It is a year since the closure of the Horizon Centre and I am still angry. There was no question we weren’t providing the absolute best care we could; we were widely recognized as a beacon of good practice; our budget was peanuts, but still we were decommissioned.
The Horizon Centre was a PCT managed GP surgery registering people seeking asylum in Salford. It was set up in 2004 in response to the “dispersal” of people in exile away from London and the South East. There was recognition that this population has specific needs not easily addressed in a ten minute GP consultation. Our team became highly committed and specialised over eight years. We understood just how important the wider determinants of health are in engaging with vulnerable migrants.
Following a failed attempt at tendering the service to “any willing provider”, leaving us without an alternative management structure, we were closed in September 2012. Our patients were expected to find a GP wherever they could. This is at best described as “challenging” for those without mastery of the English language, a passport, or utilities bill. Through my links with the NGOs in the city I know many are still struggling to receive appropriate care.
Andy Burnham, the shadow health secretary, spoke recently at The British Muslim Heritage Centre of the need to provide “whole person care” for the “complex blur of physical, mental and social” problems. This is exactly what we provided, at a bargain price, for a community of people with the potential to contribute positively to our economy in the future.
Our patients, often mentally and physically traumatised by their experiences of exile, showed remarkable resilience, but the UK asylum system is designed to deter people from staying here. They come from the places we see on the news like Sri Lanka, Congo, Iran, and Syria. They come because they are involved in politics, caught up in wars, gay, married to someone with another religion, or just in the wrong place at the wrong time. All have multiple losses you or I find it difficult to comprehend: family, friends, careers, homes, health, language and culture. On arrival most struggle to understand a country where they are not allowed to work and they do not expect even the minimal benefits they receive. It became clear to us just how important work is for health as we saw people lose their self-esteem by languishing in social isolation and hazardous housing conditions ruminating on their losses. Their fear was evident in every consultation.
We were able to help people navigate the complexities of the NHS and meet their basic requirements of security, shelter and warmth through liaison with non-statutory bodies. We helped them report Hate Crime to the police. Dignity was at the forefront of everything we did using face-to-face trained professional interpreters. We practiced holistic “care according to need” in the true spirit of the NHS.
I watched in despair as patients became cold, thin, hungry, anaemic and hopeless once
the asylum appeal process, which can take years, was exhausted. People become destitute with no recourse to public funds. This means a person seeking sanctuary no longer has receipt of the paltry Home Office benefits or even the right to shelter in a homeless hostel. People are reliant on Red Cross food parcels to eat, and drafty church halls to sleep, in this city, today. At least at the Horizon Centre we could find them some shoes, treat their pneumonia, continue their asthma inhalers and monitor their suicide risk whilst they were enduring this plight.
In return we had considerable engagement with our public health agenda. Our screening programme resulted in the treatment of over 360 cases of latent TB, which would otherwise have had the potential to reactivate and spread within the indigenous population. Through developing cultural sensibilities we were able to achieve good cervical screening rates despite a population of women who had often been scarred by sexual violence and Female Genital Mutilation. Patients were brought up-to-date with immunisation schedules and treated for previously undiagnosed chronic conditions to prevent further complications. Despite high numbers diagnosed with complex Post Traumatic Stress Disorder and severe depression we did not have any patients commit suicide.
With increasing localization and fragmentation of health services it is these vulnerable groups who stand to lose most. Our patients would never be “profit making” but treating them fairly and humanely (their entitlements to primary care are well-stated to GPs by the BMA and RCGP) we can help a group who has the will to contribute positively to our society in future. Failing to do this is not only embarrassing in terms of our international obligations to those fleeing persecution, but also shameful in terms of our communities’ responses to the basic needs of the human beings in distress we see before us. It is difficult to comprehend how, as Yasmin Alibhai-Brown wrote in The Independent, our compassion ends at Calais.
For those only interested in the economic argument good accessible primary care is by far cheaper than the unscheduled crises brought about by lack of basic support. Greater Manchester is set to lose £30 million when NHS funding allocations in the North West lose their inequalities money. This marks a downward spiral for those in most need of care, but without a voice to demand it.
Migration is a normal part of twenty first century life; it’s not going away. We are connected in ways we never dreamed possible even ten years ago. Policing the immigration status of our patients is destructive to a therapeutic relationship. It is not the remit of a doctor or a practice receptionist. Asylum claims are for lawyers to decide. Let’s embrace our status as a developed country and welcome to our health service those in difficulty from less fortunate nations. After all we couldn’t function without them: people with a non-UK heritage staff twenty per cent of our NHS.
Dr. Rebecca Farrington, GP.