Case study

Image of SesenThis is Sesen

Sesen arrived in the UK two months ago from Eritrea, where she had been involved in political activism and was subsequently detained.

  • She has an ongoing claim for asylum.
  • Sesen is currently living in UKVI accommodation.
  • Her family remains behind in Eritrea; in particular, her son.
  • Sesen’s health is average, though she frequently suffers from persistent headaches.

What will Sesen need from health services to help her with these issues?

  • The ability to register with a GP.
  • Support to address and understand her persistent headaches.
  • The possibility of having a health check following her activism and subsequent detention in Eritrea.
  • Support to deal with the fact that she has been forced to leave her son behind with family.

What do you think will be important to Sesen when she is accessing care?

Pick 3 statements you feel best reflect this then click the button below to see the answer.

  1. That the service is easy to use; that she is given clear information and support to understand where necessary.
  2. Sesen feels confident that she will be treated with respect throughout the service.
  3. She gets appropriate information in a way that makes sense to her about staying healthy and seeking care when necessary.
  4. Sesen’s particular experiences and associated needs are understood because the service actively seeks information about the communities they serve.
  5. Her situation is understood holistically because her service is supported by multi-agency networks, information and resources.
  6. That the service has good links with complimentary services eg: interpreting and special support organisations.

It’s true that...

  1. If Sesen feels comfortable and informed, then she is more likely to remain engaged with the service.
  2. If Sesen feels that she is being treated with respect, the guidance offered to her will have more impact.
  3. If Sesen is supported to understand and discuss her health and her options, she is more likely to have a favourable impression of service providers and share the positive health messages with her community.
  4. If the service has strong links with the community, it will probably appear more trustworthy and should be able to provide a more relevant, appropriate service to Sesen.
  5. If Sesen feels that the services are acting together to support her to tackle issues which impact on her health and wellbeing, she is more likely to be satisfied with her care.
  6. If Sesen has access to professional interpreters or sound referrals if necessary, she is more likely to have her needs met and view her care as better quality

However, essentially, all the definitions are equally relevant to access, as:

  • Without the information and networks to support both service users and providers, access will be patchy at best.
  • Accessible facilities are nothing if not backed up by aware, responsive and supported staff.
  • Therefore training is essential for staff to better understand and better respond to service users’ experiences and needs.


Real access is...

...more than numbers through the door. In reality to Sesen, to other migrants in the UK - and to the broader population here, it means:

Able to use the service with ease

Confident of being treated with respect

Coordinated services: links with interpreter services, community organisations, specialist care etc.

Equal access to both preventative and curative healthcare via appropriate information and means

Sensitive, responsive and relevant to individual needs and circumstances across the community

Service supported by multi-agency networks, information on migrants and practical resources

What does this mean in practice?

In the following video, service providers discuss their strategies for strengthening the accessibility of their services.
As you are watching, consider how these refer to the definitions of ACCESS.

Definitions of access that look at service uptake or receipt of support alone are inadequate:

  • we need to look at the processes of accessing support and the quality and perceptions of the support received
  • without clear and updated information, strong networks and ongoing support to health staff to work in flexible and adaptive ways, access will be inadequate
  • with them we can practically improve both medical and social outcomes across the community

Myth or fact?

Changing legislation, media stories and insufficient information can have a huge impact on the provision of care and the perception of what can be accessed freely.

On the following pages you will be presented with a range of statements regarding service provision and access.

Are the following statements TRUE or FALSE? Click your response and find out more.

1. The provision of professional interpreters is as fundamental as installing a wheelchair ramp.



2. Maternal and Infant Mortality rates among refugees, asylum seekers and migrants are broadly similar to those of the UK’s host population.



3. The scale of ‘health tourism’ (i.e. overseas visitors arriving in the UK for the sole purpose of obtaining free NHS care) is rising dramatically.



4. Nobody can lawfully be prevented from accessing GP services because of their immigration status.



5. Refugees are more likely to access A&E then their GP.



6. ‘Ethnic Matching’, where service providers are matched by ethnicity to their patients, will ensure cultural understanding and improved access.




  • The work of service providers is underpinned by legislation against discriminatory practice.
  • Primary care is freely available to all regardless of immigration status.
  • Secondary care is freely available to those who are ordinarily resident and chargeable to others, unless their care falls under certain categories, such as emergency or public health risk.
  • Health tourism is essentially a myth; inaccessible services cost the NHS more through missed appointments, inappropriate service use and delayed care.
  • Monitoring needs to be sensitive, but also detailed enough to be useful and accurate. It must also be part of a broader strategy to improve services and understand communities.
  • Migration experience and its impact needs to be included as a social determinant of health above and beyond ethnicity and culture.
  • Service providers need to understand the motivations and decision-making of migrant communities through ongoing engagement and communication.

Do you feel confident to:

  • Define an accessible service?
  • Give practical examples to the definitions?
  • Challenge the myths around access to health care by migrants?