Improving Roma health: a guide for health and care professionals
Supporting health and care professionals to improve services by better understanding the health outcomes that some people in the Roma community face.
Applies to England
Main messages
Roma communities experience social exclusion and barriers in access to health and care services. They have multiple overlapping risk factors for poor health and a life expectancy up to 10 years less that non-Roma communities in the UK.
Roma communities are identified for protection under the Equality Act 2010. Despite this, they often experience registration refusal, discrimination and digital exclusion. Other barriers relate to language and literacy needs and lack of cultural awareness and stigma.
As a health care professional you can improve Roma people’s health by:
- ensuring all possible efforts are made to effectively communicate with Roma patients to enable informed decisions about their health
- building trusting relationships, showing empathy, a non-judgemental attitude and a positive attitude to overcoming problems
- effectively facilitating access to health services
As a healthcare team leader you can collaborate with other local services to support people from Roma communities.
As a healthcare commissioner you can provide visible leadership and increased commissioning support to services for Roma communities.
1. Introduction
Who is this guidance for
This guidance is for people providing health and care services to people in the Roma community. This includes:
- frontline health and care professionals
- team leaders
- commissioners
It sets out good practice and practical actions that you can implement in your services to support the needs of the Roma community.
Related guidance
The guide was developed by the Roma Support Group along with partners in the Health and Wellbeing Alliance. Further information about Roma culture and the barriers Roma people face accessing healthcare in specific areas is available in a specialised version of the guide on the Roma Support Group website.
Roma people in the UK
The Roma people are a distinct ethnic group originating in India but have been living in Europe for many centuries. Arriving in the UK from other European countries, Roma communities are no longer nomadic and usually live in conventional housing. Some Roma groups have been in the UK for some time and will be more able to speak English and are more familiar with the UK healthcare system.
In 2013 there were an estimated 200,000 Roma in the UK. Gypsy, Roma and Traveller communities are among the most disadvantaged in the UK, particularly when accessing healthcare services.
Their first language will usually be Romanes, the Roma community language, which has many different dialects. Their second language will usually be either Polish, Slovak, Romanian or other languages spoken in their country of origin. For more information, see the language guide in the Resources section.
Religious affiliation will often be Catholic or Eastern Orthodox, although Pentecostal churches and Jehovah’s Witnesses also have many Roma members. There are also some Roma Muslims.
2. Barriers in accessing healthcare and its effects on Roma people’s health
Roma communities are considered to be an inclusion health group because they are socially excluded and have multiple overlapping risk factors for poor health. Roma life expectancy is reported to be up to 10 years lower compared to non-Roma communities in the UK.
Roma communities are identified for protection under the Equality Act 2010. Despite this, some people in the Roma community experience barriers in accessing health services, including:
- registration refusal
- discrimination
- digital exclusion
- language and literacy needs
- lack of cultural awareness and stigma
Roma people are usually grouped with Gypsy and Traveller communities in policy development and public service planning. Although some barriers to healthcare are similar to barriers these other communities experience, such as digital exclusion and access to GP registration, Roma people also share many difficulties with other migrant communities. This includes language barriers and unfamiliarity with the UK healthcare system. Roma people who have recently arrived in the UK may not be aware NHS healthcare is free at the point of access for most people. Everyone, regardless of immigration status, has the right to access free primary care from a GP, urgent care centres and walk-in centres. Lack of contact with health services can mean that many Roma people have little information about disease prevention. Poor housing or environmental conditions can contribute to physical health and mental health issues including stress, anxiety and depression.
Social, educational and cultural factors based on past experiences of stigma and discrimination, being denied access to public services will affect how Roma people engage with and access NHS healthcare. Distrust of health professionals, health-related taboos, misinformation about what happens in hospital or previous experience of being excluded from health services in countries of origin can lead to over-using emergency services or presenting at A&E with a serious condition that could have been treated earlier. Further details on barriers to healthcare access are provided in the specialised version of the guide on the Roma Support Group website. It is important that health and care professionals are aware of the full range of challenges that people from Roma communities may be facing in their daily lives. This includes the effects of poverty and social exclusion on health, both in the UK and their countries of origin.
3. Taking action to support people from Roma communities
Information and communication
If you are a frontline health and care professional you can improve Roma people’s health by communicating in a way that allows your patients to understand and make informed decisions about their health. You can do this by:
- using clear, jargon-free communication when asking Roma patients about their expectations of you
- clearly and explicitly stating your goals and intended outcomes for them
- offering access to a Roma or non-Roma interpreter matched to the patient’s sex and age to ensure they are fully able to communicate and understand, where possible
- ensuring your patients are aware of their entitlements to access primary care services, including GP registration (further information is available in the Resources section)
- following up referrals and appointments with reminders via text, social media channels (where appropriate), voice messages or a phone call
- providing clear visual information and instructions (for example on your website) on using public transport to get to your service
- providing other accessible formats, including via face to face outreach services, diagrams, videos, story-telling with role models in community languages, wordless picture stories or web accessibility tools such as text-to-speech software
Building trust
If you are a frontline health and care professional you can improve Roma people’s health by building trusting relationships, showing empathy, a non-judgmental attitude to the individual’s circumstances and a positive attitude to problem-solving. You can do this by:
- ensuring the same health professionals, interpreters and receptionists see the patient for repeat appointments, where possible
- supporting and engaging with individuals to access services if they miss appointments and avoid universally applying policies of not treating them
- providing consultations with health professionals of the same sex where possible, particularly for sex-specific health concerns
- being clear about your reasons for asking whether a patient is from the Roma community and how you will use that information (for example, you can explain that your aim is to improve services for the local community)
- asking the patient for their views on engaging with their family members where appropriate and possible. For example, a whole family approach could be adopted as part of the care of elderly patients
Increasing access to healthcare
If you are a frontline health and care professional, you can improve Roma people’s health by supporting patients to effectively access health services. You can do this by:
- considering booking longer appointments if patients have complex needs or language barriers
- offering telephone or face to face consultations as an alternative if patients have trouble accessing video appointments
- setting up drop-in sessions to see a GP at convenient times with no appointment necessary, where possible
- working with Roma community champions or culturally aware bilingual advocates, ideally employed as health mediators to support GP registrations and referrals
- advising EU citizens on charging for the use of some healthcare services if they have not yet applied to the EU Settlement Scheme and do not have alternative valid immigration permission
- Adapting services informed by the Roma Support Group’s report on lessons learned during the COVID-19 pandemic
4. Working with other services to support Roma people
If you are a healthcare team leader and outreach coordinator who works with Roma communities, you can improve Roma people’s health by collaborating with other local services to take action to support people from Roma communities. You can do this by:
- working with GPs, community groups, school nurses and other health professionals to provide basic public health information, health screening and support to access services
- bringing services (for example screening and vaccination) to where people are, through mobile health teams, ideally skilled in community languages
- holding question and answer (Q&A) sessions with Roma peer groups on specific health issues
- providing training for frontline workers and non-Roma interpreters translating from community languages (for example Polish, Romanian, Czech and Slovak) on cultural context and barriers to healthcare for the Roma community (for further information see the Resources section)
- training more interpreters from the Roma community where possible, linking with Roma voluntary, community and social enterprise (VCSE) organisations and services to support community members in developing their interpreting skills
- training health professionals on using software to dial in interpreters, such as Attend Anywhere
- designing patient experience questionnaires with input from Roma community members alongside other inclusion health groups to help improve the services you provide
- adapting public health messages to community concerns and services to changing needs. For example, during the coronavirus (COVID-19) pandemic, some public health outreach teams moved to socially distanced home visits and addressed concerns about vaccine hesitancy through conversations with community members
5. Commissioning services that include Roma people
By:
- including the Roma ethnic group category and Romanes language for the purposes of local monitoring for ethnicity and language, in line with the 2021 census
- ensuring commissioned local services and GP practices are more welcoming and inclusive by providing staff training and reviewing practice policies. For example, resources like the Doctors of the World’s Safe Surgeries initiative can help with this
- offering appropriate interpretation and translation services. NHS England has published guidance for commissioners on interpreting and translation service in primary care
- gathering basic intelligence about the local Roma population and its healthcare needs. For example, you can do this by speaking to community organisations, schools or GP receptionists
- conducting a needs assessment informed through engagement with the Gypsy, Roma and Traveller community and supporting organisations
- explicitly considering and referring to Roma health needs as part of developing health and wellbeing boards’ joint strategic needs assessments (JSNA), integrated care boards and integrated care partnership strategies ‘Five Year Forward Plan’ for integrated care systems (ICS)
- including specific measures for service providers to improve Roma health that they should address and report on as part of their bid to provide services
- building partnerships with local organisations to ensure any work to improve Roma health is informed by Roma people
- avoiding commissioning services or projects that are only digital, and making sure that services always offer alternatives to online appointment booking, including face to face appointments with GPs or secondary healthcare services
- developing further strategies to overcome digital exclusion and language barriers to accessing healthcare, such as working with community groups to understand support needs
6. Resources
For case studies showing real life examples of how healthcare can be improved for the Roma community, see the specialised version of the Roma health guide on Roma Support Group’s website.
Local organisations supporting the Roma community
You can find a list of local organisations supporting the Roma community on page 12 of the Roma Support Group’s EU Settlement Scheme toolkit.
You can find a services directory of local organisations supporting Gypsies, Roma and Travellers from Friends, Families & Travellers.
Health information and training
For information on social exclusion, see Council of Europe: Human rights of Roma and Travellers in Europe.
You can find a range of resources on Roma health from across Europe on the European Public Health Alliance website.
Roma Support Group has produced a video on coronavirus guidance for the Roma community in the UK (Romanian).
Roma Support Group offers training sessions for health and care professionals on cultural awareness.
GP registration
NHS England guidance on registering with a GP.
NHS England has produced a patient information leaflet on registering with a GP for Gypsy, Roma and Traveller communities.
GP practices can sign up to Doctors of the World’s Safe Surgeries initiative to ensure that lack of ID or proof of address, immigration status or language are not barriers to patient registration.
The charity Groundswell has produced ‘My right to healthcare’ cards to make it easier for people to register with their GP.
Healthcare for inclusion health groups
Inclusion Health: applying All Our Health provides guidance on preventing ill health and promoting wellbeing of people in inclusion health groups.
For guidance on improving engagement with inclusion health groups, see the inclusion health self-assessment tool for primary care networks.
The Faculty for Inclusion Health’s Homeless and Inclusion Health standards for commissioners and service providers includes principles for clinical standards in inclusion healthcare.
Language and translation services
NHS England guidance for commissioners on interpreting and translation services in primary care.
The University of Manchester has produced a Romani language resource, which includes learning materials and a dictionary.
Policy and entitlements
The Friends, Families and Travellers website has provided a section on policy, publications and information on issues affecting Gypsies and Travellers.
For EU citizens’ entitlements to healthcare, see the Migrant health guide.