Equal Opportunities Committee

Meeting date: Tuesday, June 26, 2012

Official Report 476KB pdf

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Gypsy Travellers and Care

Agenda item 3 is oral evidence from the Scottish Government in our Gypsy Travellers and care inquiry. I welcome our second panel and ask the witnesses to introduce themselves.

I am the Minister for Public Health.

I work for the Scottish Government in its adult care and support division and am here to take questions on carers issues.

I am from the patient focus and equalities branch of the chief nursing officer, patients, public and health professions directorate of the Scottish Government and am here to take questions on health.

I will give a bit of background before I open up the session to questions from committee members.

The Equal Opportunities Committee has carried out a number of Gypsy Traveller inquiries. It seems that, every couple of years since 2001, there has been yet another inquiry into Gypsy Travellers and various issues. It is now 2012, and no real progress seems to have been made despite the numerous previous inquiries.

The committee decided to carry out two inquiries into specific issues that affect Gypsy Travellers: care and accommodation. It seemed to us that they were the most pertinent issues that Gypsy Travellers had. It is clear that there is a lot of crossover between the two. Accommodation affects the care of Gypsy Travellers and their care affects their accommodation. That crossover in our inquiries has thrown up a lot of very interesting aspects of Gypsy Travellers’ lives. We have had a number of sessions with Gypsy Travellers. Representatives of the Minority Ethnic Carers of People Project have been in, and we have had an awareness-raising session with Gypsy Travellers.

Before I hand over to members, I want to ask about hand-held records. In 2001, it was recommended that hand-held records be rolled out across national health service boards. We have heard evidence from a number of Gypsy Travellers that the use of hand-held records is patchy across Scotland. Some Gypsy Travellers have their own hand-held records, some local authorities do not use them at all, and their success seems to be patchy. Given the nature of the Gypsy Travelling lifestyle—Gypsy Travellers travel around the country—it seems that, if every Gypsy Traveller held their own record, it would go with them wherever they were. Their health record would follow them. What are the panel’s views on the benefits of hand-held records? What can be done to ensure that they are rolled out across the Gypsy Travelling community?

A considerable amount of work went into the creation of hand-held health records. That work was undertaken by the national resource centre for ethnic minority health, which is now part of NHS Health Scotland’s equality team. Hand-held records came about as the result of a piece of work that NRCEMH did in which it looked at how the health service responded to the needs of Gypsy Travellers. A range of things came from that work and a range of things has been taken forward as a result of it. One issue that was highlighted was access to health records, and that led to the development of hand-held patient records.

It would be fair to say that the use of hand-held patient records has been very patchy. The previous census showed that there were around 1,500 to 1,600 Gypsy Travellers in Scotland. When the hand-held records were produced, there were requests for more than 1,000 of them to be used by local health boards. However, that does not necessarily mean that they were used. Evaluation work on their use was undertaken in 2009, but the feedback on the extent of their use and their success in being used was very limited.

As a result, we have looked at whether we could do more to improve consistency in the use of hand-held patient records, whether there are problems with them that act as barriers so that they are not used in some areas, why there is good practice in one health board area and not in another and what lessons can be learned from that, and we have asked the equality unit in NHS Health Scotland to undertake a stocktake of what each board is doing, how widely each board is using hand-held records, what the benefits are when boards use them, what the barriers are to those that do not use them, and what we can do to encourage their greater use. NHS Health Scotland has started that work, which will give us a much more thorough and detailed insight into the pros and cons of hand-held records.

As the minister who is responsible for looking at issues around health inequalities, I think that there is clearly value in consistent health information transferring from one board to the next. Before asking boards to make more use of hand-held records, however, it might be better to look at whether there are problems with the present arrangements that we could address to make the hand-held patient record system better. If we can make the system better, will that increase its use? If so, we can look at how to proceed. It would be fair to say that more progress could have been made, but now that NHS Health Scotland is looking at the issue in more detail and evaluating it more thoroughly, we should get the information and evidence that we need to decide what action we need to take to get health boards to make greater use of hand-held records.

15:30

Thank you minister. Does anyone else want to come in on hand-held records?

I have one point. The Gypsy Travellers were involved in the creation of hand-held patient records, so I do not think that the design of the records is the barrier to usage. What might some of the barriers be? I do not think that it is the records themselves, given that they were mainly designed by the Gypsy Travellers themselves, albeit in conjunction with others.

I suspect that there are a number of barriers. It might be worth looking back in time to when use of those records started. A range of awareness events were held to make health professionals and Gypsy Travellers aware of the scheme. Members of the Gypsy Traveller community were involved in running those events to increase awareness and understanding of the purpose of hand-held records.

Barriers might be caused by staff turnover in health board areas. New staff who are addressing the needs of Gypsy Travellers might have less awareness of the records. Also, as I am sure we all know, individuals can be creatures of habit. They get into the way of taking a particular approach and, when something new comes along, they might not necessarily decide that that is the way they want to go. Some Gypsy Travellers might not be aware that they have the option of having hand-held records, and some might choose not to take that option; that is always an individual’s right.

There is a variety of possibilities and NHS Health Scotland needs to evaluate that thoroughly. That will involve exploring the issues with health boards, with health professionals who use the records, with Gypsy Travellers, and with other stakeholders, to try to identify the barriers. We then need to look at possible reasonable measures that we could take to address the issues.

You are right to say that Gypsy Travellers were involved in designing the system. It might need to be tweaked a bit. If so, let us look at doing that and see whether we can increase its use.

Minister, what is the timescale for NHS Health Scotland to do that work?

I have not fixed a timeframe, but I hope that it will take months rather than years to see what lessons we can learn. I am conscious that this problem has been on-going since 2001. If we are to continue to use hand-held patient records, we must be sure that they are being used. If they are not being used, we need to find a better option. I hope that the evaluation will take months rather than years. It will be complex because of the number of different stakeholders who are involved in the process. Dealing with them can prove to be challenging.

Health Scotland has already convened a group of people to scope that piece of work. It is important to reflect on the point that the hand-held record is only one of a range of approaches that health boards have been taking. There are also outreach and anticipatory care work programmes, which means nursing staff going into encampments. We are also linking people with named general practitioners and dentists. We want to ask Health Scotland to look at a range of activities, of which the hand-held record is only one.

There is a range of barriers to people using a hand-held record; those may be to do with literacy or someone’s expectations of the health service. Similarly, there is a range of reasons why people do not turn up, for example, to an anticipatory screening appointment, or a keep-well clinic in their area. Given the nature of the Gypsy Traveller community, we need to develop a basket of responses rather than focus on only hand-held records or anticipatory care. There is a range of approaches that may or may not be successful and we need to evaluate them thoroughly before we make any clear recommendation.

The stocktaking that NHS Health Scotland will undertake and other activities to which Alastair Pringle referred will take longer to do because of the complexity of the issue. However, I hope that work on hand-held records will be done in a shorter timeframe.

We heard about the suggestion of having so-called open-house practices in which a number of GP practices share medical records for Gypsy Travellers. Would you like to see that happening more widely?

It is important to ensure that our health services are open and accessible to everyone, whether Gypsy Travellers or otherwise. We are always looking within NHS Scotland to see how we can improve patient access to the health service in general. Some of that is around information sharing between different health professionals or between social care and health professionals. We will always consider and try to encourage general practitioners and others to use ways of improving patient access and information sharing.

My knowledge is more about the care side of things. I noted that in your introduction, convener, you referred to the link between care and accommodation, and you have been talking about health records and access in that regard. I know that the committee is concerned about access to assessment and care packages.

A good, on-going aspect of practice is the independent living movement in Scotland. Work is going on in that area to ensure that portability of care becomes a reality, although that will take some time. For example, it would mean that a Gypsy Traveller moving from area to area could take their care assessment and care package information with them to the next local authority. There would be limitations on that regarding resources and local authorities’ flexibility, but it is an evolving aspect of good practice in the care rather than the health dimension.

Do you expect a roll-out of portability of care in the way that you described for the wider population? Or will it be specifically for the Gypsy Traveller community?

It will be for the wider community.

That is fine. I just wanted to be clear about that.

On the issue of accommodation, there are various sites in Scotland for Gypsy Travellers but we know that there are not enough. The existing sites seem to be located in areas that are not particularly desirable, whether they are under pylons, next to rubbish dumps, or whatever. With regard to that, my stereotypical idea of Gypsy Travellers and some of the myths about them were certainly taken care of in the awareness session that we had. However, the sites are not adequate or fit for purpose in many ways and we seem to have known that for some time. We do not seem to have done enough on investment or relocation. Will the minister comment on that?

Each local authority must determine where it wants such sites to be located and what facilities they should have.

Around two years ago, there were particular issues in Aberdeen and Aberdeenshire, where the local authorities faced challenges to do with illegal encampments. The then Minister for Housing and Communities, Alex Neil, instigated a working group to try to address some of the specific challenges that the two councils faced. A number of the group’s recommendations were taken forward to try to address some of the issues.

In the past couple of months, we had a meeting of a group of stakeholders on the issues of sites and illegal encampments. The aim was to consider how to spread more widely the elements of good practice in some local authority areas in addressing those issues. The first meeting of the group took place a couple of weeks ago. From that, there has been a recognition that we need to do more on the guidance that is issued to local authorities and to look at some of the good practice that could be utilised in other council areas. We will work with COSLA and the other stakeholders to consider how the good practice that exists in some local authority areas can be used in other areas.

The evidence that we heard in the round-table meetings was that there is no good practice, so I would be interested in hearing where you believe there to be good practice. We certainly have not been made aware of it. We have a real concern that, on most sites, the facilities are inadequate and that many sites are not fit for purpose, which has an obvious impact on people’s health. We should bear it in mind that, although we have fixed pitches, there are not enough. Also, some people are transient, but there are certainly not enough sites around the country for people who wish to travel, although many Gypsy Travellers do not travel and some of them are in houses.

I am interested to hear where good practice is taking place, because that was not evident in what we heard. I certainly cannot recall any evidence of good practice.

The good practice that I am referring to was raised in the discussion that took place at the stakeholders meeting, which involved Gypsy Travellers, local authorities, the police and others. They recognised that local authorities are taking an inconsistent approach to the provision of fixed-pitch sites and to dealing with illegal encampments. The meeting considered the experience in some areas. Some of the work that has been done since the group that considered issues in Aberdeenshire has identified areas in which a more progressive approach has been taken to dealing with the issues. We need to ensure that the benefits can be achieved by councils in other parts of the country, which is what the new working group is considering. It aims to ensure that the more beneficial approaches in some parts of the country are utilised in other parts of the country.

One thing that might come from the process is that there is a need to look at the existing national guidance for local authorities. That is the subject of a petition that is before the Parliament’s Public Petitions Committee. The petitioner was a member of the group that had the initial discussion on the issues. I understand that a couple of the points that have come from that are about considering whether we need to refresh the existing national guidance and whether some of the good practice—which the committee might not have heard about, but which I believe was mentioned in the group—can be spread more widely and taken on by other local authorities.

I am not being discourteous. I am probably talking about an interpretation of good practice by the Gypsy Traveller community, although others might believe that good practice takes place. To be fair, there is a great deal of willingness to ensure that improvements are made, but I return to the point that there are probably insufficient sites and pitches for people. I hear what you say about it being in the hands of the local authorities to address that, and I am glad that you are perhaps looking to the national guidance to see whether there might be some movement with reference to that. There is insufficient accommodation for our Gypsy Traveller community, which results in illegal campsites.

Those are all valid points. If the group produces proposals that can assist us in developing future guidance for local authorities, to help them to understand what they should be doing, we are open to that. That is what the working group is looking into.

15:45

I have a few questions about healthcare and access to GP services. We heard interesting evidence about the benefits that can be derived from healthcare initiatives, and providing funding for those seems to have a direct effect. One witness who quoted personal research said that, over a 12-year period, there had been an increase in the life expectancy of Gypsy Traveller men from 55 to 61 in the group that he worked with. This may touch on something that Mr Pringle said earlier. Are there specific plans to provide more funding for some of those projects, which seem to be directly beneficial?

There is absolutely no doubt that Gypsy Travellers suffer from greater health inequalities than other members of society. Some of the work that we have done through our keep well programme has been about closing down those inequalities. The programme is not specific to Gypsy Travellers but is about closing down health inequalities per se, although it includes Gypsy Travellers.

Health boards have been tasked not only with continuing to mainstream—as they are doing—the keep well checks, but with focusing on those who are hard to reach. I am talking about those groups who may not engage with the health service, which we know is an issue among Gypsy Travellers, and who may not present early enough for the right preventative treatment to be given. We are trying to ensure that minority groups such as Gypsy Travellers are among those on whom boards are focusing in trying to close down health inequalities. Some boards have succeeded in doing that, and the programme has had a range of benefits for the country as a whole. It is important that it is focused on those who may not engage with services, so that they get the opportunity to have the keep well health check.

I am encouraged by that. You talk about an NHS that is open and accessible. However, the evidence that the committee has heard so far from the Gypsy Traveller community suggests that they regard the NHS as anything but open and accessible. It has emerged that Gypsy Travellers are slow to place their trust in people, although they benefit from establishing a relationship with an individual.

That brings me to the question of GPs. We heard evidence that Gypsy Travellers had been refused access to a GP when they turned up at a health centre, which raised issues about how we can get rid of the healthcare inequalities to which you referred. The Gypsy Traveller population in Scotland is estimated to be approximately 15,000 and their travelling patterns are fairly easy to predict and map. Is there any proposal to prepare a map of their travelling patterns showing the locations of GPs who are prepared to be consulted by Gypsy Travellers?

I think that there are 1,500 Gypsy Travellers in Scotland, not 15,000—that is according to the count that took place in January 2009.

I am sorry, minister, but

“The Gypsy/Traveller community estimates its numbers at more than 15,000”

in Scotland.

The last count that we have is 1,590.

That raises an enormous question. If there is such a divergence in the estimates of the size of the Gypsy Traveller population, surely that needs to be addressed.

You are right. The most up-to-date information that we have is from 2009. Information from the most recent census will be available in 2012 and will give us up-to-date figures for the number of Gypsy Travellers.

Your point about access to services is important, particularly with regard to GP and primary care services, as Gypsy Travellers can experience difficulties in accessing them. Often, if an individual is unable to access a GP service, their first port of call is an accident and emergency department. That is not always an appropriate route and it does not necessarily lead to a good use of the health service’s resources.

The idea of mapping out Gypsy Traveller-friendly services has a level of merit. My concern about that approach is that there might not be a uniform pattern of such services across the country, and individuals might not be in close proximity to a particular service. We have tried to ensure that we mainstream the provision of care, because we believe that anyone, irrespective of their background, ethnicity or place of residence should be able to access healthcare services. That is probably a better approach to the provision of health services in Scotland.

We need to do more work on identifying why there are problems with particular GP practices. NHS Health Scotland will consider certain issues. We know that there are some practices, such as some in Aberdeenshire, that have been proactive in the work that they have done with Gypsy Traveller communities, although they have had to continually refresh their approach—as some of the evidence that you received from NHS Grampian suggests, following the initial burst of action with the Gypsy Traveller community, the work must be refreshed because of people moving and the changing nature of the locations that they can be in.

It is a challenging area. I would like to identify practices that are not engaging in the way in which they could be and find out whether there are courses of action that we could take to assist them. We want to pass on lessons from the experience of the practices that are engaging effectively in order to address issues or concerns that they might have. We want our approach to result in a much more consistent service across the country rather than having a select number of Gypsy Traveller-friendly practices.

I understand that people are concerned that there are GP practices that might not be as open to the Gypsy Traveller community as they should be. We need to examine the barriers and see what we can do to address them.

I am interested in your response. How do you find out which practices are not treating Gypsy Travellers?

Part of the approach involves a consideration of where we know that Gypsy Travellers spend a certain amount of time—areas with existing sites and places that are used as temporary encampments. We will work to see whether there is work that we can do with GPs in that locality.

Part of the dialogue that NHS Health Scotland will have will involve speaking to the Gypsy Traveller community to find out whether there is a pattern to the areas where there is a particular problem, to identify what the barriers are and to find out what could be done to deal with those issues. If some of those issues cannot be addressed easily in those communities, consideration will have to be given to whether there are wider issues that we must address. We must look at the areas where the Gypsy Traveller communities often tend to be and see what we can do with the practices in those localities.

We heard from one GP that it seemed a perfectly workable practice for a GP who was attending to a Gypsy Traveller patient and who knew that they would leave imminently for another area to alert the Gypsy Traveller to a GP in the place to which the Gypsy Traveller was going and to communicate with that GP to say that the patient would be coming to them and what the issues were. Is there anything that the Scottish Government can do to facilitate the element of co-operation that already exists among GPs?

That is a good example of the type of co-operation that should be taking place. Where such co-operation is not taking place, we need to identify what we can do to help to facilitate it. I would not like to give the committee the impression that there is an easy solution, because it can be extremely challenging to address issues to do with the health service and the way in which it traditionally interacts with patients.

From our side, we must engage with the Gypsy Traveller community to ensure that when its members engage with the health service, they continue to keep in touch with it. I understand that, in some health board areas, part of the challenge can be to do with the fact that someone who requires in-patient treatment and has been put on the list to get that treatment moves without notifying the health service that they have moved. That means that when they move into another health board area, they have to go back on the waiting list. There are communication complexities when individuals move. This is a two-way process. Gypsy Travellers who link in to the health service must ensure that they keep it informed as and when they move so that GPs, if they are willing and able to, can pass on information to a practice in the area that they move to. That is why some of the stocktaking work that NHS Health Scotland undertakes will allow us to identify whether there are specific measures that we, as a Government, can take to assist in addressing those issues.

I think that the committee is slightly bewildered about why a GP would refuse to see a Gypsy Traveller.

That is a very good question. I think that that is unacceptable. If the committee took evidence from such a GP, they would give you their explanation. I, too, would like to know why that is the case and what we can do to address the situation. Do they refuse to see Gypsy Travellers because their list is full? Do they do so because of previous issues that they may have had with Gypsy Travellers, as a result of which they have decided to take a particular approach? We need clear answers to those questions. We need a clearer understanding of what is happening if we are to address the situation effectively and to make provision for the support and assistance that may be required at Government level to address it.

The minister will be aware that a GP with more than 30 years’ experience of working with Gypsy Travellers gave evidence to the committee. I think that the committee was universally impressed by that gentleman’s commitment and the extensive knowledge that he had of the Gypsy Travelling community. I would like to think that the Scottish Government could short-circuit the process by talking directly to someone who knows what he is talking about. I think that he could quickly and effectively inform the Scottish Government about the extent of current deficiencies and how better measures could be put in place, which I think could be done with relative ease.

I will ensure that NHS Health Scotland contacts him to discuss his professional experience and his suggestions about how we can address some of the issues.

I have not asked about the centralisation of services. The example of midwifery was pointed out to us. Previously, if a female Gypsy Traveller had a good relationship with a GP, that GP could make a general assessment of her health, including if there was pregnancy. The centralisation of midwifery services has meant that that local facility is no longer available. Has any scoping work been done on the consequences for the Gypsy Traveller community of centralised health services?

16:00

Each board will provide maternity and midwifery services in its area in the way that it considers to be most appropriate. The decision about how services should be provided to individual patients and the most appropriate support from midwifery services is ultimately one for clinicians.

That will be more challenging in parts of the country in which there has been some centralisation of services. That is why it is all the more important to ensure that when someone presents to a GP and may require midwifery services those services are planned in a way that addresses those issues, and that an expectant mother is aware of those issues and what can be done to address them. That may mean trying to organise the provision of more outreach work by the local board, which can shape the work to help to support Gypsy Travellers. Some Gypsy Travellers, for their own reasons, may choose to go to that in-patient facility. However, that must be an informed choice and we need to ensure that services locally recognise the unique issues that may arise in the case of a Gypsy Traveller who is more distant from a central service.

Before I bring in Jean Urquhart with a supplementary question, I have a question about community pharmacies.

As you know, community pharmacies provide a successful and important minor ailment clinic service throughout Scotland—there are community pharmacies all over the place. Recently, I had a discussion with community pharmacists who said that they would be more than happy to provide a minor ailment service to Gypsy Travellers. The problem is that, in order to access that service a person has to be registered with a GP, and a number of Gypsy Travellers are not registered with GPs.

Could an initiative or scheme be considered whereby Gypsy Travellers could access minor ailment services through community pharmacies without being registered with a GP?

I am sure that it is not beyond the wit of man to find a way in which we could address that issue. NHS Health Scotland can look at that issue as part of its stocktaking exercise on how our health service is responding to the needs of Gypsy Travellers.

You make a valid point—as I am sure that members appreciate, the role of community pharmacists and the nature of the services that they provide has changed dramatically in the past five or 10 years. I suspect that that will continue to be the case and that, because of the skill set that pharmacists can contribute to that area, our community pharmacists will increasingly become a point of focus for initial support and assistance for individuals. I will ensure that NHS Health Scotland considers that as part of its stocktake.

My question was answered fairly comprehensively in your response to Annabel Goldie. I felt outrage when I heard about doctors turning away Gypsy Travellers, and I wondered why it was happening. Since then I have discovered that other groups fall into that category. I appreciate hearing that the minister feels that there is work to be done throughout Scotland.

We had evidence from Dr McNicol that there had been some money for investigating further what Gypsy Travellers needed. It would be essential to meet him, because of the culture and needs of Gypsy Travellers, which there is something quite special about. We might rethink how we deliver health services to Gypsy Travellers. It may be that not every doctor will be able to appreciate that culture—because it is quite different—and the kind of services that Gypsy Travellers need.

That difference needs to be recognised, because it is not just like somebody else coming in with a sore throat or a sore head. There is so much to the Gypsy Travellers’ lifestyle and culture, and it should be recognised that some of that might well deliver poorer health, but not all of it. Their story is quite complicated and it needs to be heard before we can make a judgment on their medical service.

That is why it is important that we evaluate where things are working well, and good work is being done on how we can learn from good practice in other areas. That is why I am keen for the stocktake to consider the barriers and whether we can take action to address them.

In the past, the Royal College of General Practitioners has done some work with GPs on working with Gypsy Travellers. Some of the evidence that the committee received from NHS Grampian demonstrates that it would be wrong to try to find a one-off solution. We will have to revisit and re-evaluate the issues to see how effective our solution is, and to take on board the comments and changing nature of Gypsy Travellers and their needs. The initial input can have a good outcome but things can dwindle off, and we need to ensure that health boards and GP practices continue to update and progress the work that they are doing in the area.

I would not like to give the committee the impression that we will ever reach uniformity across all GP practices; they are all in different circumstances and they have different needs and demands placed on their time. If there is a clear number of areas in which there are barriers that can be addressed, we should look at doing that. People should not be denied access to GP services when it is reasonable that they should have that access.

Are the British Medical Association or the RCGP involved in the stocktake exercise?

NHS Health Scotland is leading on it, but a range of stakeholders will be involved in the discussions; I expect those to include medical professional bodies. To be honest, I am more interested in hearing about the experiences and issues of those who are at the coalface. We might have to engage with some of the professional bodies in addressing some of the issues that might arise from the stocktake and ask for their assistance in addressing those issues with their membership. We could look at their suggestions for solutions to some of the issues that might arise.

However, my personal priority is for NHS Health Scotland to focus on what is happening at the coalface, the experience of the staff who are working at that level, and the issues that have to be addressed to deal with some of the difficulties that Gypsy Travellers are experiencing.

I whole-heartedly agree. It is imperative that we should learn about the issues from the coalface. Getting a wider understanding of the overarching issues that affect GP practices and why they do not universally take on patients from the Gypsy Traveller community means that it is important to liaise with the British Medical Association and general practitioners.

One of the things that a health minister does is to have regular contact with professional bodies, including the RCGP and the BMA, which are always keen to raise their issues with the Government. Such bodies will, of course, be part of any wider discussion that takes place but, as I said, I am conscious that the real learning will come from coalface experience and using that to the best of our ability to address the problems.

A number of witnesses have told us about the problems that they have faced in trying to get adaptations for their home. Some spoke about the length of time for which they have had to wait for things—for example, 18 months for a shower or 11 months for steps.

One council official told us that there was a difference between how grants are processed for those who are in a fixed house and those who are in a caravan or chalet. Scottish Parliament information centre research shows that there is no specific Scottish Government guidance on how grants can be accessed by someone who owns a mobile home but rents their pitch from the local authority or another body.

Given that there are guidelines for homeowners, those who rent their fixed home and those in housing association accommodation, does the Government have any plans to issue guidance for those who live in mobile homes? That could remove the barrier of people thinking that they are being stigmatised when the fact is that there are currently no guidelines.

As a former occupational therapist, I know that this is a very challenging area for local authorities and health services. The type of adaptation that may be made to a traditional bricks-and-mortar property does not always lend itself to a mobile home, so some of those options are not always available to people in mobile homes. That can make some issues quite challenging to deal with.

There are clear building regulations for adaptations in a bricks-and-mortar home that must be complied with in order for local authorities to take the work forward. It can be quite challenging to apply those to mobile homes. We have an independent adaptations working group that is currently looking at guidance on the provision of adaptations by local authorities and health services. The group is considering a range of issues around accessibility, the way in which services are provided and how we can improve the available guidance for local authorities. The group is due to report in September this year, which should assist us in considering whether we can do something more to provide local authorities with guidance in that area.

As I am aware from my previous professional experience, providing guidance can be challenging because the environment that people are seeking to adapt may be quite difficult. Adaptations may be needed for only a limited period at a particular location, and if someone then moves, the adaptation may need to be recreated in another area. There are questions around whether adaptations can be made on a temporary or portable basis, or on a permanent basis. Such questions can make seeking to provide those services quite challenging for local authorities.

Once we have the report from the independent adaptations working group, the Government will be able to consider what further action we can take forward to assist local authorities in relation to guidance on adaptations.

I accept what you say. However, the stumbling block at present is not just whether people can get the adaptation but whether they can gain access to the grant in the first place. Authorities must also take the advice of the person who requires the adaptation. We heard about a woman who told the installers that if they put the adaptation elsewhere, she would still be able to get into her second bedroom; that was not allowed, and she is now waiting on her second application to allow her into her second bedroom.

There is also the issue of respite care. We heard from a witness with a disabled daughter who was entitled to and allocated respite care. However, given the ethnic differences of Gypsy Travellers, the family wanted her sister to attend her instead of male carers. That request was refused. Can such issues be looked at? I understand that that is one unique example, but it is to do with culture and ethnicity, and we should ensure that we do not put up barriers to respite care that should not exist.

16:15

Just to be clear, are you talking about someone who was on a respite break and a member of the family wanted to make their meals?

They were going to help with the care, to clean, to assist with swimming and so on. The person concerned was female, and the family wanted the sister to go with her.

When a local authority undertakes an assessment—this applies as much to Gypsy Travellers as it does to everyone else—it must assess whether care arrangements are ethnically appropriate. If an individual has specific ethnic issues with regard to the care they are provided with, that should form part of the local authority social care assessment. Social work departments are responsible for carrying out assessments, putting together the care plan that results from that assessment and considering how to address the individual’s care needs, and ethnic issues should form part of that process.

What might be a challenge in certain areas is having a service that understands and addresses a person’s specific ethnic issues. If there is, say, a large black and minority ethnic community in an area, the local authority will have to pursue with service providers in the area the provision of culturally appropriate services. That is not so much a matter for national guidance; it is more about the assessment process and service delivery. After all, the service that an individual gets is tailored to meet their needs appropriately. As I have said, social work staff do that when they carry out assessments.

I want to make a couple of comments about some of the issues that have been raised and then ask a number of specific questions. Picking up on Siobhan McMahon’s last comment, I note that although the Equality Act 2010 protects the ethnicity of Gypsy Travellers it also presupposes that the people who deal with them understand that. That might not always be the case, and I think that there is an awareness issue to deal with in that respect.

As for lifestyle, I think that we either value diversity or we do not. Everything that we have been told devalues the diversity and lifestyle of Gypsy Travellers, many of whom have been told that all their problems would be sorted if they moved into a house. Such an approach is not helpful; it does not help, for example, with aids and adaptations or continuity of treatment, which, given their lifestyle, is already a challenge.

Although we received some information about life expectancy, which Annabel Goldie touched on, I understand that there has been no official research on the matter other than that carried out in Ireland, which showed that a man’s life expectancy is 11 years less than that for a woman. However, other research shows that Gypsy Travellers who live in houses—of course, their ethnicity does not necessarily mean that there is a mobile element to their lifestyle—have the poorest health.

With regard to what we heard about the number of Gypsy Travellers in Scotland—and the difference between 1,500 and 15,000 is certainly significant—I was interested to note that the minister took his figure from the census. Surely that raises issues about how people classify themselves. Nevertheless, the brutal question is: how can we evidence whether we are meeting the needs of the Gypsy Traveller community?

The truth will always lie in whether individuals in the community feel that their needs are being appropriately met.

But the Government must require evidence that those needs are being met.

The real test is not what happens in a study but what a person’s experience reveals. Some of the evidence that the committee has received from individual Gypsy Travellers and others shows that they do not feel that their needs are being appropriately met. If individuals are saying as much, I do not need an academic study to tell me the same thing. We need to address specific concerns, identify the various barriers and see what we, at a national level, along with partners in local government and elsewhere can do to tackle those barriers more effectively.

However, I will not pretend that that can be done in a short time. Unfortunately, some of the barriers faced by Gypsy Travellers might be the result of individual personal prejudice. As we know, that problem might take considerable time to address; nevertheless, we must address it where possible.

We also need to ensure that we know about issues such as barriers that inhibit Gypsy Travellers with identified needs from accessing services, so that we can find the best way of addressing those needs. We need greater consistency in the way in which local authorities and health boards provide services to Gypsy Travellers.

I assure you that I am all for practical examples rather than academic studies. However, in my home town of Inverness, comparative studies on life expectancy can be done even for parts of council ward areas. It will be challenging to do studies for the Gypsy Traveller community if we do not even know the numbers.

It may helpful if I come back to the committee on the point about comparative data. I will find out whether any research has been done—other than the Irish study that was referred to—that might assist the committee’s consideration. I am not aware of any off the top of my head, although I know that we will have census data that has been captured from a number of sources. However, I will check whether any studies have been undertaken in Scotland or other parts of the UK that have comparative data on life expectancy that might be useful to the committee. Clearly, such information would be useful for our thinking about what we need to do.

I may have a few more questions on lifestyle issues.

You used the term “mainstreaming”, which in itself might be regarded as offensive by the Gypsy Traveller community because it suggests that one size fits all. This committee is familiar with the term because it is often used in areas that we consider. Mainstreaming can be regarded as positive in the context of equality and treating everybody the same. However, we must also acknowledge difference.

You talked about what would happen if a Gypsy Traveller did not get treatment at a GP practice. I know from my experience as a director of the Highland Homeless Trust that homeless people face similar challenges in relation to GPs—indeed, that happens to such an extent that NHS Highland provides a doctor specifically for homeless people. In general, if people do not get treatment from a GP, they go to a hospital accident and emergency department, such as the A and E department at Raigmore hospital, where they can be asked whether they have had the condition for more than three days. If the answer is yes, they will be told to go and see their GP.

We can have mainstreaming that recognises difference. It is about ensuring that, irrespective of individual differences or where someone is in the country, people receive the required care and attention from our health service when they present themselves to it. I do not want mainstreaming to mean that one size fits all; it is about having a person-centred health service that meets the needs of each individual who presents to it with their own particular circumstances and health needs, whether they are a Gypsy Traveller or not.

We need to identify the barriers or inhibitors in the system that prevent people from initially engaging with services or continuing to use services—we have talked about the example of someone being unable to access a GP—and we need to address those barriers so that people get the service that they require.

What if the barrier is simply prejudice on the part of a GP? What sanction can be taken in that case?

I do not want to get into talking about what the barrier might be.

What if it were prejudice?

If it were, we would need to address that with the GP. It may be about addressing a misinformed view of Gypsy Traveller culture to ensure that Gypsy Travellers’ issues and needs are appropriately addressed. We have a range of different services in the NHS that can do that.

If the issue of prejudice presents itself, we must address it effectively. However, such issues must be addressed not only by Government but by professional bodies, which have an important part to play in ensuring that their members recognise areas of prejudice that may exist in their practice. The Government is more than happy to work with professional bodies to address such issues. We already do that with healthcare staff in a number of areas in the NHS in Scotland.

We must be clear about what the barriers are and determine the most effective method of addressing them. One of the best ways of addressing some of the issues can be peer-to-peer input, whereby GPs who are providing a service or engaging positively share their experience with GPs who are not doing that. We must identify and be clear about the barriers before we can start to think about the most appropriate ways in which to address them.

What assessment—if any—has been done of the impact of self-directed support on Gypsy Travellers? What steps will be taken to ensure that Gypsy Travellers are able to access self-directed support appropriately?

The issues around self-directed support are the same issues that exist within social care in general and relate to access to services. Self-directed support is not a new form of social care; it is just a hierarchy of options that individuals are given after a social care assessment has been undertaken.

Gypsy Travellers must be able to access the type of social care provision that they require. They should be given the same options as everybody else. Those options are to receive a direct payment, to direct the local authority in relation to who provides their care, or to receive a traditional care package to be provided by the local authority—or to have a combination of all three of those. If the Social Care (Self-directed Support) (Scotland) Bill is passed, it will provide people with that legal right irrespective of whether they are a Gypsy Traveller.

The point that you raise highlights some of the challenges around portability. Self-directed support can be a useful way of addressing some of the cultural issues that individuals may experience, as a result of which they may feel that a service does not suit their needs. They may choose self-directed support as a way of bringing in a service to meet their individual needs more effectively and in a way that they are more comfortable with. Along with COSLA and others, we are working on portability to ensure that if a Gypsy Traveller who has a self-directed support package moves into another local authority area, they will be able to take that package with them. The same care provider may not be able to provide the service in that local authority area, but that is another matter. It is a difficult technical area because there are different charging policies in different local authority areas, and different services are provided in rural and urban areas. The difference in the mechanisms that are used by different local authorities can also create difficulties.

It is a complex area that will take some time to address, but it is a long-standing issue. I am sure that Dennis Robertson will recognise from his previous career that the portability of care packages between local authorities has been an issue for decades, partly because of the complexities involved. A working group is looking into the area, which will give us the opportunity to address some of the issues that Gypsy Travellers, like anyone else, may experience if they choose a self-directed support option.

Thank you very much, minister. Do committee members have any very brief questions?

I have two points. First, I understand the point about adaptations. It brought to mind the minefield that exists around procurement and everything else. One size sometimes fits all within the procurement mentality. I sincerely hope that we are moving away from that.

Secondly, we keep referring to GPs but I wonder whether we really mean GP practices and the wider aspects of medical care, including practice nurses. Should there be a greater awareness among the profession of the needs of the Gypsy Traveller group? Would you encourage awareness training within the various boards?

Given some of the evidence that the committee has received from Gypsy Travellers, there is clearly a need to raise awareness and understanding. NHS inform has a role to play in working with different professional groups to raise their awareness and understanding around some of the issues. I do not want to pre-empt the stocktake that NHS Health Scotland is undertaking, but I suspect that awareness raising is likely to be one of the issues that is highlighted. We will then have to work out the best way to take that forward to ensure that GP practices have a greater awareness. Practices in particular areas where there are Gypsy Traveller communities will have experience in that field. GPs from those practices may have an important part to play in addressing some of the misconceptions that other GPs may have around Gypsy Traveller issues.

16:30

To return to the earlier point about the number of Gypsy Travellers, I want to clarify the figures for Annabel Goldie. The figure of 1,590 Gypsy Travellers relates to those living on registered sites—that is why there is such a variance in the figures. I understand that part of the difficulty in quantifying the population is its transient nature. We get confirmed figures for the snapshot of time that we have to carry out the census. However, people often move on and potentially they can be double counted.

So those figures would not include people living in houses who are Gypsy Travellers.

I believe that in the last census in 2010, an additional element was introduced to try to capture information on Gypsy Travellers who are resident in permanent properties. Part of the difficulty in being able to come to a clear figure is because the exercise has to be done within a limited timeframe. People can move in that period of time, so it is difficult to come up with an accurate figure.

As there are no further questions, I thank the minister and the witnesses for coming to give evidence.

16:32 Meeting continued in private until 16:47.