“I can’t read your leaflets, and we move around a lot — don’t just talk at me, doc”

This is a HEALTH-INEQUALITIES / health-literacy consultation. Gypsy/Traveller communities experience among the WORST health outcomes and shortest life expectancy in the UK (EHRC Research report 12, 2009), driven by discrimination, mistrust of services, low literacy, poor continuity from a mobile lifestyle, and access barriers — so the FIRST task is to BUILD TRUST: acknowledge prior poor experiences, be respectful and explicitly non-judgemental, thank him for coming, and signal genuine partnership, because without trust nothing else lands. Do NOT rely on written information: with low literacy, leaflets and forms are useless or alienating, so communicate verbally in plain language, use visual aids and TEACH-BACK, avoid jargon, check understanding repeatedly, and offer an advocate if helpful (for an English speaker with low literacy, an interpreter is not the need) — "talking at" him or handing over leaflets is precisely the failure to avoid. Practise cultural HUMILITY: do not stereotype or assume his diet, beliefs or willingness; ask, listen, and tailor to his circumstances and priorities, respecting his autonomy and actively countering the sense of being judged that drives disengagement. Co-create a REALISTIC, FLEXIBLE plan for a mobile life — a portable record/summary of diagnosis and medication, clarity that he is entitled to care anywhere (NHS England patient registration standard operating principles: registration without proof of address, temporary residence for up to 3 months, immediately necessary treatment; walk-in/urgent services) and how to access it when moving, and prioritisation of the FEW highest-impact achievable actions rather than an overwhelming standard pathway he cannot follow. Manage the diabetes pragmatically (key medication adherence, concrete simple dietary change, smoking, BP, and essential complication screening — eyes, feet per NICE NG19, renal — against an individual HbA1c target per NICE NG28) with feasible monitoring and continuity workarounds, asking what he drives before any DVLA advice. The hidden agenda is wariness rooted in discrimination and the practical realities of literacy and mobility, with the wife’s worry the opening — earn trust this visit, make care accessible and flexible, prioritise ruthlessly, and leave him respected and willing to return, since a single good experience can transform engagement.