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Caring for Dispersed Asylum Seekers
A Resource Pack
Caring for Dispersed
A Resource Pack
HR / Workforce Performance
Management IM & T
Clinical Partnership Working
Document Purpose For Information
ROCR Ref: Gateway Ref: 1602
Title Caring for Dispersed Asylum
Seekers. A Resource Pack
Author Department of Health & Refugee Council.
Publication Date 19th June 2003 Target Audience Health workers and service planners working with asylum seekers and refugees.
Circulation List See target audience (above). The resource pack will also be available at www.doh.gov.uk/asylumseekers Description A resource pack that provides those who work with asylum seekers information on entitlement to healthcare, support available from the National Asylum Support Service, and coverage of policy in healthcare, social care and mental health. Good practice examples also feature.
Cross Ref N/A Superceded Docs N/A Action Required N/A Timing N/A Contact Details Justine Osborne Asylum Seeker Health Co-ordination Team Room 5W56 Quarry House Quarry Hill Leeds LS2 7UE.
Tel: 0113 2546605
Justine.Osborne@doh.gsi.gov.uk For Recipients Use Introduction The Department of Health and the Refugee Council have worked together to produce this Resource Pack for all frontline health staff and service planners who come into contact with Asylum Seekers and Refugees.
Its main aim is to help local health and social care agencies to meet the needs of asylum seekers who are dispersed to their areas. Key concepts and entitlements are set out along with examples of good practice. Initiatives such as local development schemes, personal medical service pilots and the development of health assessments for asylum seekers at induction centres are all covered.
There are many misconceptions about Asylum Seekers and Refugees. These terms cover a huge range of people from different countries and cultures, people of different ages, some on their own, some with their families – all of whom have come to the UK to seek refuge. The aim of the resource pack is also therefore to create a greater understanding of cultural difference and expectations both of those who seek asylum and those that provide asylum seekers with health and social care.
It is important that we update and develop the resource pack, for example we would like to expand the social care section, and that is why we are placing it on the internet at www.doh.gov.uk/asylumseekers. We would also like to add further models of good practice, so if you would like your work featured or wish to see new areas and issues covered, then please contact the Department of Health – via the above web address or using the contact details in Annex A.
Asylum Seeker Co-ordination Team Department of Health June 2003 Acknowledgements The Resource Pack is based on interviews with over 40 health projects and local councils. It was also informed by a survey of PCTs and Local Consortia receiving asylum seekers under the dispersal arrangements and other published research.
Much of the material was put together by Sasha Acimovic and Alison Fenney, both while working at the Refugee Council Policy Unit. An advisory group, under the Direction of the Department of Health’s Equality Strategy Group and drawn from Royal Colleges, other professional bodies, local government, and the voluntary sector provided invaluable assistance. The Home Office National Asylum Support Service (NASS) and policy colleagues in the Department of Health have also been generous with their time and interest.
The Refugee Council Registered Charity No: 1014576 The Refugee Council is an independent organisation and registered charity which is financed by a variety of sources including Government departments and the European Commission. It is the largest organisation in the UK working with asylum seekers and refugees.
They provide help and support and work with asylum seekers and refugees to ensure their needs and concerns are addressed. They also run a counselling line. The web address is www.refugeecouncil.org.uk Contents
1. Entitlement to healthcare Introduction
1.1 A person who has formally applied for asylum in the United Kingdom (UK) is entitled to NHS treatment without charge for as long as their application (including appeals) is under consideration. In common with those normally resident, they will have to pay certain statutory NHS charges, unless they also qualify for exemption from these, and will have to go on NHS waiting lists.
1.2 Since they are entitled to free NHS treatment, asylum seekers are entitled to apply to a general practitioner – providing either general medical services or responsible for the provision of personal medical services – to register as a patient. If the doctor agrees to accept a person as a patient, then the person may be asked to complete a form – GMS 1. There is no requirement to ask to see official documentation (e.g a passport) but it may help if the applicant has available some supporting evidence of address, such as a Application Registration Card (ARC) or a letter from the Home Office. Further information on GP registration can be found on Page 24.
1.3 It is the responsibility of the NHS trust or Primary Care Trust (PCT) providing secondary care to establish if a person is entitled to treatment without charge (although out-patients may have to pay charges for drugs and appliances unless they are exempt). All patients, regardless of their status or nationality are subject to the same basic screening process and can expect to be asked the following question about their residential status as part of the hospital registration
• Have you been living in the UK for the past 12 months?
1.4 Those patients who have not been living in the UK for the past 12 months can expect to be
asked further questions such as:
• On what date did you arrive in the UK?
• What is the basis for your stay in the UK?
1.5 Asylum seekers who have made a formal application for asylum, those with Exceptional Leave to Remain (ELR) and refugees are exempt from charges for NHS hospital treatment. The NHS trust providing treatment can ask patients for documentary evidence to confirm their claim to free treatment. A Home Office letter confirming an application for asylum/ELR/Refugee Status or an ARC will suffice.
1.6 Certain services are exempt from charges for everyone. This includes medication supplied by hospitals for the treatment of sexually transmitted diseases but in the case of services which relate to HIV/AIDS only the initial test and counselling is free. People not eligible for free hospital treatment are required to pay the full costs, including drugs, of any HIV treatment Caring for Dispersed Asylum Seekers beyond the initial test and counselling. Where a person has been identified as chargeable, not an asylum seeker, for HIV/AIDS treatment an HC2 (certificate for full help with health costs) is not applicable and the full cost of the drugs should be recovered from them.
1.7 People who have been granted asylum are fully eligible for organ transplantation. For people whose applications for asylum are still being assessed it is for the NHS trust providing treatment to consider if they can be placed on the main waiting list for an organ.
1.8 For further information on entitlement to secondary care treatment without charge you can visit the overseas visitors web-site. The address is www.doh.gov.uk/overseasvisitors Help with Access to Health Services 1.9 If asylum seekers and refugees are having difficulties registering with a GP, they should contact their local PCT who will be able to provide a list of doctors to whom they can apply. Where a person, who is entitled to free NHS treatment, has had their application to join a doctor’s list refused, they can apply to the PCT, which has the power to allocate them to a GP.
1.10 PCTs will also be able to provide information on local Community Dental Services and dentists in an area treating patients under the NHS. NHS Direct provides information on local GPs and NHS dentists. You can also find out about services in your area (including PCT contact details) by going to: http://www.nhs.uk/localnhsservices/default.asp
1.13 If they are accepted for NHS treatment, asylum seekers are also entitled to the help listed in paragraph 1.11 in the same way as any other UK resident. For example, women who are pregnant or have given birth in the previous 12 months are entitled to free prescriptions if they have an exemption certificate. Asylum seekers with an exempting medical condition, eg diabetes, are entitled to free prescriptions if they have an exemption certificate. GPs hold application forms for these certificates. They should be sent to the address on the form. The exemption certificate will start from the first day on the month in which the form is received.
1.14 Other asylum seekers may apply for help with health costs on income grounds.
Asylum seekers not supported by NASS 1.15 Asylum seekers who are not supported by NASS or those supported by the Interim Arrangements and who are not otherwise entitled to free prescriptions, will need to complete form HC1 (claim for help with health costs including prescriptions through the NHS Low Income Scheme (LIS)). Health practitioners who come into contact with asylum seekers should encourage them to apply. They may also be entitled to free treatment in accordance with paragraph 1.13.
1.16 Since the interim support arrangements were introduced on 6 December 1999, the Health Benefits Division (HBD) of the Prescription Pricing Authority (who run the LIS for the Department of Health) have made arrangements for claims from asylum seekers to be given priority. They have arranged for a separate postcode to be printed on white envelopes, which asylum seekers can use to send off their HC1 claim form.
1.17 HC1s are available from the HBD or in bulk from Prologistics, Department of Health, PO Box 777, London, SE1 6XN. Tel: 08701 555 4555. Fax: 01623 724 524. A pre-addressed manila envelope is supplied with each HC1 form and should be discarded. PCTs, local authorities, NHS practitioners and agencies providing advice to asylum seekers should obtain a supply of white envelopes with the alternative postcode by telephoning the HBD help desk on 0191 203 5555 on Mondays to Fridays, 8.30am to 5pm. An NHS certificate HC2 (certificate for full help with health costs) or HC3 (certificates for partial help with health costs) will generally be issued within five working days of posting the HC1 claim form to the HBD. The HC2 and HC3 certificates are normally valid for 6 months after which a new HC1 form must be completed.
1.18 Each certificate will show the period it is valid for and the names of the people it covers.
Certificates sent out by NASS will include all members of the asylum seeker’s family who are included in the support payments and may include other adults, for example an asylum seeker’s parents. Certificates sent out by the HBD will include the asylum seeker and partner (if he/she has one) and dependent children. Other adults should make their own HC1 claim. More information is available in leaflet HC11 Are you entitled to help with health costs? This is available from main post offices, Prologistics (address at paragraph 1.17) or on www.doh.gov.uk/nhscharges/hc11.htm Failed Asylum Seekers Primary Care 1.19 When an asylum seeker fails their claim to asylum and all appeal processes have been exhausted, from the date their asylum claim failed, they become ineligible for routine NHS primary care treatment and GPs, PMS providers or NHS Walk In Centres should charge the individual concerned for any such treatment provided. However, there are exceptions for emergencies or for treatment which is immediately necessary. When any person requires such treatment, this must be provided free of charge by an NHS provider.
1.20 When an asylum seeker fails in their claim for asylum, and all appeal processes have been exhausted, they will become chargeable for any hospital treatment from the date their asylum claim failed – unless they have been in the UK for more than 12 months. Immediately necessary life saving treatment should be given to failed asylum seekers who have been in the country for less than 12 months if required, even if they are unable to pay. However the charge Caring for Dispersed Asylum Seekers
Funding of Health Services for Asylum Seekers 1.22 PCTs are responsible for providing their populations with healthcare, and decide how to configure local services to meet the needs of local residents including asylum applicants.
1.23 Revenue allocations are now made direct to PCTs to allow them to plan and provide services to meet local needs. Funding is allocated to PCTs on the basis of the relative needs of their populations and a weighted capitation formula is used to calculate PCT’s target shares of available resources. For 2003/06, a revised formula was used. This formula recognised key factors such as deprivation and local population changes more effectively than before.
1.24 Local Development Schemes (LDSs) and Personal Medical Services (PMS) pilots allow PCTs to use funding to aid provision of primary care to asylum seekers. A new GP contract is also under consideration, which will allow for the funding and provision of ‘enhanced’ services. For further information on LDSs, PMS and the new GP contract, see Page 25.
1.25 All asylum seekers residing in Induction Centres (see Page 19) will also receive a health assessment, which should reduce time required and costs incurred for initial health appointments in dispersal areas. For 3 years from April 2003, the Department of Health and Home Office will be providing those PCTs with induction centres extra funding towards the costs of providing health assessments.
2. Home Office Asylum Policy – Latest Developments
2.1 The Nationality, Immigration and Asylum Act 2002, received Royal Assent on 7 November
2002. It is a major landmark in the reform of nationality, immigration and asylum policy.