1. Health and care issues for ethnic minorities in the inner-city Nilufar Ahmed St Georges Hospital Medical School and Queen Mary’s School of Medicine and Dentistry

2. Demography 100 women aged 35-55 recruited randomly through GP lists. All first generation migrants 76 married; 17 widowed; 7 separated/divorced. Average time in UK 18 years (range 4-32 years) Average 5.2 children LFS – Bangladeshi families 4.7 persons per household compared to 2.3 in General Population This study- 6.6 persons per house reflecting target sample 87% of homes had 5 or more persons

3. Care 32% involved in care – mostly to husband Often providing care as well as looking after young children Unsupported care Only 3 respondents receiving carers allowance

4. Housing 70% had no access to outside space 80% living in council tenements - often overcrowded high rise flats 65% of these had no lifts 56% were living at a density of 1.5 or more persons per room. Twenty-seven of the families were living two or more to a room.

5. Lack of support It’s hard because we live on the fourth floor and there is no lift; because of that he can’t get out very much… I would like some help in getting him out of the building…We have asked the doctor but they haven’t said anything. If there was somewhere he could go to talk to people of his own age I think that would help him... We have asked the doctor but he hasn’t let us know about anything. Safia 53, caring for husband

6. Refusal of support They were going to give us a nurse to look after him at home, but he doesn't want that…he wants me to do everything. And we just want to do whatever keeps him happy, so we haven't got a nurse…When he is very ill, its too much for me to do on my own, They [health services] tell me that it is too much for my health - but what can I do? If he doesn't want anyone then I have to do it. Salma 53, caring for husband

7. Needs of carer neglected I had to do it all. The Social Services would just come and give him his diabetes injection…They would ask him if I was looking after him alright, if he needed anything. And he was happy with the way I looked after him and would say he didn’t want anyone else. But nobody asked me if I wanted any help, if I could look after him alright Nargis 41, caring for husband

8. Isolation I always need to keep him happy...always listening to him. Somedays, it becomes too much. If I want to go somewhere....he wants me to stay in the room. If I'm cleaning, he tells me to get him something to eat or "get me this or get me that". It's too much for one person. I am suffering so much Feroza 41, caring for husband

9. Demands of care He needs help with doing everything. Bathing, dressing, toiletting, feeding. If he goes to the bathroom he messes it up totally. He soils his clothes. He can't go out. Me and my sons do the shopping. I don't know if I should say this about my own husband but he can be very demanding. He always wants things straight away. He always wants different things to eat and drink. If he asks for something and you get it, by the time you've got it he will have changed his mind and wants something else and starts shouting. Fazira 54, caring for husband

10. Cycle of care My daughter-in-law takes care of me. I take care of my husband and she takes care of me. But now she is not well, she is going to have a baby. I can't go out because my legs hurt. And we don't have a lift that makes it worse. I can't walk up and down the stairs. I can't even take my daughter to school anymore Jannat 37, caring for husband

11. Health Only 4% reported health as very good 52% reported health as poor or very poor 77% identified a long standing limiting illness Almost 80% of this group said their illness prevented daily activities

12. Mental Health GHQ-12 used to measure distress 39% scored significantly compared to just 19% in age comparable sample of general population Only 4 respondents mentioned any mental health problems Suggests only 10% diagnosed Language issues major contributor to problems Problems with medication Problems with Bengali counsellors – services not monitored

13. Lack of communication I had three miscarriages after I came here. I was really stupid. The doctor gave me some medicine and I didn't really understand what it was all about. I went to see them because my periods had stopped and he gave me some medicine. I was obviously pregnant and that's why my periods had stopped, but he gave me some tablets and immediately after taking them I lost the baby. And then I lost another two after that. Shumie 36 m in UK 19 years

14. Present situation Inappropriate translating/interpreting services Poor knowledge of available services Lack of communication within and between services Lack of monitoring of ‘matched’ services