Table of contents
- Other pages in this release
- Main points
- Managing health and seeking healthcare
- Barriers to accessing healthcare
- Trust in health services
- Experiences of relationships with healthcare workers
- Towards solutions
- Gypsies and Travellers in England and Wales, data
- Cite this statistical bulletin
1. Other pages in this release
- Gypsies’ and Travellers’ lived experiences, overview, England and Wales: 2022
- Gypsies’ and Travellers’ lived experiences, culture and identities, England and Wales: 2022
- Gypsies’ and Travellers’ lived experiences, homes, England and Wales: 2022
- Gypsies’ and Travellers’ lived experiences, education and employment, England and Wales: 2022
- Gypsies’ and Travellers’ lived experience, justice, England and Wales: 2022
- Gypsies’ and Travellers’ lived experiences, methodology, England and Wales: 2022
2. Main points
Participants described experiencing a range of health conditions, which, coupled with delayed healthcare seeking and perceived barriers to accessing healthcare, could create vulnerability to negative health outcomes among Gypsies and Travellers.
Participants described environmental factors, such as site locations and living conditions as well as occupational hazards that they felt were linked to the health conditions they experienced.
Challenges were described in registering with a GP surgery without a fixed address, particularly among those living in Gypsy and Traveller sites or roadside.
Delayed access to healthcare could result in delayed diagnoses and treatment, and could undermine access to screening and preventative care, with potential negative health consequences.
Experiences of perceived discrimination and derogatory attitudes of healthcare providers could further undermine access to healthcare, as participants had concerns about the likelihood of receiving help and feared facing negative judgement or discrimination.
Familiarity, understanding and open communication with trusted health practitioners appeared to support access to and engagement with healthcare.
3. Managing health and seeking healthcare
Participants from Gypsy and Traveller communities described experiencing a range of health difficulties, including chronic obstructive pulmonary disease (COPD), asthma, diabetes, bladder problems, “the c-word” (cancer), and mental health difficulties. They believed many health conditions were caused by environmental factors, such as sites located in polluted areas with poor standards. Some also described experiencing work-related injuries or conditions.
Views on the potential public health implications of poor site conditions, for example overcrowding, lack of available water and infectious disease outbreaks, were reinforced by local or central government participants.
Although participants described mental health challenges affecting Gypsies and Travellers, they suggested this topic is not widely spoken about within communities. Difficulties accessing mental healthcare were also mentioned. These partly linked to apprehension about seeking help and feeling misunderstood or treated unsympathetically by healthcare workers because of their ethnicity, and partly linked to difficulties asking for help at all.
Some participants described approaches to self-management of health symptoms through the use of home remedies. Although participants also described using the healthcare system, home remedies were said to have been used intergenerationally, particularly for managing minor ailments.
Some described a belief that speaking about ill health or seeking healthcare could worsen health conditions, with participants largely speaking about accessing healthcare only when very unwell. Delayed health seeking was particularly described among men.
Additionally, women described requiring female health practitioners for certain health needs that, if unavailable, could further undermine seeking healthcare.
Delayed presentation to healthcare services among Gypsies and Travellers was also recognised by local authority participants, who highlighted the importance of preventative approaches to healthcare as beneficial both in human terms and financial savings.
Health seeking experiences were not universal. Some participants described seeking healthcare earlier, accessing preventative care including cancer screening and antenatal care. Where reported, family encouragement to access healthcare, particularly from the younger generation, appeared to support engagement. Health seeking was also linked to access (see Section 4: Barriers to accessing healthcare).Back to table of contents
4. Barriers to accessing healthcare
Participants described barriers to accessing health services, particularly primary care services. This could undermine access to routine immunisations and preventative care, and result in delayed diagnoses and treatment, including regular or repeat treatment. Almost all community member participants described difficulties accessing a GP surgery without a fixed address, as part of their own experience or that of others around them. This appeared particularly challenging for those living roadside or on Gypsy and Traveller sites.
Participants who worked for civil society organisations (CSO) described the option to register with a GP using the surgery’s postcode. However, this did not appear to be widely known or to always enable GP access.
Where participants did describe managing to access a GP with a site address, this seemed to be possible through the support of individual local authority staff or CSO support workers. However, additional challenges could be faced with navigating burdensome systems to retain access, including not being able to receive postal communications to site addresses, which could be required to remain registered and to receive health information.
The perceived need for support from council staff to be able to access a GP surgery was also reinforced by local authority participants.
Some participants described feeling the need to move into settled accommodation to be able to access health services, for example moving into bricks and mortar, even if this went against individuals’ broader preferences and cultural values (see Gypsies’ and Travellers’ lived experiences, homes, England and Wales: 2022 bulletin).
Participants mentioned facing literacy barriers to engaging with health services and the increasing use of computer systems to access appointments as challenging for some.
As a result of the challenges people described with accessing a GP surgery, many spoke about relying on accident and emergency services and walk-in clinics to access medical care, sometimes waiting several hours to be seen, or travelling long distances to access a trusted GP.
People also spoke about experiencing barriers to emergency services and health visitors coming to sites, with several people describing delayed access to emergency services or experiences where ambulances would only visit sites with police escorts.
Described experiences with difficulties accessing GP surgeries and health visitors could also undermine access to preventative care and routine immunisations.Back to table of contents
5. Trust in health services
Police presence when accessing emergency health services could be particularly challenging given the wider context of difficult relationships with the police (see Gypsies’ and Travellers’ lived experiences, justice, England and Wales: 2022 bulletin). Fear of police presence appeared to undermine trust, feelings of safety and engagement with health services.
Participants also described concerns around the potential for negative social judgements and the involvement of social services when accessing healthcare, with fears of children being taken into care as a result.Back to table of contents
6. Experiences of relationships with healthcare workers
Participants described experiencing some positive relationships with healthcare workers, which appeared to make a difference in supporting their access and engagement with health services. However, participants also described having experienced perceived discrimination and derogatory attitudes from healthcare providers, as well as anticipating discrimination based on others’ experiences. Fear of discrimination and doubts about whether help would be offered from healthcare providers appeared to undermine access to healthcare.
Challenges with accessing health services because of perceived derogatory attitudes were described relating to interactions with a range of health practitioners, and particularly mentioned in relation to GP surgery reception staff, who were perceived as gatekeepers to GP access.
One participant described not feeling able to see a doctor because of not being registered, having tried and been told “oh, you don’t belong here, get out” (male, aged 80 to 90 years, bricks and mortar).
The view that reception staff can present barriers to accessing GP surgeries was reiterated by local authority participants.
Perceptions of differential treatment because of ethnicity were described, as well as communication barriers including misunderstanding and use of different terminology between health practitioners and community members. These were linked to delayed diagnosis.
Again, this was not universal, and some participants described experiences engaging with health services where they did not feel they were treated differently based on being a Gypsy or Traveller.
Participants highlighted the difference good relationships with health practitioners made for their engagement with health services and the quality of care received. A good relationship included feeling listened to, understood, and respected by health practitioners.
Participants appreciated communication approaches that were receptive and accessible, including health practitioners offering clear explanations and listening to concerns. Relationships could be supported through familiarity over time, and some described travelling long distances for a trusted health practitioner.
Some felt that the quality of relationships with health practitioners had deteriorated over time, with less regular contact with a health practitioner undermining familiarity and trust-building.Back to table of contents
7. Towards solutions
Participants suggested possible solutions that could improve described difficulties with access to health services, such as accessible formats for delivering health information and appointment reminders, mobile outreach clinics visiting sites and people with lived experience linking community members to health services.
Additionally, having more flexible health services that allow access without a fixed address, GP access cards that can be handed to receptionists to facilitate registration, and support for navigating literacy barriers were said to support access to healthcare.
Participants felt it important that health practitioners develop a better understanding of Gypsy and Traveller culture, ways of life and communication needs, with greater awareness and empathy seen as supporting engagement, trust and relationship building.
The need for training of healthcare providers, and particularly of reception staff, was raised as an important route to improve awareness of Gypsy and Traveller culture. Accountability mechanisms to then ensure appropriate communication approaches were being followed by healthcare providers were seen as a potential mechanism to address any discriminatory practices.
For more information on cultural practices, please see Gypsies’ and Travellers’ lived experiences, culture and identities, England and Wales: 2022 bulletin.
Central and local government participants also highlighted the need for more robust and timely data about Gypsy and Traveller communities to understand and plan more effectively to meet their healthcare needs.Back to table of contents
8. Gypsies and Travellers in England and Wales, data
Please note, as this is a qualitative study based on data collected from interviews and focus groups, there is no accompanying dataset.Back to table of contents
Bricks and mortar
This term is used commonly by Gypsies and Travellers when talking about homes which are permanent structures, such as houses or flats.
In this bulletin, “community members” and “participants” refers to people currently living in England and Wales, aged 16 years and over, identifying as Gypsy or Traveller, who took part in this research. Where quotes have been used from local or central government participants, this is explicitly stated. We aim to portray the views of participants and to reflect their words as closely as possible. Some quotes have been edited for language and grammar to improve accessibility, without changing the content or meaning.
Living at the roadside means staying temporarily on public land, such as in a car park or on a verge next to a road.
Gypsy and Traveller sites are authorised places of residence which may be owned and managed by the council or privately.Back to table of contents
More information about the background and rationale, approach to sampling and recruitment, strengths and limitations, design of the material and approach to analysis can be found in our accompanying methodology.Back to table of contents
11. Cite this statistical bulletin
Office for National Statistics (ONS), released 7 December 2022, ONS website, statistical bulletin, Gypsies’ and Travellers’ lived experiences, health in England and Wales: 2022
Contact details for this Statistical bulletin
Telephone: +44 1633 455674