Ms Brigid Quirke:

Pavee Point is delighted to have the opportunity to be here and we welcome this focus on Traveller health inequalities. We have provided a comprehensive submission, which will serve as a reference document, and we are also available if the members of the committee require any further information. We will give a quick overview of the issues involved and leave time for discussion at the end, as we feel that is the best use of time. We would like to highlight the key issues in the area of Traveller health, including the poor health status of Travellers, the impact of broader social determinants, to which Ms Sherlock referred, the positive developments that have occurred and the need for investment in a strategic and co-ordinated response to address these Traveller health issues.

I will now contextualise Traveller health within the broader social determinants. There is a need to recognise the causal pathways, which include discrimination, education, employment and accommodation. If we are to realistically address Traveller health inequalities, we need a whole-of-Government approach in addressing these determinants. We commend the work of the committee to date in exploring these issues and recommend that other thematic sessions should include questions on their impact on Travellers' health.

Next year will mark a decade since the publication of the comprehensive all-Ireland Traveller health study. That took three and a half years to complete, cost taxpayers €1.3 million and involved a concerted effort between Traveller organisations, Traveller peer researchers from primary healthcare projects and researchers in UCD. The study yielded an unprecedented participation rate of 80%, an exceptional response. The evidence of the study, which we keep highlighting, showed that Travellers have the lowest life expectancy of any group in Ireland. Overall life expectancy for Travellers is 66, with Traveller men living some 15 years less and Traveller women some 11 years less than their counterparts.

In addition to those statistics on infant mortality and overall mortality, it is important to note that the study suggested that institutional discrimination does exist within the health services. Less than half of all Travellers had complete trust in health professionals compared with trust levels in the general population, according to a study. More than half of Travellers were concerned about the quality of care they receive when they engage with the service. Some 40% of Travellers reported discrimination in accessing health services. This was supported by almost 70% of the service providers, who agreed that their services discriminated against Travellers. Services providers were also interviewed in the study to determine what they felt were the issues.

We know from the study that Travellers are dying from the same causes as the general population. They are not dying of any exotic illnesses particular to Travellers, they are dying of heart disease, cancer, respiratory disease and suicide. They are, however, dying in far greater numbers across all ages. If this was any other group in Irish society, it would be seen as a national crisis.

However, as our colleagues have pointed out, the findings of the study have been largely ignored. When they were published in 2010, we were told no action could be taken as there were no resources available due to the recession. Despite the recovery, we still have no action and Traveller health continues to deteriorate. We believe it is not prioritised within the Department, or within Government, and we require leadership and urgent action.

It would be remiss not to acknowledge that some very positive developments have occurred in the past 20 years, in particular the development of a strong Traveller health infrastructure at national, regional and local level. I refer also to the establishment of the National Traveller Health Advisory Committee. That was a structure within the Department of Health that represented Travellers, the HSE and the Department. It was responsible for the development of Traveller health policy and it had oversight of the Traveller health budget. Its achievements include the publication of the Traveller health strategy in 2002, the piloting of the ethnic identifier, which has now been rolled out, and the groundbreaking All-Ireland Traveller Health Study.

We acknowledge that the committee heard last week that the National Traveller Health Advisory Committee was reviewed and that a recommendation was made to disband the group. However, that was not the case and, in its absence, there are no representative mechanisms to drive a response to the detailed findings. As we said, we have a lot of evidence and many strategies; we need an implementation plan.

We are awaiting the establishment of an essential structure to monitor Traveller health policy and mainstream Traveller health across the Department in line with the commitments in the national Traveller and Roma inclusion strategy, NTRIS.

At regional level, we have the Traveller health units, which are partnership structures between HSE and local Traveller groups coterminous with the original health boards, through which Traveller health issues are highlighted and mainstreamed into regional health service provision.

In addition to national and regional structures, the Primary Health Care for Travellers projects at local level, which have been acknowledged as the cornerstone on which health services are delivered effectively to Travellers, were clearly reflected in the All Ireland Traveller Health Study, with 83% of Travellers receiving health information from the primary healthcare projects. There is also a higher uptake of cervical screening and breast cancer screening in areas where the projects exist.

Unfortunately, this Traveller health infrastructure has weakened due to lack of investment in the past ten years, leading to the closure of a number of these essential projects.

There has been disproportionate disinvestment in Traveller health which pre-dated austerity. This was when the budget was transferred from the Department to the local health structure. This was identified in 2009 to the Joint Committee on Health and Children in which we highlighted that in 2007, €1 million was allocated for Traveller health developments, of which €100,000 was allocated towards the All Ireland Traveller Health Study, with the remainder put towards balancing the HSE budget.

Similarly, in 2008, a further €1 million was allocated to Traveller health developments. The HSE introduced a stipulation that one could only spend in 2008 what one spent in 2007, therefore, once again, €900,000 of the Traveller health budget went to balancing the HSE budget. Of a potential €2 million for Traveller health development funding, given Traveller health status, the All Ireland Traveller Health Study and the significant needs, €1.8 million was used to balance the HSE books. We believe this reflects a lack of prioritisation of Traveller health and a disregard for Traveller health inequalities. Traveller health has not received any new development funding from the Department of Health. There has been once-off funding and money given towards the employment of mental health workers locally.

We welcome the commitment in Action 73 of the NTRIS to develop a detailed action plan with clear targets, indicators, timeframes and resources. A robust consultation process produced the first draft of the action plan, which totally ignored some of the recommendations from the consultation process. While we would like to acknowledge the HSE's commitment to revise the plan, there is a need to ensure that the revised plan includes the establishment of a new institutional mechanism under the aegis of the Department of Health and the HSE to drive the implementation of the plan.

Our recommendations are the same as those of my colleagues from Mincéir Whiden. The need for ethnic equality monitoring is the last one. We need to roll out the ethnic identifier across all health and social care administrative systems. We require that to monitor access, participation and outcomes in terms of all services for Travellers. This will provide an evidence base to inform Traveller health policy and service utilisation in the future. It would also help to target and ensure more effectiveness and efficiency in the health service. It will also ensure that under section 42 of the Irish Human Rights and Equality Act 2014 there will be a statutory requirement on public health bodies which are mandated to take proactive steps to assess equality and eliminate discrimination.