Agenda item

Rachel Jones (Director of Strategy, Planning & Partnerships, Kent & Medway CCG) and Dr Anjan Ghosh (Director of Public Health, KCC) were in attendance for this item.

1.    Ms Jones provided an overview of the paper, recognising that there were health inequalities experienced within the Gypsy, Roma and Traveller (GRT) community including a 10-year mortality gap (the national average). She highlighted that nationally there was a lack of data and information on this community. She recognised that the Kent and Medway CCG had a responsibility to improve the health of the GRT community but reflected that the wider determinants of health were impacted by so much and no one service area could resolve the issues alone.

2.    Ms Jones believed the introduction of the Integrated Care Board (ICB) provided an opportunity for joint working between councils, education, health and other public services, to identify what really made an impact and put the necessary changes into effect.

3.    An area of concern for Members was the ease of access to primary care services. Ms Jones explained that individuals did not need to provide an address, or ethnic background data, to access GP services. It was their legal right to access healthcare. However, she also recognised that not all primary care settings understood that or failed to accept additional patients. The CCG was working almost weekly on informing surgeries about access criteria, and there was a leaflet available that set out the process. She commented that the CCG often struggled to find out about access issues because very few people from the GRT community reported that there was a problem. She encouraged Members to share such experiences with the CCG so targeted communications could be circulated.

4.    Members asked to be sent the information around how individuals, particularly from the Gypsy, Roma and Traveller community, could register with a GP. 

5.    Recognising that younger generations were more likely to access online information, Ms Jones explained that the CCG website listed sites where care was available, such as Minor Injury Units. Some pathways also had the option for self-referral. Overall, Ms Jones agreed there needed to be more collective action and highlighted the positive relationships built during the targeted engagement for the Vascular Services changes.

6.    Mr Goatham said Healthwatch had carried out work in 2017 and 2019 on the GRT community. A key barrier identified had been the use of postal letters by the acute trusts – literacy rates were lower, and members of the community sometimes did not have a fixed address. The Chair asked Ms Jones if there were any examples of best practice, perhaps utilising phone calls or video conferencing. Ms Jones said she would take it away and see what more could be done, perhaps by involving the voluntary sector. One Member suggested an alternative to the written word might be imagery.

7.    Ms Jones confirmed that commissioning teams did not as a matter of course carry out general engagement work with the Gypsy, Roma and Traveller community. However, targeted engagement was carried out when needed, as evidenced by the covid-19 vaccination outreach work, and the Vascular Services review. Also, community services such as midwifery did go into the community. Ms Jones said direct engagement from a commissioning perspective was an area that could be considered further.

8.    A Member asked what was being done to ensure Gypsy, Roma and Traveller individuals were not being discriminated against when accessing primary care. Ms Jones accepted that discrimination happened, but felt this usually happened when someone was uninformed, particularly around access criteria – individuals did not need an address to register with a GP. The issue applied to other communities as well. The CCG constantly worked at GP education events and ensured leaflets were readily available on the website, as well as the complaints process.

9.    Ms Jones explained there was a joint responsibility between the NHS and Public Health to ensure primary care was available but also to work to improve health overall. The new ICB would be important, and it had named two strategic health and equality priorities in deprivation and mental health - mental health was a real challenge amongst the Gypsy, Roma and Traveller community. There needed to be more work on how meaningful services were provided to a community that chose to travel.

10. Members spoke generally about access to education and literacy levels.

11. One Member voiced their concerns around the poor experiences of the Gypsy, Roma and Traveller community. They spoke about poor health, lower levels of literacy, lower life expectancy, infant mortality rates, suicide rates, and the lack of understanding of their rights. The lack of data available meant it was difficult to make effective plans. The Member questioned whether KCC or the NHS had an Equality Impact Assessment. They felt a Short-Focussed Inquiry (SFI) by KCC was required.

12. The Chair supported the call for an SFI but explained that it was down to the Scrutiny Committee to agree the SFI work programme. A proposal had gone to the Committee before, but another topic had been agreed. A Member reflected that an SFI was not as detailed as a full Select Committee. Asked what an SFI would cover, the Chair proposed to liaise with the Vice-Chair of the Scrutiny Committee (who sat on HOSC also) about the best way forward.

RESOLVED that

i)        The report be noted.

ii)       The Chair and Vice-Chair of HOSC liaise with the Vice-Chair of Scrutiny to put forward a proposal to the Scrutiny Committee for a Short-Focused Inquiry.