Survey of South West health authorities and local authorities

 

A recent report on Inequalities in Health (South West Region, 1999) highlighted the plight of local Travellers but gave no further information on their circumstances or needs. This third component of the research outlined in this report was designed in part to fill this gap through identifying relevant data sources and activities. It was carried out mainly through the use of postal questionnaires mailed to the Directors of Public Health at each of the 8 health authorities in the region and the Chief Executives of all of the 51 local authorities with the request that they be passed on to the most relevant person in the organisation.
Respondents were also asked to send on any relevant documentation relating to their work with Travellers. Follow up letters were sent to non-respondents after 8 weeks and telephone calls were made as a final reminder. This produced a response rate of 80.4% from local authorities and 87.5% (7 of 8) from health authorities. The questionnaire used is presented in Appendix 2 . The research team also received around 15 documents illustrating work on Travellers carried out by responding authorities.

 

In order to complement the questionnaires, both face-to-face and telephone interviews were carried out with individuals identified as key stakeholders in relation to Traveller health in the region.  These included the health visitor responsible for running the Travellers’ Health Project in Bristol (see Box 2) as well as a number of individuals responsible for providing education for Traveller children. Members of the research team also attended a workshop to meet with local Traveller representatives and colleagues from Ireland.

 

Box 2 Bristol Traveller Health project   One of the more substantial examples of good practice uncovered during this research was the Traveller Health Project which was set up in Bristol by a health visitor in 1990 and continues to offer care. A very positive report on the first two years of the project (Neligan, 1993) led Avon Health Authority to offer further funding and in 1994 Sarah Rhodes took over the post of specialist health visitor. Over the years the work of the project has involved a number of different initiatives including a mobile dental unit. One of the most popular initiatives was a Well Woman service with monthly clinics for screening and health promotion as well as the treatment of chronic problems. However, this part of the project ended when Avon Health Authority declined to give further funding (Rhodes 1998). The Bristol Traveller Health Project has lasted longer than other initiatives in the region and has achieved considerable success by responding to the needs of Travellers as they themselves present them.

 

 

The results from both health and local authorities showed what appeared to be a relatively low level of activity with regard to both data collection and service delivery directed towards Travellers. Among the local authorities only four identified an individual charged with the task of liaising with Travellers. A few local authorities cited examples of what they defined as good practice. These consisted mainly of specialised needs assessments and audits but the details were often unclear. Most energy appeared to be going into educational initiatives, reflecting the statutory responsibilities of authorities in this area as well as the availability of earmarked funds (NATT, 1999). Not surprisingly, claims of good practice coincided with the appointment of a specific liaison person.

 

In the case of the health authorities, three out of the seven who responded had a named individual with responsibility for Travellers but only one out of the seven reported that they regularly collected specific data on this group. Four reported specialist services for Travellers and three had published reports. No health authorities claimed to be able to identify examples of good practice with regard to Travellers.

 

These results from both local authorities and health authorities need to be treated with some caution. In the case of the local authorities there was considerable complexity in the devolved/delegated nature of various responsibilities which impacted on work with Travellers. It was sometimes unclear at which level (if any) responsibility lay and hence there was some doubt about whether the questionnaires were reaching the right people. However, the surprisingly high response rate did suggest that they were arriving on the desk of an appropriate person who had the knowledge and the authority to answer.

 

Care also needs to be exercised in interpreting the time frame of the responses given. Most people included in their returns any interventions carried out over the last few years. These were rarely dated and it was not always clear whether or not they were still in operation. Hence the findings could not be used as evidence of activities being undertaken currently. Rather they seemed to reflect the work of the past five years or even longer. This problem of timing was exacerbated by the fact that many of the interventions appeared to be short-term and lack of continuity was a major problem.

 

The findings did indicate major variations in the levels of activity carried out by different authorities. But again these need to be interpreted with caution. Evidence from the DETR Count indicated a very uneven distribution of  Travellers around the region. This was also evident in the replies to the survey. Some of the smaller authorities reported no Travellers in their population while some of the larger county councils had many. Indeed the respondent from Somerset reported that Travellers were the largest ethnic minority group in the area. Under these circumstances, the appropriateness of the spending levels of different authorities can only be assessed in the context of the numbers of Travellers involved. In general the high rates of activity did seem to coincide with the largest numbers of Travellers and low levels of activity often reflected the absence of a Traveller population.

 

As well as variation between authorities the survey also suggested fragmentation within them. In some authorities there was evidence of tension regarding where responsibility for Travellers lay and the context within which they were to be treated. It was clear, for example, that workers in education, housing, environmental health and social services could all have a professional interest in Travellers. However, their concerns might be very different and might sometimes have little to do with promoting the health of Travellers themselves. For some, their mandate necessitated that Travellers be seen mainly as a problem from which others should be protected rather than a group whose own needs should be met.

 

Overall then, the regional picture was one of relatively little activity directed specifically at Traveller communities. With the exception of those authorities with specialist liaison workers, there were few examples of specialist services or of dedicated systems for data collection or needs assessment. The remainder of this report therefore focuses on the challenges faced in improving the evidence base for this group both regionally and nationally.