Examination of witnesses (Questions 548
THURSDAY 11 JANUARY 2001
and DR FADUMA
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
(Dr Hussein) Okay.
(Ms Edmans) My name is Teresa Edmans, I work for Redbridge
and Waltham Forest Health Authority but manage the Community Health
(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
(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
(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
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.
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
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
(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.
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 LondonCamden and Islingtonwhich
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.