Survival is more essential than health for Croydon’s vulnerable asylum seekers
Healthwatch Croydon, publishes its Refugees and Asylum Seekers: The Health and Wellbeing of those in Croydon report, based on the experiences of over 100 asylum seekers in Croydon of all ages, as well as those working in organisations on the front line.
They have found that the experience of expectant and new mothers and children, who have social protection such as benefits and accommodation, can be very different from that of single adults who do not have such access. Without financial support or work visas, adults can find themselves homeless – desperate to work, but without official documentation, not able to secure legal employment. This places them in a position of vulnerability and risk and many have said they have experienced exploitation, violence, malnutrition and constant tiredness.
While adult asylum seekers do have good access to primary and emergency care services, this is not necessarily their greatest need. Many are preoccupied with survival - getting through the day and night. It is local charities that end up supporting them and this is not sustainable. There is a need for a more integrated approach by Croydon Council, NHS providers and local charities.
- Service accessibility: Children and advocates say there are long waiting times for psychological and emotional support for asylum seekers. Frontline staff say it is virtually impossible to get homeless adults assessed by a psychiatrist, since there is a lack of clarity of whether service exists. Many women would only see female GPs for religious reasons, but there are not enough women GPs available.
- Information and advice: Not all people are aware of the full range of services available and when and how to access them. The Community Mental Health Team (CMHT) has been seldom seen at hostels, and other venues where vulnerable people may be found. Tamil women spoked of anxiety and depression and were not aware that they could get support.
- Language challenges: Children and adults with poor levels of English can feel intimidated at the reception desk and in the consulting room, with a single bad experience being enough to discourage people from returning and seeking future help. People also often struggle to complete application forms and paperwork, with some finding basic questions difficult. There is a lack of awareness of interpreting services, with variable support offered.
- Better support and access: Patients on waiting lists should receive meaningful and timely support from local groups. Refugees and asylum seekers need to access rehabilitation support. Sharing female GPs across relevant surgeries would be beneficial in reducing waiting times.
- Clearer information and advice: Better information is needed on when to self-manage, use NHS111, see a pharmacist or doctor, visit a walk in centre, or attend A&E. Posters and flyers in various formats and languages need to be widely available. CMHT needs to link up with charities to visit and educate groups of vulnerable people, continuing existing good practice of professionals working in partnership with charities. Tamil women need to be signposted to relevant support services.
- Understanding: Particular care should be taken with new and recent arrivals to ensure they are welcomed and understood. Staff should proactively support patients to complete paperwork and signpost to support organisations, where they cannot assist directly. GPs and providers should raise awareness of interpreting support, and do their best to identify, and act on, cases where interpretation is clearly needed.
Jai Jayaraman, Interim Healthwatch Croydon Chief Executive, said “The issues raised in this report overlap on policy areas of welfare, housing and health, however given our remit, we limit our recommendations to health related actions that are achievable in the short term. These include improving information in appropriate languages and formats; developing better customer service for those with low levels of English; and encouraging community mental health providers to work closely with charity partners to spend more time on the most vulnerable. An integrated approach on these solutions between Croydon Council, NHS providers and charities will deliver a better service for those who need it."
Dr Tony Brzezicki, Clinical Chair for NHS Croydon CCG said: "We welcome Healthwatch Croydon’s report and their focus on access to healthcare services for refugees in the borough. As the report highlights, we recognise the value in continuing to work with our partners across Croydon to reach those who are in the greatest need of care. We would also like to take this opportunity to remind local people that to get the best and fastest care they can call NHS 111 which is easy and free to call from landlines and mobiles. Callers can speak to highly-trained advisors with a confidential interpreter service, available in many languages. NHS Croydon CCG also commissions award winning healthcare for those who find themselves homeless, as well as to refugees and asylum seekers, both in the community, and at the Rainbow Health Centre in Thornton Heath."