Dr. Mary Favier:

On behalf of the ICGP, I thank the committee for its invitation to discuss key health issues affecting the Traveller community. The ICGP is tasked with providing education and training to the general practitioners, GPs, of the country. We are a membership organisation that sets quality and standards. Approximately 85% of GPs are members of the ICGP.

As has been well elaborated on at this meeting, a recent study has found that the Traveller community is affected by several significant social determinants. As the ICGP, we want to concentrate on those that most impact on general health. The life expectancy statistics show stark inequalities in health among the Traveller population compared to the general population. Studies in maternal health, communicable diseases, addiction and mental health, including suicide, serve as clear indicators of the extent of this health inequity.

The high levels of mortality and morbidity among Travellers are well documented. The life expectancy figures are most stark. A male Traveller can expect to die 15 years sooner than a male in the general population, with a female Traveller 11.5 years earlier than her counterpart in the general population. The infant mortality rate is 3.6 times higher for Traveller children than in the general population. While there have been improvements among Traveller mothers attending antenatal services and having shared antenatal care between maternity hospitals and GPs, more than 2% of Traveller mothers still receive no antenatal care.

It is encouraging to know that many Travellers engage with primary healthcare services in particular, as evidenced by the 2010 All Ireland Traveller Health Study. The study found that up to 91% of Travellers obtained their health information from GPs. Travellers' own health beliefs may impact on access to health services, however. For example, GPs treat appointments as the start of a process in treating their patients whereas Travellers may view the consultation as a single issue that should be dealt with in one visit. These are matters of which we need to be aware. In some cases, if symptoms do not improve, it can lead to a visit to a hospital emergency department rather than a return to the GP.

Health initiatives for the Traveller community must be informed by the principles of equality, human rights, social inclusion and respect for Traveller values, beliefs, culture and perceptions. As with the general population, Travellers should have improved access to, participation rates in and outcomes from healthcare services.

The very high prevalence of suicide among Travellers is of particular concern. Measures that would help include on-site sessional counselling and general practice, culturally appropriate awareness campaigns and outreach services signposted to primary care.

Targeted health initiatives and associated information materials for Travellers and healthcare providers should be culturally appropriate. Any identified interventions should be designed to improve self-esteem among Travellers, reduce stigma and remove barriers to care. Regardless of the health policy initiatives instigated for Travellers, the views of Travellers must be included when designing such interventions. Traveller participation and co-operation in previous studies, research and information design have been key to their success.

While Travellers experience issues with access to GPs, the same is true for large sections of the population. Clearly, access to GP services needs to be improved and some basic improvements could make large differences. Practices that offer a combination of booked appointments and some same-day appointments would improve Travellers' access to GP services. Cultural awareness training is appropriate for all practice staff and should be developed with input from the Traveller community.

The process of obtaining and retaining a medical card needs to be streamlined and simplified. The health outcome differences between Travellers and the general population are avoidable and with appropriate resourcing and planning, these issues can, and should be, addressed urgently. The Irish College of General Practitioners looks forward to playing a significant role in this area.

We are happy to take questions.