Migrant Health: Rapid Needs Assessment
Due to the sensitivity of the information in this JSNA chapter, the full needs assessment is not published publicly. If you would like to make a request to view this chapter, please email firstname.lastname@example.org.
The below document is the executive summary which provides an overview of the key findings and recommendations for the Surrey system.
This chapter was published in May 2023.
- Aims and objectives
- What’s working well
- Key findings
- Key sources of information
A word from our sponsors Trudy Mills, Michael Coughlin, and Elaine Newton:
“Asylum seekers and refugees can show great resilience despite their experiences and the adversity they face. We know that many have significant vulnerabilities in terms of poor health and the risk of, or experience of, all forms of abuse and exploitation. Surrey system partners remain committed to supporting these groups to see improvements and addressing the significant vulnerabilities.
The report was requested by system partners following a workshop looking at what had gone well over the last 18 months and how could we do better to support the individuals and families seeking asylum. An incredible amount of work has already been undertaken and teams responding across the system in local councils, primary care, community health, safeguarding, emergency planning and VCSE organisations. This report provides a snapshot of the current provision of services in place across six key topic areas (primary care, women and child health, mental health, education, housing, community integration) in Surrey and identifies the challenges, and gaps and recommends actions. This will help us bring the system intelligence together to develop a local action plan for improvements.
Many thanks are due to the Public Health team in Surrey County Council for leading on developing this report with the support of system partners, focusing on local findings and recommendations in relation to the health, wellbeing and safeguarding needs of vulnerable migrants.”
Lead author: Qanita Vora, Public Health Programme lead, Public Health, SCC.
Contributing authors: Ella Turner, Research Officer, BIA Research, SCC. Louis Hall, Public Health Registrar, Public Health, SCC. Charlène Carayol, Public Health Analyst, PHITT, SCC. Conor Wooley, Public Health Analyst, Public Health Analytics, SCC.
Research engagement group: Qanita Vora, Rheanna Mitchell, Conor Wooley, Olusegun Awolaran, Victoria Buckroyd, Ella Turner, Silvia Molino, Rich Stockley.
Migrant Health Phase 1 JSNA Delivery group: Qanita Vora, Louis Hall, Ella Turner, Charlène Carayol, Lena Adbu, Ashley Field, Elaine Newton, Phil Anderson, Lisa Andrews, Victoria Buckroyd, Justine Chatfield, Lisa Gavin, Sarah Goodman, Saba Hussain, Rheanna Mitchell, Helen Milton, Helen Raison, Helen Snelling, Katherine Saunders, Rich Stockley, Silvia Molino, Caroline Upton, Robert Verchaai.
Supervisors: Lisa Andrews, Helen Raison.
With special thanks to our sponsors:
- Michael Coughlin, Executive Director, Partnerships, Prosperity and Growth, Surrey County Council, through the Surrey Wider Immigration Group.
- Trudy Mills, Executive Director for Children’s Community Services, Surrey & Borders Partnership NHS foundation Trust, through the Surrey Wider Immigration Group.
Elaine Newton, Director of System Improvement and Assurance, Surrey Heartlands Integrated Care Board.
Aims and Objectives
This Rapid Needs Assessment (RNA) aims to inform commissioners and stakeholders of the current provision of services in place across six priority areas in in Surrey. These priority areas include mental health, primary care, maternity and child health, education, housing, and community integration.
This RNA aims to identify the needs of this population group and better understand any key challenges and gaps in the current response. This RNA recommends priority actions for immediate response and has been produced with a view to informing a strategic approach to health improvement.
This RNA focuses on asylum seekers and refugees currently residing in:
- Bridging hotels – Accommodation for Afghan Relocations and Assistance Policy (ARAP) and Afghan Citizens Resettlement Scheme (ACRS) scheme.
- Private homes – Homes for Ukraine Scheme and Ukraine Family Scheme.
- Initial Accommodation hotels (IA) and Overflow Dispersal Accommodation (ODA) – Accommodation for asylum seekers arrived via irregular migration routes.
A mixed methods approach to data collection was adopted and consisted of:
- A systematic review of the relevant advice, guidance, and policies.
- A review of publicly available data on migrants and health in the UK.
- A review of the data submitted by key stakeholders on the health of migrants in Surrey.
- A review of local reports from stakeholders on migrants in Surrey.
- Semi-structured interviews with 23 professionals to discuss their experience as a service provider or commissioner of services for asylum seekers and refugees.
- Qualitative surveys on service user experience with 9 frontline staff.
- A service mapping exercise with key stakeholders.
What’s working well
- Consistent initial health assessments across Surrey
- Surrey Heartlands Asylum and Afghan refugee GP resource pack
- ABC on-site service delivery model of primary care
- Community resources and support from voluntary organisations
- Development of trusted relationships between providers and these population groups
- Cultural awareness and consideration
Women and Child Health
- Surrey community outreach model
- Happy Baby community
- Understanding the needs of the population
- Joint working with nurseries, hotels, and family centres
- Race Equality and Minority Achievement (REMA) services
- Termly Network Training
- Basic needs i.e., food and safe shelter provided
- Ukrainians residing in sponsors homes happy with accommodation
- Sense of community spirit
- Partnership framework to support social integration
- Funded transport for Ukraine population group
- Leadership role of a community project manager in supporting the Ukraine population group
- Agile, flexible, local partner response
- Outbreak management
- Unprecedented demand managed well, especially during COVID-19 pressures
Asylum seekers and refugees are an extremely vulnerable group with very different needs compared to the rest of the UK population. Services designed for the general population do not currently sufficiently meet the needs of this group due to a variety of factors such as:
- Differing specific health needs i.e., communicable disease screening, complex chronic diseases
- Complex nature of pre-migratory experiences i.e., conflict, war, famine
- Difference in presentation and awareness of mental health conditions
- Cultural differences i.e., perceptions of care, contraception
Every public service is designed under the assumption that the service user can speak English. Therefore, those that can’t are automatically disadvantaged. Other challenges identified were the lack of available translated resources to support service users, and the limited pool of interpreters which results in difficulties in access. The mitigations currently in place to support who do not speak English is limited.
As would be the case for anyone entering a new country, asylum seekers and refugees have very little understanding of how public services work and how to access them. There is also an added complexity where they are unsure what they are entitled to. Consequently, there is a lower uptake of some of these services (healthcare, education, housing) compared to what would be expected based on need.
A frustration for many people working in migrant health is the scarcity of intelligence to inform decision making.
This Rapid Needs Assessment highlighted some gaps in occupational mental health provision for frontline staff working with this population group. Frontline staff are at risk of experiencing vicarious trauma and occupational mental health and wellbeing support is a vital resource for staff working with vulnerable population groups with complex needs and funding for this area should be prioritised. Examples of support that is working well and could be replicated are an occupational mental health support hub, peer to peer support, and information packs.
It was identified that not all staff working with vulnerable population groups have access to the relevant training. Training such as Trauma Informed Care (including TIC for asylum seekers and refugees) and Mental Health First Aid should be accessible to all staff, with hours dedicated to training allocated as part of their role.
Short-term contracts of some service providers were a particular challenge for those working in primary care and hinder staff from carrying out training as part of their contracted hours.
The remote location of a lot of the temporary accommodations, affordability, and lack of transport links were highlighted as a challenge experienced by service users. This is having a significant impact on service users being able to access local amenities, health appointments, education settings, employment, and community integration activities.
Equity in support and provision to aid community integration was identified as gap in this population group. However, this report has not just identified inequalities between migrants and UK nationals but also between migrant groups depending on the scheme they have arrived on. Some people receive timely English language lessons, some do not. Some people receive a free bus pass, some do not. Some people receive an NHS number, some do not. These inequalities are systemic, unfair and most importantly, avoidable. There are pockets of excellence where the system works well to support the local migrant population. The next step is to embed this work across the whole of Surrey by working together so this becomes the norm.
RNA findings have identified that challenges and gaps that the local system faces are not specific to Surrey, and moreover, some are not within the gift of the local system to resolve, especially due to financial and resource constraints. Therefore, there is an urgent need to strengthen national leadership pathways where local systems can escalate immigration, funding, housing, data and communication challenges and have leadership groups that review and address these challenges that can support local system partners to address the needs of this vulnerable population group in an equitable and agile manner.
Many of the challenges identified in this report are driven by a lack of finances. In the absence of increased funds, consideration is needed around how best to make use of the resource that is available to the system.
- Continuation of targeted services to support the specific needs of asylum seekers and refugees in temporary accommodations. This includes the strengthening of some targeted services where gaps where identified, such as dental care, infectious diseases screening pathways, and care for those with complex mental health needs.
- Review and consolidate funding, making necessary changes to the funding allocation process in order to maximise and ensure best use of a limited resource.
- Ensure service users have adequate means of understanding and communicating with the system and their community.
- Raise service user and service provider awareness and understanding of public services, including how to access them and what they are entitled to.
- Strengthen data insights and intelligence around migrant health.
- Ensure frontline staff working with this population group have access to occupational mental health and wellbeing support.
- Upskill staff engaging with this population group – from interpreters and healthcare providers, to housing and police – to improve awareness and recognition of factors specific to this population.
- Raise awareness and understanding of cultural differences between service users, providers, commissioners, and communities.
- Identify strategic solutions to transport challenges experienced by all service users.
- Strengthen local partnership working.
- Improve equity and equality in access to public services.
- Strengthen national leadership.
Key sources of information
The following sources of publicly available information were used to inform and support the Migrant Health Rapid Needs Assessment:
- Office for Health Improvement and Disparities (OHID) advice and guidance on the health needs of migrant patients for healthcare practitioners Migrant health guide – GOV.UK (www.gov.uk)
- UK Visas and immigration operational guidance on refugees, asylum, and human rights Visas and immigration operational guidance: detailed information – GOV.UK (www.gov.uk)
- The Migration Observatory asylum and refugee resettlement in the UK The Migration Observatory (ox.ac.uk)
- UNHCR The UN Refugee Agency asylum in the UK UNHCR – Asylum in the UK
- Home Office statistics on migration and border control from Home Office administrative systems Migration statistics – GOV.UK (www.gov.uk)
- Home Office How many people do we grant protection to? – GOV.UK (www.gov.uk)
- Home Office asylum and resettlement datasets Asylum and resettlement datasets – GOV.UK (www.gov.uk)
- Home Office statistics on Ukrainians in the UK Statistics on Ukrainians in the UK – GOV.UK (www.gov.uk)
- Homes for Ukraine in Surrey dashboard about the Homes for Ukraine Scheme in Surrey Homes for Ukraine in Surrey | Surrey-i (surreyi.gov.uk)
- Home Office management information on homelessness duties owed to Ukrainian nationals – for England, by lower tier local authorityHomelessness management information – Ukrainian nationals: England – GOV.UK (www.gov.uk)
- Home Office statistics on irregular migration to the UK, including small boats Irregular migration to the UK, year ending September 2022 – GOV.UK (www.gov.uk)