'Respond'-A novel approach to healthcare delivery for people seeking asylum

People seeking asylum (PSA) often experience complex health needs and barriers to healthcare access, yet no "gold-standard" framework for healthcare delivery exists. From July 2021 to March 2023, the 'Respond' service provided community-based holistic health assessments for PSA in temporary accommodation in North-Central London. This paper aims to describe the experience of the Respond pilot by analysing routinely collected retrospective clinical data and semi-structured interviews with service-users and key stakeholders. 86.2% of those eligible (1497/1736) attended the appointment. The majority of service-users were adults travelling alone (75.1%; 1125/1497) and male (75.9%; 1136/1497), with median age 28 years (IQR 23-36). Thirteen percent were children within 116 family units. Most common countries of origin were Iran (24%, 344/1497), Iraq (11.7%, 168/1497), and Afghanistan (9.5%, 136/1497). At least one health need was identified in 83.2% (1246/1497), of which 19.7% (201/1020) were acute health concerns. Half of all adults (52.6%, 634/1206) and 24.0% of children (29/121) had at least one asymptomatic infection. Mental health concerns were reported by 55.9% (669/1197) of adults. Developmental, behavioural or emotional concerns were raised by parents for 17.2% (26/151) of children. Safety concerns were reported by 14.6% (17/116) of families and 7.9% (94/1184) of adults. Service-users and stakeholders reported a positive experience of the holistic approach. Safety and rapport with staff were identified as key to disclosure of sensitive topics. Challenges were highlighted in provision of care for this population and the importance of cross-sectoral collaboration. We demonstrate high rates of engagement and acceptability of a bespoke, holistic healthcare service for PSA. We identified significant physical and mental health needs, and frequent asymptomatic infection in our population. Proactive assessment, by appropriately trained staff within dedicated, funded services is vital to address health needs and inequalities for this vulnerable population.