Select Committee on Health Minutes of Evidence

Examination of witnesses (Questions 548 - 559)



Mr Austin

  548. Good morning. Can I thank you very much for coming to give evidence this morning. I wonder if I could ask the witnesses if they could firstly say who they are, to introduce themselves. Could I just remind you, as I did to the earlier witnesses, that the microphones are here only for recording purposes, they do not amplify your voice, and the acoustics are rather poor in here. If I could ask the witnesses and Members, particularly for the benefit of the shorthand writer, to speak up. If you would like to introduce yourselves.
  (Dr Hussein) My name is Faduma Hussein. I am from Somalia and I am a medical doctor. I work as a lay health adviser with the Community Health Project. We run refugee access clinics in Waltham Forest, which are based in Leyton, and we have two access clinics for asylum seekers and refugees to help them to become familiar with the health system in this country and to get them registered with GPs. We started running an African Women's Clinic in the borough because I worked as a gynaecologist in Somalia and women started coming with gynaecological problems. That clinic was based mainly on female genital mutilation, which is one of the traditional practices in Somalia. We help women to be referred to other services. That is run through the community health centre.

  549. We will come on to ask you about the actual nature of the work. That is fine as an introduction. I am sure there will be lots of questions about the actual detail of your work.
  (Dr Hussein) Okay.
  (Ms Edmans) My name is Teresa Edmans, I work for Redbridge and Waltham Forest Health Authority but manage the Community Health Project.
  (Mr Blake) My name is Mark Blake, I am the Director of a charity called Blackliners. We are an HIV, sexual health charity targeting ethnic minority communities.

  550. Dr Hussein started to answer my first question and she might want to add to it. Would you describe for the Committee the work that you have done to improve the health of the communities that each of you serve? Dr Hussein, do you want to add anything else?
  (Dr Hussein) I started with what I am doing with the Community Health Project, the refugee access clinic, where we help asylum seekers and refugees get registered with a GP and give them information about the health services because most of the people coming to access our clinic have come from different countries where the health service is completely different from here. We give them information on how to get registered and if they do not speak the language we provide them with interpreters or write letters for them telling the GP centre to provide them with an interpreter. That process goes on through the health authority in our borough. We send the details of the person to the health authority so they are registered with a doctor in the borough. If the person speaks a little bit of English we ask them to go around to the GP's surgery and ask if they can get registered. Again, there are some people who come just for emergency problems, so we try to get them on the spot GPs around the area. Health promotion is our main issue in this project. We talk to asylum seekers about access to the health service and where they can go without any referral and what the GP does for them, if they need to go to the hospital they must be referred by the GP. Of course, we have problems with some clients who think that they can go to the hospital without going through their GP, so that has to be explained. We have three doctors working in that project, all of us from a refugee background, two of us are from Somalia and one from Tunisia. One speaks Urdu and Hindi and I speak several languages, Arabic, Czechoslovakian, and the other doctor speaks Russian. That makes us a team which can provide communication, interpretation and all that. I do not know if I am talking too much but I will speak about the African Women's Clinic. The African Women's Clinic was established in October 1999. That was because many women came to our access clinic for gynaecological problems, especially women who had practised female genital mutilation in their country. As a gynaecologist I was working on that project for several years in Somalia. They asked for help and support for some issues on gynaecological problems. I give them information and I give one-to-one health promotion and information on cervical screening, breast screening, all health issues which concern women, and female genital mutilation is one of the main subjects we are working on. We refer them to other services where they can get help and we give them health promotion so they do not carry on the practice.
  (Ms Edmans) The Community Health Project started some six years ago and was an initiative with a Housing Action Trust where the Housing Action Trust was taking over four main social housing estates in the area and approached the Health Authority to look at what health had to do with regeneration and what its impact might be. Initially the project started on two of the four housing estates having a population of around 2,000 people, but after a period of time and the success of some of the work, that extended to include a population of 160,000 and included 92 GPs. The health outcomes that have been over those years are many and I can include some of those: a 33 per cent reduction in prescribed medication; a 50 per cent reduction in repeated GP attendance; significant improvements in the mental and physical wellbeing of people; getting people into jobs; using local services and supporting local businesses; tailoring services to the specific needs of local communities and taking them out to communities where they are at; strengthening partnerships, because in our patch many of the relationships between many of the partnerships were quite poor, and also bringing in and developing new partnerships that may be unusual to the health care system; sharing decision making with local communities, community ownership, community tolerance of other health needs, in other words we are all working on estates where mental health was discriminated against by other people on the estates and there is a lot more tolerance of that and understanding; also building trust between the statutory services and local communities. Faduma will probably talk a little bit more but it was the local people and local tenants who decided that we wanted to work with refugee communities. Faduma was a tenant on the housing estate, she was housed there because she was a refugee. The local communities said they wanted to do work with refugees and since then we have seen something like 1,300 refugee adults and have contact with 200 unaccompanied minors. There is an improved uptake of other services, which Faduma has touched on slightly about how we now network into other services and pilot and signpost, also about young people being instrumental in changing local services to meet their needs. I see all these things as health gains for the local community.
  (Mr Blake) Blackliners runs a number of services. We have an advocacy and an advice service for people who are HIV Positive where we help them access housing benefits and provide immigration advice and legal support. We have a peer education project where we have taken the steps to employ people from the ethnic minority communities. The second highest HIV prevalence group is people from Sub-Saharan communities and we have employed a number of individuals from those communities who are HIV Positive to lead a peer education project which is focused on supporting people from those communities to access and get the benefits from combination HIV therapies because the feedback we have is that people from these communities are not getting the benefits from combination therapy for a number of reasons, which I will not go into at this point. Also they present as HIV Positive later on and, therefore, the actual benefits that could be gained from combination therapy they are not receiving. We also have a team that is focusing on the sexual health needs of the young people particularly from the black and ethnic communities, particularly in South London. Lambeth, Southwark and Lewisham have the highest rates of teenage pregnancy in the country and some very appalling statistics around other sexually transmitted infections such as gonorrhoea and Chlamydia. We are working specifically on that patch with other community organisations, such as colleges. There is a lot of work with the Prince's Trust at Brixton College, for instance, trying to target young people and provide the information to local schools. That is a flavour of some of the things we are involved in.

  551. You would say presumably if we are serious about narrowing the health gap between different social and ethnic groups that it is vitally important to tackle sexual health?
  (Mr Blake) Sexual health is a major issue. We have got some of the worst statistics in Europe around teenage pregnancy and statistics around infections, such as gonorrhoea and Chlamydia, unfortunately are on the rise. Coming out of all the Aids scares of the late 1980s and early 1990s I think we have really lost our focus in terms of sexual health. We are hoping for big things from the National Sexual Health Strategy.

  552. Could I ask you if you think that the voluntary sector is better able to respond, or more quickly able to respond, to changing health and wellbeing needs among local communities than the statutory sector? If so, why?
  (Ms Edmans) I think that they have much more flexibility to be able to respond quickly. That does not mean to say that the statutory services could not do that if there were things that were slightly different and I think on the fringes that is the case also. The voluntary sector is often better placed because of the relationships they have with the community and the network structures. It is about the partnership more than one or the other. It is about how we work jointly together. There is a lot of scope for flexibility and quick responses.
  (Mr Blake) I would echo those points but I would also stress that I feel the voluntary sector can respond if the structures are there. I think some of the partnership structures at the moment are not conducive to getting the best out of the voluntary sector. If you can imagine small voluntary organisations possibly do not have the capacity to be spending lots of time within meetings, and a number of these partnership arrangements generate lots of meetings, and that is a real issue at local level.

Mrs Gordon

  553. Do you find that some of these meetings are on your own funding? Do you find that a problem, this short-termism of much of the voluntary sector's funding and the constant worry about actually carrying on projects?
  (Mr Blake) That is always an issue in the voluntary sector.

Mr Burns

  554. I was wondering if I could ask both of you how you have engaged local people in your services and activities?
  (Ms Edmans) The project was developed on a number of principles. One was about community development and ensuring that local people had the decision making power, so we did not do anything unless we consulted and the community agreed to us doing that. During the course of our work we have always included, involved, as Faduma and other people are witnesses to, local people having a voice in that, thinking about how you outreach to young people and making the involvement process, having a voice different from just asking them, so thinking quite imaginatively about how people can engage in that.
  (Mr Blake) I think for us it is a little different because we are focused on different constituencies but some of the things we have tried to do, as I mentioned earlier, include the peer education work. One of the issues within the HIV voluntary sector is that we have not been very good, believe it or not, at getting Positive people involved in delivering interventions, so we have tried to do that and also in relation to our trustee levels, trying to recruit trustees specifically from the user group. Quite crucial for us is the networking with all the various community fora and what have you.

  555. Do you have any numbers of people involved in both of your organisations?
  (Mr Blake) We have a paid staff team of 21 people and a volunteer team of 16.
  (Ms Edmans) We have a small core team of people that is made much larger by sessional workers and others. Approximately 95 per cent of those people are local people. We try to employ from the local population but we have lots of people doing voluntary work within the projects. We link in with lots of educational and employment initiatives so that we can take placements as well, so that is another way in which we can interface.

  556. How do you think that socially excluded communities can become more involved in increasing their use of health services?
  (Ms Edmans) I think that Faduma and other people are an example of that, partly because the doctors Faduma has spoken about actually work alongside our nurses to run the clinics and they have the language skills. If you are looking at what the barriers are and you have to tackle the barriers, they are about developing trust with the communities, about taking it to where people are at and providing it by people that they feel safe with. That goes for a range of communities. We work with the homeless communities as well and, again, we try to engage people from those communities to work alongside our nurses and other practitioners. Also by taking services out to them and working alongside the people they would trust, like the voluntary sector, so not saying "you have to come here and these are the health services", but much more an integration of services to try to reduce the barriers that are often there.
  (Mr Blake) Involving people within community activities, which is a long haul process, is not something that can happen overnight. In terms of trying to actively involve people within the local community in the key focal points within that community, if it is the local school it is the governing body and the Parents/Teachers' Association, if it is around a local health centre, community centre or residents' association the key is getting those communities involved within those various local structures and fora.
  (Ms Edmans) Particularly among refugee communities there are the sorts of barriers to prevent them becoming involved and it is about how you try to overcome those barriers. Many of the refugee communities that we have worked with have wanted to be involved in various things and it is about how you create a structure or an opportunity for them to do that.

  Mr Burns: Thank you very much.

Dr Stoate

  557. You have talked already about some of the difficulties faced by ethnic minority groups in accessing health care services and how perhaps if they present with HIV they do not get the benefit of the triple therapy and so on. I am more concerned at the moment about how do we actually get to identify the health needs rather than the health care needs? Do you think that primary care trusts and health authorities are any good at actually assessing the health needs of ethnic minority groups in the community?
  (Mr Blake) I think they could be doing a lot better.

  558. What could they do to improve it?
  (Mr Blake) I am specifically talking from a London perspective. Within London the issues are accentuated because 30 per cent of London's population is made up of people from ethnic minority communities. If I took the example of mental health, with my day job hat off I am a non-executive director of a community health trust within London—Camden and Islington—which has 300-odd mental health beds and 90 per cent of the people occupying those beds will be from ethnic minority communities. That is a major service issue and we know that. We have all the statistics around the over-representation of services in terms of diagnosis of schizophrenia, etc and we also have a lot of research that actually tells us in specific ethnic groups that there is a great deal that could be done in terms of work out in the community to prevent people getting to the acute stage.

  559. That is my point.
  (Mr Blake) We are not doing enough.

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