ITEM 5 Health Care Resettlement Jan 25 (002)
North Lanarkshire Council · 25 February 2025
Back to IJB Performance, Finance and Audit Committee — 25 February 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 5 SUBJECT: Health Care Resettlement for asylum seekers and refugees across Lanarkshire. TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Maggs Thomson, Head of Health Author(s) of Report Sharon Simpson, Health and Social Work Manager Susan Lyttle, Health Improvement Manager (Asylum Seekers & Refugees) DATE: 13 January 2025 This paper is coming to the IJB PFA for: For approval ☐ For endorsement ☐ To note ☒ The purpose of the report is to provide an overview on the arrivals of refugees, asylum seekers and unaccompanied asylum seeking children to Lanarkshire. This report will also provide an update on the work of the resettlement programme. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Sharon Simpson, Health and Social Work Manager and Susan Lyttle, Health Improvement Manager (Asylum Seekers & Refugees), NHS Lanarkshire. 3. RECOMMENDATIONS It is recommended that the IJB PFA: acknowledge the contents of report. Future reports can be provided.
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The UK Government has made a commitment to resettle refugees from various countries since 2015. From 2015 until 2019, approximately 300 Syrian refugees were settled in Lanarkshire. The Scottish Government (SG) in conjunction with COSLA has also made a commitment to support Unaccompanied Asylum seeking Children (UASC) with approximately 5-6 arrivals per month in Lanarkshire. In spring 2020, the ‘UK Resettlement Scheme’ (UKRS) was established in response to the ongoing refugee crisis across the globe and a number of refugees continue to arrive in Lanarkshire from Syria and other countries such as Sudan, Iraq, Palestine and Afghanistan. The Afghan Relocations and Assistance Policy (ARAP) was launched in 2021, reflecting the changing situation in Afghanistan with Lanarkshire continuing to see a number of arrivals via the ARAP programme. Mears Group are the company who have been awarded government contracts to provide accommodation and support to asylum seekers. In December 2021 the Home Office and Mears Group established an emergency contingency accommodation for single male asylum seekers at a hotel in East Kilbride with a capacity of 93 residents. As part of the widening Asylum Dispersal Strategy, Lanarkshire is now starting to receive small numbers of families into dispersal accommodation that have been procured and supported by Mears Group. In response to the crisis in Ukraine, the SG and COSLA agreed to support Ukrainian people coming to live with relatives and friends, via the Homes for Ukraine scheme or The Scotland Super Sponsor scheme. The number of arrivals was much higher than anticipated with a requirement for the use of 6 hotels across Lanarkshire to support the increasing numbers of arrivals. None of the hotels are used now as people have moved on to their own accommodation. Approximately 2000 Ukrainian people have resettled in Lanarkshire. The Healthcare Resettlement team was established in October 2022 to provide assistance and support to refugees and asylum seekers in accessing healthcare services upon their arrival into interim hotel accommodation across Lanarkshire. Alongside this a Health Improvement Manager post was secured to conduct a population health needs assessment and to help build capacity in the Third Sector to support the resettlement of asylum seekers and refugees. The healthcare team was an initial response to the Ukraine crisis however the team has not been functioning since December 2023. The significant decline in the numbers of Ukrainian arrivals and the closure of hotels has meant the workload Yes ☒ No ☐ N/A ☐
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3 decreased substantially and currently there is no ongoing requirement to provide clinical triage or health needs assessment to the Ukraine population. Work is ongoing to further define and refine the service model to assure that appropriate levels of assessment and response are delivered timeously and to level appropriate to need. This is in the context of a demand profile that is variable with unpredictable complexity. To date there has been little research to understand the challenges faced in accessing healthcare or how healthcare experiences affect the health and wellbeing of asylum seekers, refugees and displaced persons in Scotland or indeed in the UK. A population health needs assessment (PHNA) for these populations was undertaken to ensure that their health needs are addressed and health inequalities are reduced. This report will provide a summary of the refugee and asylum arrivals to hotel accommodation, the settled population and recommissioned properties. It will also provide a summary of work completed to support resettled populations and ongoing work of the Health Improvement Manager for Health and Wellbeing of Asylum Seekers and Refugees. 5.1 Health Care Resettlement The purpose of the Oversight Group and the Resettlement Operational Groups is to provide forums to ensure a planned and strategic approach to the delivery of healthcare and wellbeing for displaced people, refugees and asylum seekers, settling in Lanarkshire. The Oversight Group provides a platform for the planning, the financial and professional governance and accountability of the care and support being delivered, and ensures reporting of performance and key outcomes to the relevant forums and structures. The Resettlement Operational Group oversees the resettlement process for individuals requiring health care services. The group works collaboratively to ensure the efficient and effective resettlement of clients, enabling them to access health care services as and when required until they are fully integrated in to localities and can access universal services. The interim Health Care Resettlement team haven’t been in post since December 2023. Pathways have been developed for direct referrals to services including Midwifery Services, Mental Health, Sexual Health, Public Health, Mears and the wider Vaccination Service. Standard Operating Procedures have been compiled to support the administration of vaccinations to the asylum population within their current accommodation. A resettlement health care repository has been set up on a shared drive to ensure knowledge, information, processes and protocols are accessible. A resettlement email has also been developed to share and transfer information with colleagues and partners. One WTE Health Improvement Manager is currently in post until March 2025 and conducted a training needs assessment of health care staff and a population health
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4 needs assessment of asylum and refugee populations resettling in Lanarkshire to inform planning for future support. Connections have been made across all NHS services to improve their understanding of the health needs of refugees and asylum seekers and the rights and entitlements of them to access health services. Information for staff on supporting the healthcare and wellbeing of asylum seekers and refugees living in Lanarkshire has been created and is now available on a landing page on the NHSL intranet, FirstPort. The development of information for the public to access is also planned. 5.2 Recommissioned properties At present there are circa 2000 people from Ukraine now settled in Lanarkshire within recommissioned properties, private arrangements and hosting arrangements. There have been a number of properties recommissioned across Lanarkshire to support Ukrainian refugees: Birkshaw Tower in Wishaw has 53 properties occupied with 116 people in total residing there, consisting of 78 adults and 38 children. High Coats in Coatbridge has 142 properties occupied at this time with 306 residents consisting of 216 adults and 90 children. Barrack Street accommodation has 109 adult residents at this time. 5.3 Asylum population Currently the Bruce Hotel in East Kilbride is hosting 87 male residents. All new arrivals to the hotel have been offered a health needs assessment specifically developed for the asylum population. These assessments have helped identify any immediate health concerns or underlying medical conditions. Vaccination history has been sought and those with outstanding vaccinations that have consented are being immunised by the team and connections have been made with the wider vaccination service moving forward. Networks of support have been set up and the Health Protection team have offered and carried out TB screening to many of the residents. 5.4 Unaccompanied Asylum Seeking Children Lanarkshire has been supporting young people arriving under the revised National Transfer Scheme for Unaccompanied Asylum Seeking Children (UASC). Demographics of arrivals have been mainly boys aged 16-17yrs with a small number of 15 year olds. The health needs of this population are predominantly supported by the Through Care and School Nursing service. All of these young people are residing with foster placements, children’s houses or supported accommodation. 5.4.1 North Lanarkshire Within North Lanarkshire, 51 young people have been supported, 47 males and 4 females. Main countries of origin are Afghanistan, Sudan, Eritrea, Vietnam with a few others from Albania, Egypt, Iraq and Iran.
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5 5.4.2 South Lanarkshire Fifty-seven UASC have been supported in South Lanarkshire with currently 52 young people still residing and eligible for support, comprising 3 females and 49 males. Six of these young people are in residential or foster care and a further 12 are being supported in the community whilst they await the outcome of their claim for asylum. Countries of origin include Iran, Vietnam, Iraq, Syria and Afghanistan. 5.5.1 Resettlement Health Care & Wellbeing Improvement Plan 2023-2024 A Resettlement Healthcare & Wellbeing improvement plan is currently being updated. The main high level outcomes of this plan are: 1. Staff and service providers have a sound knowledge and understanding of the rights and health and wellbeing needs of New Scots settling in NHS Lanarkshire area. 2. Appropriate and timely health & social care services and wider wellbeing services, that are sensitive to the needs of New Scots settling in Lanarkshire are established. 3. All staff have access to up to date information regarding resettled populations, access to translation & interpreting services as well as to technology & equipment that supports the delivery of services for resettled populations. 4. New Scots are thriving and are integrated into their local community & able to access health & wellbeing services and supports. 5.6.1 Support - Strategic & Operational Groups & Third Sector Involvement A Lanarkshire Resettlement Healthcare and Wellbeing Oversight group and an Operational Group are fully established and the Oversight Group has ratified the current improvement Plan. A Lanarkshire New Scots Integration Network has been established to bring together community and voluntary, and statutory partners to increase the level of support available to New Scots in Lanarkshire. The network aims to mobilise and co-ordinate community assets to address their needs and to support their integration. Scottish policy guidance and standards on NHS interpretation support have been developed in a bid to help NHS Scotland staff to understand the support available for their patients who do not speak or use English and to help ensure they have equitable access to health services. Public Health Scotland have produced a Competency Framework for Interpreting (2020) and locally NHS Lanarkshire has developed their own guidance on the use of interpreters in their Communication Support for Spoken Language, British Sign Language and Interpreting Policy (2022). The national Resettled Populations Health and Wellbeing Group (Refugees, Asylum Seekers, Displaced People) is chaired by Public Health Scotland. The aim of the
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6 group is to share good practice, resources and foster joint work in relation to the health needs, access to services and to the resettlement and integration of ASRs. It also provides a forum for Scotland wide staff to work together to update on and respond to national or local policy developments in healthcare and health improvement of these target populations. An Equality Impact Assessment (EQIA) has been completed for the Resettlement Healthcare & Wellbeing Programme. Work to date has focused on addressing the immediate and longer term health needs of those ethnic minority groups who have recently resettled in Lanarkshire. 5.6.2 Training Needs Assessment A training needs assessment (TNA) has been carried out with NHS Lanarkshire staff most likely to come into contact with asylum seekers and refugees as part of their healthcare role. The TNA aimed to identify areas where staff may require further training and knowledge to identify areas where staff may require further training and knowledge to improve the provision of good quality and equitable health care delivery to refugees and asylum seekers resettling in Lanarkshire. The results of the TNA will inform the development of any recommendations on how best to support healthcare staff to provide high quality care for these populations. 5.6.3 Population Health Needs Assessment A Population Health Needs Assessment (PHNA) was undertaken. To date there has been little research to understand the challenges faced in accessing healthcare or how health care experiences effect the health and wellbeing of asylum seekers and refugees in Scotland or indeed in the UK. The undertaking of a health needs assessment on these populations will help ensure that their health needs are addressed, reduce health inequalities but also support future planning and integration to local health care systems. The PHNA aimed to find out the following: • What do people asylum seekers and refugees (ASRs) know about health services in Lanarkshire? • What factors promote and what factors inhibit people’s access and use of health services? • What is the availability of routinely collected health data on these populations? Findings The review of the evidence base highlighted that ASRs can face multiple challenges with their basic needs and rights not always being met. The stress of travelling to seek asylum, unemployment, poor living conditions, living in fear of deportation and being subjected to racial discrimination can have a profound and detrimental effect on their mental health and wellbeing.
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7 The 2021 census was delayed and had not been published when the PHNA was completed. The PHNA highlighted that there is no single source of data that is able to provide an accurate estimate of the number of people from various countries seeking refuge in Scotland and the ever changing picture of immigration makes it difficult to anticipate the demand or need for service provision. Now that the 2021 census data is available, the results will be reviewed to assess if this has any impact on the results. The results from the PHNA, mirrors the main findings of the review of the literature. Challenges include: language and communication barriers, some lack of understanding on how to navigate our healthcare systems, different expectations of healthcare provision, a need for increased awareness of the ASR population’s rights and some difficulties accessing and using interpreters. It was highlighted that there are clear distinctions between the refugee and asylum seeker populations as well as the various sub groups within each - the refugee population is much larger but with less severe health issues and the asylum seeker population is much smaller but with more complex health issues. This study also identified a need to involve service users in health service design as well as the need for culturally-sensitive services and healthcare staff trained in culturally sensitive and trauma informed practice to provide good quality care and onward signposting for these populations. 6. Conclusions The programme of work is ever changing and necessitates partnership and multidisciplinary working to ensure connectivity to support the transition and integration into main stream services. The work has had a profound impact on improving health outcomes and overall wellbeing of asylum seekers and refugees. A partnership approach has ensured that that the settling populations can easily access healthcare services, resulting in timely diagnosis, treatment and improved health outcomes. Through the support of the Health Improvement Manager, the wider team have empowered asylum seekers and refugees with the essential knowledge and skills to maintain and improve health, prevent ill health and navigate the health care system independently. The arrival of Ukrainian refugees to Lanarkshire has greatly decreased such that there are no hotels in Lanarkshire required to provide temporary accommodation. Additionally, there is currently one hotel hosting asylum seeking males. As part of the Widening Asylum Dispersal Strategy, Lanarkshire is now seeing people seeking asylum moving in to dispersal accommodation. At this time numbers have been low however it is difficult to estimate these numbers. The Mears Housing Group procure accommodation for asylum seekers and the local authority resettlement teams will notify health of any new arrivals in to the area. The Mears Welfare Officers will support GP registrations as directed. Those male asylum seekers residing in the hotel accommodation are supported by one GP Practice as a Local Enhanced Service (LES) agreement.
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8 The numbers of people seeking asylum and refugees coming to and settling in Lanarkshire will continue to increase. By working together, we can ensure that refugees and asylum seekers in Lanarkshire have access to the health care services they require to live healthy, fulfilling lives and integrate into our community effectively. 7. Implications Workforce – A Service Manager in North and South have been identified and agreed to oversee any future programmes of work and will attend single and multiagency meetings that are currently in place. All relevant information, processes and pathways have been developed and accessible on the resettlement shared drive and regular meetings have been established to facilitate a seamless transfer of information and responsibilities. Currently there are no new arrivals of Ukrainians to interim hotel accommodation therefore no clinical triage will be required however if there were to be a large number of new refugee or asylum populations arriving in Lanarkshire this would have an impact on universal services. Standard Operating Procedures and pathways have been developed to support this until any new arrivals are fully integrated into mainstream health services. The situation is changing regularly regarding arrivals, therefore this report sets out what is known to date. There is no ongoing funding and/or an indication of a predictable volume / flow of people coming to Lanarkshire that would indicate the need for a discrete Resettlement Team. Moving forward the model being proposed is one that creates a sustainable approach and ensures that we can react At this time the model needs to be finalised and signed off and an implementation plan developed that will identify process, staff and training. The current infrastructure of the Strategic and Operational Resettlement Healthcare Groups will be the vehicle to support the change in model. 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☐
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9 People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) Resettlement Healthcare & Wellbeing Improvement Plan 2025-2026 incorporates measures for each action. 7.3 FINANCIAL All refugees and asylum seekers have a right to health care. Funding for health can be accessed for refugees coming via the UKRS. This is funding that can be drawn down by NHSL from the Home Office to cover primary and secondary care costs, in the initial year up to £2,600 per person. Unfortunately, there is no additional funds that health can access to cover the costs of the Ukrainian refugees, asylum seekers or UASC. The Health Care Health Improvement staff and the Health Care Resettlement team was established on a temporary basis from the reserves drawn down from this funding. Funding may be required for public health screening. A refreshed LES agreement was being developed and accepted by the GPs, which has provided them with a payment for each person registered with their practice paid from this current fund. This LES agreement has been agreed until the 31st of March 2025. All refugees have access to public funds, the UASC have become the responsibility of and are cared for by the Local Authority. The asylum population residing in initial hotel accommodation are supported by Mears with accommodation and meals provided however they have no recourse to public funds and those families living and arriving in dispersal properties do not have any recourse to public funds. The details of the proposed capacity have been agreed and approved by Finance. Appendix 2. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Stakeholders have been consulted and involved through the development of the Health Care Resettlement oversight and operational groups. Multiagency groups are currently in place across both local authorities. A community and third sector Yes ☒ No ☐ N/A ☐
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10 conference took place in June 2023 and as a result a Lanarkshire New Scots Integration Network has been established to bring together community and voluntary, and statutory partners to increase the level of support available to New Scots in Lanarkshire. A training needs assessment has been carried out with NHS Lanarkshire staff most likely to come into contact with asylum seekers and refugees as part of their healthcare role aimed to identify areas where staff may require further training and knowledge. A Population Health Needs Assessment was undertaken and will inform service delivery for resettled populations. Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed. Appendix 3
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11 EQIA added to website: 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Sharon Simpson Health and Social Work Manager Sharon.Simpson@lanarkshire.scot.nhs.uk Yes ☒ No ☐ N/A ☐ Yes / Date added ☒ No ☐ N/A ☐
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12 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed