Vulnerable refugees ‘barred’ from health services

The National Children’s Bureau has examined the provision of public health services by local authorities, in delivering the Healthy Child Programme, for refugee and migrant children from birth to five.

The NCB’s review of evidence relates to refugee and asylum-seeking children, and children of economic migrants, born within and outside the UK.

The mental health of young refugee and migrant children is highlighted in the report as ‘by far the most dominant issue’, as they are particularly vulnerable to mental health problems, and are at higher risk compared with their peers, the NCB says.

Unaccompanied asylum-seeking and migrant children are especially vulnerable to post-traumatic stress, depression, anxiety, sleep disorders, self-harm and loneliness. ‘Public health experts advise that the mental health needs of children seeking asylum are underestimated and neglected,’ says the report, Delivering the Healthy Child Programme for young refugee and migrant children.

NCB reviewed the joint strategic needs assessments (JSNAs) and other information available for 16 local authority areas with significant proportions of residents born outside the UK.

While collecting data on mental health problems among children and families is challenging, calculating the extent among refugees is even harder because official health statistics tend not to cover immigration status.

‘But we do know from qualitative research that there are higher rates of mental health problems and that it is a key health concern,’ said Zoe Renton, head of policy at NCB.

These children may also be indirectly affected through the impact of their parents’ and carers’ mental health problems.

Ms Renton said, ‘Maternity Action has evidence of pregnant women being dispersed across the country and links between them and their GPs being broken. Young children may be directly and indirectly affected by being born to parents who face stress and upheaval.’

Anxiety, depression, phobias and PTSD are some of the most frequently reported health problems. These have been linked to people’s experiences before and during migration, and the circumstances of people arriving in the UK. The immigration process itself leads to greater PTSD scores, and uncertainty about claiming asylum, or a failed claim, can lead to depression.

Since October 2015, local authorities in England have taken on the provision of health promotion and protection services for under-fives as part of the Healthy Child Programme 0-5.

NCB argues that LAs need greater support. Ms Renton said, ‘More guidance is needed around health inequalities.’

She added, ‘Some local authorities are shaping a specific offer for refugee children and their families.’ However, there is concern that the programme guidance is ‘quite out of date’ and there is ‘little detail’ on working with refugee families.

NCB’s report collected case studies to share practice examples. They includeSandwell delivering health advice alongside immigration support and English-language courses; Harrow co-locating services for migrant parents with child health promotion and interventions in children’s centres, and Walsall’s specialist health visiting service.

Ms Renton said, ‘We want the Department of Health and Public Health England to focus on young refugee children who face specific barriers’ – such as ensuring they register with their GP and that there are interpreters available.

A key problem is confusion surrounding families’ entitlement to health services and whether they need to pay for healthcare.

Refugee families already face particular barriers around access to NHS secondary healthcare, such as hospital treatment.

The Immigration Act 2014 narrowed the definition of ‘ordinarily resident’ to include only those who have indefinite leave to remain, although there are exemptions for some vulnerable groups, including refugees and asylum-seekers. This means that some undocumented migrants are charged for most secondary healthcare.

NCB says research by Doctors of the World and Maternity Action indicates that charging for secondary care poses a barrier to accessing healthcare even among those who may be entitled to it, due to confusion about entitlement among families and service providers.

Ms Renton said, ‘There is evidence of families facing barriers to accessing services because NHS staff are confused about entitlements. There is confusion about the information individuals need to register with their GP. Even if a family may be entitled to free care, we know charges pose a barrier.’

The NCB is calling for a blanket exemption to all health charges for under-18s and pregnant women.

While primary care is seen as an important route to public health and preventative services – such as immunisation and health checks at GP surgeries – the Government has consulted on plans to extend charging to include GP services, primary dental care and prescriptions.

No final decision has been made by the Government, but the recent Queen’s Speech contained a reference to charging for ‘overseas visitors’.

The NCB is concerned that extending charging to primary healthcare will undermine efforts to promote good health among all children – a requirement under the UN Convention on the Rights of the Child – and the Government’s own immunisation programmes.

Although some exemptions will apply, these charges would likely have implications for refugee and migrant children’s access to public health services and for local authorities seeking to promote good health and well-being among their population of young children.

Doctors of the World argues that access to healthcare will only worsen with the introduction of primary care charging.

The UN Committee on the Rights of the Child is currently assessing the UK’s performance on children’s rights and is due to report on 9 June.

‘They’ve been clear before that the right to public health has been firmly at the centre. Primary care charging undermines that right for children,’ Ms Renton said.

CASE STUDY: DOCTORS OF THE WORLD’S FAMILY CLINIC

The clinic in Bethnal Green, London, provides specialist care for pregnant women and families. This includes mental health support. It also plays a role in identifying trafficking, domestic violence and other safeguarding issues, makes referrals to children’s services if needed and supports access to the Healthy Child Programme.

In 2015 the clinic worked with 175 migrants, asylum seekers and refugees. The clinic, which runs twice a month, offers a specialist service, including obstetric checks, child health assessments, assistance with antenatal referrals, GP registration, information on rights and entitlement, referrals to advice and support and food banks.

Last year the clinic helped 52 women to self-refer for antenatal care, and nine women who needed urgent medical attention in hospital.

More than half of the pregnant women had not received any antenatal care after ten weeks. Reasons for not accessing antenatal care included not having registered with a GP, fear of being reported and prohibitive healthcare costs.

Three women stopped attending antenatal care after receiving bills through fear of debt and being reported to the Home Office.

Fifty-one children were helped by the clinic last year, including 27 under-fives. Thirty children did not have a GP, despite half of their parents trying to register with one. Common reasons included admin issues such as no proof of address.