HEALTHCARE NEEDS DISPERSAL GUIDANCE

Table of Contents

Scope and Purpose

Beginning the Asylum Process

Initial Accommodation Site Health Check

Applying for Asylum Support

Dispersal

Maintaining continuity of care

Arranging Accommodation

Role of the Independent Asylum Support Medical Adviser

Role of Dispersal Accommodation Provider

Relocation to Alternative Asylum Support Accommodation

Regional Health Contacts

Representations from NHS Clinicians or NHS Health Professionals

HC2 and HC1 Forms, Free or Reduced Cost for Statutory NHS Charges

Further Guidance

HIV/AIDS – Dispersal Guidelines

Tuberculosis –Dispersal Guidelines

Mental Health –Dispersal Guidelines

Pregnancy / New Mothers- Dispersal Guidelines

Glossary

Letters, Contact Lists and Flowcharts

Scope and Purpose

This document provides guidance for UK Border Agency staff when dispersing asylum seekers/failed asylum seekers and their dependants who have apparent or non apparent health needs, following an application for asylum support under theImmigration & Asylum Act 1999 (“the1999 Act”).

This instruction replaces Policy Bulletin 85: Dispersing Asylum Seekers with Health Care Needs and Policy Bulletin 61: Pregnancy.

In each region and in the Case Resolution Directorate (CRD), asylum support caseworkers are usually responsible for considering applications for support. These caseworkers are either embedded in asylum teams or within separate support teams. Overall responsibility for the case rests with the case owner and they may be the first point of contact for the asylum seeker or failed asylum seeker raising a health issue.

In this instruction the term caseworker will be used to refer to the UK Border Agency officer responsible for carrying out the support function, as responsibility may vary on a regional or Directorate basis. The case owner is specified where they must carry out a specific function. The case owner and support team caseworkers must ensure that they share any relevant information which may affect dispersal or the ability of the asylum seeker or failed asylum seeker to attend a UKBorder Agency event, such as a reporting event.

This instruction does not cover asylum seekers or failed asylum seekers who have or appear to have ‘care needs’ over and above destitution and the provision of accommodation. These cases should be referred at the point of claim to the Local Authority Social Services Department. A person who appears to have care needs is unlikely to be able to live unaided in UK Border Agency accommodation. They or their representatives should request a ‘Community Care Assessment (CCA) to determine their eligibility for Local Authority support. Local Authorities are obliged to provide suitable residential accommodation under section 21of the National Assistance Act 1948 where an individual has a care need which requires some additional help over and above provision of accommodation, for example, assistance with personal care or household tasks. The definition of ‘care need’ was clarified in the House of Lords judgment M v Slough Borough Council on 30th July 2008. In Scotland the power to provide suitable accommodation is set out under section 12 of the Social Work (Scotland) Act 1968, instead of under section 21.

In general, asylum seekers and failed asylum seekers with confirmed care needs who require additional help over and above provision of accommodation are supported by a Local Authority, and as a result, may not be eligible for support from the UK Border Agency. For guidance on dealing with such cases, see Policy Bulletin 82- Asylum Seekers with Care Needs.

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Health Entitlement for Asylum Seekers and Failed Asylum Seekers

Information on eligibility for free National Health Service (NHS) health care for people in selected immigration categories is set out in the table of entitlement to National Health Service (NHS) treatment, which can be accessed via the following link:

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Application of this instruction in respect of children and those with children

Section 55of the Borders, Citizenship and Immigration Act 2009(“the 2009 Act”) requires the UK Border Agency to carry out its existing functions in a way that takes into account the need to safeguard and promote the welfare of children in the UK.It does not impose any new functions, or override existing functions.

Officers must not applythe actions set out in this instruction either to children or to those with children without having due regard toSection 55 of the 2009 Act. The UK Border Agency instruction‘Arrangements to Safeguard and Promote Children’s Welfare in the United Kingdom Border Agency’ sets outthe key principles to take into account in all Agency activities.

Our statutory duty to children includes the need to demonstrate:

  • Fair treatment which meets the same standard a British child would receive;
  • The child’s interests being made a primary, although not the only consideration;
  • No discrimination of any kind;
  • Asylum applications are dealt with in a timely fashion;
  • Identification of those that might be at risk from harm.

Caseworkers should bear in mind the additional vulnerabilities of children with disabilities and/or serious health problems and seek further information from child welfare agencies before deciding whether or not to disperse a family out of area. If the decision is that dispersal should go ahead, the statutory welfare agencies should be alerted to make appropriate arrangements with the services in the dispersal area.

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Beginning the Asylum Process

This section provides guidance on handling of asylum seekers with healthcare needs during screening and routing to InitialAccommodation (IA). This section and the subsequent section, Initial Accommodation Site Health Check, do not apply to failed asylum seekers in receipt of support under section 4 of the 1999 Act, asInitial Accommodation under section 98 of the 1999 Act is limited to asylum seekers and their dependants. Guidance on dispersal of section 4 applicants with health care needs starts in the section Applying for Asylum Support.

Registering an asylum claim (Port/Local Enforcement Office/Asylum Screening Unit action)

The screening officer should complete a screening interview. As part of the screeningprocess the applicant will be asked about any medical conditions (pre-existing and/or recent), medical intervention or drug treatment. Women will be asked if they are pregnant. If the screening interview cannot take place, the applicant must be asked as soon as practicable about any pre-existing medical conditions he/she or any of his/her dependants may have, or if the applicant is a woman or if any of the applicant’s dependants are women, whether the applicant/any of the dependants are pregnant.

If there are any influencing factors, such as the applicant or his/her family member being vulnerable as defined by regulation 4 of the Asylum Seekers (Reception Conditions) Regulations 2005, that theInitial Accommodation Healthcare Teamshould be made aware of, or regular appointments with a consultant that may affect where the applicant will be routed, the referring officer must make the Asylum Routing and Initial Accommodation Team aware of them. Regulation 4 of the 2005 regulations states that a vulnerable person is –

  • a minor
  • a disabled person
  • an elderly person
  • a pregnant woman
  • a lone parent with a minor child; or
  • a person who has been subjected to torture, rape, or other serious forms of psychological, physical or sexual violence

who has had an individual evaluation of his situation that confirms he has special needs.

(N.B.The Initial Accommodation Healthcare Teams are qualified practitioners in healthcare service delivery, who offer general medical assistance and health screening to applicants and their dependants in Initial Accommodation. For more information on the services provided by theInitial Accommodation Healthcare Teams, refer to Initial Accommodation Site Health Check).

If any such medical issues are identified, the information should be entered on to the Notes and Special Conditions screen on CID.

Any medical evidence or notes must be keptconfidential and records should be kept according to best practice.

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Routing of asylum seekers to Initial Accommodation

A person who has claimed asylum and requires asylum support accommodation at the time of application will be transferred to UK Border Agency InitialAccommodation (IA), provided under section 98, usually in the region that has responsibility for considering his/her application for support under section 95 of the 1999 Act. The UK Border Agency has contracts with InitialAccommodationproviders in all the regional areas.

Unless there are extenuating factors which require the routing of a person to the London and South East area, routing of asylum seekers who request support accommodation will usually be away from London and the South East of England. The asylum seeker will normally be routed to a regional location within 48 hours of an asylum claim being made, with the asylum seeker staying in “Overnight Accommodation” if onward travel to the allocated region is not possible on the day the asylum application is made. The regions and the location of IA are as follows:

North West - Liverpool

Midlands and East of England – Birmingham

Scotland - Glasgow

Northern Ireland - Belfast

North East, Yorkshireand the Humber–Wakefield

Wales and South West - Cardiff

Londonand South East – N.B. limited accommodation within London and surrounding areas

Consideration should be given to finding the most suitably locatedIA for asylum seekers and, if applicable, their dependants with health care needs. If the asylum seeker or, if applicable, his/her dependant is receiving treatment for a severe or complex healthcare need, the Routing Team should, if possible, route the asylum seeker to theIA closest to where the asylum seeker is being treated. If the healthcare need is not severe or complex, the Routing Team should, if possible, route the applicant to theIA closest to where the applicant/dependant is being treated, if being treated outside the London and South East region. Refer to Severe or Complex Healthcare Needs for examples of what is considered to be a severe or complex healthcare need.

Consideration of the health needs of the asylum seeker and, if applicable, his/her dependants should be given where the transfer toIA will include an overnight stop. The Routing Team in conjunction with the team at point of claim should ensure that there are no pressing health needs and that the person has sufficient medication.

When routing families with children, the Secretary of States obligations under Section 55 of the 2009 Act should be taken in to account. Refer to Application of this instruction in respect of children and those with children for further information.

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What to do if a scheduled medical event has been booked prior to routing to Initial Accommodation

If an asylum seeker claims at the Asylum Screening Unit (ASU) in Croydon and provides the screening officer with medical evidence of:

  • a hospital/consultant appointment that is booked within the next week, or
  • a regular series of ongoing medical appointments with a treating clinician,

in a specific area, taking in to account the nature of the case, the IA in the most suitable geographical location should be used. This may mean that the asylum seeker is accommodated in the London and the South East region. Following attendance of the appointment it may be appropriateto route the applicant to another region or remain in the London and South East region until continuity of care can be arranged in another region. Each case will be decided on its individual merits.

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Identification of medical needs and notifying Initial Accommodation providers by the Routing Team

When making routing arrangements, health information that may impact on appropriate routing arrangements may be obtained from CID, such as in the ‘Special Conditions’ screen, or verbally from referring officers at points of claim. If any health or other issues have been identified which affect the provision of Initial Accommodation, enough information should be communicated to the Initial Accommodation provider in the Special Needs/Additional Information box in the Service Commission Form to enable the provider to ensure appropriate arrangements are put in place. For further information on the appropriate communication of information to accommodation providers, refer to Informing the dispersal accommodation provider of health care needs and sourcing property. The completed Service Commission Form should be faxed to the IA provider to inform them of the name of the applicant and, if applicable, the name of his/her dependants, the estimated time of arrival, and any specific accommodation requirements.If the applicant or one of his/her dependants is identified as having a pre-existing medical condition or communicable/infectious disease or is taking medication which requires urgent referral to the IA Health Team, Routing Team caseworkers should request in the Service Commission Form that the IA provider advises the applicant to contact the IA Healthcare Team as soon as he/she arrives in IA. For further information on the routing of asylum applicants, refer to the Routing Asylum Applicants to Regional Asylum Teams AI.

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Initial Accommodation Team

If an applicant or one of his/her dependants is identified as receiving treatment for a severe or complex health need, if the details of the treating clinician(s) are known, as soon as possible following the routing of the applicant to his/her allocated Initial Accommodation, theIATeam should send aTreating Clinician Notification of Arrival in Initial Accommodation Letterto the treating clinician(s). The letter contains the following information:

  • the address of theIA,
  • requests that thetreating cliniciannotifies the UK Border Agency of any information that will assist in maintaining continuation of care, and
  • the contact details for the Initial AccommodationHealthcare Teams (see Initial Accommodation Healthcare Team Contact Details).

A copy of the letter should be sent to the IA Healthcare Team. For information on the definition of a severe or complex health need, refer to Severe or Complex Health Needs.

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Initial Accommodation Site Health Check

Asylum seekers and, if applicable, their dependants resident in IA are entitled to receive a health care service delivered by a healthcare team independent of the UK Border Agency. Though this applies to the vast majority of regions, in some regions an alternative healthcare service is in place. The healthcare team are qualified practitioners in health care service delivery. As well as offering general medical assistance, applicants and their dependants will be offered health screening including the following:

  • assessment of current health status and addressing of any immediate concerns;
  • testing for tuberculosis (TB), according to local guidelines(tests for other conditions such as Hepatitis A,B or C may be considered if there is cause for concern, and for Human Immunodeficiency Virus (HIV) if the applicant wishes it to be done);
  • recording of the patient’s history of immunisations and vaccinations. At present and according to local guidelines, TB vaccinations may be offered to 16 year olds and under, and in some regions, but not all, MMR (Measles, mumps and rubella) vaccinations to 16-25 year olds (as a special risk group);
  • recording of maternity history. Family planning advice is offered to both men and women;
  • a pregnancy test; if there is a medical concern or the asylum seeker wishes it to be done;
  • any sexual health issues are discussed on assessment and appropriate action taken;
  • identification of special needs and liaison with the UK Border Agency, or whoever is sub-contracted to oversee dispersal, to ensure the provision of appropriate accommodation and support where needed;
  • where there is clinical need children under the age of 5 years are seen by a health visitor, and nutritional needs assessed and appropriate advice given;
  • individuals with a history of physical or psychological maltreatment, or mental health issues will be seen by theInitial AccommodationHealthcare Team for appropriate initial treatment / counselling. Any concerns about children are reported through the correct channels and liaison with the Local Authority Social Services Department takes place.

The HC2 certificate will be sent by the UK Border Agency to the applicant as soon as a decision to grant section 95 support is made. HC2 certificates are issued when the asylum support application form has been assessed and approved (usually within a week of arrival). For further information, refer to HC2 and HC1 Forms.

Where theInitial AccommodationHealthcare Teams consider that dispersal out of IA should be delayed on medical grounds, a written request should be made to the dispersal team stating the length of delay being requested and the reasons why. When considering such requests, caseworkers should refer to Dispersal: Criteria for deferral or selective dispersal on health grounds for guidance.

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Applying for Asylum Support

This section provides guidance on the application process for asylum seekers applying for section 95 support, and for failed asylum seekers applying for section 4 support, and the identification of healthcare needs during this process.

Asylum applicants accommodated inInitial Accommodation applying for section 95 support

As IA provided prior to dispersal is only short term. Representations about healthcare needs should be made by the applicant as soon as possible. The target dispersal timescale is 19 calendar days.

A Voluntary Sector representative from the Wraparound Service will assist the asylum seeker in completing an Asylum Support Application Form (formally known as NASS1) within 48 working hours of the applicant arriving inIA. This event provides a further opportunity for the applicant to disclose information about whether he/she, or any dependants, suffers from a medical condition which needs treatment, medication or counselling, whether treatment is being undertaken in a particular area of the country, or in the case of a female, if she is pregnant. The Asylum Support Application Form will then be sent to the regionalIADispersal Team who will determine if the applicant is eligible for support, and if any special conditions need to be met.

Accommodation is offered on a no choice basis, taking into consideration any disclosed special needs that are accepted by the UK Border Agency. Dispersal will normally be within the geographical region that the UK Border AgencyIA is located, but may on occasion be to another region (for example if the person has been housed in a particular region for a course of treatment which has finished, he may be moved to another region). For further information on dispersal, refer to Dispersal and the Dispersal Policy Bulletin.