What Is Preventing Gypsies and Travellers From Accessing Person-Centred Care?
By Barry Price of QCS (www.qcs.co.uk)
To mark Gypsy, Roma and Traveller History Month 2021, QCS’s Barry Price reveals the social care inequalities that Gypsies and Travellers face.
In this, my first column for The Carer, I want to talk about a subject that is particularly close to my heart. I want to devote this piece to talking about the challenges that the Gypsy and Traveller communities face when accessing social care services. It’s a subject that I am very passionate about – not just because I’m a professional carer – but I’m also proud of my Traveller family heritage.
Having a unique insight into both worlds, you’d think it would be easy for me to outline the issues and provide solutions. But it is not that simple. Take a paper written by Avril Fuller and Sarah Sweeney, for instance. The study, which was published by ‘Friends, Families and Travellers’, a national charity, states that there are at least nine different groups. Each one is incredibly diverse and wide-ranging, comprising of different communities and ethnic groups – each with their own history, traditions and culture. Some Gypsies and Travellers are nomadic, others live on sites, but most – like me – are settled in houses or bungalows.
However, despite the subtle cultural differences, Gypsy and Traveller communities are united by the fact that they often struggle to access health and care services. According to a 2011 Census, only 70 percent of Gypsy or Irish Travellers said that they were in good health.
ACCESSIBILITY OF SERVICES
Accessibility of services is a huge problem for communities who travel. If a community bases itself in Kent for the summer months, for instance and then moves north for the winter, how does it access social care services? The care and support Travellers require does not move with them and I think portability of care would make a massive difference to those Gypsies and Travellers who choose to live a nomadic lifestyle.
But, if we are really serious about tackling some of the inequalities that Gypsy and Travelling communities face, then the care sector must show a greater willingness to understand our way of life, our customs and traditions that define who we are as a people.
The Care Quality Commission has made great strides in this respect. Over the last few years, it has recognised the importance and the need to address a lack of cultural understanding within care services. Take its 2016 paper entitled, ‘Gypsies and Travellers. A Different Ending: Addressing Inequalities in End of Life Care’, for instance. It states ‘a lack of cultural understanding’, an inability to understand cultural needs and ‘unequal access to services’ as the major challenges.
A LACK OF UNDERSTANDING
Over the years, I have seen the challenges highlighted play out in care homes a number of times. On one occasion, an elderly gentleman from the Traveller community came to the care home that I was managing. His wife was in hospital and there was nobody to look after him. Living in bucolic settings all of his life, he had never lived in a house. At night when the doors in the care home were locked, he was incredibly anxious and stressed. Unfortunately, staff found it hard to communicate with him and did not understand his fears. It was only after we spoke to his family and friends that we began to understand his life history. From there, we were able to devise a support plan that put his cultural needs first. During the day, we ensured that he could go outside and work on the care home garden. We also let him build a fire, albeit under controlled conditions. In the end, the man was supported with a package of care for him and his wife to go home. But I think simply taking the time to understand his needs meant that he stayed at the home and received much better support, than if care workers had not made the effort to explore his life history.
HOW CHANGE CAN BE AFFECTED ON THE FRONT LINES
I think that this example – and many others that I could mention – raise important questions. The big question is if the CQC is publishing advice and guidance on how to overcome cultural barriers, why does it not appear to be filtering down to the front lines?
There are no easy answers to this question, and in some respects the social care sector finds itself stuck in a vicious circle. Why? Well, a sizeable number of the Gypsy and Travelling community tend to only access social care services as a last resort.
Firstly, let’s explore some of the reason behind this. On the rare occasions that it happens, many Travellers in homes cannot understand why they can’t visit their loved ones as and when they choose. Moreover, many communities, which are exceptionally close-knit and matriarchal in their make-up, don’t understand why their loved one can only receive limited visitors, and why they can’t bring in home cooked own food into the home.
Culture, Relationships, Religion and spirituality also play a central role in the lives of many Travelling groups, and while worship is openly encouraged in care homes, it may seem strange to some that not everyone in the home places the same importance on religion as they do. Finally, as the CQC document points out, when a person in the Travelling community dies, our culture dictates that the body be released for burial quickly. Sadly, when a member of the Travelling community passes away in hospital or in a care home, this doesn’t always happen.
BREAKING A VICIOUS CIRCLE
And the vicious circle? With very few people from the Gypsy and Travelling community choosing to access care services, it is difficult for care staff to learn about the culture, to understand it and to create bespoke per- son-centred care plans. How can you do so when you have never met or cared for someone in the Travelling community? For many care professionals, the lives of Gypsies and Travellers remain an enigma. Their lives are esoteric and arcane.
One way of raising awareness is through funding. But with so few members of the Travelling community using care homes, those who hold the purse strings may take the view that it is not worth funnelling money into a body of research where there isn’t a perception of need.
But it is a fundamental mistake to think in this way. With the care and health sector likely to form a much closer union after Covid, we must invest more money, time and effort into awareness and educational programmes, which care workers and members of the Travelling community can access.
THE POWER OF CONTENT
At Quality Compliance Systems (QCS), the leading provider of content, guidance and standards, we believe that having access to a set of pre-assessment communication tools could make a big difference. There are lots of words, phrases and vocabulary, which are unique to the Travelling culture that care workers simply won’t understand. Being able to do so, however, would, in my opinion, make a huge difference to the travel- ling community and might raise levels of engagement. Secondly, the care sector needs to work harder to cre- ate activities and care plans, which are specifically designed to draw out cultural, spiritual, social, personal and life history.
Most of all, we must make it easier for Travelling communities to access person-centred primary, secondary and social care services on their terms. There are many examples of social care providers and GP practices who have succeeded in this respect. How have they done so? Well, it’s not rocket science. They have reached out to Travelling and Gypsy communities and established good relationships, which in turn have helped them to adapt services to the needs of specific groups.
Maybe it’s time more of us in the care sector followed suit.
Barry Price is a Specialist in Adults with Learning Disabilities and Complex Needs.
Quality Compliance Systems (QCS) is a leading provider of content, guidance and standards for the social care sector. If you wish to find out more about QCS, why not contact QCS’s compliance advisors on 0333-405-3333 or email sales@qcs.co.uk?
