Transcript Kiran Kenth and Elizabeth Lawson-Bennett (NHS

Sensitising Professionals and Volunteers
Working in Health Services
to the Needs of Immigrants & Migrants
Kiran Kenth and Elizabeth Lawson-Bennett
NHS Birmingham
Migrants – A Local Picture for Birmingham
Migrants are a heterogeneous group:
•Asylum Seekers
•Refugees
•Refused Asylum Seekers
•Illegal Immigrants
•Entry Without Visa Clearance/Undocumented
UK Boarder Agency (2009) - 3,453 supported Asylum seekers from 58 countries placed in Birmingham.
•Iraq (468)
•Zimbabwe (439)
•Iran (356)
•China (280)
•Eritrea (229)
•Pakistani (209)
•Democratic Republic of Congo (204)
170 different languages are spoken
80,000 migrant workers based in Birmingham were issued with National Insurance Numbers (NINO’s) –
fall in the number of NINO registrations for the 8 EU accession states (38 – 24%)
Asylum Seekers supported by UKBA
Top 5 Nationalities Being Supported Under Section 95:
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Zimbabwe (741)
Pakistan (302)
Afghanistan (250)
China (241)
Iran (217)
Top 5 Nationalities Being Supported Under Section 4:
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Iran (501)
Zimbabwe (410)
China (440)
Iraq (646)
Somalia (239)
Asylum Seekers by Gender and Age of Main Applicant
500
450
400
350
300
250
200
150
100
50
0
Under 20
20 - 29
Male
30 - 39
40 - 49
50 - 59
Fem ale
60 - 69
70 or over
Health Policy Context
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Tacking Health Inequalities, Investing in Health 2
DRE programme and National Indicators
World Class Commissioning
NHS Rights and Entitlements
Access to NHS care for foreign nationals
Asylum Seeker Health Model
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Specialist primary care service - Asylum Seeker Health Team (950 registered patients)
Asylum Seeker Health Screen – UK Border Agency Hostel for Newly Arrived
Partial integration with mainstream primary health care
£500,000 per annum investment by one PCT (but accessed on a pan-Birmingham basis)
Main Areas of Consultation :
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Acute episodes of poor physical health and/or mental health
Sexual health issues
Maternity care
Chronic dependence on drugs, alcohol or other substances
Chronic disease management/Need for medication for long term conditions
Follow up immunisations
Letters related to health for other agencies
A Significant number of consultations require an interpreter
Key Issues
Access to Services
• Difficulties in accessing and registration with GP services, interpretation & language
services and maternity services
• Understanding of UK health system
• Professionals unequipped to signpost individuals correctly
Health
• Communicable Disease – TB and Immunisations
• Sexual Health – FGM, HIV and other STI’s
• Women's Health – late stages of pregnancy and maternity care
• Long Term Conditions – Diabetes, Hypertension
• Health promotion for new migrant communities – Drugs and Alcohol
• Mental Health
Wider Impact
• Language
• Destitution and impact on health
• Dispersal of asylum seekers
• Lack of awareness on entitlements to health care
• Irregular or undocumented migrants
The Proposed Solution
• Integrated Primary Care Services for newly arrived asylum seekers,
refugees and economic migrants
• Integrated Primary Care Services for those who have ‘No Recourse to
Public Funds’
• Enhanced patient experience
• Galvanisation of support available through all key stakeholders
• Best possible start for newly arrived asylum seekers
• Continued access to healthcare in the community on confirmation of
asylum status
• Utilising the skills and experience of existing staff and transferring this
in to specialist coordinated care in the community
Section 98 Asylum Seekers
Singles & Family Groups
Supported in Initial
Accommodation
Stone Road
Unaccompanied Minors
Section 95 Asylum Seekers
Supported in Dispersal
Accommodation in Birmingham
Section 95 Asylum
Seekers Supported by
Family & Friends
Section 4
Failed Asylum Seekers
Economic Migrants
Single Point of Contact
Migrant Health In Reach Team
(Currently ASHT Team)
Single Point of Contact
Migrant Health In Reach Team
(Currently ASHT Team)
Single Point of Contact
Migrant Health In Reach Team
(Currently ASHT Team)
Single Point of Contact
Migrant Health In Reach Team
(Currently ASHT Team)
12 Month Local Enhanced Service
for Migrant Community Health
3 Month Process from
Commencement of
Local Enhanced Service
Managed Transfer of
850+ Patients
Currently Registered
With ASHT to LES
('One Off' LES Payment for Each Patient)
Initial
Accommodation
Health Screen
‘One Off’ LES Payment for
New Registrants
Summerfield
Patients
Transferred to
General Primary
Care Following
Expiration of LES
Finch
Patients
Transferred to
General Primary
Care Following
Expiration of LES
Greet
Patients
Transferred to
General Primary
Care Following
Expiration of LES
Other Interested
GP Practices Who
Fulfil the LES
Criteria
Patients
Transferred to
General Primary
Care Following
Expiration of LES
Migrant
Community
Health Model
Lessons Learnt
1. Performance Management – robust framework needed to
demonstrate impact over time
2. Need – a successful service will have the ability to change and adapt
according to identified need
3. Shared Ownership – generated from shared investment of resources
4. Communications – a successful service will be supported by an
effective communications plan which targets patients, professionals
and the general public