1. Vulnerable migrants: different journeys
Seeking asylum
Fleeing domestic violence in the UK .
Managed migration programmes

2. asylum: Definitions Asylum seeker Refugee
Sought on the basis of a well-founded fear of persecution because of
race
religion
political opinion
nationality
membership of a particular social group
Is outside their country of nationality or residence (if no nationality)
Is unable, or owing to such fear, unwilling to return to that country
Geneva Convention 1951
Refugee
Has been granted right to remain in the country in which they have sought asylum
Or granted right to remain under a managed migration scheme.
November 2015
Asylum Seeker Health

3. Gateway protection programme
UNHCR settles 80,000 each year worldwide
750 per year in UK.
Stateless and intractable refugee situations.
Partnership approach for 1 year intensive support and orientation.

4. Vulnerable persons relocation scheme
Special scheme for Syrian resettlement
2015: New political climate, 20,000 announced over 5 years.
5 years humanitarian protection status. Right to work, public funds, family re-union.

5. Common health problems
Skin infections (fungal infections, scabies)
HIV, STIs and sexual health problems
Neglected chronic diseases
Tuberculosis
Post head injury and other chronic pain syndromes
Complex post traumatic stress disorder
Physical manifestations of psychological distress

6. Challenges and opportunities: what we have found
New patient checks: A powerful opportunity for screening (HIV, Hep B and C, STIs, FGM, cervical cytology) but a matter of delicate timing.
Partnership working and signposting. Get to know therapists, refugee advice and advocacy organisations, faith groups, emergency housing
Taking every opportunity to keep in contact with patients (up to date details and support workers)
Focusing on what you can do, not what you cant.
Innovative ways to engage patients in getting feedback on services. Challenging but worthwhile.
Imaginative approaches to multidisciplinary teams: Building relevant, supportive MDTs

7. Working with vulnerable migrants; what are your hot topics?
Making sense of the asylum system?
Challenges of interpreted consultations?
Changes to migrants’ entitlement to health care?
New rules on reporting and referral of FGM?
Managing unrealistic expectations of healthcare?
Health impacts of current government policy; how should we respond?
Refugees and immigration in the media; influencing the narrative?
Models: Specialist “safety net” practices?
Challenging consultations with vulnerable groups?
How to improve attendance rates (especially in secondary care)?
Dealing with the emotional impact on ourselves?

8. Asylum process Initial application and screening interview
Dispersal. Support (case worker, benefits, accommodation)
Asylum interview
Positive decision
5Y leave to remain
5Y humanitarian protection
Discretionary leave
Negative decision
Appeal
Section 4 support:
Trying to leave
Unfit to travel
Judicial review
Human rights act
Loss of all benefits, housing and can detained or deported
Detention (fast track)

9. Current Healthcare Entitlements of Refugees and People Seeking Asylum
Asylum seekers
Refused Asylum seekers
Primary healthcare
Free
Secondary healthcare
Charged
Emergency healthcare
Maternity care

10. Proposed Healthcare Entitlements of Refugees and People Seeking Asylum
Asylum seekers
Refused Asylum seekers
Primary healthcare
Free
Charged (partially)
Secondary healthcare
Charged
Emergency healthcare
Maternity care

11. Immigration Act 2014 Measures Tougher criteria for access to free care
Introduction of an up-front ‘Migrant Health Levy’ (visa surcharge for non-EEA visitors and students).
More proactive identification of chargeable patients, more aggressive cost recovery by hospitals
Extending charges to primary care and A&E care!
Widely held concerns
New barriers to care for the most vulnerable.
Will lead to delayed presentation with problems deteriorating into health crises
Worrying public health implications from under treated infectious diseases
A heavy burden of new bureaucracy for GPs and A&E.
Restrictions on access will be wider than intended due to patient fears, health professionals’ confusion and lack of documentation amongst the most vulnerable.