Published: 27/06/2002, Volume II2, No. 5811 Page 22
When my grandfather came to this country as a refugee from Nazioccupied Vienna, he was declared an 'unfriendly alien' and packed off to a 'reception centre' on the Isle of Man for 'assessment'.
Today's government proposals are not that different; only the terminology has changed. But the reception my grandparents and my mother received was not all bad. The NHS welcomed them.
They eventually registered with a London GP, a German-speaking Jew who not only dealt with their health problems, but also made them feel welcome in a strange and cold country.
What has changed today? If you took your evidence from politicians and media alone, the country is overrun by fake refugees looking for jobs. The reality is, apart from special deals struck by the government for Bosnian refugees, there has been no major increase in the size of the refugee community.
Public services have reacted admirably for the most part to the perceived 'epidemic'. A head teacher from Newcastle said asylum seekers' children added untold riches to the life of their school. A GP welcomed asylum seekers into his practice. But both wanted more resources to help respond effectively to humanitarian emergencies and more intelligence on what works.
While the government and society grapple with the balance between a fortress and humanitarian solutions, public services must have practical, effective answers. First, one solution does not fit all.
Legislation has changed so many times in recent years, services are forced to make up solutions as they go along. Second, new waves of different groups are always arriving - so different solutions are needed for each.
What works best? Much of the best research is not published and many good examples of transitional primary care for refugees have not been evaluated.
Luckily there is a wealth of knowledge, often untapped, from those providing services to black and minority-ethnic communities from whom many refugee groups are drawn. Probably the best guide to refugee health and healthcare is Meeting the Health Needs of Refugees and Asylum Seekers in the UK: an information and resource pack for health workers by Angela Burnett and Yohannis Fassil.
Before dispersal came into being, we commissioned a literature review which showed little evidence to support a dispersal policy.
1It found that refugees and asylum seekers tended to be in reasonably good physical health. Their mental health needs were much greater.
What they needed most from their host country/ community was to understand how things worked, what their entitlements were and how to access services.
Our review said communicable disease risks were not necessarily high among refugees - though children were not always fully immunised and TB remains an issue for some.Yet the only major health scheme on offer at the time at the port of entry was patchy, ineffective TB screening.
We recommended that the Home Office and Department of Health provide a broader 'welcome pack' on service entitlements and how to access them. This measure was not achieved in time, making the work of local authorities and health consortia much harder.
Important, too, has been our continuing inability to count refugees and asylum seekers and their distribution for planning purposes. The new census offers an opportunity to develop better methods of doing this. The portentry TB screening scheme should be dropped and the resources used properly as a generic rather than TB-specific service. It could be transformed into a notification system for primary care trusts and local authorities to help plan for the size, language and cultural needs of refugees more effectively.
The government must develop models of healthcare - whether for the new 'accommodation centres' or for varying clusters of refugees needing housing, schools and healthcare.
Extra resources need to be allocated to public services for minority ethnic communities with changing language needs.
The negotiation of the new GP contract pricing is a chance to recognise the extra costs that practices with highly mobile patients incur. If the PCT resource allocation formula can build in a better weighting for population mobility and language need, some of the needs of our most excluded communities can be met in primary care. The rest will depend on good primary care leadership and local authority practice.
1Aldous J, Bardsley M, et al. Refugee Health in London. Key Issues for Public Health. Health of Londoners Project, June 1999.
Dr Bobbie Jacobson is public health director, East London and the City health authority.