How an innovative statutory and voluntary sector partnership met the need for refugee health assessments in the context of the Irish Refugee Protection Programme Dr. Bridget Kiely & Diane Nurse

Health Service Executive (HSE) overview Safetynet & HSE | Statutory and voluntary sector partnership Health Service Executive (HSE) overview Responsible for the provision of health and personal social services for everyone living in Ireland, with public funds. Approximately 100,000 employees Divisions include Acute Hospitals, Health and Wellbeing, Mental Health, Social Care, Primary Care, Mental Health, Community, Strategy and Planning, Clinical Programmes, Quality Improvement etc. Provides services either directly or through funded agencies via service level agreements

Social Inclusion… Primary Care €133.3mil - 0.96% of health budget Safetynet & HSE | Statutory and voluntary sector partnership Social Inclusion… Addiction, Homelessness Intercultural Health Traveller/Roma LGBT/DSGBV Primary Care Equality of access, participation & outcomes Hep C, Prison health, HIV/AIDS, Survivors of abuse, Trafficking, etc 650 employees - 0.62% of HSE Service delivered via SLA under Section 39 (@70:30) Enhance access of vulnerable groups to health services €133.3mil - 0.96% of health budget The Health Service Executive employs 100,000 people making it Ireland's biggest employer. The HSE employs more than 65,000 staff in direct employment and a further 35,000 are employed by voluntary hospitals and bodies funded by the HSE. The budget of almost €12 billion is the largest of any public sector organisation. The majority of employees are frontline staff providing patient care.

Irish Refugee Protection Programme Safetynet & HSE | Statutory and voluntary sector partnership Irish Refugee Protection Programme Established by Government Decision on 10 September 2015 as a direct response to the humanitarian crisis Pledged to accept a total of 4,000 persons EU relocation – 2,622 asylum seekers via the EU Relocation Programme Refugee Resettlement – 1,040 programme refugees under the resettlement programme currently focused on resettling UNHCR refugees from Lebanon Other Mechanisms – The balance through a variety of different mechanisms including the acceptance of unaccompanied minors and family reunification 65% EU Relocation 9% Balance 26% Programme Significant influx

Health Assessments for newly arrived migrants in Ireland pre IRPP Safetynet & HSE | Statutory and voluntary sector partnership Health Assessments for newly arrived migrants in Ireland pre IRPP Mechanism in place to offer all new arrivals a health assessment and screening for infectious diseases in accordance with national guidance Depended on a single centrally located service with limited capacity Local resources had been cut during downturn Became clear there was not capacity to manage the large numbers arriving under IRPP to remote locations

Safetynet Overview Annual Report 2017 Safetynet & HSE | Statutory and voluntary sector partnership Safetynet Overview Annual Report 2017 Safetynet Primary Care is a medical charity that delivers quality care to those marginalised in society without access to healthcare, including homeless people, drug users and migrants. Vision Everyone has access to healthcare regardless of means, circumstances, race or creed. Mission To enable access to appropriate acceptable quality healthcare to those marginalised in society. Approach Think outside the box to implement services that adapt to the patient rather than expecting the patient to fit with the system. 4 arms- homeless- inreach and outreach homeless services- clinics in homeless hostels and a bus at night for rough sleepers, open access clinics for Roma, Limerick, Cathedral, network of services dealing with homeless and vulnerable groups- shared IT system, networking events and the Mobile Health and Screening Unit

The Mobile Health & Screening Unit Safetynet & HSE | Statutory and voluntary sector partnership The Mobile Health & Screening Unit Safetynet’s Mobile Health and Screening Unit (MHSU) is a new service provided by Safetynet Primary Care in partnership with HSE Social Inclusion. The MHSU provides the following services when there is an identified need among a vulnerable group not accessing health care services: Health screening and medical assessments for relocated refugees. Communicable disease screening including TB, Blood Borne Viruses, STIs for groups at risk. Clinical assessments and prioritisation as part of healthcare needs analyses for response and service planning The Mobile Health and Screen Unit (MHSU) is a health team (GP, Nurses, Project Manager and Driver) working from a mobile clinic equipped with an X-ray and consultation room. Started in March 2017, responded to a call from Social Inclusion Our approach is to work with local services and service managers to meet gaps, and facilitate integration into routine primary care services

Work of the Mobile Health & Screening Unit Safetynet & HSE | Statutory and voluntary sector partnership Work of the Mobile Health & Screening Unit Conducted comprehensive health assessments for all arrivals under the IRPP since March 17 The first Irish mobile X Ray Unit operationalised One stop Infectious Disease Screening for homeless and vulnerable groups in Galway and Limerick Offered screening to new arrivals under family reunification Supported the integration of internally relocated asylum seekers into local health services and provided the HSE with data to inform additional health care services required

Work of the Mobile & Screening Health Unit Safetynet & HSE | Statutory and voluntary sector partnership Work of the Mobile & Screening Health Unit Data/Numbers Health assessments for 647 Syrian arriving under IRPP completed Of the Syrian refugees assessed All had comprehensive health assessments within 10 days of arrival and were integrated into the local health system with local GP providing ongoing healthcare. 34% had a medical condition 10% had mental health issues 2.4% had chronic HBV Current medical Conditions Any immediate health needs met- rest prioritised for local GP review. Standardised assessment across centres, gather data to support additional services where indicated. Dental needs was something not well prepared for- since first involved secured funding to support access to dental care Catch up immunisations were minimal due to work done in Greece, but all children reviewed and recommendations made

Mobile Health & Screening Unit – Key Learning Safetynet & HSE | Statutory and voluntary sector partnership Mobile Health & Screening Unit – Key Learning Developing relationships with local healthcare providers to facilitate integration Preparedness allowing ability to respond quickly (within 10 days) 1 4 Communication of emerging issues Flexibility of approach 2 5 Capacity of leverage of different expertise, skills etc of partners in Statutory & Voluntary sector Focus on integration into existing systems and not creating parallels 3 6

& Dr. Bridget Kiely, GP, Safetynet MHSU Tel: 0871523589 Email: info@primarycaresafetynet.ie www.primarycaresafetynet.ie & Diane Nurse, National Lead Social Inclusion, HSE Phone: 00353 1 6201703 Email: diane.nurse@hse.ie www.hsesocialinclusion.ie