LEADERSHIP
26 | Nursing in Practice | October Autumn 2023
LESSIONS IN
LEADERSHIP
Looking after asylum-seeking families
Derby is a Home Office dispersal location , where asylum seekers are housed when they reach the UK , and Virginia Hickman is part of a dedicated team funded by Derby City Council and the NHS to support children and families arriving in the city
I was a practice nurse for around eight years before I became a health visitor , so I ’ ve always worked in the community . Public health commissioned us to safeguard and support children of asylum-seeking families , who often go under the radar as they do not access healthcare . Although babies and children may come under universal services , we found their needs weren ’ t really being met .
We ’ re a team of four working in partnership with the local authority : two public health nurses , a family health practitioner and a child practitioner from the council who looks at the social side , supporting early years .
As public health nurses we both have school nurse and health visitor qualifications , so we can address the full 0-19 age range . We follow the healthy child programme , with all the normal contacts , but our work is needs-led . If there ’ s a family that requires more contact , we support their health needs for as long is required .
I am also a non-medical prescriber so I can prescribe within my scope of practice , easing access to healthcare for patients and avoiding the need for a GP appointment .
Complex health needs These are vulnerable families , new to the county , and not always able to access financial or social care support . With that comes the risks of health inequalities , and the children may have complex health needs as well .
Our service helps overcome language and cultural barriers and a mistrust of services . They may be from somewhere with little or no provision , or where healthcare is not free . We help them navigate aspects of the system like registering with a GP and accessing care out of hours . Some children may need specialist care , like orthotics or audiology , and we offer guidance on referrals .
They might not have had a positive experience of healthcare services in their country , and we also need to consider the UK ’ s wider reputation for things like social services as they can be suspicious of different agencies . We try to develop a good relationship so they ’ re aware of how we can help , but this does take time .
Our aim is to see a family within seven days of their arrival , undertake health assessments with the children and give the families the information they will need should they become ill . If a child has any existing health needs we address those as soon as possible , and we check if they are up to date with their vaccinations and liaise with local GPs on that .
We generally have the flexibility to meet our seven-day target , unless people are coming in larger numbers , for example from a country affected by war , like Ukraine or Afghanistan . Even if they do arrive all at the same time , then at least they tend to be in one place .
On my caseload I can have up to 40 patients , which is quite manageable . At the moment we ’ ve got 36 parents , including two expectant mums , and 30 children in one initial accommodation hotel , and I think we ’ ve had
We ’ ve had the freedom to develop our own service to reduce inequalities , meet the families ’ health needs and keep them safe
about 25 Ukrainian families over the past year . The average caseload is between 30 and 40 .
When we were first set up , we identified families who were registered with a GP , or who we knew were coming to one of the bridging hotels . As Derby is a dispersal city – where asylum seekers are housed until their applications can be processed – it can be harder to reach people in the community due to data protection and lack of information sharing from local authorities . We try our best – we know there are 200 addresses in the city so if we can ’ t get hold of them by phone , we knock on doors .
You want to do the right thing for the families and the children but it can be quite difficult , particularly when you turn up unexpectedly and you don ’ t know where they ’ ve come from . But we ’ ve now got a good relationship with Serco – the Home Office housing contractor in our area – and they tell us when families move in .
We use the Language Line interpretation service , or a face-to-face interpreter if we have enough notice . Google Translate can help , particularly if there ’ s been an influx of numbers with high demand on translators who speak a particular language .
A service designed by the team Over the past year we ’ ve looked at what we need to offer and the service has been very much designed by us as a team . It ’ s up to us to find the families and be creative . We ’ ve had the freedom to develop our own systems , so we deliver what we set out to do for families – reduce health inequalities , ensure they ’ re accessing healthcare in the right way to meet their needs , and keep them safe .
As a specialist nurse at Band 7 there ’ s an expectation that it ’ s our service to push forward and develop . But we still need safeguarding and specialist knowledge ; it ’ s a very rewarding job , but the families can be quite traumatised and have differing needs . You have to understand that each family is unique in order to meet their particular needs or signpost them to other services .
It would be great to have more nurse-led services like ours across the country . We liaise with GPs and others associated with the families , such as councils , charities and the Home Office , and we have regular professional liaison meetings . We ’ ve had huge success by sharing information and good practice through working as a team .
In July 2023 , our team won a regional NHS Parliamentary award for health equality for the service we provide to our families . It was a proud moment when we went to Westminster for the national awards to celebrate what we had achieved and represent our trust .
Virginia Hickman is a specialist community public health nurse for asylum-seeking families at Derbyshire Healthcare NHS Foundation Trust
• Written by Katherine Price