Narrowing the Gap Improving health pathways for asylum

Narrowing the Gap: Improving health pathways for asylum seekers in Initial Accommodation Dave Newall Senor Policy Officer WMSMP

Overview • • Rationale for project The function of Initial Accommodation Scoping PCTs experience of dispersal Identification of vulnerable individuals Improved referral and notification of dispersal IA health screening at Stone Road Actions and existing challenges

Context • Initial accommodation – 7 units in UK • Individuals who require accommodation whilst claiming asylum are routed to 1 unit. • Asylum process, support claim and health screening occur whilst in unit • Individuals then dispersal into section 95 accommodation after 21 -28 days. • Stone Road- Birmingham, is this regions Initial accommodation. • UKBA region includes, East of England, East Midlands and West Midlands.

Findings • Lack of contact from providers and UKBA on dispersals in many areas. • Individuals in poor health being dispersed no notification or follow up. • Statement of requirements for accommodation providers does not recognise approach every PCT takes to asylum seeker health. • Little follow up on dispersal information from PCTs • Two routes into IA – in region and routing from Croydon

Health screening in Stone Road • Heart of Birmingham PCT team in Stone Road • 220 bed spaces in Unit • Mix of section 98 and section 4 clients at present • Registered Nurse, Administrative Assistant, Health Visitor/team Coordinator & Part time GP

Screening process • Referral for 40 min interview by Refugee Council • Interpreter booked at same time by Admin staff. • Referral to other services, e. g. GP, Midwife, CPN by admin staff. • Nurse has daily emergency appointments. • GP sessions twice a week

Screening Appointment - based on Blue Book Basic demographic questions Health history Symptom screening for TB Baseline measurements BP, Weight, Height, Urine Test • Obstetric history • Brief enquiry on mood and sleeping • •

Sexual Health screening • • • History of rape Symptoms at present History of unsafe sex History of FGM Country of origin ( GUM clinic provide a specific clinic a the unit during the week)

Other services available • Referral to local midwife within walking distance, with support workers and interpreters • Referral to aligned specialist GP practice (Asylum Seekers Health Team) for Asylum Seekers for medical treatment and referral to secondary medical care. • Referral to CPN within specialist GP practice. • Health visitor in IA health team sees all children in unit.

Specialist Asylum Seekers Health Team (ASHT) at HOBt. PCT • • GP Link workers male and female CPN Practice Nurse Practice manager and administrative team Health visitor Sexual health worker

Remit of ASHT • To act as a specialist health services for all asylum seekers within Birmingham • Signposting to other GP practices more local to asylum seekers home • Signposting to other support agencies for asylum seekers • Support the services at Stone Road • PCT accepts it’s duty of care to the destitute and those on appeal who have been denied services elsewhere

Dispersal notification • IA health team should now be notified of all arrivals and planned dispersals from Stone Road • Enables the identification of vulnerable clients prior to dispersal • Vulnerability - Late stage pregnancy/ complications, HIV, TB & Infectious Diseases, Serious Mental Health issues, Chronic disease- e. g. Kidney Disease & Children under 12 months

PCT to PCT information • Vulnerable individuals referral form developed as part of project • Pre- dispersal notification allows for individual to be identified. • IA health team identify dispersal address and PCT • Fax vulnerable individual referral to PCT, offering PCT opportunity to contact IA health team • In West Midlands PCTs are informed of all dispersals out of Stone Road.

Issues so far • 37 weeks pregnant and hepatitis B positive • Mother and new born baby • Investigations into TB, night sweats, had chest x-ray and requires Mantoux test and follow up • Elderly and on medication, can walk only short distances • Post Traumatic Stress, depression and immediate gynaecological problems

Picture so far • 45 vulnerable individuals identified so far and referred. • East Midlands: Derby 1, Leicester 3 & Nottingham 1 • Lack of operational contact in Derby • Leicester - Assist practice response to referrals

Next steps • PCT and Provider meeting in West Midlands Sept 09 • Providers informing PCTs of asylum seeker numbers in several PCTs • 3 month review of process – What is experience of East Midlands PCTs ? • Some last minute changes to dispersal addresses, cases being examined by UKBA • Work to resolve section 4 issues with UKBA • PCTS reconsidering current provision for asylum seekers • Questions ? ?