Specialist refugee health centre under threat
Article published: Thursday, May 10th 2012
Salford’s Horizon Primary Care Centre, a provider of specialist healthcare for asylum seekers in the city since 2004, could face closure in an attempt to cut NHS costs.
NHS Salford, the centre’s Primary Care Trust (PCT), plan to close the centre due to the “excessive cost per patient”, despite a report from the refugee specialist network South East Migrant Health describing the city as an “under doctored area”. The practice is no longer taking on new patients, and if the cuts go through the centre is set to close in June this year.
Open since April 2004, the specialist GP surgery aims to reduce the health inequalities faced by asylum seekers and provides specialist care for issues such as post-traumatic stress disorder and child and adolescent mental health, as well as assistance for patients in accessing mainstream care and services.
In their review of the practice South East Migrant Health praised the centre, noting the provision of “high standard service” and delivery of “equitable, culturally competent, safe and effective Primary Care in a sensitive and holistic manner.”
However, an NHS Salford report written by their Acting Locality Managing Director Alan Campbell reveals how managers at the PCT began a bidding process early last year to tender out the service to another provider. The move came after the PCT’s commissioning and finance departments objected to patient costs as high as £500 per head, not counting translators, compared to much lower costs for “mainstream” patients.
But with the failure of the prospective bidders to satisfy the cost and quality requirements of the PCT the Horizon Centre was put under an emergency “caretaking management arrangement”, and staff were formally told their jobs were “at risk”. Now, with NHS reforms set in motion in March this year that scrap PCTs, this “caretaker” arrangement can no longer continue, leaving the centre under threat of closure as a “longer term more economical solution is sought” to replace the service.
Economical solutions
In place of the centre, the report notes that a steering group set up to consider replacement options for the practice decided that a “locally enhanced service” offered through a “limited number” of mainstream GPs should be established as a baseline to meet the additional needs of asylum seekers. The service would be available to patients for the first twelve months they are in the country, and NHS Salford have stated they anticipate the Horizon Centre to close once it becomes available in summer 2012.
The steering group also recommended that providers negotiate the establishment of a specialist “Tier 2” service delivered by “a smaller number of existing experienced Horizon staff” and specialist local organisations. Based at a different location to the original centre, this service would provide support through some Salford GPs in dealing with the “most intensive and risk based” elements of care such as outreach work, practices for unaccompanied asylum seeking children and care for post-traumatic stress disorder.
NHS Salford failed to respond to requests for comment, but in a statement obtained through freedom of information legislation a spokesperson said, “The new service provides a broader networking capability, opportunity for shared learning and support, contingency and shared risk management arrangements, patient choice and preference.” The PCT also said it would allow “access to more practice resources in peak demands and effective control of costs which allows reinvestment and further development of the health services in Salford.”
If the recommended Tier 2 package is put in place then NHS Salford will hope to save £300,000 per year by cutting costs from £500,000 to £200,000. Before any benefit from these savings can be seen however, £200,000 must be paid out first in redundancies and pension payouts for the staff at the centre.
If negotiations fall through and the Tier 2 service cannot be met, then NHS Salford’s fall back option of the “locally enhanced support” offered through a limited number of mainstream GPs would then go ahead. Leaving GPs to take on what the March NHS report called “the complex areas of the asylum patient care”, at a cost of just £20,000 less than the recommended option, the review admits this would see the service “lose the current expertise and preferred risk management” provided by the Horizon Centre.
Vulnerable
Others have voiced fears that the specialist work of the centre would be both missed and hard to replace if plans to close the practice go ahead. While acknowledging that cash is in short supply, one ex-medical student of the Horizon Centre highlighted the need to think about alternatives to closing the centre, pointing out how closure would cause the loss of a bank of specific knowledge and expertise on asylum seeker health.
Mule understands that some medical professionals familiar with the service have concerns that closing the centre will be a huge loss to the asylum seeker community, the working of the centre being at its most effective when it incorporates expert knowledge and experience in one place, rather than being split up and redistributed around various other GP surgeries.
There are also doubts as to whether mainstream GP surgeries would be capable of replicating the Horizon Centre’s work, as the closure may increase pressure on other services. Among the highlighted risks of scrapping the service altogether were increasing admissions to hospitals and Accident and Emergency, and encouraging these patients to remain silent about their mental and physical health issues.
Refugee organisations have pointed to the role the centre plays in building the trust of often traumatised patients in an unfamiliar country, providing a wide range of access to social care and support.
Jude Boyles, The North West Centre Manager of the medical organisation Freedom from Torture, raised deep worries about the closure: “We fear that some highly vulnerable individuals will slip through services and their physical and mental health will deteriorate.
“Many of our most traumatised clients have attended the practice and have received excellent care by the GP team, nurse practitioners, interpreting team and outreach worker. The team offer longer appointments and have built up substantial expertise in torture and its impact.”
Boyles also pointed out that the Horizon Centre is the only specialist GP Practice in Salford for asylum seekers. In consequence, it is also the only provider that currently cares for a high number of “profoundly traumatised torture survivors”, many of whom are destitute.
“Once the practice is closed we are very concerned that a number of survivors with complex needs will not access any form of medical care or their needs will not be met by mainstream primary care”, she said.
Katy Tolman
More: Migration and asylum, News, Welfare
Comments
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Thanks for this well-written piece.
The Horizon Centre provide good care to people who would otherwise have no appropriate NHS provision. I would be interested to know whether the PCT, or the CCG that will take on its responsibilities, have performed an Equality Impact Assessment as they are obligated to when considering a change such as this. Perhaps it was included in the FOI request? If not, it needs to be obtained and published as I suspect it would present major legal obstacles to the threatened closure.
Comment by Mark Ruddell on May 10, 2012 at 5:32 pm -
The NHS is a service provided by the taxpayers of the UK for the citizens of the UK.
It’s only right and proper that all NHS care for non-UK citizens is kept to an absolute minimum and reviewed constantly.
By the way, this site is a bit censorious.
Comments disappear, and sometimes whole articles too.
Are you scared of opinions you can’t handle?
Comment by pete on May 13, 2012 at 1:36 am -
Anyone has the right to healthcare wherever they come from. To say otherwise is racist.
Comment by sarah on May 26, 2012 at 3:09 pm
The comments are closed.
