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How London is Respond-ing to the needs of asylum seekers this World Refugee Day

Dr Olivia Farrant is a member of the University College Hospital (UCLH) Respond team, a community-based service delivering holistic care for asylum seeker communities in London. Olivia is also a Centenary Fellow at the UCLH Hospital for Tropical Diseases.

 

In 2021, 48,540 people claimed asylum in the UK, the highest level since 2003. The majority of these applications were made by people from Iran, Iraq and Syria, aligning closely with conflict in these areas. This rise of almost two-thirds from the previous year, together with the impact of the COVID-19 pandemic on pre-existing delays to the processing of asylum claims, resulted in the placement of many families and individuals in ‘contingency accommodation’ across the UK. Forced migration due to persecution, conflict or natural disaster is not a new phenomenon, and the principles of the 1951 Refugee Convention remain just as relevant 70 years on since its inception.

Bringing health and care into contingency accommodation

Although contingency hotels had been used prior to the pandemic, the scale of their use since then has been unprecedented. Thousands of vulnerable migrants were placed in inner-city areas during a pandemic when health and social care resources were already stretched to their limit. People seeking asylum are known to be commonly affected by complex and inter-generational needs, affecting mental, physical and social health, and may have experienced limited access to prior healthcare. This made it exceptionally challenging to provide an equitable and accessible service for this population, despite the best efforts of frontline staff.

To address these problems, our team from UCLH designed a new integrated, community-based, model of delivering care for asylum seekers called ‘Respond’. This model is designed to overcome barriers in access to healthcare, provide a wrap-around, holistic and trauma-informed service and deliver equitable healthcare for an underserved group.

An integrated and holistic response

Through the Respond model, we support GP registration, screen for a range of physical and mental health needs, including communicable and non-communicable diseases, refer and signpost to key services, and provide a patient-held record of our assessment, as show in Figure 1. We work with expert multidisciplinary input from a range of specialists with expertise in migrant and refugee health. We were commissioned by North Central London Clinical Commissioning Group in July 2021 to deliver services across Barnet, Camden and Islington.

Figure 1. The Respond model

We have assessed over 700 people in family groups and as individuals to date. We have learnt the importance of partnership working and the benefits of integrated care across traditional boundaries: primary and secondary care, adult medicine and paediatrics, health and social care. We have learnt the crucial importance of bringing healthcare into the community, of understanding where people live and their experiences in the design of an equitable service. We’ve had to overcome funding shortfalls to continue our work and have learnt the limitations of short-term retrospective funding models when trying to build sustainability into the system.

Looking ahead

Moving forwards, from a clinical perspective we will be upscaling, strengthening our partnerships and bringing in peer advocates to work with us in the implementation of our service. From an academic perspective we will be developing one of the largest clinical datasets to date describing the health needs of asylum seekers in the UK, conducting in-depth qualitative work and economic evaluation to assess for acceptability and cost-effectiveness. We will be sharing the results of an interim service evaluation of the first 12 months shortly and will be seeking feedback from key collaborators across the region and from patient advocates.

Our work is designed to address health inequalities through equitable service delivery, partnership across traditional system divides, digital innovation and cutting-edge research for an underserved group. We remain at a pilot stage and welcome feedback from collaborators and other stakeholders as we move forward.

Further reading

Farrant O, Eisen S, van Tulleken C, Ward A, Longley N. Why asylum seekers deserve better healthcare, and how we can give it to them BMJ 2022; 376 :n3069 doi:10.1136/bmj.n3069

Contact

Find out more about the Respond service here: https://www.uclh.nhs.uk/our-services/find-service/tropical-and-infectious-diseases/respond-integrated-refugee-health-service

Or email the team via: uclh.respondadmin@nhs.net

 

World Refugee Day is an international day designated by the United Nations to honour refugees around the globe and takes place annually on 20 June. Learn more about HLP’s work to support people experiencing homelessness and other inclusion health groups.


Homeless Health clinical leads update – April 2022

Co-Clinical Leads Dr Jasmin Malik and Dr Caroline Shulman joined HLP’s Homeless Health programme in September 2021. Jasmin and Caroline bring valuable skill sets to their joint leadership role having worked with inclusion health groups in primary care across London for a number of years.

Working within the homeless health network, their combined knowledge, experience and understanding of the homeless population, frontline practitioners and the commissioning landscape, enables Caroline and Jasmin to bring their joint clinical voice into the development of pan-London homeless services.

Jasmin’s background includes being a clinical lead for homelessness and mental health in Camden/NCL since 2017. This role has involved working with commissioners at a local level supporting the development of local homeless services, bringing together local networks of clinicians and frontline staff, and providing training and support to local hostels prior to and during the pandemic.

Caroline is a clinician, researcher and trainer and has led a number of projects in homeless and inclusion health. She was also a clinical lead for a multidisciplinary hospital Pathway team for a number of years. Her projects include highlighting unmet palliative care needs and high levels of frailty within the homeless population, and development of interventions to advocate for – and improve access of – high-quality services. She is also developing training resources for inter-professional learning to support localised communities of practice to better address the needs of people with multiple and complex needs.

Through their joint role for the HLP Homeless Health programme, they are supporting a number of areas and contribute to the Homeless Health Leadership Group and ICS meetings. Their work includes building upon and chairing the Homeless Health Clinical Leads Group which is an open forum for clinicians and other frontline practitioners working in homeless services, ensuring the clinical voice is heard. Members can share experiences, discuss problems and potential solutions – where necessary escalating to commissioners and other appropriate bodies, and learn from regular speakers sharing their expertise.

Jasmin has been working with ICSs to conduct a mapping of homelessness provisions across boroughs, and has convened a new steering group to take forward the Primary Care workstream. Caroline is supporting the out of hospital programme and led rapid surveys capturing a snapshot of COVID cases across London between December 2021-January 2022. She also led a subsequent winter snapshot audit to capture a more in-depth picture of hospital inpatients’ needs, helping to identify difficulties in facilitating timely and safe discharges and any gaps in step-down accommodations. Caroline is currently working on developing a survey with St Mungo’s to explore the unmet needs of people with care and support needs living within homeless hostels.

Caroline and Jasmin are also involved in work addressing the health needs of the most vulnerable rough sleepers in London as part of the T1000 project. They are also bringing their clinical voice into the mental health and substance misuse workstreams, as well as highlighting the needs raised by experts and frontline practitioners regarding other areas of need such as women rough sleepers, homeless children and families, and the transitional years between the ages of 16-25.

 

Click here to read related content from the London Homeless Health Partner April 2022 newsletter.