Asylum Seekers & Refugees Health Care The Challenges in Establishing a level playing field for ALL children and Young People Asylum Seekers & Refugees Health Care Ann Forsyth Homelessness & Asylum Service Manager Ann.Forsyth@ggc.scot.nhs.uk 0141 553 2801 Glasgow City Health and Social Care Partnership Nov 2017

Aim Increase understanding of NHS Scotland response to meeting the needs of Asylum Seekers and Refugee’s. Provide and overview of how NHSGGC and Glasgow City HSCP have responded to meeting the challenges of meeting the needs of Children and Young People Seeking Asylum and those who are refugee’s . For you to reflect on current practice and experiences of responding or supporting Children and Young People Seeking Asylum and those who are refugee’s to access health care.

Context / Current Situation World Context – 2015 (UNHCR) 65.6m displaced (40.3m internally) 28,300 per day on average leaving their home (20 per min) Over half under 18 years of age 75,000 Unaccompanied or separated Children 85% Displaced in developing countries 55% from 3 countries – Syria, Afghanistan & South Sudan UK Mid 2016 (Home Office) 36,465 Asylum applications around one dependant for every five main applicants. 38% receive leave to remain 3,472 Unaccompanied Asylum Seeking Children (UASC) Home Office Schemes – Afghan, Gateway & Syrian Year Children 2013/14 131 2014/15 91 2015/16 36 2016/17 119 2017 /18 (April -Aug) 167 Top countries of origin Iran, Iraq, Sudan, Eritrea, Syria

Asylum Seekers & Refugees? Ordinary people in extraordinary circumstances who can be isolated and vulnerable group of people but are resilient, skilled and resourceful Our Challenge Recognising our response to the enormity of world event, suffering and impact of human behaviour on other human beings Providing safety as they escape persecution, physical and psychological trauma while remain in Asylum system Providing culturally sensitive health care across the whole system –to reduce impact of social exclusion, discrimination and ultimately poor health Challenging as group as hard to predict trends, routing and demographic Increased numbers in recent years, 4,000 people dispersal throughout city, positive decisions leading to increase in homelessness demand for AS&R

Rights & Entitlement of Refugee What rights does a refugee have? A refugee has the right to safe asylum and should receive the same rights and help as anybody else who is a legal resident. Refugees have basic human and civil rights including the freedom of thought, of movement and freedom from torture and degrading treatment. Economic and social rights apply to refugees as they would apply to any other individuals. Health service will meet needs regardless of decision until person leaves the UK. In Scotland all Asylum seekers & refugees regardless of stage in process have full rights and entitlement to NHS Health care regardless of status EVERY REFUGEE SHOULD HAVE ACCESS TO HEALTH CARE.

NHSGGC Aims Ensure everyone how uses or works for NHS treated fairly All services responsible for meeting needs of marginalised groups to tackle inequalities. To ensure NHSGGC meet needs of asylum seekers and refugees in the local community and work in away to remove discrimination or prejudice response of marginalised groups. Ensure marginalised groups are able to engage by: More accessible and user friendly, with staff aware of issues. Open & honest as are with all service users Staff should not make assumptions Health response needs to be tailored to the individuals needs. Some people will require specialist services while most need equitable access to mainstream.

NHSGGC Response Asylum Health Bridging Team – Initial Health Assessment and signposting Access to GP registration for all Children in IA and to adults on dispersal across the NHSGGC area which is co-ordinated from central point. Health Improvement activity targeted through joint initiatives. Development of information – interpreting, translated information. Capacity building within NHS services - training Inequality Sensitive Practice - inquiry

AHBT Service Model Team Structure = 10.5 wte 0.5 Team Leader To ensure all new arrivals seeking asylum have an initial health assessment in the Initial Accommodation (IA). To ensure appropriate follow up primary care with a GP Practice if required while staying in IA. To provide mental health, maternity and sexual health assessments when required and refer, as appropriate, to other services. To act as a bridging service to other mainstream services. To support and monitor GP engagement for those moving through IA into mainstream dispersed accommodation. To provide information and advice on understanding and accessing appropriate health services. Team Structure = 10.5 wte 0.5 Team Leader 2 Mental Health Nurse (CPN) 4 General Health Nurse 2 Support Workers 2 Admin support Health Visitor supports families work within the Team Visiting Services Midwife from maternity services Sexual Health

Health Issues & Challenges Growing demand and change in geographical spread Introduction into NHS – GP registration & Repeat message Consultation Times – new ways working i.e. interpreting Use Health care – distress, listening need for networks Understanding community – signposting to local support Peer education – Pilot embedded in integration Health behaviours - western

GOOD PRACTICE Understand rights and entitlements – services aware of needs and therefore can better meet needs. Explain the basics such as the appointment system, waiting lists, the complaints procedure and referrals to other agencies. Wherever possible use a trained interpreter. TRY NOT TO USE FAMILY AS INTEPRETERS. Respect and consider cultural issues between individuals. Ensure that wherever possible patients are seen by the professionals of the same gender. Strengthen networks with other Refugee support agencies and LA support providers. Identify vulnerable populations sub groups e.g. children, women Remember different cultures often have different attitudes towards health, illness and medical treatments. DON’T ASSUME THAT WHAT YOU DO IS BEST. ALWAYS ASK!

Thank you Ann.Forsyth@ggc.scot.nhs.uk