The Health Integration Team at Barnsley PCT has worked since 2003 to promote access to health and social care services to new migrants and asylum seekers. The service has grown to provide health services including advice for new migrants and asylum seekers in initial accommodation, health screenings and school road shows. The team has now expanded to work with gypsy, Roma and traveller communities.
In 2010 an estimated 12% of the UK population were born abroad, comprising individuals from all over the world. Long-term migrants arriving in the UK are typically younger people, who may come to study or work. Typically, they have a similar range of health concerns to UK born people of similar ages. However, non-UK born people bear a disproportionally high rate of certain infectious diseases which are otherwise rare in the UK. In fact, a majority of new UK cases of HIV, TB and hepatitis B are found in these UK arrivals, mostly because they come from countries where these diseases are more prevalent, or less often diagnosed or treated.
Some migrants have experienced a high burden of disease and poor living conditions in their country of origin, traumatic experiences during migration, and may have left due to persecution or even torture. These psychological conditions often compound and complicate their living situation in the UK, and they may also be socially isolated due to differences in culture, few social networks, deprivation and lack of state support.
Yet it is important to provide appropriate and effective treatment, not just from a human rights or legal perspective, but also because there are health protection concerns. Communicable diseases, especially the drug-resistant strains of TB (XDR) which are increasing in many parts of the world, could spread to the wider population if not treated early.
These physical and psychological health issues also represent a large inequality, and it is increasingly the role of the public health system to reduce these.
The Health Integration Service aims to provide specialist advice and care for asylum seekers, migrant workers and immigrants within the local community. In addition the service aims to provide specialist advice and expertise on a range of issues influencing the health and social needs of asylum seekers, migrant workers and immigrants. This includes education and support for health and social care professionals and voluntary organisations who are serving these migrant populations.
Specialist services include:
- Specialist health visiting service
- Specialist adolescent health service
- Initial health screening of newly arrived clients into the Barnsley area
- Providing specialist support to the nominated General Practitioner for asylum seekers, migrant workers and immigrants within the local community
- Providing a minor illness service
- Providing a nurse led health service including diagnostics and independent prescribing
- Providing education, training and advice sessions for health, social care professionals and voluntary organisations
- Promoting the integration of asylum seekers, migrant workers and immigrants within the local population of Barnsley and the surrounding area
As new migrant issues affect so many different potential areas of work, it is important to have a cross-sector team. In Barnsley this is comprised of the regional TB network, the Nurse Prescribing Network, Yorkshire and Humber Operations Meeting, the Specialist Nurses Forum and the Infection Control Meeting.
Making it happen
Practitioners had recognised that there was a lack of appropriate services and limited information for asylum seekers. This was of particular concern for practitioners working with the Initial Accommodation Centre, a service for asylum seekers commissioned by the Department of Health. They worked with the appropriate local health commissioner to build a case for providing an initial health check for new arrivals in Barnsley and as well information on local health and social care services.
TB was identified one of the main health problems among the new arrivals, but there were concerns among the team that available tests were failing to identify latent and early stage cases. The team were aware of new tests in development and were proactive in securing a small amount of funding from the Department of Health to run a pilot of the T-SPOT test. They had to wait, however, for further UK trials before they were able to convince local commissioners to invest in this new technology. Now, Barnsley PCT has commissioned this service with an expected annual target of 240 contacts.
Psychological and mental health issues can also be common among new arrivals, and the team needed to partner with other organisations with specialisms beyond their clinical expertise to address these. However, with good signposting to existing services, there was no need to ‘re-invent the wheel’. For example they developed supportive pathways with existing voluntary agencies for people with HIV and survivors of rape.
The team also developed strong links with other health teams regionally and nationally as well as local statutory and voluntary service providers. These networks provide them with information on similar services elsewhere in the country, like developments in TB testing. Sharing knowledge and evidence about the current state of the art or innovative ideas is often as important as the initial development itself. Crucially in Barnsley, the local commissioner and provider see delivering services that meet the needs of disadvantaged patients and users as their joint responsibility.
The team commissioned a piece of local research to inform the project, and uses audit tools to demonstrate the value of the service, as well as identifying areas for improvement. However, there is a need to properly monitor all the activities and have regular evaluations to improve project delivery and demonstrate impact. While the practitioners can see the impact the service is having, communicating this to funders/commissioners and other people in the country is essential to maximise impact and create sustainable services.
Helen Taber, Senior practice nurse
01226 731 686