The lack of notice and coordination by the Home Office before moving asylum seekers means their health outcomes could be considerably compromised, says Dr Dominik Metz
I’m a GP who looks after 250 asylum seekers at a hotel in Oxford, which opened in November. On Wednesday, I got a text message from a charity saying that 10 of my patients had been notified that they would be moved to the Bibby Stockholm barge in Dorset. I was shocked and immediately concerned about my patients who I know well, as the barge is completely unfit for the intended purpose.
I went through all of their medical notes and that’s when I saw that one patient had latent TB. As he was midway through his treatment, moving him without sufficient notice could interrupt it given that it is administered one course at a time in secondary care. And if his treatment is interrupted, it could have adverse outcomes, which include him developing pulmonary TB or multidrug-resistant TB.
Meanwhile, a second patient was waiting for an urgent operation – which will now be blown out of the water with potential lifelong implications – and a third patient has been on a waiting list for specialist psychotherapy for around six months and was finally getting nearer the front of the wait list.
Sadly, there has been a continuous problem with patients being moved from one place to another without notice. When patients moved into the hotel, many had pre-existing health conditions but because they came from all over the country, they were under secondary care in different places, which could be potentially dangerous.
One of our patients, who had been living in an accommodation centre in Manchester, was diagnosed with cancer. There was a huge delay in getting him back into secondary care from our side because there was no transfer of his medical records, and this essentially delayed his cancer management by months. We also had two patients with symptoms of pulmonary TB, and moving them into cramped conditions has significant public health risks.
The challenges of caring for asylum seekers
As GPs, it can be difficult for us to organise care for asylum seekers as we’re not aware of all their health conditions. At least half the time, there’s a delay in the transfer of their medical records. The NHS numbers often don’t match up. And because of language barriers and first registrations, they often have multiple medical notes, and the data is slightly different. We might never have their records and details about where they’ve been previously as they’ve never been able to locate them.
Also, when the hotel first opened, 250 patients all presented at the same time, and it took weeks if not months to see each individual. There has therefore been a delay in seeing people about a medical problem that is often pre-existing, and when you finally come about something that is already under secondary care in a different area and refer them here, they go back to the back of the wait list.
These patients will usually have multiple mental health needs: around 30% will have PTSD, with increased depression and psychotic disorders. But then there are also undiagnosed chronic diseases and increased infectious diseases. Around 20% of our patients test positive for TB, and although most of them have latent TB and are not infectious, they still need treatment and follow-up in secondary care. If we move patients around without notice and coordination, we will likely see infectious disease outbreaks like the one at my hotel where there was a scabies outbreak. Asylum seekers have already been moved off the Bibby Stockholm barge after traces of Legionella bacteria was found in the water.
Now, if you look at what the National Farmers Union says about livestock and compare the rights that asylum seekers have with what livestock in transport have, it’s shocking. When livestock are being transported, they have rights – they have sickness passports and they have to be fit to travel – but asylum seekers don’t.
There are, of course, conditions where it’s appropriate for people to move. For example, we sometimes support people to move back to the areas they have been dispersed from if their families are there. But on the whole, continuously moving people from one place to another is having a huge impact on their physical and mental wellbeing – and that has a huge knock-on effect on the NHS.
Although the Home Office cannot access medical records, I think they should consult with a medical professional before moving anyone to check if they are fit to travel. Otherwise, the potential negative health outcomes could be huge.
Dr Dominik Metz is GP in Oxford and lead GP clinical mentor for the Oxford Refugee Health Initiative