By Phayza Fudlalla

Health and Wellbeing Programme

Manager
7
th
May 2014
5/27/2014 SW Health and Wellbeing Network meeting 1
Need for project established by surveys &
consultation:

English non-speakers vulnerable to isolation

Support for mental wellbeing highest need of BME
communities

BME volunteers need tailored support & training

Voluntary organisations key providers of emotional
support for BME communities
5/27/2014 SW Health and Wellbeing Network meeting 2
To support the BME people (mainly Arabic and
Bangladeshi community)
Living in Westminster, K&C and H&F

Experiencing challenging personal circumstances

Experiencing symptoms of stress, anxiety or
depression,

but are not accessing mental health services at
present .
5/27/2014 SW Health and Wellbeing Network meeting 3
To train bilingual volunteers to:
provide need assessments, emotional support &
advocacy to clients,

make appropriate referrals to other services
including the mental health services

record case work by writing case notes.

To support BME Community organisations:
work with vulnerable clients

enable them to demonstrate the impact of their
mental wellbeing work
5/27/2014 SW Health and Wellbeing Network meeting 4
The programme ran 2012/14.

Funded by CCG via the BME Health Forum

Ten bilingual volunteers trained by the BME
Health Forum

The volunteers training included:
basic counselling & advocacy skills

First aid mental health training course
.

5/27/2014 SW Health and Wellbeing Network meeting 5
To recruit participants:
Flyers sent to ACAL members, local partner organisations &
stakeholders to recruit.

Word of mouth by volunteers in the local community.

Volunteers taking flyers to local schools, Children Centres,
mosques, supplementary schools, friends and relatives.

Referrals received from local organisations

5/27/2014 SW Health and Wellbeing Network meeting 6
Each service user received
3-6 one-to-one sessions.

active listening, emotional support and/or advocacy,

signposting and/or escorting to other service providers
5/27/2014 SW Health and Wellbeing Network meeting 7
Ethnicity Age group Service Users by
Borough
Gender
Arab
90
18-24 4
Westminster
105
Femal
e
112
Bangladeshi 16 25-49
86
K& C 9 Male 8
British 4 50-74 30 H& F 4
Pakistani 1 Over 75 0 Brent 2
Somali 1



Spanish 1

Black
African
2

Afghani 2

Scottish 1

French 1

Mixed Race 2


120 120 120 120 5/27/2014 SW Health and Wellbeing Network meeting 8
120 service users supported
440 one-to one sessions provided
Referrals made to ;
IAPT
Third Age counselling
Gordon hospital
Refugees Therapy Centre
Marylebone Family Centre
Westminster Council Admission Office
GPs

5/27/2014 SW Health and Wellbeing Network meeting 9
Befriend a Family
Westminster Home Start
Expert Patient Programme
J ob Centre Plus
Westminster Age UK
Carers Networks
Praxis Community Projects
Westminster Muslim Welfare Trust
Westminster and Hammersmith & Fulham CAB

5/27/2014 SW Health and Wellbeing Network meeting 10
Rain Trust
Cardinal Hume Centre
Social Services
White City Community Centre
Domestic Violence Intervention Project
Westminster Housing Options
The Abbey Centre Health and Wellbeing
Programme( carers group, after school
group, physical activities, Diabetes
mentoring scheme, Community Interpreting
training course)
Open Age IT , ESOL and Chatter and Natter
group

5/27/2014 SW Health and Wellbeing Network meeting 11
Depression
Isolation
Housing overcrowding
Domestic violence
Health issues- cancer /overweight/obese
Financial problems
Dealing with teenagers
Arrange marriage
Language barriers
Older people feeling stress due to need to
completing welfare benefits /housing
applications
5/27/2014 SW Health and Wellbeing Network meeting 12
Homelessness
Caring role
Loneliness
Benefit cap & movement from Westminster
Impacts of imprisonment of family member
Impacts of Divorce e.g. family break up and
stigma
Immigrations issues
Bereavement





5/27/2014 SW Health and Wellbeing Network meeting 13
Project evaluation is currently underway
but initial findings:
I am feeling much better after have
received counselling
The project helped me to move to a bigger
accommodation
The project helped me to get my income
support and accommodation
Two volunteer have secured part-time paid
employment
5/27/2014 SW Health and Wellbeing Network meeting 14
Mrs X is an Arabic women, mid 40s.
Single mother with 4 children.
Suffering from depression for some time
Lacks social support and networks, feels isolated
Language barriers complicates dealing with most
issues.
Her teenage son is involved in gang and drugs
issues.
Police have arrested son on more than one
occasion.
Volunteer supported her over five one-to one
sessions.
She was referred to Abbey Centre physical
activities sessions and to Third Age Counselling
.I found the support given by Abbey Centre
volunteer and TAC was very helpful- I feel much
better now- thank you.
5/27/2014 SW Health and Wellbeing Network meeting 15
5/27/2014 SW Health and Wellbeing Network meeting 16
Emergency or Not?
UNSCHEDULED CARE INSIGHT
PROJECT
A Report by the

BME Health Forum

Commissioned by the NHS Central
London CCG
Who was involved
BME Health Forum
Midaye
Healthier life 4 You
Abbey Community Centre
Marylebone Bangladesh Society
Westminster Mind
Volunteers and participants
CLCCG


Methodology
The Forum recruited, via an open recruitment
process 5 community organisations that work
with clients from deprived communities in the
area covered by NHS Central London CCG to
deliver the project.
A questionnaire was produced by the Forum, the
5 community organisations (staff and volunteers)
and the commissioners.
Volunteers nominated by the community
organisations were trained to interview
participants.
In total 131 interviews (of 76 questions) were
conducted.
Selection criteria used to recruit participants:
All the participants had to be registered with a GP
within the NHS Central London CCG OR
Live within the NHS Central London CCG catchment
area and not registered with a GP at all

Additionally, the participants had to meet at least
one of the following criteria:
Patients with long term conditions (LTC) such as
diabetes, heart disease etc
Parents of children with LTC (e.g. asthma etc)
Adults without long term conditions who are frequent
users of A&E (e.g. 3 times in the last 2 years)
Parents of children without long term conditions who
are frequent users of A&E (e.g. 3 times in the last 2
years)

Demography
68% were fluent in English and 32% not
fluent in English
30% had used an interpreter
81% were female
73% had LTCs
50% had children under 18, while 19% had
children under 18 years old with LTCs
83% were unemployed and of those who
were employed, half were in part-time work
87% of the participants were from the BME
communities.
A & E Attendance 2012/13
38.4% of the population in Westminster is
BME
48.6% of the sum total of all A & E
attendances was BME
Individual groups of categorised BME
communities do not represent high A&E
usage compared to the different white
categories except for
the category Any other ethnic group. The
Any other ethnic group constitutes 11.1% of
the local population and yet has 26%
attending A&E
Key Findings
There was a fairly high number of visits
for self to A&E over a period of 2 years
44% went 1 to 2 times
39% went 3 to 4 times
10% went 5 to 6 times
6% went 7 to 8 times
Over a period of 2 years 85% of the adult
participants had accessed A & E services


Key Findings
When asked about their visits to A&E within the last
two years and how quickly they felt they needed to
be seen, 88% responded that they needed to be
seen within 4 hours while no respondents felt they
could have waited longer than 12 hours

Just over 50% of the participants were able to see
the GP within 12 hours.

When asked why they went to A&E without trying to
go to the GP first, 67% replied because they would
not be seen quickly enough, rather than because
the issue could not be dealt with at a GP practice



Why patient didnt attempt to see GP
before A&E?
Key Findings
57% felt that A&E offers a better service than their
GP practice.
When asked why Not gone to GP first, here are
some of the reasons

Key Findings
28% thought that GPs offered a better service
than A&E

74% felt their healthcare was good or
excellent at A&E

63% felt their care was good or excellent at a
GP practice

The majority of respondents valued their
relationship with their GP practice and
particularly their regular GP (when they had one)



Key Findings
82% said they were happy or very happy
with their regular GP

75% thought their regular GP was a good
or very good listener

21% were unsatisfied very unsatisfied by
the way they were treated by reception
staff at their GP surgery

Key Findings
Respondents were asked what changes would
make them go to a GP rather than A&E

59% selected same day appointments
41% better facilities, equipment and tests
17% more faith in the GPs expertise
16% a better relationship with the GP
Respondents suggested GP surgeries opened in
the evenings and on weekends there seemed
little awareness of the other urgent care services
A better systems for booking urgent appointments
that did not rely on a brief time slot to call and had
greater capacity.
Recommendations for Primary
Care
Those who feel that they need urgent care
want to be seen quickly and have little
awareness of other options besides A&E
when their GP practice is closed.
The most significant reason for attending
A&E rather than a GP practice was the
speed with which people could be seen.
To rectify this it is recommended:
A guarantee to patients that when they
have an urgent need they can be seen
by a GP in a GP surgery, Urgent Care
Centre, Walk-in Centre or Out Of Hours
service within 4 hours.
Pilot drop in clinics that are open late in
the evening (e.g. until midnight)
Raise awareness on the availability of
Out Of Hours services through direct
conversations with patients as this group
of patients do not access information
though mainstream publicity such as GP
practice websites.
Ensure every GP practice has an effective and
consistent appointments system for seeing
urgent cases, particularly children and older
people within 4 hours during their opening
hours.
Work with health professionals about when it is
suitable to advise patients to go to A&E. Many
patients reported that they were advised to go to
A&E by GPs but also by other staff such as
pharmacists or receptionists
In line with the CLCCGs Better Care, Closer to
Home strategy bring certain aspects of the
experience of A&E that people value to primary
care. Patients reported that at A&E they felt that
they were seen by experts, had tests done and
felt more involved in their care
Where practical investigations should take place in
primary care rather than in the hospitals.
Inform patients more about GPs Special Interests. If
possible refer patients to other GPs who have a
particular expertise.
Every effort should be made to involve patients in their
care so that they do not feel more involved in their care
at A&E than at their GP practice.
Ensure patients know how to change their GP practice
if not happy with their GP
wherever possible that patients with language needs
have easy access to an interpreter
Provide workshops for GPs and Practice staff on what
local community organisations are providing that can
support patients.
GP reception staff should be trained in working
with a diverse community and particularly in
working with people whose first language is
not English and/or people who suffer from
anxiety or mental distress
Research should be carried out with patients
who attend A&E repeatedly to find out why
they do so and what would make them
decrease the repeated use of A&E
Improve referrals to community organisations
and to community run health programmes as
these may be able to support patients to stay
well and to understand how to access NHS
services appropriately.
Recommendations for changes in
A&E and Urgent Care
When patients visit A&E inappropriately their experience
should be as similar as possible to attending a GP
practice. For example:
Patients could be told that they cannot be seen at A&E
and have an appointment booked for them with a GP
where they can be seen with 4 hours.
Patients could be seen by a GP at A&E who would
follow the same processes as a GP based in the
community (same access to tests etc).
Ensure that when a patient goes to A&E the staff have
access to the patients records to ensure that no
unnecessary tests are done or repeated to avoid giving
patients the impression that an examination at A&E is
more thorough.
Recommendations for Changes in
Community Provision
Community organisations could be involved in
delivering a community education programme that
raises awareness within different BME communities
about when to utilise which NHS services and what the
different services provide
Make some provision for community health advocacy
which could support patients who have unresolved
issues with their primary care in order to ensure they
are able to access appropriate primary care and do not
attend A&E as a default
Provide a structured health education programme
targeting people who do not speak English that can
support people to manage their long term conditions
and teach them how to best manage appointments
with their GP, book double appointments if needed,
and make complaints.
Recommendation for changes in
the collection of Ethnicity data
NHS Trusts delivering A&E and urgent
care services for the population of
Westminster have a contractual obligation
to collect ethnicity data. This needs to be
done to a higher standard in order to
identify who the 26% attending A&E are in
order to target the community education
programme towards these groups.
Kurdish and Middle Eastern Women Organisation
KMEWO is a women's rights organisation
strives to Empower Middle Eastern and North
African women living in the UK through Support ,
Campaigning and Education !



Founded in 1999

Registered Charity Company LTD
About KMEWO
KMEWO objectives :
Short & Long term support to women.

Campaign and lobby for positive changes in policy and
legislation .

Sharing knowledge and expertise with professionals , peers
and service providers.

Empowering women through Education and Training











KMEWO Services:
Crisis interventions to women and girls at risk of HBV , FM or FGM
( Telephone helpline and drop in advice)

Advice, information, case work , Para counselling and referral and sign posting to specialist
services
( appointments)

Provides Educational courses, workshops and Volunteering and Work placement opportunities
to women
(LFL Project)

Initiate / support Campaigns and lobbies for positive changes in policy and legislation
advocating BME and Refugee womens rights
( FGM project, CHBVF, VAW-WAV)

Held seminars , conferences and raising awareness workshops for service providers on specific
issues related to Middle Eastern and North African women
(8
th
March , 25
th
Nov. , HTP before schools events , and etc.)
FGM Project :
To organise and deliver TEN workshops to :
- Raise awareness of FGM and its different types
- Discuss cultural and religious barriers to eliminate FGM
- Inform about health consequences of FGM
- Provide awareness of policy and legislation in the UK .


Focus on KURDISH and ARABIC speaking communities
30% of the work should be with MEN !
According to Stop FGM campaign by WADI
organisation in Iraqi Kurdistan : FGM is practiced
within Middle East in :Yemen, Oman, the United
Arab Emirates, Bahrain, the Kurdish regions of
Iraq and Iran, India, Malaysia and Indonesia.

Source : http://www.stopfgmkurdistan.org/html/english/fgm_study.htm

The prevalence of FGM in Iraqi Kurdistan:

most girls in northern Iraq are likely to have
undergone FGM. In some areas, the FGM rate is
virtually 100%. The average rate is at 72.7%.

http://www.stopfgmkurdistan.org/study_fgm_iraqi_kurdistan_en.pdf
Prevalence of FGM amongst Iraqi Kurdish community in the UK:

No research available
No attention given
Closed community / politically divided groups
Structure of groups outside London

The attention of mainstream services and the government polices are mostly on
those who are affected by type 3 FGM ; but many women from ME has fallen in the
gaps because of being subjected t type 1 FGM.. This means that there are no
appropriate services especially counselling and therapeutic services for those who
are affected by type 1 FGM.


FGM within Iraqi Kurdish community in the UK:

Class differences

City and rural area differences

Religious believes / statues of local religious clerics

Educational background

Tribal and family issues

Generation gaps between women ( higher statues of mothers in law , grand
mothers and outspoken women)

The role of local womens organisations


Kurdish and Middle Eastern Women
Organisation
Office Numbers :
020 7263 1027 10.00 am- 5.00 pm ( Mon- Fri)
020 7708 0057 10.00 am -5.00 pm ( Thu & Fri)
07748851125 Any time
Languages spoken
: English , Kurdish Sorani & Krmanji
Arabic , Turkish and Farsi
www.kmewo.com
Info@kmewo.com