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Paul Mackay, an Advanced Nurse Practitioner at Priory Medical Group, talks about the work that Nimbuscare is doing to meet the healthcare needs of asylum seekers in York

Q: How did you get involved in this area of work?

A: The project came about in response to the pandemic; asylum seekers had been housed in HMOs (houses of multiple occupation), but we noticed a policy shift towards housing new arrivals in hotels so that they were able to self-isolate. We understood that their immediate and ongoing health needs were a priority. I became involved as I have a background, and a specialist interest, in working with vulnerable groups. I worked with Palestinian refugees in the 1990s and have experience of working in UK prisons.

 Q: Tell us about the people you’re working with? 

I work with a group of asylum seekers who are staying in temporary accommodation in York while their asylum claims are assessed. Many different organisations have a role in managing the asylum experience and asylum seekers can be relocated anywhere in the country. Many different agencies, interest groups and contractors provide services as part of the system. The experience for service users can be tough and the system can seem impenetrable. 

Different groups are segregated, so some accommodation is for families, women or under 18s, but the group I’m working with in York is made up of men aged 19 to 65 years. They’re from a variety of backgrounds; some have crossed the English Channel on precarious dinghies and others have been trafficked by organised gangs. They don’t necessarily see themselves as victims of that as they have got to where they want to be. Some may have obtained a visa to study here but not managed to complete their studies, invalidating their visa. 

Many are fleeing conflict or persecution and, as a group, they have a lot of unmet health needs. Some carry scars from being tortured or have enduring health conditions because of what they’ve been through and may never have had access to affordable healthcare back home. Some have no documentation at all, whereas others can show you photographs on their phones of complex medical reports, x-rays, blood test results and consultations.   

 Q: What service do you provide to them? 

A: My role is to carry out an initial health assessment to identify their medical needs, including any allergies, previous medical history, immediate medical problems and to offer them health screening. Perhaps not surprisingly, a high proportion of the patients I see have psychological trauma from torture, persecution and the uncertainty of the ultimate outcome of their claim. We can give them good access to healthcare during their time in York, including access to a GP, referral to a specialist and vaccinations for Covid-19. Each of our partner GP surgeries takes responsibility for running a clinic for them for the month.

Q: What are the challenges? 

A: One of the biggest challenges is getting them NHS numbers, which everyone who is resident in the UK is entitled to, including this group of people. NHS numbers are key to providing continuity of care as they move around the country. However, they may have multiple different spellings of their names, or may not know their date of birth or express it in a different way. Also, they can be moved anywhere in the country at a moment’s notice, so I’ve learnt to give them two months’ worth of medication. 

Sometimes, they require a referral to specialist hospital services but may move on before being seen. Our back-up plan is to provide a ‘To Whom It May Concern’ letter for them to show to their next GP if they’re moved before an important appointment can take place. I often wish we could get things done quicker for them; they’re a vulnerable group with complex needs and the asylum system does not fully take account of this. Some of these young men have a huge amount of energy, enthusiasm and drive; it’s an untapped resource. I hope they feel safe during their time here in York. 

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