Planning health services and ensuring compliance with equality legislations

We recommend that a named person leads and acts as co-ordinator and disseminator of information within each area. High quality information systems are required in order to plan and monitor services. The population of asylum seekers is dynamic, with constant changes in circumstances. Information systems to include all asylum seekers, with comparable data in all regions, should be established as part of the initial infrastructure.

When planning services, ensure that refugees have access to a similar range and quality of health services as the local community. If services for asylum seekers are perceived to be better, resentment and hostility may ensue. Every effort should be made to improve resources for the whole community. Services should reflect the standards contained in National Service Frameworks (NSFs) and the NHS Plan.

The Race Relations (Amendment) Act 2000 means NHS organisations are required to take positive action to eliminate discrimination, promote good race relations between communities, promote equality of opportunity and reduce health inequalities. Senior staff members have the responsibility

NHS Single Equality Schemes (SES)

An equality scheme is a plan that outlines a public authority's action over three years, aiming to address aspects of the general duty as outlined in equality legislations. The general duty is a positive duty that builds equality into the beginning of the process of policy-making rather than making adjustments at the end of the process. It represents a change from a legal framework where the onus is on the individual to bring a complaint of discrimination to one where the onus is on the public sector to seek out actual or potential discrimination and address it.

The Government brought together the three statutory equality commissions (Commission for Racial Equality [CRE], Equal Opportunities Commission [EOC] and Disability Rights Commission [DRC]) to create a Commission on Equality and Human Rights that covers all equality strands (sexual orientation, religion and belief, and age in addition to race, gender, disability) and human rights.

The Single Equality Scheme (SES) describes both the commitment and how DH intends to meet the duties placed on it by equality and human rights legislation. The SES is relevant to the functions and operations across DH and its Arms Length Bodies in so far that they refer to the policy environment. It covers the policy process within DH and employment related duties. The SES sets out the Department's public commitment and plan for action across the six equality strands of ethnicity, gender, disability, age, sexual orientation and religion or belief. The SES also incorporates the Human Rights programme. The current scheme covers the period 2009 - 2012 and is aligned with the DH Business Plan for 2009-2011.

There is an underpinning duty placed on NHS organisations to ensure that the experiences of individual patients (as well as larger groups and communities) are positive (the duty of quality), and that the voice of patients has increasing influence in the design and delivery of health and social care services (the duty of patient and public involvement

The Department of Health has published 10 steps to your SES: a guide to developing a Single Equality Scheme a guide to help NHS organisations develop their equality schemes. This and other support is available through the Race equality area of the DH website.

Undertaking Equality Impact Assessments (EQIAs) is a specific legal obligation, and conducting EQIAs and using the evidence to build a meaningful dialogue with communities (especially seldom heard from groups such as refugees) is central to effective commissioning and service provision, aiming to result in an evidence-based approach.

'A stronger local voice: A framework for creating a stronger local voice in the development of health and social care services' sets out Government plans for the future of patient and public involvement in health and social care. These include the establishment of Local Involvement Networks (LINks). On the NHS Choices: LINKs website you can obtain details of your local LINKs by entering your postcode.

Together with local Patient Advice and Liaison Services (PALS) LINks can play a key role in promoting refugee access.

Race for Health is an NHS based programme that works with PCTs and Trusts to drive forward improvements in health for people from black and minority ethnic backgrounds.

Feedback, complaints and compliments

Asylum seekers and refugees should have access to feedback and complaints procedures, including PALS. Information needs to be available in relevant languages, and assistance given to enable people to participate, e.g. through making an interpreter available, translating questionnaires (check that the person is literate) and organising patient groups with interpreters if required.

Many local PALS services have translated leaflets in different languages.

Commissioning services

Health care for asylum seekers and refugees should be commissioned according to local needs, numbers and the capacity of existing services to accommodate requirements.

Services may be provided in mainstream or as dedicated specialist services.

A dedicated service may be able to provide more specialised support, including language support, more time available for appointments and a more comprehensive and specialist multi-disciplinary team, and may be the best solution for those in temporary accommodation, as many are frequently moved. The ultimate aim should be to integrate people, when they are settled, into mainstream services. It should be remembered that the process of settlement may take some time.

Some newly arrived asylum seekers are offered a health assessment at an induction centre. This comprises a nurse-led health assessment, TB screening and a Primary Care Service in the induction centre. People are given a hand-held health record.

The making use of patient held records area of this website has more information in this.

Asylum seekers and refugees should be included, as part of the local community, in district-wide planning, including strategic policies of Trusts and Primary Care Trusts (PCTs), Strategic Health Authorities, Health Improvement and Modernisation Plans (HIMPs) and voluntary organisations.

An example of positive practice

Newham Transitional Primary Care Team is an example of a specialised service. It comprises of a GP, nurse practitioner, practice nurse, health visitor, clinical psychologist, reception staff and a practice manager, provides transitory quality primary care services to people currently unable to register with a GP in their local area. It assesses, treats and monitors health problems, referring to other specialist agencies as necessary. Additional services include an ante-natal clinic, asylum/benefits and housing advice and drugs and alcohol advice and care. People are normally registered between 6 - 18 months. At an appropriate time during this period the team will enable the client to register with a GP locally.

Further reading

Refugees and asylum seekers: A review from an equality and human rights perspective Peter Aspinall and Charles Watters, University of Kent 2010

This report highlights a series of problems involving the support of asylum seekers, and has illustrates some extremely worrying evidence of destitution among asylum seekers in the UK. Some strong human rights concerns are highlighted,

The Health Needs of Asylum seekers (2008) Faculty of Public Health

Delivering Race Equality in mental health care: An action plan for reform inside and outside services and The Government's response to the independent inquiry into the death of David Bennett

Leadership: National Audit Office, Delivering Public Services to a Diverse Society