Stephen Bradley, Helen Barclay, and Rebecca Farrington share advice on caring for vulnerable migrants during the upheaval the covid-19 pandemic will bring
General practices, and the rest of the NHS, are now dealing with an unprecedented public health emergency. Amid the upheaval, vulnerable migrants (including asylum seekers and undocumented people who are destitute with no recourse to public funds) will be more likely to face challenges of extreme poverty, along with additional barriers to receiving and understanding up to date advice and accessing support to stay safe. Many healthcare professionals may feel uncertain about how to help mitigate the effects of the virus for this group of patients, many of whom can’t speak English or don’t have access to a phone. Yet there are many ways healthcare services, government bodies, and local communities can help:
What healthcare services can do
Patients with limited English proficiency (LEP) may not be aware that they should avoid healthcare buildings if they have viral symptoms. Healthcare services should therefore consider posting multilingual or pictorial notices outside practices and on websites. Notices in several languages have been produced by Doctors of the World. Recording brief messages for practice phone systems in the prevalent languages of the local population could also help.
Many patients will have mobile phones but lack credit. Access to free WiFi or data will be challenging in self-isolation. Practices can text patients with brief guidance, if possible in their own language. People contacting NHS 111 have access to interpreters, however, before you reach anyone an automated voice instructs the caller to dial 9, or say “yes,” to stay on the line. Inform patients to press 9 after the first sentence they hear. When they reach a call handler, they can state the language they require.* We would support improvements to the accessibility of NHS 111 for patients with LEP.
Specific advice has been issued for people who are at high risk if infected with covid-19. However, these mainstream public health messages will not be accessible to all patients. General practices could identify the patients for whom this applies and staff could ask patients if they would have enough support to self-isolate and consent for their contact details to be forwarded to those who could help. We should also be aware that many migrants are accommodated in shared housing, where transmission risk may be higher. Some migrants will fear being charged for care or reported to the Home Office. It is crucial to reassure them that this will not happen.
Contacting individual patients with specific advice will require staff to be allocated differently and the GMC recognises that practices may need to “depart from procedures.” Creative approaches to contacting and assisting this group of patients may help. For example, by using social prescribers to counsel patients with simple guidance, or phone contact from reception staff using telephone interpretation with encouragement for those in isolation to stay there.
Existing refugee communities are often resourceful and word of mouth is a strong method of communication, but the message must be clear and consistent. Local voluntary and community organisations (VCOs) need guidance, including how to help people contact NHS 111 and organise hygiene and isolation measures. They will appreciate contact from general practices with the offer of guidance and moral support. Healthcare leaders and hospitals could also help by clarifying that no one who needs treatment for covid-19 will be charged and that no patients will be reported to the Home Office.
What government departments should do
Asylum seekers currently receive housing and basic support while their application is being processed. However, this funding ceases once a claim is accepted or fails. Undocumented migrants are also more likely to be evicted and to have no access to money, shelter, or food. They cannot be expected to leave the country in the current circumstances. For all of these groups, survival can be about meeting day to day basic needs. Accepted claimants for asylum must immediately find alternative housing and a job, or transition to benefits. The current five week wait to commence universal credit brings additional hardship and will undermine compliance with public health.
Prompt support for these groups during the covid-19 pandemic is essential for the wellbeing of individuals and the wider community. The government should urgently streamline access to benefits and call a moratorium on terminations of support for asylum seekers and work capability assessments during the pandemic and the resulting economic downturn. Shelter for the destitute is a basic human need. An infrastructure to support them countrywide is urgently needed.
The postponement of inspections by the Care Quality Commission and GMC appraisals is very welcome. NHS England should examine ways of reducing other bureaucracy, with the expectation that this resource is instead dedicated to supporting vulnerable patients.
The rapidly changing situation makes it very challenging to source high quality and up to date information in different languages. NHS England could undertake to produce this, along with recorded messages for phone systems.
How communities and local authorities should prepare
Previous outbreaks teach us that effective action requires coordination with communities on the ground. If, as expected, large numbers of people are advised to self-isolate, the people who require support to do so will certainly overwhelm the capacity of social care services.
Initiatives are already emerging to prepare for this, with local authorities stepping in to organise efforts rationally and responsibly. Undocumented migrants and asylum seekers who lack social support, and are often wary of encounters with official agencies, are vulnerable to being overlooked. It is vital that initiatives to support those in self-isolation include the VCOs and faith groups supporting vulnerable migrants and that those with language skills are encouraged to volunteer.
Sometimes healthcare professionals are the only contacts who can identify people who need help. If we don’t link them to support, we cannot assume that someone else will. As this crisis evolves, it will be vital that those caring for migrants and asylum seekers share learning and good practice. Please leave a comment if you have any other advice or useful resources.
*This service was phoned by HB on15 March 2020.
Stephen Bradley is a GP at Bevan Healthcare CIC and a clinical research fellow at the University of Leeds.
Competing Interests: Stephen Bradley is a member of the executive committee of the Fabian Society, which is a think tank affiliated to the Labour Party. He is undertaking a PhD which is funded by Cancer Research UK as part of the CanTest collaborative (C8640/A23385). He has also received funding from the Mason Medical Research Trust.
Helen Barclay is a GP at Bevan Healthcare CIC.
Competing interests: None declared.
Rebecca Farrington is a GP specialist for the Asylum Seeker Service, which is part of Greater Manchester Mental Health NHS Foundation Trust, Salford, and a senior clinical lecturer at the University of Manchester.
Competing interests: None declared.
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