We thank the Chairman and members of the committee. We are delighted to have the opportunity to be here. We have provided a comprehensive and detailed background paper which we appreciate the committee will not have had time to read in advance but which will serve as a reference document should it need it in the future. We will give a quick overview of the issues involved and leave time for a discussion which will be the best use of the committee's and our time.
I will highlight three key issues regarding Traveller health, the poor health status of Travellers and the impact of living conditions on health status; the positive developments that have occurred in the past decade; the need to ringfence and protect the Traveller health budget.
On the first point, when the report of the task force on the Traveller community, the seminal policy document on Travellers, was published in 1995, it represented a State-led response to the widely acknowledged difficulties experienced by the Traveller community. In her preface, Senator Mary Kelly, chairperson of the task force at the time of publication, stated:
...there is universal agreement that the Traveller community in Ireland today should no longer be obliged to live in conditions which are reminiscent of refugee camps. What is proposed in the Report of the Task Force is an integrated package; without the provision of adequate accommodation, improvements in educational and health provision will be difficult to undertake.
The task force made two key recommendations on the overall health status of Travellers and placed environmental health in Traveller accommodation at the centre of this approach. It defined equity as a fundamental principle of Irish health policy and stated increased funding, commensurate with the scale of the issue, should be allocated to tackle the unacceptable health status of the Traveller community and the widespread obstacles to Traveller access to health services.
The second recommendation, ER2, was that the immediate improvement of the accommodation of Travellers is a prerequisite to the general improvement in their health status. Health boards should periodically inspect all halting sites to report on health and safety matters and those reports should be made public. The task force made two additional recommendations around the establishment of Traveller health units in each of the then health boards, ER4, and around the establishment of a Traveller health advisory committee in the Department of Health and Children to draw up a national health strategy for Travellers, ER3.
We are pleased to report that three of these four recommendations have been acted upon. We have succeeded in getting a dedicated Traveller health budget, the establishment of the national Traveller health advisory committee, NTHAC, in the Department of Health and Children and the development of the national Traveller health strategy, NTHS, published in 2002. Unfortunately, there has been little positive development on environmental health concerns including accommodation provision.
The population grid for Travellers is a pyramid shape, which is usually what one associates with a developing country. It indicates a very young population with very few older people. A population bell is normal in a western European country. According to the 2006 census the age profile of Travellers is in stark contrast to the national population. It is worrying to see that while the national population in Ireland is aging, the Traveller population is dying at very young age. The average age of Travellers was 18 years when among the national population it was 33 years. Some 41% of Travellers were aged under 14 years compared to a national figure of 20%. This differential has significant implications for the State when planning and developing targets, initiatives and services for younger Travellers, particularly regarding training, education, youth, health, accommodation and employment opportunities. The census showed that only 2.6% of Travellers were aged over 65, whereas the national figure was 11%, and only 25 Travellers in the country were aged over 85 years. We want to show that Travellers have very poor health status and that one's living conditions clearly have an impact on one's health status.
It would be remiss not to acknowledge the very many positive developments over the past decade in particular. Traveller health units were established at regional level, coterminous with the old health board structure. There are more than 40 primary health care projects, PHCPs, for Travellers throughout Ireland, where Travellers are being trained as primary health care workers. In the implementation of the all-Ireland health strategy more than 400 Traveller women collected the census for the forthcoming all-Ireland study. We have FETAC accreditation of PHCPs so they are clearly of a standard and there are outcomes from them. We have a dedicated Traveller health budget. The Royal College of Surgeons has a positive action initiative whereby two Travellers are being trained as doctors. A number of the regional technical colleges have introduced Travellers to the positive action measures where they can be trained as nurses and social workers.
The Our Geels, meaning "our community" in Cant, the Travellers' language, all-Ireland Traveller health study was launched in 2007 and the fieldwork commenced last autumn. That will provide baseline data and evidence on Traveller health status and, we hope, inform a new Traveller health strategy. Travellers have been included in the intercultural health strategy and an ethnic identifier is being rolled out in Traveller health. That is useful because one can see which services people are and are not accessing, and ask why.
While acknowledging these positive developments we also acknowledge the new health needs emerging among Travellers including a growing problem of drug misuse, mental health issues, the emerging needs of older Travellers and intergenerational issues such as a breakdown between generations. There is a growing incidence of suicide among the Traveller community. These emerging health issues need to be addressed.
We acknowledge the support and goodwill of a range of individuals in the Department of Health and Children and in the HSE. The health sector has engaged actively with Travellers and Traveller organisations over the past decade and this has led to increased demands and expectations of them. We highlight that as against the Department of Education and Science and some other Departments which have not actively engaged in partnership with Travellers and Traveller organisations. However, there are structural issues which can cause problems, not least of which were the introduction of the HSE and the impact of the reform process at both a national and a local level.
Traveller organisations are being increasingly distanced from decision making and there is increasing bureaucracy as well as the potential dismantling of proven structures to reflect new HSE geographic boundaries. That is causing problems at a stage where good partnership had just begun to work. There has been staff changeover in the HSE and loss of institutional knowledge. This has also impacted on Traveller health structures and budgets.
Finally, I want to highlight the negative impact on Traveller health budgets. We argue for the need to ring-fence and protect the Traveller health budget for which the members voted in the Finance Act. Money has been allocated to address the health needs of Travellers. We understand that over €13.2 million has been allocated in additional funding to Traveller health developments since 1998. That emanated from the task force on Travellers. Unfortunately, since the establishment of the HSE it has become increasingly difficult to account for the funding allocated to Traveller health developments because the HSE has responsibility for the budget and there is a lack of transparency around what is allocated and where.
We understand that in 2007, €1 million was allocated for Traveller health developments, of which €100,000 was allocated towards the all-Ireland Traveller health study and the remainder was put towards balancing the HSE budget. Similarly, in 2008 a further €1 million was allocated to Traveller health developments and the HSE introduced a stipulation that one could only spend in 2008 what was spent in 2007. Therefore, once again €900,000 of the Traveller health budget went to balancing the HSE budget. Out of a potential €2 million for Traveller health development funding, given Traveller health status, given the all-Ireland study and given the significant needs, €1.8 million was used to balance the HSE books. This is unacceptable, and in our view immoral, given the health status of the Traveller community.
This situation is also having a negative impact on the training and employment opportunities available to Travellers who, according to the 2006 census, have a 75% unemployment rate. In 2008 we finally succeeded, through working with FÁS, in getting FETAC accreditation for Traveller primary health care projects. However, because of budget cuts in the HSE there is no funding available to Traveller organisations to employ qualified primary health care workers. There are examples throughout the country where people have spent three years training in Drogheda, Tuam, Carlow, Kilkenny and Kerry, and FÁS now states that it will not fund further training in primary health care because there are no outcomes. The reason there are no outcomes is because the HSE has kept the money that should be used to employ Travellers. For us, it is a double whammy and to say the least, it is annoying.
Of equal concern is the loss of funding from the Traveller health base budget up to 2006. For example, in the Traveller health unit in the eastern region — the old ERHA region — the funding allocated between 1998 and 2006 was €3.125 million — we have given a detailed breakdown in the comprehensive briefing document. Of the €2 million which we think was allocated since that time, the eastern region could have expected, given population numbers, to have received a further €500,000. Therefore, in theory, there is a budget in excess of €3.6 million available to Traveller health developments in the eastern region alone. However, in 2009 the eastern region has been allocated a provisional budget of €1.7 million and in a recent letter from the HSE we have been told there will be a further cut of 2%.
In effect, this means that less than 44% of the budget that the HSE has been allocated for Traveller health developments in the eastern region is going into Traveller health. The HSE has kept in excess of €2 million in the eastern region alone to balance its books. This is unacceptable, particularly given the health status and needs of the Traveller community. The HSE has to be held accountable and the funding should be released to address the urgent health needs of the Traveller community. This is particularly the case given that findings and recommendations for implementation emerge from the all-Ireland Traveller health study, that funding should be available to implement the policy.
In this short presentation, I highlight those three issues. There are many more but there is enough food for discussion in that. I thank the committee.