Ms Maria Joyce:

We welcome the opportunity to speak to the committee on Traveller health, but we also have to recognise that it is the latest in a long line of spaces, policies or others in which Travellers and Traveller organisations, like the National Traveller Women's Forum, have engaged in attempting to bring about equal outcomes in terms of health for Travellers. This is not new information and it should definitely not be this difficult to have our community's issues heard and acted upon.

In our written submission we have raised many issues and put forward recommendations, but for today I just want to emphasise one issue, namely, that the current national health structures and very limited policy implementation that has taken place for the advancement of Traveller and Traveller women's health have failed to have any meaningful long-term impact overall. Achievements have been made locally and regionally by Travellers and Traveller organisations, including primary healthcare projects, but we should also recognise the contributions made by individual healthcare and HSE professionals. However, while the Department of Health continues to behave like an absentee landlord, ignoring the need for structural and institutional changes in the health service's thinking and practice, we will progress no further.

As our submission points out, the studies and research have been done, and the findings, as the committee has heard from Kathleen and Brigid, are stark and shocking, yet there has been no targeted strategy or action plan put in place to address the health inequalities for Travellers since Traveller Health: A National Strategy 2002-2005 and the national intercultural strategy over a five-year period, which ended in 2012. Health issues for Travellers have been excluded entirely from all mainstream health related strategies, including the current Healthy Ireland framework. I suggest that members google the document. There are two references to other strategies within it with regard to Travellers. The only direction that the Department of Health appears to want to go down is to pigeonhole all matters concerning Traveller health into social inclusion. This is not the answer, and again the question has to be asked how long more we have to wait for the Department of Health to meet its own policy commitments to Travellers. We need implementation.

Nine years after the launch of the all-Ireland Traveller health study in 2010, as Brigid has said, there is still no Department lead and there are no personnel with a brief on Traveller policy within the Department of Health. It has been more than two years since a commitment was made to develop and implement a detailed national Traveller action plan based on the findings of this study using a social determinant approach. Yet as has been said, Travellers continue to die from cancer, heart disease and other preventable conditions, including death by suicide, in greater numbers than the majority population. Of course we cannot demonstrate that with hard data because there is still no desegregated data collection across all of the health systems in Ireland, and I will say that that suits the Department in that regard.

Regional Traveller health units are under-resourced and their funding has not been ring-fenced for Traveller health. Despite underspends in some Traveller health budgets, the HSE in some regions made cuts to key services for Travellers under cost-saving measures, reducing the hours of Traveller community health workers and other supports. In one region the Traveller health unit has not met, despite efforts by Traveller groups in the area to make it happen. There also needs to be more accountability and transparency within the health system in relation to Traveller health budgets. In addition to this, the national Traveller health advisory committee, which was the driver behind the all-Ireland Traveller health study, has not been convened since 2012, despite repeated calls by Traveller organisations. Members will have heard Brigid say at a previous meeting that it was a recommendation that it would not continue to meet. That was misleading to this committee. That was not the case

In 2017, we saw the launch of the national Traveller health-Roma inclusion strategy, with a range of actions on health. We are still awaiting the long-promised national Traveller action plan from the Department of Health. Another commitment was also made by the Department to review and improve existing arrangements for engagement between Traveller organisations, the HSE and the Department of Health. In May 2018, the Department, the HSE and organisations participated in a workshop where our views and position were made very clear around a number of issues, including the effect of monitoring and implementation of Traveller policy, the need for institutional mechanisms representative of all stakeholders to drive the implementation, and dedicated resources - financial and personnel. These issues and other issues are being raised continually by all stakeholders with little response from the Department of Health. A draft of the national Traveller health action plan was circulated for feedback in March 2019.

The draft document was inadequate and demonstrated the lack of attention and commitment the Department of Health has given to addressing the health inequalities of Travellers. The repeated request is that the Department of Health urgently address the issues we have raised here today by finalising and, more importantly, implementing a holistic and gender responsive national Traveller health action plan which will deliver, hopefully, real change in health outcomes for Travellers. An independent implementation body must be established and much have ring-fenced budgets in order to drive delivery and implementation. There are more recommendations in our submission but I will not go through them now.

The issue is implementation. The studies, statistics and evidence are available. Travellers are dying in greater numbers and at earlier ages than is the case in the majority population. How much more of that evidence is required before there is action?