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Leaving NASS Support 3.20 From 8 April 2002 asylum seekers who are granted either refugee status or ELR by the Home Office have 28 days to leave NASS accommodation. People in this position are eligible to community care grants from the social fund. An asylum seeker previously supported by NASS qualifies as someone who has been ‘without a settled way of life’: Social Fund Direction 4 (a) (v) – people setting up home as part of a planned programme of resettlement. Asylum seekers who are recognised as refugees are eligible for a backdated lump sum of the difference between the support they have received as an asylum seeker and full income support rates. This does not apply to those who are granted ELR. From 1 April 2003 ELR was replaced by ‘Humanitarian Protection’ (see Annex B.) Employment 3.21 Asylum seekers are no longer entitled to request permission to work. The employment concession which had made this possible was abolished on 23 July 2002.

4. Health Guidelines Initial Health Assessment

4.1 A health assessment should be carried out shortly after the arrival of an asylum seeker to the UK. In most cases this will be done in induction centres and results recorded in a hand held record.

Induction centres

4.2 A network of induction centres is being developed across the UK. Asylum seekers will stay in these centres for a short period (usually a few days) before being dispersed. Induction gives asylum seekers the opportunity to be briefed (in their own language) on key issues, to apply for NASS accommodation an or support and also to receive a health assessment. The induction centre network should be at full capacity by approximately March 2004.

The health assessment

4.3 Initial health assessments in induction centres, are/will be nurse led (though with access to a

GP) and will:

• involve a health needs assessment;

• record a basic health history;

• address public health concerns;

• feed into the dispersal process;

• include screening for tuberculosis.

Hand held records

4.4 Each asylum seeker residing in an induction centre will be issued with a national hand held record, kept in an inscribed blue wallet. Details of the initial health assessment – and all other healthcare appointments undertaken while at the induction centre – will be recorded in this, along with contact details of the healthcare staff that the asylum seeker has seen. Where possible, ‘language’ and ‘need for an interpreter’ will be recorded as well. The asylum seeker will take the hand held record with them on dispersal, with a copy of their records also filed at the relevant induction centre.

4.5 There will be space in the hand held records for input in dispersal areas. Copies of other health records/letters given to the asylum seeker can also be hole-punched and inserted into the blue wallet.

4.6 Any details entered into the hand held record must be discussed with the asylum seeker, to ensure informed consent and to reduce the risk of confidentiality breaches.

Caring for Dispersed Asylum Seekers Procedures in dispersal areas 4.7 On first contact, health staff in dispersal areas should ask asylum seekers to produce their hand held record as this may contain important information about their state of health. To facilitate this process, it may be useful for health staff to have a ‘blank copy’ of the record to show the asylum seeker. The information in the record should reduce considerably the amount of time taken for any health checks/GP registration medicals that are undertaken in dispersal areas.

4.8 Asylum seekers arriving in dispersal areas may not always have a hand held record, especially in 2003/early 2004 before the induction centre network has been developed to full capacity. If this is the case, a health assessment should be carried out as soon as possible. If a local protocol is not already in existence, copies of the national hand held record can be ordered (contact the Department of Health Asylum Seeker Co-ordination Team, see Annex A). Alternatively, a hand held record template is available at www.harpweb.org.uk/content.php?section=practical&sub=p1 Some other examples of good practice are included on the next pages. Consent to health assessment should follow the General Medical Council’s guidance and assessments cannot be compulsory however the benefit to the asylum seeker of a health assessment should be explained.

The Health Support Team (HST) Parkside Health, The Medical Centre, 7e Woodfield Road, London W9 3XZ Tel: 020 8451 8175, Fax: 020 8451 8176.

Staffing • 7 Community practitioners (health visitor and district nurse background), 2 Community Nurses and 4 Support Workers.

Access The overall aim of the support team is to provide intensive support to vulnerable client groups with gradual integration into mainstream services. The HST works with asylum teams and refugees and the homeless (including those in temporary accommodations). A systematic outreach programme to hotels and hostels has identified new arrivals to the team. Open access health advice sessions are held in a number of locations – day centres, family centres and hostels. Referrals from any source (e.g. Housing, GPs) are encouraged, including self-referrals. The team also holds, family centre based health advice sessions with interpreting support (including TB screening).

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Health Promotion Culturally sensitive healthy living groups on areas such as women’s and men’s health, dental and dietary advice have been established. Advice is adjusted to take account of living conditions. The HST works with voluntary organisations to provide input to groups e.g. Somali Welfare Association, Arabic Women’s Groups.

Community representatives and the HST are working with new arrivals to ensure that accurate information is disseminated about health and health services.

Lunchtime Learning Programmes A programme of multidisciplinary workshops/seminars to examine issues of importance to these client groups, to support practioners and to share models of good practice. Post Graduate Education Authority approval has been granted for the entire programme and sessions are individually evaluated.

Funding The HST is funded by the local Community Trust/PCT.

Health Inequalities Team (HIT) 28 Netherhall Road, Doncaster DN1 2PW, Tel 01302 739547, Fax 01302 366189 Staffing

• Specialist health visitor – budget holder & management of interpretation service.

• Specialist health visitor – Lead on families. Immigrants and overseas student TB screening.

Commencing a rolling program, working with young people re: diversity & cultural awareness.

• Specialist health visitor for the homeless other vulnerable clients.

• Secretary – Co-ordinates interpreter booking service for primary care.

Access Promote and facilitate equal access to local services, focusing on health care. Advocate expressed needs as well as conducting health needs assessment.

Key drivers Good links with accommodation providers, of which there are three private and one Local Council.

An essential part of the work has been formalising the relationship with accommodation providers in agreeing on prompt notification of new arrivals, notifications include necessary information such as age and Caring for Dispersed Asylum Seekers sex and cases that have moved or moved out of the area. Monthly multi-agency meetings ensure a coordinated approach to integrating asylum seekers into local services and community.

–  –  –

Health Promotion Health promotion drop-in sessions organised at a local community centre for two hours a week on sexual health awareness and other health education.

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Induction Programme (1-7 days approx,

depending on support requirements) including:

• Accommodation/full board in induction centre

• Orientation & support briefing

• Help with NASS form

• Asylum process briefing

• Health Assessment/TB screening

• Rights and responsibilities briefing

• Dispersal briefing

• Travel NASS in Croydon send list of available dispersal Asylum applicants matched with accommodation (location and description) to appropriate dispersal accommodation induction centre

–  –  –

Asylum applicants transferred to dispersal area accommodation, taking their hand held health records with them Caring for Dispersed Asylum Seekers Immunisation 4.9 Among certain nationalities there is a lack of familiarity with the concept of immunisation.

Many refugees and asylum seekers will not have been immunised against common communicable diseases and children in particular are likely to have had immunisation schedules interrupted or not even started. An immunisation history will be taken as part of the initial health assessments in induction centres and will be recorded on hand-held records.

Detailed information on immunisation policy can be found at www.doh.gov.uk/greenbook Registration with GPs 4.10 The decision whether to accept any person, including an asylum seeker, as a patient is for a GP to make, as with any other ordinary UK resident entitled to free NHS treatment. GPs also have the discretion to refuse to accept any patient onto their list. However if a patient is unable to register with a GP, PCTs have powers to allocate such patients entitled to NHS treatment to a GP. GPs have the choice of accepting these patients either as fully registered patients, or as temporary residents if they are in an area for more than 24 hours but less than 3 months. They may offer to accept non-qualifying patients as private patients, liable to pay fees for treatment.

4.11 Although it is normally necessary to register as a patient – either permanently or as a temporary resident – in order to receive services there are exceptions for emergencies or for treatment which is immediately necessary (defined as treatment which cannot be reasonably delayed until the patient returns home.) When any person requires such treatment this must be provided, free of charge, by a GP regardless of whether the patient is registered or not.

Receptionist & Practice Managers 4.12 The role of the receptionist is very important, as they will be the first point of contact for asylum seekers. They should have access to interpreting services if necessary, which, given the nature of the work is likely to be through the telephone.

Appointments 4.13 Many asylum seekers will have had no previous experience of having to make an appointment to see a doctor. In many other countries their access to healthcare is through a walk-in clinic or hospital when they need it. It is important to be aware of this patient expectation which may lead to disappointment and frustration on both sides when not met.

–  –  –

4.15 Different religions have different days of worship and staff need to be sensitive about these when booking appointments. A multi-faith calendar, which gives celebration dates for different religions, may be a useful acquisition.

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Models of Primary Health Care 4.19 The best model of health care for asylum seekers is to facilitate integration into existing mainstream services. This may not be possible straight away, so dedicated initiatives may be appropriate for asylum seekers new to an area.

4.20 Different areas provide their services in different ways: with regards to primary care some PCTs ensure that there is space on GMS surgery lists for asylum seeker populations. Others use Personal Medical Services to set up surgeries for local vulnerable populations – which may or may not include asylum seekers.

4.21 Another way of reducing local pressures on primary care is to establish a dedicated resource of a salaried GP. Such specialist solutions are perhaps most appropriate in areas with a relatively high density of refugee populations or very transient populations.

4.22 There can be an uneven distribution of asylum seekers or refugees between practices, with some practices taking on more than others. PCTs should ensure that such practices are adequately supported and resourced (via a GMS, LDS or adjustment to their PMS contract.) Local Development Schemes 4.23 Section 36 of the 1997 Primary Care Act, gives PCTs the flexibility to improve the development and responsiveness of General Medical Services, by giving local GPs financial incentives through Local Development Schemes (LDSs). Some PCTs have set up LDSs for asylum seekers – paying practices an extra amount upon registration of someone from this target group.

Caring for Dispersed Asylum Seekers Kensington, Chelsea and Westminster Local Development Scheme Contact – Anna Barnes, Primary Care Development Manager, Westminster PCT, Trust HQ, 50 Eastbourne Terrace, London,W2 6LS. Tel: 020 7725 3333. E-mail: anna.barnes@westminster-pct.nhs.uk This LDS has been established to improve access to primary care for refugees, asylum seekers and others in temporary accommodation. The scheme acknowledges the greater workload that can often come with members of this target group by incorporating an additional payment to the practices for each individual on their practice list who is a member of the target group, and for whom the practice has met certain quality standards. Practices opt into the scheme and the PCT actively promotes the involvement of practices that have high levels of diversity represented on their practice list. The scheme also seeks to ensure that quality data is collected to enable the PCT to address any service development issues identified.

The scheme has an advisory group comprised of refugee voluntary organisations, the local interpreting service, a local mental health service targeting asylum seekers, the Health Support Team, two GPs, one practice manager and a member of the community development team.

There is an ethnic monitoring strand to the scheme including:

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