From OUTside to INvolvement

Dr Kate WarrenRegistrar in public health

NHS Walsall

From OUTside to INvolvement

• Partners in the project:- WELCOME - WRASSA - WARMA - Citizens Advice Bureau- NHS Walsall - Walsall Council

• Funded by Government Office West Midlands: Migration Impacts Fund

• Aim – Reduce the impact of migration on health and other public services in Walsall

New migrants – who are they?

• Asylum seekers including unaccompanied children

• Refugees• Refused asylum seekers• Economic Migrants

– European– Others via Points based system

• Family reunion• Overseas students• Undocumented migrants

The scale of migration in Walsall

• Numbers doubled after expansion of the EU to over 1200 new migrants per year

• Majority from South Asia and Eastern Europe• Over 100 asylum seekers housed by the Border

Agency• Unknown numbers of refugees• Unknown numbers of undocumented migrants• Small numbers of Looked After Children

National Insurance Number Applications from overseas nationals, Walsall

Issues for Walsall

• Variation (policy, economy, housing capacity)

• Not a “critical mass” for specialist services such as Birmingham/Coventry– Reliance on voluntary sector and short term

projects

• Services require extra time and resources

• Mobility of migrants – continuity of care

• Tight geographical spread

• Holistic/social approach to health needed

Commissioned activity

• Certification for volunteers to provide advice• Drop-in / phone-in: information for clients• Arts and social events as engagement tools• Recruitment to local involvement channels• Training and collaboration with services• Regional networking• Translated resources produced and shared

(Welcome to the West Midlands website)

Health

Primary care

• Access to General Practice

• Appropriate use of services – Choose Well

• Translation tools / interpreters

• Awareness of staff – cultural norms, entitlements to healthcare

Health

Maternal and child health

• Identification and appropriate care for migrant women with specific problems e.g. Female Genital Mutilation

• Integration of NICE guidance and pathway for vulnerable women in service specification for midwifery

• Child protection awareness

Health

Mental Health• Pre-migration factors

– War, torture, rape, persecution

• Post-migration factors– Poverty, poor housing, social isolation, immigration

processes, language barrier

• Cultural perceptions of mental health• Awareness of specialist area in MH services• Creative writing workshops resulting in a

published booklet

Health

Health protection

• Blood borne viruses – HIV, Hepatitis– Encouraging testing

• Tuberculosis– Symptom awareness

• Sex workers– South Area Partnership

Social determinants of health and other issues

• Housing

• Poverty – benefits

• Crime/safety

• Employment

• Education/training including ESOL

• Social isolation

• Community cohesion

What Now?

• Importance of retaining specialist knowledge and momentum

• Capacity building in voluntary sector

• Embedding lessons learnt into commissioning processes

• Elements of service delivered by different agencies

• Changes in Public Health- can this help?

• Questions and suggestions