Kiran Kenth and Elizabeth Lawson-Bennett NHS Birmingham Sensitising Professionals and Volunteers Working in Health Services to the Needs of Immigrants & Migrants

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: Zimbabwe (741) Pakistan (302) Afghanistan (250) China (241) Iran (217) Top 5 Nationalities Being Supported Under Section 4: Iran (501) Zimbabwe (410) China (440) Iraq (646) Somalia (239)

Asylum Seekers by Gender and Age of Main Applicant

Health Policy Context 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 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 : oAcute episodes of poor physical health and/or mental health oSexual health issues oMaternity care oChronic dependence on drugs, alcohol or other substances oChronic disease management/Need for medication for long term conditions oFollow up immunisations oLetters 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

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