Welcoming Displaced People in Somerset - A system response

Welcoming Displaced People in Somerset - A system response

Somerset has seen a shift in its demographic population in recent years. Historically, the county has comprised a population with minimal diversity, with pockets of migrant workers from other countries living across the area. Over the years however, the landscape has changed, and we have witnessed one of the most significant population changes in a long time. This is partly due to the rise in planned resettlement schemes, such as the Syrian Vulnerable Persons Scheme, Afghan Relocation and Assistance Policy and the UK Resettlement Scheme, but also from the Homes for Ukraine which saw over 1500 Ukrainians move into Somerset since April 2022. Furthermore, Somerset saw its first Contingency Interim Accommodation stood up last year, and further arrivals through Asylum Dispersal, further diversifying the county

It is estimated that Somerset has now welcomed approximately 1800 displaced people, and we are likely to see this figure grow further. There will be other displaced people who have arrived in the County via the Ukrainian Family Scheme and BNO Hong Kong scheme. No data is available for those arrives through these routes.

This case study will discuss the approach the Somerset system has taken to collaboratively welcome and support the needs of asylum seekers and refugees in a rural county.

Multi-agency tactical approach

At the core of all of the work in Somerset has been the approach to work together as a system. Multi-agency tactical meetings were set up to help coordinate the work – these brought together partners from Health, VCFSE, Local Authority (social care, education, public health etc), Police, Home Office and other colleagues to effectively respond.

This way of working has proven to be highly effective; this approach was used when liaising with Home Office colleagues on the proposal of new asylum contingency accommodation sites to decide their suitability. By pooling together knowledge of local areas, we were able to prevent two sites being set up in unsuitable areas; these had limited access to healthcare or where health services were already highly pressured, lack of public footpaths and limited transport options, and schools with no further capacity. Further, due to the rural nature of these sites, the impact of social isolation and limited access to support services and other amenities, was also considered. It is important to state that Somerset welcomes collaborative working with Home Office and ClearSprings Ready Homes colleagues, therefore whilst the suitability of proposed sites were being discussed, the Somerset system also propose alternative sites, informed by local knowledge.

We hope to continue the excellent partnerships we have built for any future responses.

Creating infrastructure to support organisations and professionals

Given the growth in people who are displaced in Somerset, it has been important through the services offered to ensure the infrastructure in place is sufficient and appropriate to the needs of this inclusion health group.

Six Welcome Hubs have been created across the county, originally in response to the Homes for Ukraine scheme, but with the wider aim of supporting any displaced person in Somerset. The welcome hub infrastructure has meant that support is available in the local community, delivered by the VCFSE sector, utilising their skills, local knowledge and experience. This model has tried to account for the rurality in Somerset; each hub is able to tailor the support they offer according to the needs of the individuals based in those specific communities. Support in the hubs can include benefits and employment advice, ESOL classes, housing advice, and health and wellbeing sessions – Ukrainian accredited psychologists also volunteer to provide mental health and wellbeing support; these help to address some of the most pressing wider determinants that impact the health of displaced people.

Embedding Welcome Hubs into existing communities has also allowed for further professional development when working with asylum seekers and refugees, which will help to build resilience should any further planned or unplanned schemes be announced.

Health system response

Somerset ICB, Somerset Foundation Trust, Primary Care and Local Authority Public Health colleagues quickly rallied together to respond to the health needs of asylum seekers placed in a contingency hotel to ensure that health services were accessible and available in a timely manner, and to minimise the potential risk of infectious disease spread to the general population, following concerns of diphtheria. It was essential to consider the lack of government funding, and the semi-rural nature of the accommodation site, together with the existing pressures on health systems, when planning services.

An operational ICB health cell, a multi-agency tactical cell (with health presence), and a core health steering group were set up to respond. Clinical space was arranged within the hotel for supporting health services. Within weeks, the Mass Vaccination team were present in the hotel delivering immunisations for COVID-19 and Diphtheria Prophylaxis; their presence continues seven months later, where they are now additionally supporting with 0–5-year-old immunisations.

Integral to the health response is an onsite health check service delivered by Taunton Vale Healthcare, a practice which is not local to the accommodation site but who are passionate about inclusion health. This service has ensured new arrivals are seen by a GP in a timely manner, and through effective communication with the local primary care network, patients are referred on for further timely health care interventions.

Somerset Wide Integration Sexual Health service (SWISH) have also provided onsite support and care, tailoring their offer to account for the cultural perceptions towards sexual health, and the complex needs of some individuals who present with previous history of sexual trauma. Health visitors provide needs-based support and advocacy for children and their families, as do Maternity service colleagues whom at present, are supporting ten pregnant ladies with onsite and offsite care.

Mental health and wellbeing support

It is well known that asylum seekers and refugees can experience multiple traumas on their journey to seek asylum. Studies have shown that 30-40% of asylum seekers and refugees are found to experience PTSD symptoms (Blackmore, et al., 2020), and they are five times more likely to have mental health needs over the general population (The Kings Fund, 2021).

Mental health and wellbeing support has therefore been a priority in Somerset for this group. Open Mental Health is an innovative mental health and wellbeing support network for adults providing 24/7 support in Somerset; it comprises an alliance of mental health organisations offering access to a range of support services such specialist mental health services, money and benefits support, housing support to community activity and support workers. Open Mental Health, VCFSE, Public Health and accommodation staff have proactively engaged to explore ways to provide appropriate and timely support in a system that is already stretched.

Access to services has improved greatly, with translation and interpretation being considered at the forefront now. Additionally, through the delivery of donated laptops, Taking Therapies have adapted to not only seeing patients in person locally, but also through virtual appointments when at the top of the waiting list, to enable support to be delivered quicker, and by ensuring all materials are translated and interpreters are present. Additionally, the VCFSE community have been providing a range of low-level interventions for both adults and children to improve emotional well-being; activities include ESOL classes, arts, cooking classes, tennis and cricket sessions and peer support groups, to name a few.

Furthermore, The Trauma Foundation South West have recently concluded a 13-month training programme on working effectively with interpreters and mental health workers. The funding has supported 109 mental health and support workers to feel more confident about working effectively with interpreters, 10 interpreters to feel better equipped to work in mental health settings, and 38 hosts or workers on the Ukraine scheme to be better able to support their own self-care and avoid vicarious traumatisation in their work. The noticeable change in appetite to consider groups who do not speak English as a first language will no doubt support more individuals to access mental health and wellbeing services.

Further engagement through questionnaires is taking place with the wider VCFSE and health sector to gain understanding into confidence levels when supporting this group and highlight any gaps too. The responses will help inform training need and identify any unknown barriers for access into services. Interviews were also held with residents living in the hotel to help inform any service development, taking into account their experiences when navigating the mental health system in Somerset.

Looking forward:

• TB service - Somerset is a low prevalence TB area. However, the needs of displaced population has led to partners in Somerset co-producing a new TB screening service which will support health inclusion groups who will have a higher risk of TB acquisition, in particular asylum seekers and refugees and the rough sleeper community. The needs of these groups will be considered when designing the service, and consideration will be given to any barriers faced with accessing these services.
• Health and Wellbeing Champions - A key element for the future sustainability of healthcare for residents in the hotel is the co-production of ‘Health and Wellbeing’ champions from a variety of cultures; the aim of project is to not only improve health literacy and understanding of NHS systems, but to also consider the needs of this group when planning for public health initiatives, to maximise engagement ad sustainability. At the heart of this initiative is to empower individuals so they are able to take autonomous control of their healthcare, in turn reducing reliance on accommodation staff and allowing for their right to privacy with regards to their health.
• Health Checks - There are plans to commission a Health Check service more widely across Somerset for all Displaced People, taking into account the needs of these groups, who are living in a rural county with limited access to transport, together with the pressures currently faced in Primary Care.
• Wellbeing Practitioners - Additionally, work is underway to commission Wellbeing practitioners jointly between Public Health and the Open Mental Health Alliance to provide support to all refugees and asylum seekers across the county in Welcome Hubs.

We still have a long way to go to ensure services and systems are set up to support asylum seekers and refugees as they would for other population groups. However, there is an ever-growing presence of individuals, communities, and services championing for the needs of this inclusion health group. The Displaced People Service at Somerset Council has recently been set up to support and build infrastructure across the county, and together with Somerset partners, we hope to improve knowledge and awareness about this group within services but also across the county, so that asylum seekers and refugees will continue to be welcomed in Somerset.

Permission has been granted to share this case study from partner organisations and for NHSE to publish it as part of the framework.