Identifying needs, barriers and improving access to coordinated care for asylum seekers and refugees (vulnerable migrants). An approach to sustainable improvement

Abstract

Introduction: Vulnerable migrants are arguably one of the most vulnerable groups in society, facing multiple challenges, with complex health needs that are often unrecognised. Health professionals may not have a clear understanding of the rights of vulnerable migrants and may not be aware of their physical and mental health care needs. Materials and methods: Clinicians across three specialties, alongside colleagues from the Health Inclusion Team (HIT) established a working group. With input from Public Health Southwark, we were able collect and analyse community and hospital level data and develop data-driven, targeted interventions. Results and discussion: Between 2019 and 2023 the asylum seeking population in Southwark has increased 20 fold from 100 to over 2,0001•The most common nationalities were Iranian, Eritrean and Iraqi1.•39% were between 18–30 years. 73% were male. 6% were over 45 years old1.•There were 259 children as of September 20221•18% of residents had been there over a year, with an average (ongoing) stay of 154 days (>5 months)1We reviewed presentations to the Emergency Department (ED) from local Initial Accommodation Centres (IACs) between September 2021 and October 2022. 194 (0.19%) out of 102,804 ED attendances were from IACs, of which 87 were under the age of 17. The HIT identified the following needs from data collected between 2018–2022:•High levels of depression and anxiety (57.6%), PTSD (22%), victims of torture (29% disclosed), victims of rape/sexual assault (12% disclosed)•T2DM (14%), hypertension (14%) in a younger population (98% under 65 years old), often poorly managed•Vitamin D deficiency (20–40%), Iron/Folate deficiencies•Latent TB infection (17.1%), Schistosomiasis (4.7%), Strongyloides (5.9%), Hepatitis B (1.2%), Hepatitis C (1.2%)We conducted a survey of 41 health care professionals in our ED. 58.5% didn't know how to recognise vulnerable migrants. 84% did not feel confident in managing vulnerable migrants. 80% didn't know of any organisations to signpost vulnerable migrants. 85% wouldn't feel confident in advising vulnerable migrants on prescription charges and 36.6% incorrectly stated that immigration status is required to register with a GP,In response, we have developed:•Resources for health professionals outlining the needs and rights of vulnerable migrants•Patient information leaflets signposting to local services in multiple languages•Discharge checklist for ED health professionals to ensure appropriate, holistic care has been considered•Embedded training for ED doctors and allied health professionals delivered by HIT•Streamlined referral process between HIT, Respiratory and Infectious Diseases services•A referral proforma for patients referred in to ED from local IACs•Trust representation at the Southwark Borough Asylum Seeker and Refugee Group Conclusion: Vulnerable migrants are often marginalised and already face significant health inequalities. Within our hospital there are significant knowledge gaps and system level challenges in intelligence gathering to better understand secondary care needs of this group, placing them at even greater risk of health inequalities. Alongside quantitative data from across the care system, patient, public and stakeholder engagement is critical to better understand barriers and enablers in order to help address inequalities and improve patient care.