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Cornwall: Listening to the needs of inclusion health groups

Cornwall Council’s public health team have been looking at the experience of inclusion health groups including Gypsy, Roma and Traveller communities and the sea fishing community. The aim is to better understand their health experiences and improve access to services and facilities.

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The challenge

Building trust and engagement with community groups is a critical first step in reducing health inequalities – and it takes time. Cornwall Council’s public health team have been working with NHS colleagues and other partners to better understand people’s experience of health and access to health services. The aim of this work is to understand the barriers and enablers to healthcare access and improve the health outcomes for these inclusion health groups

The fishing community

Fishing provides a significant economic contribution to the Cornish economy and its cultural life, but it’s a risky business. The job is physically demanding and brings health and safety risks. On top of that, fishing is among the industries with the poorest general health and limiting long-term illness outcomes. Research shows that fishermen are less likely to seek support for health concerns or to access services. 

Outreach work with the fishing community by Cornwall Council’s ‘Healthy Cornwall’ service is already well established, offering support including mental health, NHS health checks and help to stop smoking. 

This work began a decade ago with an offer of NHS Health Checks at the quayside in Newlyn, Cornwall’s largest fishing port, and has grown to provide more outreach support in more locations. Partnership work has been key – with organisations such as the Fishermen’s Mission, Seafarer’s Hospital Society and Fairwinds Cornwall. 

As part of the Innovation for Healthcare Inequalities Programme in Cornwall, funding was secured for in-depth qualitative research to further understand fishermen’s attitudes and behaviours to health issues, particularly cardiovascular disease, as well as barriers and enablers to healthcare access. The University of Exeter was commissioned to conduct this research. 

This resulted in a report, ‘Health and access to healthcare in Cornish fisheries’, published in 2023. A subsequent multiagency workshop brought stakeholders together to explore the findings and recommendations. An Integrated Care System (ICS) wide steering group is now to be set up to develop a strategic approach to improve the health inequalities experienced by fishermen in Cornwall and the Isles of Scilly. 

Gareth Walsh, Public Health Practitioner at Cornwall Council, said: “We are now looking at how the system can collectively support this group to access healthcare. Fishing is always going to trump every health appointment, so we need to look at how we bring healthcare to them – and their families too.” 

The Gypsy, Roma and Traveller community

Cornwall’s Gypsy, Roma and Traveller community is the county’s second-largest ethnic minority group, with around 1,800 members, according to the census. However, they experience the worst health outcomes of any community group in the county.

A successful bid as part of the Accelerator Programme, run by NHS England and the Institute for Healthcare Improvement, enabled Cornwall’s public health team to access resources to begin to address some of the health inequality challenges affecting this community. 

One priority was to improve early cancer diagnosis rates, focusing initially on cervical screening for women aged 25-64. This was a partnership between primary care, public health and local voluntary sector organisations. The work was done at one of three residential Gypsy and Traveller sites run by Cornwall Council. It enabled people eligible for cervical screening to attend an on-site information session run by a nurse and GP; the majority then received screening. 

A community survey was run for the site’s residents to explore issues relating to health service access and issues around health and cultural beliefs, education and barriers to healthcare. The results of the survey will help to shape future work, and these initiatives have paved the way for similar work to be conducted at other council-run sites. 

Cornwall Council is developing a five-year strategy for Gypsy, Roma and Traveller communities to ensure they have equal access to all services and facilities. Health and wellbeing will form a key part of this strategy along with homes, celebrating diversity and equality of opportunity. 

Eunan O’Neill, Public Health Consultant, said: “Through building trust and fostering community engagement, we hope that other health interventions will be developed to address the expressed and felt needs of this population.” 

Listening to communities

This work has reiterated how building trust is an essential first step in improving health and wellbeing outcomes. It can take time to get past the legacy of cynicism and mistrust felt by communities who may feel they have been let down by agencies in the past, with promises made that did not materialise. 

The process must involve listening to people and being honest about what can or can’t be done, Eunan O’Neill said. What the community feels they need may not tally with what the agency thinks they need. “For example, the Gypsy and Traveller community talked about dental health, so we have connected with the ICB (Integrated Care Board) to look at how we can respond to that. The opportunity will be lost if you don’t show that you’re listening.”

Change must be evidence-based, realistic and appropriate in order to be sustainable. “People often want to rush in and work with these community groups but it’s important to give it time. You have to iteratively follow out where you’re going and how you bring people on board. The ICB now recognise these are priority groups and we are going into conversations about how we make sure the systems work for them.” 

Contact

Gareth Walsh, Public Health Practitioner: [email protected] or Eunan O’Neill, Public Health Consultant: [email protected]