REFUGEE SERVICES: One PCT has chosen to respond to the needs of its 1,500-plus asylum-seeker population by setting up a special scheme to provide walk-in clinics, home visits and referrals.Kay Ratcliffe reports

Asylum seekers from Kosovo started to arrive in Luton in 1997-98. At that time, there was one health visitor working with homeless clients who took over the care of the 14 Kosovan asylum seekers in the town. The local health trust employed a part-time advocacy worker to support the health visitor.

By the end of 2000 and beginning of 2001, there were 1,550 asylum seekers in Luton.Most were from Kosovo, but others arrived from Somalia, Congo, Zimbabwe, Sri Lanka and Afghanistan.

With funding from the future Luton primary care trust, Luton primary care group employed two Albanian-speaking link workers, one specialist community nurse and one support worker.

Today, there are 1,669 asylum seekers registered with our service and approximately 20 are arriving every month, even though Luton is not a dispersal area for the National Asylum Support Service under current arrangements. These people are coming to Luton to stay with friends and relatives and accepting a subsistence-only package.

The development of the team continues, even though the number of asylum seekers in Luton should not be increasing at its current rate.

The team now consists of:

nurse practitioner and team leader;

advocacy worker;

specialist community nurse;

administrative support;

Albanian link-worker;

health visitor for travellers;

podiatrist for homeless clients;

mental health nurse for homeless clients;

link-worker bank for other languages.

Services

We hold drop-in clinics on Monday and Friday mornings at a community centre in the centre of Luton.We also provide home visits for those unable to attend clinics. The clinics are staffed by community nurses, the advocacy worker, the Albanian link-worker and a support worker.

Clients are referred to us from a variety of agencies, including NASS, social services, other health professionals and the British Red Cross. An appointment letter is sent to each client with a leaflet about our services.

If the client does not attend, we either carry out a home visit or send a pack containing details of our service, an NHS Direct leaflet and an HC1 application form, so they can apply for access to free prescriptions, dental care, eye tests and free travel to hospitals.

We deal with any health issues and offer help with housing, making sure clients get the correct services.

We also provide a tuberculosis screening service.

Each client is given an initial 30-minute health assessment by a community nurse, during which we compile a physical and psychological history.

We see a wide range of conditions, including mental health, HIV, chest infections and foot problems, because many clients have walked miles from their own country.

Some of the asylum seekers have suffered terrible atrocities, but are willing to talk about these issues.

We have had women who have been gang-raped and some who are pregnant as a result.We have seen men who have been tortured and their families victimised.

People talk about the terrible living-conditions they have suffered and not being able to feed their families. Some days can be harrowing, but team members are very supportive of each other.

We employ Albanian link workers and have a linkworker bank for other languages. They assist at health appointments with GPs, hospitals, dentists, opticians, physiotherapists and so on.

We attempt to take clients through the complete process of their appointments. This provides continuity for the client and for health professionals. The link workers also help other health professionals who work with asylum seekers and translate literature for them.

The team has strong links with the health authority department which allocates patients to GPs. This enables us to help clients register with practices.

There are a number of GPs in Luton who are happy to accept asylum seekers, though others try to remove these clients from their list as soon as possible.

The team is happy to advise on education, to visit other agencies and to assist in the education of staff on asylum-seeker matters.

This will enable other agencies to work positively with asylum seekers and help stop the many myths surrounding their stay in this country.

Luton health action zone has made some money available for pregnant asylum seekers who have no other means of receiving help.

The funding is used to buy equipment such as cots and prams.

The team, working with a volunteer, manages the referrals of these expectant mothers and ensures that they have the equipment they need.

In recent months, there have been large numbers of pregnant women coming to Britain who are HIVpositive. They are unable to breastfeed because of the risk to the child, but are not eligible for milk tokens.

They have to provide their babies' milk from their already-meagre food vouchers, although far-reaching changes to this system have recently been announced by home secretary David Blunkett.

Walk-in centre

Luton is soon to have a walk-in centre in the town centre and the team hopes to be based in the same building. This will give asylum seekers easier access to all services.

We are auditing our drop-in clinics to ensure that the service is meeting the needs of clients.

We may make appropriate changes once its results are available.

A member of the team is working on the possibility of clients being able to hold their own notes.Hand-held records are a positive tool for all clients, and for asylum seekers, who have difficulty with language and understanding the systems, this should ensure continuity of care.

Future needs

There is a need for a local counselling service for asylum seekers.A number of clients who come to the UK from war-torn areas are in need of specialised counselling.

At present, we refer them to the Medical Foundation for the Victims of Torture, in London, which provides an excellent service. But the foundation is short of counsellors, and in recent months has had to refer clients back to local services.This creates a problem as referrals have to go through the GP, which is time-consuming.

We need to develop our own local services so that we can provide appropriate and specialised counselling for these clients.

Key points

More than 1,500 asylum seekers have registered with a specialist support scheme set up by a primary care trust.

It is staffed by primary health professionals and holds walk-in clinics two mornings a week.

The scheme helps asylum seekers find GPs and advises on housing problems.

Staff have found some of the work harrowing.

lThe government should make extra provision for pregnant asylum seekers who cannot breast feed because they are HIV-positive.