Understanding the experiences and inequity of refugees and asylum seekers in accessing health services and receiving care

Healthwatch Brighton and Hove worked with Sanctuary on Sea to hear  about the experiences and inequity of refugees and asylum seekers in accessing health services and receiving care.  They spoke to 49 people.

Many of the widely understood issues around GP access are shared by refugees and asylum seekers. Access issues are compounded among this community where there are language barriers and where there are complex processes to register for a GP. Seeing a GP was often viewed as the ‘last resort’ when accessing health care, with alternative sources of advice used (e.g. friend/family, looking online).

Seeking alternative health care advice may be a product of the barriers refugees and asylum seekers face in accessing GPs (e.g. language, digital exclusion, knowing how the health system works or cultural barriers), the long waiting times for appointments (the leading issue people would ‘like the NHS to focus on’), and their general distrust of the care they receive - 18% of refugees and asylum seekers said that their needs were ‘not at all’ met at their last GP appointment, which is higher than the national average (10%). 

Excessive waiting times for appointments and language barriers were repetitive themes throughout both focus groups. Additional barriers to access support were digital exclusion, lack of available interpreters, and perceptions towards poor quality of care from health professionals. 

In explaining the beliefs about poor care, people spoke about being “not taken seriously” with the focus on helping people to “get back to work” rather than curing the condition. The quality of care was thought to be hindered by a failing health system, too wrapped up in protocols and management, and the stepped care model which prevents direct and quick contact with consultants, something very different to people’s country of origin.

Cultural issues such as wanting to be touched by a GP (to express their treatment was taken seriously) and understanding the roles of nurses and pharmacists were additional themes mentioned. 

To counter access issues, people spoke about “bypassing the system”, through visiting A&E or exaggerating symptoms. 

In terms of accessing health services, there is much reliance on informal forms of support such as friends and family, community centres and support groups. Only 5% have been helped by a social worker and 18% by a community support worker. 

The support for mental health, often more enhanced for refugees and asylum seekers, is not available or suited to their often traumatic backgrounds. The cultural issues of some refugees and asylum seekers not understanding mental health and not always acknowledging it as a condition compounds the difficulties in accessing support. 

However, most people held a positive perception from the care provided through GPs, hospitals and mental health services. This implies that once the hurdles of access are overcome by refugees and asylum seekers, people are reasonably content with the care provided. In terms of a solution-focused approach, people also spoke about increasing awareness of the health system, through group work led by a member of the community.