Matter for discussion, submitted by the RCN Grampian Branch
That this meeting of Congress discusses the health care provision for asylum seekers and refugees throughout the UK.
At the end of 2014 there were just over 117,000 refugees in the UK and about 36,400 asylum seekers, equating to 0.24% of the population. Under separate regulations in England, Scotland, Wales and Northern Ireland, refugees (those granted asylum, humanitarian protection or temporary protection by the UK) and asylum seekers (those applying for asylum, humanitarian protection or temporary protection whose claims, including appeals, have not yet been determined) are exempt from charges for NHS services.
According to a joint report by See Me, the Mental Health Foundation and the Scottish Refugee Council (SRC), around 10% of asylum seekers in the UK are dispersed to Scotland while awaiting the outcome of their applications. Overall, the SRC estimates that there are 20,000 refugees and asylum seekers living in Scotland. The provision of health care to asylum seekers is devolved to Scotland and the New Scot policy focuses on integration in Scotland. In contrast to other parts of the UK, the Scottish Government has a policy of providing support “on the same basis as a UK national who is ordinarily resident in Scotland”.
In Northern Ireland, new regulations governing access to health care for migrants were introduced in 2015. Asylum seekers and refugees are now not required to pay for primary or secondary care and are also entitled to register with a GP. The new regulations extended the range of treatments that must always be provided free, to include treatment for AIDS and HIV. They also withdrew any distinction in entitlement to free health care between pending asylum seekers and those who have been refused asylum.
The Welsh Government has set out its commitment to supporting and enabling refugees and asylum seekers coming to Wales to rebuild their lives and make a full contribution to society. The Refugee and Asylum Seeker Delivery Plan was launched in March 2016.
Comparative research from English-speaking countries and work by the Faculty of Public Health have highlighted some of the common challenges faced by refugees in receiving treatment, such as lack of understanding of the system and language barriers. Refugees and asylum seekers may also have particular health needs due to traumatic experiences in their home country, time spent in refugee camps, the impact of their journey to the UK, loss of family and friends, poverty and isolation.
Women and girl refugees who have undergone, or are at risk of undergoing, female genital mutilation (FGM) are a particularly vulnerable group. The health consequences are significant, and nurses and or midwives need to be vigilant and know what action to take should they suspect that someone has been affected. The RCN provides information and resources on this issue.
A joint report from the Refugee Council and Maternity Action has also highlighted the particular vulnerability of pregnant and new mothers who have been dispersed or relocated to different parts of the UK while pregnant and seeking asylum. The report shows that dispersal had an extremely adverse effect on their mental health.
Given the UK’s diverse population and the growing complexity of charging arrangements for different migrant groups across the UK, it is essential that frontline health staff are aware of refugees’ and asylum seekers’ entitlements and particular health needs. Barriers to access must be addressed, including access to appropriate interpreting services.
“It takes so little to give someone hope”, said Philomene Uwamaliya, a mental health lecturer, herself a refugee from Rwanda.
Many delegates spoke personally at Congress in this matter for discussion.
Fraser Scott, proposer, gave us insight into how difficult it is to assess and treat someone who speaks no English, is terrified and there’s no interpreter or clinical history available immediately. He explained how people seeking asylum might react differently from our expectations and our own assumptions can influence how we work with them.
Samantha Spence spoke personally about how the system let down an asylum seeker who was a new mother with a premature baby and was struggling to breastfeed. She was moved mid-care to another part of the UK and ended up in A&E when her baby had a reaction to the infant formula she’d been given.
Ed Freshwater a mental health nurse echoed the problem of asylum seekers being moved just as he’d begun to treat them. He called for a period of stability for those engaged in health care services.
Another delegate, Jess Morehouse, shared her experiences of working in Oxford with a group who give food and care and help to asylum seekers and refugees. She spoke of this hidden population who are almost invisible to the majority of the UK population. She said it’s not just about providing much needed services, but also about changing the face of compassionate care.
Nurses are well placed to provide culturally sensitive care, we excel as compassionate people, said Roger Cowell.