Migrants

Migrants are widely described as people who belong to (or have an allegiance) to one state/country, but move into another for the purpose of settlement.

Migrant populations are diverse, and many have social, cultural and health needs. Migration is driven by many reasons (including economic, family reunion, study, humanitarian reasons or human trafficking). As a consequence migrants may have several diverse health and social care needs.

Migrant populations have different health and wellbeing issues depending on lifestyle risk factors, cultural practices, country of origin, genetic and hereditary factors and wider determinants (poor housing, lower economic opportunities, unemployment and living in deprived areas).

This topic links to the following JSNA topics:

Last updated: 2013-03-12 16:05:35
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1. What are the key issues?

Migrants have poor access to (and uptake of) services compared to the general population.

Migrants are often housed in unsatisfactory conditions with inadequate heating.

Emergency accommodation does not always meet some of the cultural needs of migrants.

Migrants often live in more deprived and unsafe neighbourhoods.

Migrants experience racism and discrimination.

Many migrants become isolated, which can lead to poor mental and physical health.

Migrant workers are often subject to exploitation (such as unfair pay and exposure to unsafe working).  

Migrants often work below their qualification level. This may be due to a lack of language skills and lack of recognition of overseas qualifications and work experience.

Mental health problems (including post-traumatic stress disorder) are common in refugees and asylum seekers, but also common in other migrant populations due to isolation, racism or lack of access to services. Low self-esteem and self-worth have been identified locally among migrants.

Sexual health issues including sexually transmitted infections, HIV and unwanted pregnancies as well as accessing culturally appropriate services are problematic for some migrants.

There is a lack of (or incomplete) screening and immunisations (including communicable diseases, cervical smears, breast screening and hearing and eye checks) for migrants.

Migrants have poor access to dental care and some may have a lack of understanding of dental health needs.

Hypertension and diabetes among some of the migrant population (such as South Asians) is higher than the general population. 

Behavioural health problems (including alcohol misuse and smoking) may be a problem for some migrants.

There is a lack of advice and support for the transition period from asylum status to refugee status locally.  Eligibility and accessibility of services (e.g. housing, benefits, education and health) may lead to health problems.

There is a lack of comprehensive data to reflect the current migrant population.

The local Housing Options service is not made aware of the decisions on individual asylum cases in a timely manner.

There are not enough interpreting services due to the ever changing needs of the community. The services that are available are not flexible enough to meet the needs of migrants.

Anecdotal evidence suggests that some migrant populations consume a diet of high saturated fat, high sugar and salt which can contribute to an increased risk of diabetes and heart disease.

There is evidence that migrants fail to register with a new GP when they move elsewhere.

Some asylum seekers receive temporary registration (when entitled to full registration), and therefore they do not have an NHS number and so cannot access the full range of services available.

Migrants present more often to hospitals due to poor access to primary care and communication needs.

Last updated: 12/03/13

2. What commissioning priorities are recommended?

2012/01

Enhance the collection of the health needs of the migrant population.

2012/02

Improve communication and mutual understanding about the health and social care entitlements of migrants, such as advice, information and guidance for both front line staff and migrants (particularly asylum seekers).

2012/03

Work closely with the voluntary sector, faith organisations, employers and landlords to ensure the migrant population receive the information and advice on how to access local services.

2012/04

Work closely with the local interpreting service, school admission and/or education support services to understand the profile of Middlesbrough migrants.

2012/05

Improve access to (and conditions of) migrant workers’ housing.

2012/06

Devise and implement a plan to increase GP registrations by migrant workers.

2012/07

Work with Clinical Commissioning Groups to ensure that primary care contracts and specialised services are negotiated with the consideration of the health of migrants.

2012/08

Develop a plan to ensure the early diagnosis of blood borne viruses (HIV, Hep A,B and C), prevent onward transmission and improve outcomes.

2012/09

Target asylum seekers and refugees to encourage them to access mainstream mental health services

2012/10
Encourage migrants to be screened for chronic medical conditions. This may improve early identification and support and avoid preventable complications, A&E attendances and avoidable hospital admission.

2012/11

Develop a plan to identify mental health problems and provision of appropriate support to reduce risk of crisis and suicide

2012/12

Early identification of mental health problems and the provision of appropriate support are required, to reduce their risk suicide or need for crisis interventions.

2012/13

Targeting of populations at risk of developing Type 2 diabetes and CVD is required to lead to the delivery brief intervention programmes. This will raise the community’s awareness and ensure sustainable changes around their physical activity/dietary behaviours.

2012/14

Work closely with existing BME networks, community groups, leisure services and primary care services to develop culturally sensitive health schemes.

Last updated: 12/03/13

3. Who is at risk and why?

Age

Migrants are likely to have more children than the general population.

The population of older migrants will rise over the next few years.

Gender

Women from South Asian communities are less physically active compared with their white counterparts.

Obesity is more likely to be reported in Black Caribbean and Pakistani girls and Indian and Pakistani boys.

Socioeconomic status

Migrants often live in deprived areas. Poverty, isolation and discrimination lead to poor health outcomes (especially for mental health).

Ethnicity

Black African: High risk of infectious diseases, mental disorders, pneumonia, HIV, perinatal disorders and diabetes.
Afro-Caribbean: High risk of diabetes, prostate cancer, mental disorders and cerebrovascular disease.
Asian: High risk of tuberculosis, diabetes, chronic heart disease, cerebrovascular disease, perinatal conditions, and respiratory diseases.
Chinese: High risk of cancer, digestive system issues, congenital anomalies and diseases of the eyes and ears.

Tuberculosis rates are highest amongst Black Africans, followed by Pakistani, Indian and Bangladeshi groups.

Uptake of preventative services (such as cervical cancer smears) is lower in South Asian women.

Asian children have lower levels of physical activity but are less likely to report smoking or alcohol consumption behaviours.

The highest levels of accidents recorded are in the Black Caribbean population.

Education

Children who have English as an additional language have lower levels of attainment compared with children who have English as their first language.

Employment

Migrant workers may find it difficult to access services due to long working hours and/or shift patterns.

Lifestyle

Bangladeshi men have higher smoking prevalence (44%) compared to men in the general population (27%).

Destitute refused asylum seekers

Asylum seekers who are declined entry are required to leave the UK once all appeals have been concluded. They then automatically become destitute as all forms of support will be withdrawn including accommodation and subsistence payments. Homelessness ensues with mental health often worsened.

Last updated: 12/03/13

4. What is the level of need in the population?

Nationality: non-British

Middlesbrough has a higher non-British population (6%) compared to the North East (3.2%) in 2010.

Country of birth: non-UK

The proportion of Middlesbrough’s population born outside the UK (8%) is higher than the regional average (5%) in 2010.

Births to non-UK-born mothers

The proportion of births in Middlesbrough to mothers who were born outside the UK (19%) is higher than the North East (10.3%).

New international arrivals

In 2010, the formal estimate from the Office for National Statistics (ONS) was for about 2,500 new migrants who will stay more than a year (‘long term migrants’) to arrive in Middlesbrough.

The National Insurance Number (NINo) data only records migrants over the age of 16, who are planning to work or claim benefits and would therefore not take account of dependants.

Net migration

Source: ONS

Net migration in Middlesbrough has significantly increased in the last 6 years. In 2010, net migration was 2,000.

Country of origin (NINO)

While EU accession migration is falling, migration from non- EU accession countries continues to rise. The top country of origin is India followed by the Czech Republic and Pakistan.

Workers registration scheme

In Middlesbrough, the total number of workers on the Workers Registration Scheme in 2010 (60) was considerably lower than in 2007 (120).

International students

There are 2,370 international students undertaking higher education courses in Middlesbrough. This represents 12% of the international student population in the North East.

In 2010 there were 2,225 pupils attending maintained primary schools and state-funded secondary schools in Middlesbrough whose ‘first language’ is not English.

Asylum seekers

In 2011/12 there were about 592 asylum seekers accommodated in Middlesbrough. This represents 29% of the asylum population of the North East.

Last updated: 12/03/13

5. What services are currently provided?

GP Services

A specialist GP service for migrants is offered at the Haven practice.

DH (2005) Introduction to National Health Service

A factsheet that explains the role of the NHS to newly arrived individuals seeking asylum is available from the Department of Health. It covers issues such as the role of GPs, their function as gatekeepers to the health services, how to register and how to access emergency services. The factsheet is available in more than forty languages.

Refugee services

North East Refugee Service (NERS) provides support, education and volunteering opportunities for asylum seekers and refugees.

Housing

The homeless and housing advice service is provided by Erimus Housing. This service is accessible by refugees and other migrants. The service provides a range of housing solutions to those in housing need (including homelessness).

Middlesbrough Council’s Shield service provides limited access to private rented sector accommodation. A referencing service is operated for landlords. It is open to all groups, and the referencing process for asylum seekers is very short due to the lack of housing history. This service enables quick access to private rented accommodation.

Justice First

Justice First is a charity organisation which provides support to people who are seeking asylum in the UK and whose appeals have been rejected. This helps them to re-engage with the legal system.

Tees Achieve

Tees Achieve provides language classes such as English for speakers of other
languages (ESOL) to new migrants.

Interpreter services

Face to face interpreting (mainly by the Everyday Language Solutions charity). Interpreter services are provided in all districts in Tees Valley.

Last updated: 12/03/13

6. What is the projected level of need?

While net migration to Middlesbrough was 2,000 in 2010, future net migration is projected to decrease. This projection assumes no changes in policy or international conditions.

Last updated: 12/03/13

7. What needs might be unmet?

Interpreter services

There is an increase in preventable diseases due to lack of awareness (i.e. diabetes within the Asian communities).

Misdiagnosis may occur due to the use of unqualified and untrained interpreters.

Language and communication skills

The availability of English language provision is key both for health and community integration. Evidence suggests that English language learning has a significant and positive impact on individuals, communities and the productivity and safety of workplaces with lack of fluency in the language condemning most migrants to poverty or being marginalized.

Housing

Suitable temporary accommodation is not available (and long-term periods in some cases).

Access to decent, settled and affordable accommodation in the private and social sectors that meet the social, cultural wellbeing needs of migrant households are not always available.

Transport issues

Access to services is hampered by lack of affordable transport.

Last updated: 12/03/13

8. What evidence is there for effective intervention?

Social Care Institution for Excellence (2010)

Good practice in social care for asylum seekers and refugees.

www.scie.org.uk

Access to the NHS by migrants and overseas visitors for primary care staff and commissioners.

http://www.pcc.nhs.uk/news/4775

Including Migrant Populations in Joint Strategic Needs Assessments (2011). www.idea.gov.uk

Audit Commission (2007)

Crossing borders: Responding to the local challenges of migrant workers.

http://www.audit-commission.gov.uk/SiteCollectionDocuments/AuditCommissionReports/NationalStudies/CrossingBorders.pdf

NHS Evidence

Provided the best available evidence on health needs and access to health care of migrant and minority ethnic groups, and on the management of the health care service for these groups.

www.evidence.nhs.uk

NICE (2010)

A model for services provision for pregnant women with complex social factors. 

http://guidance.nice.org.uk/CG110

NICE (2011)

Preventing type 2 diabetes: population and community-level interventions in high-risk groups and the general population.

http://www.nice.org.uk/guidance/PH35

Department of Health (2003)

Caring for dispersed asylum seekers: a resource pack. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4010379

Department of Health (2011)

Female genital mutilation: multi-agency practice guidelines. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124551

The Health Protection Agency (2006)

Migrant health a baseline report. http://www.hpa.org.uk/Publications/InfectiousDiseases/TravelHealth/0611MigrantHealth2006/

Last updated: 12/03/13

9. What do people say?

Interpreting services

Feedback from the Everyday Language Solutions (ELS) interpreting team indicates there are problems with the quality of interpreters.

Feedback from the ELS service users indicate that the presence of a qualified interpreter makes a huge difference to their quality of healthcare.

Feedback from the Race Equality Foundation and Department of Health learning event (November 2011) was that interpreting standards need to be in place to prevent misdiagnosis. They also need to be used by professionals more often.

Middlesbrough neighbourhood survey

The Middlesbrough neighbourhood survey 2009/10 has provided the following information regarding migrants:

(http://consult.middlesbrough.gov.uk/portal/cgd/mns09_10)

Last updated: 12/03/13

10. What additional needs assessment is required?

Employment profiles

Economic migrants may be living in accommodation supplied by their employers or may be living in the private rented sector. The misperception that migrants are accessing social housing needs to be challenged as some evidence suggest that they access poorer quality and much overcrowded houses within Middlesbrough. More needs assessment within this housing area can shed light to improve the health of migrants.

GP registrations

Migrants who have valid identification, a place of residence and who have come into the country as a visitor can register with a general practice or extended medical services. Reviewing the eligibility criteria for migrants in terms of GP registration might assist in the overall understanding of migrants health needs.

Effective commissioning for improving migrant health

The following are required for effective commissioning:

  • An estimation of the numbers/types of migrant;
  • Knowledge of their expectations of healthcare and of the prevalence of risk factors for major communicable and non-communicable diseases from their former country of residence;
  • Cost-effective interventions to address needs in a flexible way;
  • Clear aims, service plans and accessible care pathways;
  • A common dataset for comparing provider performance;
  • Clinical quality indicators linked to contract payments; and
  • Clear health improvement outcomes which should also include patient
    reported outcome measures (PROMs) for migrant, refugee and BME groups.
Last updated: 12/03/13