Item three: Nowhere to go
Resolution submitted by the RCN Adolescent Health Forum
That this meeting of RCN Congress ask RCN Council to lobby agencies to urgently review access to health and social care by groups regarded as being socially excluded, such as Travelling communities and homeless people
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Report on this debate
Marcelle De Sousa of the Adolescent Health Forum asked Congress to lobby agencies to urgently review the access to health and social care given to socially excluded groups such as travellers or the homeless, more accessible services are needed which are not based on targets.
"One size doesn't fit all", said Greg Usrey of the Health Visitors and Public Health Forum, he asked for integrated health services which offer marginalised groups the level of service they deserve.
Joy Winks of the School Nurses Forum highlighted that the needs of these groups are great and stated that both nurses and society must take responsibility for how they treat these people. Karen Sanders, Lewisham and North Southwark Branch, said that socially excluded groups are human beings like us and have the right to access health care irrespective of their needs or ability to pay.
The resolution was passed by a majority vote of 98.57%.
For: 98.57%
Against: 1.43%
Abstain: 7
Background
For many years it has been recognised that mainstream general practice and NHS community health services do not always meet the needs of marginalised groups, such as Travellers and homeless people. For example, GP registered patient listings can make it difficult to access services, while childhood vaccination programmes can be challenging to maintain for children living within a Travelling community.
The issue of health inequalities, resulting from socio-economic factors, is now high on the health agenda. Many of the policy initiatives to reduce health inequalities, expand primary and community health services, and improve public health that are currently underway in all four UK countries now incorporate a specific focus on the needs of vulnerable and marginalised groups.
In England, the Transforming community services programme is generating outcomes which have the potential to ensure primary care services meet the needs of all people, including those considered to have been marginalised from mainstream services in the past, while the Every child matters strategy aims to improve the health and wellbeing of all children.
In Scotland, the 2008 Equally well report of the ministerial taskforce on health inequalities sets out the Scottish Government's strategy for improving the health of the most poor and excluded citizens. The strategy includes a strong focus on children's early years and on improving the life chances of vulnerable children, such as those facing homelessness. While an implementation plan has now been published, there are no recent documents focused on the specific health needs of gypsies and travellers.
In its Improving the health of homeless and specific vulnerable groups standards 2008/09, the Welsh Assembly Government (WAG) confirms its belief that gypsy travellers are one of the most disenfranchised groups in society. The WAG is working to tackle these inequalities and ensure that the special health needs of gypsies and Travellers are met in a planned and strategic manner.
The Northern Ireland Executive has extensively documented health inequalities and deprivation within Traveller communities. Through the Investing in health programme, delivered through the health and social care trusts, it has established a range of activities to promote improved health and access to services for Travelling families.
For many years the RCN has undertaken substantial work in relation to health inequalities and the measures required to reduce these. In England, the RCN has challenged the Department of Health to ensure these issues are considered in relation to any health reform involving the reorganisation or restructure of primary and community health services.
In 2008, the Children and Young Peoples Group of the London Network for Nurses and Midwives, in conjunction with various stakeholders, held an event at RCN headquarters to investigate the ways in which Traveller and gypsy communities access health care. Community members reported they experienced poor primary care health services, and that they were treated with suspicion. It was also reported that a number of sites have poor housing without electricity, and are not fit for habitation. As a result, families suffer from a high incidence of asthma, eczema and chest infections.
References and further reading
Department of Health (2008) High quality care for all: NHS next stage review final report, London: Stationery Office.
Parry G et al. (2004) The health status of gypsies and travellers in England, Sheffield: University of Sheffield School of Health and Related Research.
DH The Child Health Promotion Programme. Pregnancy and the 1st 5 years of life. 2009.