Asylum Seeker Health Coordination Team Gareth James

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Asylum Seeker Health Co-ordination
TeamGareth James
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Contents

• DH team
• Home Office context
• Asylum process development
• Entitlement.
• Health assessments
• Mental health

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Asylum Seeker Co-ordination Team

• Joining up policy across DH.
• Working with other Government Departments (i.e.
  Home Office, Department for Education and
  Skills).
• Supporting healthcare services caring for asylum
  seekers.
• Funding health assessments in initial
  accommodation.

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Home Office 5 year Asylum and Immigration
Strategy

• Renewed commitment to UKs international
  obligations to protect genuine refugees and end
  abuse of system.
• New Asylum Model
• Increased detention and swift removal of failed
  asylum seekers

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New Asylum Model (NAM)

• A new fast track process for asylum claims with
  close contact management.
• Complete Case Management Teams to handle
  screening and case management.
• Dispersal to period of claim accommodation within
  approximately two weeks.
• Full implementation Dec 2006

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NAM implications and challenges

• Faster process potential for more rapid
  throughput through initial accommodation.
• Pressure on gathering medical evidence to support
  an asylum application.
• Single caseworker for whole process could provide
  more stability quicker decision.

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Accommodation Strategy 2005

• NASS currently accommodates around 35,000 asylum
  seekers and their dependents, mainly away from
  London and the South East as part of its policy
  of national dispersal.
• Negotiation of new contracts for the provision of
  accommodation, to asylum seekers. This will see
  some relocation of dispersed asylum seekers.

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Accommodation Strategy transitions

• Likely that GPs in most dispersal areas will
  experience some relocation of asylum seekers over
  the next four months.
• If asylum seekers have medical conditions which
  impact on their ability to move, these will be
  taken into account if it proves necessary to find
  them alternative accommodation.

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New accommodation contracts
Housing providers to ensure that tenants have
information on local GP practices and how to
register. If a person has a pre-existing
medical condition, the housing provider will take
them to register with a GP within 5 working days.
If that person is in need of medication, it
will be done within 1 working day.
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New accommodation contracts

• Pre-existing conditions examples
• Long-term conditions, requiring regular
  medication e.g. diabetes, heart problems, asthma.
• HIV, if already diagnosed, and no continuation
  of care arrangements have been made.
• Acute mental health issues.
• Pregnant women
• Children under 9 months.

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Entitlement asylum seekers
A person who has formally applied for asylum is
entitled to NHS treatment without charge for as
long as their application (including appeals) is
under consideration. Asylum seekers can apply to
a general practitioner to register as a
patient. Asylum seekers are exempt from charges
for NHS hospital treatment.
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Entitlement failed asylum seekers
For secondary care, immediately necessary
treatment is should always be given, without
delay, irrespective of eligibility or ability to
pay. However if an individual is found to be
chargeable, recovery of costs will be pursued as
far as the trust considers reasonable.
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Entitlement failed asylum seekers
Any course of hospital treatment already underway
at the time when the asylum seeker's claim,
including any appeals, is finally rejected should
remain free of charge until completion.
"Implementing the Overseas Visitors Hospital
Charging Regulations - Guidance for NHS Trust
Hospitals in England" advises on when to make
charges.
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Maternity services
Maternity services should always be treated as
immediately necessary care, and receipt of care
should not be dependent on ability to pay.
However, patients may be liable for charges.
Managers have been reminded of the need for
sensitivity by DH - patients should not be given
the impression that care will be withheld if they
cannot pay.
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HIV services
Initial diagnostic testing for HIV and associated
counselling are free to all. HIV treatment itself
is chargeable to failed asylum seekers, if course
of treatment began after asylum claim is turned
down. Pregnant women who are found to be HIV
positive should receive HIV treatment where
necessary to prevent mother-to-child
transmission.
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Entitlement failed asylum seekers
Health service Circular 1999/018 states that
failed asylum seekers should not be registered
with GP practices for free NHS treatment.
However, GP practices have the discretion to
accept failed asylum seekers as registered
patients, to receive free primary care.
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Entitlement failed asylum seekers
2004 public consultation on the entitlement of
overseas visitors to NHS primary care services.
The aim of the consultation to bring primary
care regulations in line with those for secondary
care. Situation unchanged as Ministers consider
responses.
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Induction centres / initial accommodation

• Remain part of a integrated approach to asylum
  under NAM. Newly arrived asylum seekers receive
• assistance in completing the form to claim
  support (NASS1)
• briefing on the process, rights,
  responsibilities and the UK
• health assessment

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Health assessments developments

• Mantoux test to detect latent TB
• development of translated resources
• responsiveness to mental health issues
• closer relationship with NASS on delayed
  dispersal / more informed dispersal
• health assessments established in new IA sites.
• supporting staff

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Scott Review

• Independent review undertaken by Hilary Scott
  former deputy Health Services Ombudsman report
  published Dec 2004.
• Review looked at how NASS can take account of
  asylum seekers with healthcare needs during the
  dispersal process.
• 27 recommendations to improve NASS policies

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Scott Review progress

• Healthcare bulletin for NASS staff to follow
  when dispersing asylum seekers.
• Clear process for delaying dispersal for those
  with complex healthcare needs.
• Development of training for NASS staff dealing
  with local health services starting with NASS
  health leads.
• Improved healthcare information for asylum
  seekers before they are dispersed PCT database
  pilot.

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Immigration service removal centres
Encouraging removal centres and PCTs to work
together to develop local protocols to improve
the interface between health services in centres
and local NHS. Initial discussions on bringing
private health care providers in centres within
the Healthcare Commissions programme of
inspection.
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Mental health services

• DRE highlighted the particular barriers which
  refugees and asylum seekers face in accessing and
  using mental health services.
• facilitation of access to mental health services
  for asylum seekers.
• greater awareness amongst commissioners and
  providers of key issues / improvements

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Contact details
Gareth James 0113 254 6289 gareth.james_at_dh.gsi.gov
.uk Michael Swaffield 0113 2545002 michael.swaffi
eld_at_dh.gsi.gov.uk Justine Osborne 0113
2546605 Justine.osborne_at_dh.gsi.gov.uk
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DH Asylum Seeker website

www.dh.gov.uk/asylumseekers