What are the key inequalities?

Asylum seekers and refugees have different entitlements to support dependent upon their legal status - summarised in Table 2 (taken from North East Public Health Observatory 2008[i]). Failed asylum seekers who are not entitled to support under section 4 are in the worst position

Table 2 - Refugee and asylum seekers entitlements

Some refugees and asylum seekers may not have good English skills and therefore find public services difficult to access. A number of voluntary and public agencies in Newcastle are working with limited funds to address this by providing advice and/or interpreting services. In addition, from 2007/2008, the government placed restrictions on the provision of free ESOL (English for Speakers of Other Languages) classes to asylum seekers. Adult asylum seekers are no longer eligible for free ESOL tuition unless they have waited in excess of six months for their claim to be decided.

Discrimination and abuse can be a problem for refugees and asylum seekers regardless of their legal status. This is something the local strategic partnership attempts to minimise through the Safe Newcastle Partnership and the Newcastle City Council Community Cohesion Strategy. Asylum seekers often require legal advice but there is a limit on legal aid available. In addition, the Government refuses the majority of cases at the first application, usually necessitating an appeal.

Even supported asylum seekers receive very limited financial assistance so that even a need to travel can cause hardship. Asylum seekers and, of course, failed asylum seekers are not entitled to work. Homelessness is clearly a problem for failed asylum seekers with no support but even those granted refugee status must leave their supported accommodation and make there own arrangements within 28 days.  For failed asylum seekers destitution is a serious issue - those who feel unable to agree to leave the country are not entitled to any publicly funded support and are entirely dependent upon friends and/or the voluntary sector. A number of voluntary sector agencies are working to provide support to destitute 'failed' asylum seekers. They are supported, were appropriate and within the law, by Newcastle City Council and Your Homes Newcastle Asylum Seekers Unit.  

Recently published research from the North East Public Health Observatory with Primary Care Trusts in the region examines the health issues affecting new arrivals in the region, including Asylum Seekers and refugees. Newcastle PCT has a team within the BME Health Improvement Service who work with refugees and asylum seekers. The NEPHO report found that PCTs in the region were generally knowledgeable about asylum seekers and their health especially in the urban areas, such as Newcastle, that had received the most over time. The research identified the following health issues as being especially prevalent among asylum seekers and refugees across the region. It is important to remember that many of these issues apply equally to children as well as adults.

• Mental Health issues, including post traumatic stress disorder (PTSD), the consequences of trauma and rape, and isolation.
• Sexual Health issues, including Sexually Transmitted Infections (STIs), HIV and unwanted pregnancies. At least one specialised practice, Arrival, make condoms available
• Lack of, or incomplete, screening and immunisations - covering a wide variety of checks from communicable disease, cervical smears, breast screening, hearing, eye checks
• Dental Health - poor dental health and accessing dental care was an issue noted directly in at least four responses.
• Poor nutrition and consequences such as vitamin deficiencies
• Skin diseases and parasitic diseases
• Musculoskeletal problems, particularly of the feet - sometimes from travelling
• Behavioural health problems - opium use, domestic violence, alcohol use, tobacco and smoking 
• Hypertension, H. pylori and diabetes - Sunderland's Health Needs Assessment work has found higher frequencies and earlier onset of these conditions

• As an example, the NEPHO report highlights that in a recent analysis of case records by the liaison psychiatry team at the Royal Victoria Infirmary in Newcastle found that they had seen 50 cases of self-harm in asylum seekers and refugees between 1998 and 2007.
• In addition, Newcastle PCT highlight a number of areas that are of particular concern in Newcastle, notably sexual health and mental health issues, many of which are the consequence of torture or abuse. Dental problems were also highlighted by Newcastle PCT as was the fact that many people also require catch up immunisations and cervical smears. The other major issue highlighted in Newcastle was the task of ensuring access to healthcare:

• Access to appropriate services including GP registration and secondary care services, particularly in relation to sexual and mental health and appropriate initial assessment, clear explanation and discussion with patients.
• Destitute asylum seekers being denied access to secondary care except A&E treatment, proposals to restrict primary care to this group too which has public health implications.
• Those on Section 4 support having vouchers rather than cash which can mean that they must travel long distances to spend them; having less to spend than those on income support and often not being able to buy appropriate provisions for babies.

• Some asylum seekers and refugees come from parts of the world that have high rates of certain diseases. Authorities need to be aware of what these diseases are, who may need to be screened and arrangements for proper control - the Health Protection Agency has responsibility in this area. Infectious diseases that are significant are Tuberculosis (TB), Human Immunodeficiency Virus (HIV), Hepatitis and Malaria.  There are some concerns that not all cases of HIV are being picked up. For example, in the Black African population in the North East living with HIV (290 of the total number of 868), there are 213 women and only 77 men. This is much more likely to represent the ways in which HIV is detected in antenatal settings than the incidence of HIV (NEPHO 2008)

What are the key gaps in knowledge/services?

It is very difficult for us to know where people go when they have been through the asylum application system. If a decision is positive then refugees may move freely around the UK. 'Failed' asylum seekers who the UK Border Authority do not remove from the country will lose access to support and be lost to the authorities.

What are the risks of not delivering our targets?

If we fail to manage and meet the needs of refugees and asylum seekers, we risk

• Increasing numbers of destitute homeless asylum seekers with no recourse to public funds
• Increasing pressure on the third sector organisations
• Social and community cohesion problems
• Public health problems because of
  
  • particular health needs that people have upon arrival and;
  • health problems that may emerge because of destitution

Is what we are doing working?

The Asylum Seekers Unit at Your Homes Newcastle succeeds in supporting asylum seekers under the terms of the contract

Newcastle City Council takes its duties under the National Assistance Act 1948 and Children Act 1989 very seriously and supports more people in this way than all of the other local authorities in the region combined. Newcastle is talking to other authorities in the region in an effort to share the workload more widely.

The recent report by the North East Public Health Observatory [1] found that, like other PCTs in the region, Newcastle PCT has specialist staff, knowledgeable about asylum seekers and refugees

There the numbers of destitute failed asylum seekers who have no recourse to public funds continues to increase but there is a limited to what local public agencies can do address this. We will continue to assist our partners in the voluntary sector in their support and campaigning work.

[1] New Arrivals in North East England: Mapping Migrant Health and NHS Delivery - North East Public Health Observatory (2008)

What is coming on the horizon?

Recent case law on the national assistance act means that up to half of the people currently supported by Newcastle City Council under the terms of the act may no longer be entitled to that assistance. As of December 2008, the authority is engaged in a review of all cases and plans a managed move of all eligible cases onto UK Border Authority support - either section 95 or section 4. The Council is implementing these changes in consultation with its third sector partners. The primary concern arising from this change is that those people unwilling to accept section 4 support may become destitute.

What should we be doing next?

Most of the issues and our plans for what we should be doing next are set out in previous sections.

In summary:

• Continue to help, were possible, destitute 'failed asylum seekers' by working with our third sector partners
• Support asylum seekers while they wait for a decision on their asylum claim and assist them to move on if their claim is successful
• Continue to monitor asylum seeker health needs
• Support the integration of refugees and asylum seekers into the city
• Continue to support vulnerable asylum seekers and children under the National Assistance Act and the Children Act

Many asylum seekers and refugees have serious physical and mental health problems - because of the countries they are from and because of their experiences. However, the relatively successful partnership working between the various voluntary and statutory agencies in the city together with the managed nature of asylum seekers arrival in city means we are confident that we do well at meeting their health needs. As emphasised throughout this report, our principal area of concern is what happens after the asylum application process, particularly the situation of destitute 'failed' asylum seekers who remain in the city.