1. From OUTside to INvolvement Dr Kate Warren Registrar in public health NHS Walsall

2. From OUTside to INvolvement Partners in the project: - WELCOME - WRASSA - WARMA - Citizens Advice Bureau - NHS Walsall - Walsall Council Funded by Government Office West Midlands: Migration Impacts Fund Aim – Reduce the impact of migration on health and other public services in Walsall

3. New migrants – who are they? Asylum seekers including unaccompanied children Refugees Refused asylum seekers Economic Migrants –European –Others via Points based system Family reunion Overseas students Undocumented migrants

4. The scale of migration in Walsall Numbers doubled after expansion of the EU to over 1200 new migrants per year Majority from South Asia and Eastern Europe Over 100 asylum seekers housed by the Border Agency Unknown numbers of refugees Unknown numbers of undocumented migrants Small numbers of Looked After Children

5. National Insurance Number Applications from overseas nationals, Walsall

7. Issues for Walsall Variation (policy, economy, housing capacity) Not a “critical mass” for specialist services such as Birmingham/Coventry –Reliance on voluntary sector and short term projects Services require extra time and resources Mobility of migrants – continuity of care Tight geographical spread Holistic/social approach to health needed

8. Commissioned activity Certification for volunteers to provide advice Drop-in / phone-in: information for clients Arts and social events as engagement tools Recruitment to local involvement channels Training and collaboration with services Regional networking Translated resources produced and shared (Welcome to the West Midlands website)

9. Health Primary care Access to General Practice Appropriate use of services – Choose Well Translation tools / interpreters Awareness of staff – cultural norms, entitlements to healthcare

11. Health Maternal and child health Identification and appropriate care for migrant women with specific problems e.g. Female Genital Mutilation Integration of NICE guidance and pathway for vulnerable women in service specification for midwifery Child protection awareness

12. Health Mental Health Pre-migration factors –War, torture, rape, persecution Post-migration factors –Poverty, poor housing, social isolation, immigration processes, language barrier Cultural perceptions of mental health Awareness of specialist area in MH services Creative writing workshops resulting in a published booklet

13. Health Health protection Blood borne viruses – HIV, Hepatitis –Encouraging testing Tuberculosis –Symptom awareness Sex workers –South Area Partnership

14. Social determinants of health and other issues Housing Poverty – benefits Crime/safety Employment Education/training including ESOL Social isolation Community cohesion

15. What Now? Importance of retaining specialist knowledge and momentum Capacity building in voluntary sector Embedding lessons learnt into commissioning processes Elements of service delivered by different agencies Changes in Public Health- can this help?

16. Questions and suggestions