting sites (e.g. of dogs)
  • lack of health practitioners’ cultural knowledge of these communities
  • poor knowledge of where and how to access specialist advice.

Accordingly these lead to lost opportunities to make positive impacts on the health and wellbeing of members of these populations

Health care staff and ambulances were not always able to identify or reach individuals at unauthorised and authorised locations and boaters in areas with limited towpath access could in effect be cut off from health care leading to ‘self-treatment’ or long journeys to A&E for treatment.

Although satisfaction levels with primary health care were reasonable, information was provided on instances of prejudice or lack of understanding of the barriers experienced by Traveller/Boater communities.

Some concerning findings emerged in relation to attitudes of some health staff towards Boaters, a theme echoed by New Travellers who reported stereotypical assumptions by some health staff in relation to presumptions of substance misuse by this population, leading at times to refusal of adequate analgesia following injury.

In relation to attitude to health service use:

  • 30% of respondents said they would only use a doctor/hospital as a last resort if someone in their family was very seriously ill/injured
  • 21% said they would use a GP/hospital whilst, using alternative medicine at the same time

GPs

GP registration was frequently only obtained for our sited sample after some considerable difficulties, on occasion (even for households with families) following intervention by specialist services such as Julian House (homeless health services).

Of the 50 respondents 39 respondents (78%) felt that men were much less likely to see a GP or other health care provider than were women.

Boaters in particular are likely to experience continual movement as a result of CRT regulations and in many cases GPs were in excess of 20 miles distant from the current place of residence.

For those patients who are registered with a GP access to appointments/level of care are regarded as reasonably good.

Brighton Gypsy and Traveller Community Intelligence 2013 18

During the period July – September 2013, 44 individuals from the G&T community around Brighton were interviewed and responded to a questionnaire using site visits, drop in centres and telephone.

The sample consisted of 28 women (4 pregnant) and 16 men, of which the majority (19) were aged 23-39 and mainly Irish and New Travellers (18 each). 32 were living on unauthorised encampments and 36 were residing in and around Brighton.

Key findings;

  • Registering with a GP was a key issue and barriers included lack of fixed address, lack of ID, rudeness of reception staff and lack of awareness of eligibility for free healthcare. Embarrassment about having poor literacy leading to barriers approaching reception staff.
  • Lack of awareness from service staff about Traveller culture.
  • Requests to be seen by a same sex doctor not taken seriously, leading to patients providing inaccurate symptoms due to embarrassment.
  • Lack of parking at A&E for van drivers.
  • Criticism of walk-in services, primarily due to lack of cultural competency.
  • Bladder, lung and bowel issues were highlighted as particularly prevalent, due to lack of basic amenities on sites.

Key recommendations;

  • Potential for a health card to be provided to Travellers to present to frontline staff discretely to indicate a need to help with filling in forms.
  • Cultural awareness training for frontline staff, particularly in GP clinics and walk in centres.
  • Provision of better advice to services for registering patients with no fixed abode, CTAX information or utility bills.

Opticians and dentists

There was fairly low use (in the main) of optical and dental services even amongst some populations at risk of age-related visual degeneration. Use of screening services was also relatively poor amongst the majority of the sample, largely because of challenges to registration and a culture of only accessing primary care services at times of need.

Domestic Abuse and Substance Misuse services

One finding of particular concern regarded the very low level of reporting/help-seeking behaviour indicated by the survey in relation to domestic violence or substance misuse.

[[Care |Carers]]

There was a very strong concurrence across all parties that care of older and disabled Gypsies/Travellers and Boaters as well as terminal care as required would be preferred within community settings although a number of barriers to accessing support were reported by participants:

  • refusal of assistance in relation to ‘non-standard’ support packages such as asking carers to assist in chopping wood or opening lock gates.
  • levels of knowledge of support packages remains low
  • social care staff are often highly unfamiliar with the needs of Gypsies/Travellers/Boaters

Counselling

Overall whilst only very few respondents had made use of professional bereavement support services, there were indications that if culturally aware counsellors were available that 64% of Gypsy/Traveller/Boaters respondents would potentially make use of such services.

Self-treatment

Alternative medicine (including use of herbal remedies) is used by two thirds of the sample including all but one New Traveller and most (87%) of Boaters.

A number of respondents reported self-treatment varying from buying and administering pain-killers over the counter to pulling their own teeth.

Limited use was made of pharmacists for seeking health advice amongst the sample, instead many used the internet including specialist Gypsy/Traveller websites

Education

According to the School Census carried out by the Department for Education, in B&NES in the financial year 2013/14, 0.01% of state primary and secondary children's ethnic classification was Gypsy/Roma, significantly lower than in the South West (0.16%) and England (0.25%). 19

The 2007 West of England Gypsy and Traveller accommodation (and other needs) assessment concluded they have high rates of low educational attainment. 20

Travellers of Irish Heritage and Gypsy/Roma pupils are 2.7 and 2.6 times more likely than White British pupils to have Special Educational Needs (SEN). 21

Intra-community cohesion - 2012 Health Survey 22

Across all communities the degree of intra-community cohesion was stronger than found amongst the majority of ‘mainstream’ communities indicating thick levels of social capital.

Relationship with the rest of the community

The 2007 West of England Gypsy and Traveller accommodation (and other needs) assessment concluded that they experience a high rate of social exclusion in society andthere is high under-reporting of racist hate crime amongst Gypsy/Travellers, and a high rate of bullying of travellers and gypsies in school. 23

2012 Health Survey 24

The attitudes of neighbours to Gypsies/Travellers remained the lowest rated score across all domains and for all communities.

All populations surveyed demonstrated levels of distrust and only moderately good relationships with surrounding populations who were reported to be relatively unfriendly towards Gypsies/Travellers in their midst.

New Travellers express the lowest level of satisfaction with regard to their neighbours attitudes towards them.

Boaters reported the lowest levels of discrimination towards their community.

New Travellers and Boaters reported feeling generally safe from crime and this may in part pertain to density of residence and the belief that their community ‘looks out for each other’.

Are we meeting the needs? 25

There is one legal site for Gypsy and Traveller communities in the area at the Carrswood View Traveller site in Bath. However, this is not sufficient to meet current need. 

The Bath and North East Somerset Gypsy, Traveller, Boater, Showman and Roma Health Survey 2012 26

The Bath and North East Somerset Gypsy, Traveller, Boater, Showman and Roma Health Survey 2012 raised a number of key issues that needed to be addressed.

The purpose of undertaking the health audit of Gypsy, Traveller, Boater, Showmen and Roma residents was:

  • to ensure good practice in equality of delivery to minority ethnic (and other potentially vulnerable) groups,
  • to be at the cutting edge of engaging with new equalities duties inherent upon Clinical Commissioning Groups to meet the needs of local service users, as embedded within the Health and Social Care Act 2012.

Following the recommendations of the 2012 Survey BaNES NHS CCG implemented the funding for an independent Gypsy, Traveller & boater Outreach and Support Service. The Service (operating out of the Bath based charity Julian House) was piloted in 2015 and currently has funding until the end of 2018. It provides;

  • the provision of trained community health advocates;
  • the development of culturally appropriate health resources for Gypsy/Traveller and Boater communities;
  • outreach services to sites and towpaths;
  • training for health professionals on engaging with these service users;
  • urgent recommendations in relation to GP registration of itinerant boaters/Travellers who do not have a postcode/fixed residence;
  • the utilisation of experienced health professionals and advocates from amongst the communities in question to provide dedicated targeted health services;
  • suggestions for cross-boundary working and the appointment of lead professionals for specific communities
  • mediation with and advice to the Canals and Rivers Trust (CRT) to ensure that itinerant boaters/continuous cruisers are not subject to repeated movement when experiencing poor health.

The Service also offers;

  • delivery of cultural awareness specialist training to a range of health professionals,
  • access to specialist resources drawn up with local Boaters/Travellers
  • sharing resources and ‘best practice’ from agencies such as Derbyshire Gypsy Liaison Group; Leeds GATE and Friends, Families and Traveller and those under development via Inclusion Health projects,
  • enhanced awareness of the existence of specialist Traveller health visitors in the B&NES locality.

Other improvements:

  • Continued support and offer of hand held medical records to address challenges of the mobile nature of Traveller, Gypsy and boater communities and the difficult locations they live in.
  • partnerships with service users that are ‘appropriate’ and not patronising.
  • Engagement with other organisations to provide health care staff to work on devising health promotion materials and sharing ‘ownership’ of any future initiatives such as ‘health boats’ or ’towpath clinics’ for Boaters.
  • Recruiting representatives from the travelling community to work with health professionals to deliver training and specialist materials to practitioners.
  • Sensitive in-reach support and signposting to services for those suffering from domestic abuse and/or substance misuse.
  • Inter-area working by health care professionals and community members.