A framework to guide the commissioning of healthcare services for people seeking asylum in England

Abstract The increasing number of people seeking asylum (PSA) in England, compounded by delays in processing their cases, has led to an urgent need for tailored practices to overcome barriers to healthcare access. While local examples of excellence in healthcare provision for PSA exist, a national framework to guide healthcare for these groups is lacking, leading to fragmentation and inconsistency in service provision. This collaborative research project with the British Red Cross took a co-production approach, involving three peer researchers with lived experience from the outset. From a literature review of case studies on improving access to healthcare for PSA, a preliminary framework of good practice was developed and explored with participants with lived experience of seeking asylum during three in-person workshops refined this. Finally, two focus groups with policymakers and healthcare professionals (HCPs) explored challenges in commissioning services, ensuring final framework relevance to the policy context. In total, 60 participants with lived experience attended three workshops and 19 policymakers and HCPs attended focus groups. Workshop participants emphasised the critical role of improving communication in healthcare settings and educating HCPs and PSA on entitlements and the NHS system. Policymakers highlighted the importance of robust leadership and a standardised national approach that can be adapted locally. Capacity constraints within the NHS and primary care system were highlighted as barriers to good quality care provision. Findings were collated into a practical framework, describing five pillars of good practice; 1)Working in partnership; 2) Upskilling the healthcare workforce; 3) Including lived experience voices; 4) Improving data on local needs; and 5) Strengthening pathways into healthcare. The framework provides guidance to enhance the accessibility, consistency and quality of healthcare services for PSA, addressing critical gaps in the current system. Key messages • A novel framework to guide commissioning and provision of healthcare for people seeking asylum has been developed, drawing from existing pockets of excellence to aid a consistent national approach. • The framework presents five pillars of systemic good practice, highlighting the importance of strategic partnerships, workforce training and data collection in providing good quality care.