Written evidence submitted by Traveller Intervention Belfast Health and Social Care Trust (MEM0029)

Background

Belfast Health and Social Care Trust (BHSCT) in partnership with the Public Health Agency (PHA) have a long established Traveller health and wellbeing programme.

In 2010 BHSCT established its Traveller Health Project. Central to this project was the Trusts commitment to address the health inequalities experienced by Travellers in the BHSCT area. The Traveller Health Project was commended by the British Irish Parliamentary Assembly for its innovative approaches in 2014 and won first place in the Belfast Healthy Cities, promoting health equity award in 2015.

The current model of service delivery was developed as a result of research commissioned by BHSCT (2015) into Traveller service users’ interaction with Trust services and an analysis of the health and social care needs of the Traveller community. This qualitative and quantitative research focused on the needs of Traveller women and Children and identified several gaps in service.

This research was followed by an extensive consultation process with Traveller support organisations, Travellers and other key stakeholders in 2016, which was jointly initiated by Belfast City Council and BHSCT.

As a result of this research and the consultation, BHSCT reshaped it Traveller Health Project into a Traveller Early Intervention Project.

In the 2021/2022 financial year, the PHA have allocated £163, 496 to BSHCT to deliver on the Traveller Early Intervention Project. This represents a £15,000 increase in funding from the previous financial year.

In the absence of a Traveller Integration Strategy for NI, BHSCT utilised the learning and best practice from the Republic of Ireland and the Common Basic Principles for Roma Inclusion to inform the value base of the Traveller Early Intervention Project.

Value framework for BHSCT Traveller Early intervention Project

Explicit but not exclusive services:

Provision of services focusing on the Traveller community as a target group but not to the exclusion of other people who share similar socio-economic circumstances. This approach does not separate Traveller-focused interventions from mainstream policy initiatives such as the NI Public Health Framework “Making Life Better”.

Mainstreaming and desegregation

Supporting Travellers to access mainstream services, providing bridging services where barriers exist and ending the provision of segregated services.

Inter-cultural approach

Combating prejudices and stereotypes by facilitating Travellers to come together with people from different ethnic backgrounds and cultures.

Awareness of the gender dimension

Focussing on the needs of Traveller women and children and the multiple layers of inequality they face.

Additional Policy Dimensions

The model is also directly relates to key recommendation within the All Ireland Travellers Health Study (AITHS) and the key priorities outlined in the PHA Traveller Health and Social Wellbeing Action Plan for Traveller Health. A wealth of research has identified the most successful interventions for Travellers is to target early intervention to connect families with children to early years and other targeted services.

BHSCT Traveller Early Intervention Project.

Three themes for action were identified by BHSCT for the Traveller Early Intervention Project - these are:

Giving Every Child the Best Start

Giving Every Child the Best Start and take account of particular needs across the life course and cover childhood and adulthood, with emphasis given to children and young people, and to supporting individuals’ transitions into and through adulthood and older age. Early intervention is prioritised with support given to young Traveller families including home visits and helping them to access existing services such as Surestart etc.

Empowering Healthy Living

The BHSCT works with the PHA and others to empower the Traveller community to make healthier choices and informed decisions about their health by improving health literacy. This includes the provision of appropriate and accessible health information and advice to all, which is evidence informed and tailored to meet specific needs.

Developing Collaboration

“Developing Collaboration” considers strengthening collaboration for health and wellbeing at regional and local levels. This theme identifies three areas of work around which a number of partners have been developing collaborative approaches. These areas have been recognised as being of importance in improving health and reducing health inequalities by bringing together communities and relevant organisations at local level to assist with addressing Traveller Health needs in a collaborative manner maximising current investment and resources from a number of stakeholders. While distinct elements of the Traveller Early Intervention Project are delivered by separate organisations it is effectively one team, with agreed referral pathways and a level of partnership working that ensure the needs of Traveller service users are met and this was highlighted in research carried out by the University of Worcester in 2019.

Services currently commissioned by BHSCT:

Extern Multi-Disciplinary Homeless Support Team

A study carried out by BHSCT highlighted the issue of homelessness within the Traveller community, with more children currently living in hostels than there are living in halting sites. Extern’s Multidisciplinary Homeless Support team piloted a dedicated Social Worker, working on an assertive outreach model, to support Travellers of no fixed abode, those living in Hostels and those facing accommodation stress.  This intensive support programme ( which now has a full time social worker and a part time family support worker attached) aims to improve health and social well-being and access to the statutory and voluntary support services necessary to secure and sustain independent accommodation. This innovative approach has proved particularly effective in supporting these vulnerable families.

Barnardos Traveller Early Years’ Service

The AITHS identified that at both primary and post-primary level Traveller children have an absence rate 6-7 times that of the general population or other ethnic minority groups. To address this inequality BHSCT has commissioned Barnardos to deliver on a number of key actions including a ground-breaking programme to support Traveller children in their transition from Primary 7 to Year 8 and the provision of family support programme for pre-school Traveller children to prepare them for entry to primary school.

The HEART Project Healthy Living Centre

The Heart Project provides a service on behalf of three Healthy Living Centres in North and West Belfast and supports the Traveller community to access services in those healthy living centres. The project provides significant support to Travellers to access other health and social care services including registration with GPs. It also support Travellers to access mainstream services such as youth and educational programmes and promotes the participation of Travellers in civic society.

Community Restorative Justice

CRJ provides a service that supports the avoidance, resolution or transformation of conflict as it impacts on the Traveller community. Restorative justice approaches are used to address ongoing conflict and the issues that contribute to that conflict. CRJ encourage social inclusion and access to services with a specific focus on children and young people and support settled communities to understand Traveller culture

Monitoring and Evaluation

In the 2019/2020 financial year, BHSCT commissioned an external review (funded by the PHA) of the Traveller Early Intervention Project. The purpose of this review was to:

• Explore the current policy context to ensure that the BHSCT direction of travel was in keeping with current policy and best practice;
• Assess if the delivery model is addressing the health and social care needs of the Traveller community in BHSCT area;
• Benchmark if the service delivery model represents value for money.

While there was some recommendations in relation to the monitoring systems used by BHSCT and PHA (which were accepted by BHSCT), the overwhelming conclusions were that the services being delivered by BHSCT were making an impact on the Traveller service users and the health inequalities they faced.

Recommendations were made that BHSCT adopt a new monitoring methodology that was more robust and captured more detailed information on service users and these were implemented by BHSCT.

Monthly monitoring meetings take place with the four service providers and the BHSCT lead manager and a “practitioner’s forum” meets quarterly to discuss complex cases and best practice. A quarterly project monitoring form is submitted by BHSCT to the PHA.

Moving Forward

BHSCT is acutely aware that despite our best efforts, much more needs to be done to effectively address the health (and other) inequalities, faced by Irish Travellers. To this end we continuously strive to improve our services and ensure they are evidence based. BHSCT, the PHA and Belfast City Council, have recently commissioned an extensive research study on the inequalities face by BAME communities in Belfast, with a specific focus on Irish Travellers. It is hoped that this work will be completed by June 2022 and that it will become the bench mark for all public services to measure their accessibility to BAME communities.

September 2021