HEALTHCARE PROVISION FOR ASYLUM SEEKERS AND REFUGEES Associate Parliamentary Health Group 16th June 2004 Dr Astri Robinson Asylum Seeker Coordination Team ASYLUM SEEKERS “...owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable, or owing to such fear, is unwilling to avail himself of the protection of that country...” United Nations 1951 Convention relating to the Status of Refugees (Geneva Convention) ASYLUM SEEKER A person who has applied for refugee status (i.e. claimed asylum) under the Geneva Convention and is waiting for a decision from the Home Office REFUGEE A person accepted as a refugee under the Geneva Convention. This person will be granted indefinite leave to remain, permanent residency, and is eligible for family reunion - spouse and children under 18 also given indefinite leave to remain. EXCEPTIONAL LEAVE TO REMAIN A person granted the right to stay in the UK for 4 years as there are strong reasons against returning to the country of origin. ASYLUM APPLICATIONS 2003 49,370 applications (61,050 inc. dependants) Top 3 countries: Somalia, China, Iran 2002 84,130 applications (103, 080 inc. dependants) Top 3: Iraq, Zimbabwe, Afghanistan 2001 71,025 applications (91,600 inc. dependants) Top 3: Afghanistan, Iraq, Somalia SUPPORT FOR ASYLUM SEEKERS From April 2000 the National Asylum Support Service (NASS) has been responsible for the support of asylum seekers. • Accommodation and subsistence • Subsistence only (where choosing to stay with families) • Specific grants e.g. maternity grants Unaccompanied minors and those with special needs continue to be supported by local authorities. Asylum seekers and refugees are entitled to full NHS provision. RESHAPING THE PROCESS Asylum seekers are a heterogeneous group, Many are healthy but some have specific health needs Many will have difficulty accessing NHS services appropriately due to lack of understanding or for cultural or linguistic reasons. Historically there has been a considerable concentration of asylum seekers in London and the South East of England. This puts a disproportionate pressure on services in these areas. NASS disperses asylum seekers to areas where there is a ready supply of accommodation away from the South East. INDUCTION CENTRES A managed process giving intense support prior to dispersal. In 7-10 days newly arrived asylum seekers receive: • assistance completing the form to claim asylum (NASS1) • briefing on the asylum process, rights + responsibilities in the UK AIM: to reduce pressure on London and the South East by ensuring that people spend as short as time as possible in this area - This prevents people from developing ties with local services and the local community and reduces the likelihood of return at a later stage. INDUCTION CENTRES - health provision All asylum seekers are offered an initial health assessment and screening for TB. The assessment is recorded in a hand held record. AIMS: Allow access to health care for immediate needs, Reduce burden on dispersal areas by: carrying out an initial health assessment preventing exacerbation of health problems through delayed access to care. flagging up chronic and non-urgent needs Address individual and public health risks through screening for TB. INDUCTION CENTRES - rollout East Kent Pilot site opened June 2002. 3 sites 540 bedspaces. Dispersal across regions Yorkshire and Humberside Opened July 2003. 2 sites 105 bedspaces. Dispersal predominantly across Yorkshire and Humberside. Greater Manchester Due to Open July 2004. Distributed model. 250 bedspaces. Dispersal predominantly across Greater Manchester. DISPERSAL Asylum seekers are dispersed to „cluster‟ towns and cities across England and Wales. NASS accommodation is given until final determination has been reached (Home Office decision made and, where appropriate, all rights of appeal exhausted). Those given leave to remain are free to move around the UK, to find work and to access services on the same basis as other UK residents. Those whose application is rejected and who exhaust all subsequent rights of appeal are „failed asylum seekers‟. They are not able to reside in the UK legally and have limited access to services. DISPERSAL - spreading expertise Refugee Health Conference Hosted by Lambeth Southwark and Lewisham Refugee Health Team Conference for GPs working with Asylum Seekers + Refugees. Shepway PCT and DH. Conference for nurses working with Asylum Seekers + Refugees. Sheffield Health and DH “Caring for Dispersed Asylum Seekers: A resource Pack” DH “Meeting the Health Needs of Refugess and Asylum Seekers in the UK.” Burnett and Fassil KEY ISSUES - Mental health “Delivering Race Equality: A Framework for Action” • Access to, and design of, health and social care services • User and carer experiences within health and social care services • Health outcomes “Caring for Dispersed Asylum Seekers: mental health resource pack” www.mentalhealth.harpweb.org.uk KEY ISSUES - Interpreting services NHS Direct National Contract • Telephone-based interpretation; • Translation services; • Remote based access to British Sign Language interpreters. “Guidance on developing local communication support services and strategies” • Analysis of existing provision • Recommendations for commissioners/planners. Multilingual phrasebook, over 60 of the most common medical questions for first contact staff. British Red Cross Society and DH. www.communicate-health.org.uk, multilingual appointment card.
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