1. 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
Glasgow City Health and Social Care Partnership
Nov 2017

2. 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.

3. 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/
2014/
2015/
2016/
2017 /18 (April -Aug) 167
Top countries of origin
Iran, Iraq, Sudan, Eritrea, Syria

4. 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

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. 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!

11. Thank you