INTRODUCTION

Public Health Warwickshire welcomes the opportunity to respond to the Warwick District consultation on sites for gypsies and travellers, preferred options. Having reviewed the document, Public Health Warwickshire have summarised the key messages, background and local context, health and social inequalities and recommendations in relation to gypsies and travellers and the links and key public health considerations that should be taken into account within the consultation process.


KEY MESSAGES

In general:

1. The health status of Gypsies and Travellers (G&Ts) in the UK is much poorer than that of the general population and also poorer than that of non-Travellers living in socially deprived areas.
2. G&Ts have low health expectations, poor access to, and uptake of health services, especially of primary and social care.
3. G&Ts' health and wellbeing are determined largely by wider socio-economic factors, such as: inappropriate accommodation and living conditions; social and economic exclusion and racism; inadequate education and cultural differences.
4. Two interventions have proven beneficial to G&Ts' health and wellbeing:
* Local provision of legal, regulated, well organised and managed accommodation sites (especially permanent, but also transit);
* Use of local outreach teams (OT) and initiatives to provide health care and education on site, including G&Ts involvement and participation.
5. Local authorities have a legal and moral obligation to ensure social and health equity for their populations, including support for minority and disadvantaged groups. Development of well managed G&Ts sites is in line with the national policies and priorities.
6. Considering the Warwickshire G&Ts' population, the shortage of legal camps and existing unauthorised encampments, a need for more authorised sites (especially short-term/transit) has been identified.
7. Unauthorised encampments pose a significant threat to both G&Ts' and local communities in terms of social cohesion, education, health and wellbeing as well as unnecessary resource consumption.
8. Most of the public concerns are related to perceptions rather than evidence however, existing evidence suggest that G&T sites are not a threat to the local community and bring significant benefits to the travelling communities.
9. Evidence suggests that longer term programmes and interventions are more beneficial for the social integration, health and wellbeing, education and reducing inequalities in G&Ts. However, transit/short-term sites can offer opportunities for health promotion and diseases prevention, especially if coordinated with a travellers' liaison and the local primary and social care services.
10. The decision and planning developments should incorporate appropriate communication, awareness raising with local people and gaining community support.

BACKGROUND AND LOCAL CONTEXT
There is a huge shortage of LA Sites and even less transit sites which has left over 25,000 people displaced, with nowhere to stop legally or safely. G&Ts are usually forced to stop on common land or on roadsides, most often without sanitation, waste disposal/collection, clean drinking water or electricity. Being forced onto inappropriate stopping places usually creates social tension between local people and Travellers, with road-siders being blamed for an increase of crime and fly-tipping.

The present legislation, including. the Housing Act 2004 and the Planning and Compulsory Purchase Act 2004, places a legal and moral duty on LAs to assess the accommodation needs of G&Ts and to include specific sites and criteria in Local Development Frameworks. The need for more such sites is supported by a range of evidence, also suggesting that cost of non-provision (both financially and morally) provides a strong case for persuading local politicians and members of local community that there is no option but to consider carefully planned new sites.

Current situation in Warwickshire
The exact number of G&Ts within Warwickshire is difficult to quantify. The Warwickshire Gypsy and Traveller Accommodation Assessment has found the following:
* There are 4 authorised GRTs sites in Warwickshire: Alvecote, Griff, Pathlow, Woodside.
* There are 2 unauthorised developments.
* There are a large number of unauthorised encampments (115 encampments/599 families (299 children) so far in 2013).
* Access to facilities and services is restricted for households on unauthorised encampments.
* A countywide floating support service.
* An estimated additional transit site need: 40 in Warwickshire (Warwick 15, Startford-upon-Avon 10, Rugby 5, North Warwickshire 5 and Nuneaton and Bedworth 5).

Findings from the accommodation assessment needs surveys, conducted both in the North and South of the County show:
* Household size is significantly larger with a significant minority of the sample (12%) households over 60 years of age and young families being the predominant household type.
* A third of school age children does not regularly attend school or receive home education. Children on unauthorised encampments and socially rented sites had the poorest attendance.
* The majority of respondents (nearly ¾) felt they were 'local' to the area they were residing in.
* The G&Ts are largely sedentary. Feeling settled and poor health were the main reasons that were cited for not travelling.
* Self-employment was a major source of income, including: gardening/tree work, UPVC and guttering and scrap.
* Nearly a fifth of respondents wanted to see the development of more transit/short-stay sites. Interest was shown from households from all types. For G&Ts in authorised/settled accommodation the creation of more authorised short stay sites would enable an increase in family visits and help to maintain the tradition of travelling. Such sites should be around 10 pitches in size with a large number of people expecting to use the site for between 1-4 weeks.


Gypsies and Travellers - HEALTH AND SOCIAL INEQUALITIES
The literature specific to the Gypsy and Traveller population indicates that, as a group, their health overall is much poorer than that of the general population and also poorer than that of non-Travellers living in socially deprived areas (Parry et al., 2004). The continuous instability and trauma caused by frequent evictions, discrimination, racism and harassment, often becomes part of their way of life, leading to chronic physical and mental health problems. They have poor health expectations and make limited use of health care provision (Van Cleemput et al., 2007; Parry et al., 2007).

In an report from the Institute for Public Policy Research (IPPR), Crawley (2004) emphasised the appalling inequalities experienced by Gypsies and Travellers in relation to health and education. A range of evidence is showing:

1. G&Ts die earlier than the rest of the population, having one of the lowest life expectancies in the UK as well as the highest rates of infant mortality. They experience poorer health, including: high rates of infectious diseases, increasing problem of substance and alcohol abuse among unemployed and disaffected young people, high suicide rates, depression and anxiety, poor maternal and women's health, poor children's health (accidents, injuries, infections, premature death), poor dental and oral health and high levels of multi-morbidity.

2. G&Ts are less likely to receive effective, continuous healthcare including: access to primary care and community care services, maternal and child care, screening and immunisation, and end-of-life and palliative care. Barriers to health care include: racism and discrimination, cultural beliefs, illiteracy, negative experiences, traditional role of the family, inadequate health service provision, and no fixed abode.

3. Children's educational achievements are worse and declining further still due to: lack of access to pre-school, out-of-school and leisure services for children and young people, extremely low participation in secondary education (discrimination, abusive behaviour on the part of school staff and other students are cited as reasons for leaving education at an early age), un-quantified but substantial negative psychological impact on children who experience repeated brutal evictions, family tensions associated with insecure lifestyles, and an unending stream of overt hostility from the wider population.

4. G&Ts have low employment rates and high poverty, accelerated criminalisation at a young age, leading rapidly to custody, lack of access to culturally appropriate support services for people in the most vulnerable situations, such as women experiencing domestic violence, poor sanitation, bad conditions and poor access to clean water.


RECOMMENDATIONS

There is an evidence based need:

1. To develop appropriate, authorised, well planned and managed permanent and transit accommodation sites, in agreement with the local community.
2. To raise awareness of the cultural needs of G&Ts communities among health and other social care service providers as well as the police and the public.
3. For assertive outreach work in order to improve health outcomes for G&Ts. The value of community outreach health projects undertaken in partnership with voluntary sector and local Gypsy and Traveller agencies has been recognised. Evaluations are overwhelmingly positive and indicate significant health gains. However, the majority of projects run for between one and three years with a risk that the health improvement will be lost once they come to an end.
4. For targeted on-site services to children (immunisation, psychological and developmental support), pregnant women (immunisations, screening, psychological support) and to increase male engagement in preventative health care.
5. To provide G&Ts with information and communications in accessible format and with appropriate content.