Standard 20: Health and Migration (Version 11)

Why it matters. A person who has fled war or been displaced often carries trauma and mistrust of institutions. Care that does not take this into account can be harmful even when it is technically correct.

Sample. Review 10 patient records with a migration history, and the care adaptations recorded.

1. Care is adapted to the patient’s migration and displacement history.

Method. Check each sampled record for the history and the adaptation made.

Evidence to show. Migration history and trauma-aware assessment record (HMG-FRM-001).

Pass when. Every record with a history shows the adaptation made.

2. Trauma-informed practice is applied where signs are found.

Method. Check each record with trauma signs for the trauma-informed step.

Evidence to show. Migration history and trauma-aware assessment record (HMG-FRM-001).

Pass when. Every record with trauma signs shows a trauma-informed step.

3. Barriers from legal status are identified and addressed.

Method. Check each record for the legal-status barrier recorded and the action.

Evidence to show. Migration history and trauma-aware assessment record (HMG-FRM-001).

Pass when. Every barrier found has an action recorded.

Immediate fail (any one means the criterion is not met). A traumatised patient is examined in a way that repeats past harm.

Good practice. Care plans are reviewed with the patient at each visit, and a named clinician is responsible for adapting the plan to the patient’s history.

Partial because. care is adapted at the first visit, but it is not reviewed when the patient’s circumstances change.

Why it matters. A migrant who does not know how the health system works, or how to book a visit, may give up on care. Helping them understand their own care and how to use the system keeps them engaged.

Sample. Review the information given and the understanding checks for 10 patients.

1. Each patient is given plain-language information on their care.

Method. Check each sampled record for the information given.

Evidence to show. Understanding check record (HMG-FRM-002).

Pass when. Every sampled patient has the information recorded.

2. Understanding is checked by teach-back.

Method. Check each record for the teach-back result.

Evidence to show. Understanding check record (HMG-FRM-002).

Pass when. At least 90% of records show teach-back checked.

3. Patients are supported to navigate the health system.

Method. Check each record for the health system steps explained.

Evidence to show. Understanding check record (HMG-FRM-002).

Pass when. At least 90% of records show the steps explained.

Immediate fail (any one means the criterion is not met). A patient does not return because no one explained the follow-up.

Good practice. Plain-language information is given in the patient’s language, in both written and picture form, and is repeated at discharge.

Partial because. information is given, but only in writing and not in the patient’s language.

Why it matters. Children should never be asked to interpret for their parents, and a patient who cannot follow the conversation cannot consent. A trained interpreter or cultural mediator is needed for language barriers.

Sample. Review the interpreter and mediator use register for the last 6 months, and the policy.

1. A trained interpreter or cultural mediator is used for language-discordant consultations.

Method. Check each language-discordant consultation for the interpreter recorded.

Evidence to show. Interpreter and mediator use register (HMG-REG-001).

Pass when. Every language-discordant consultation has a trained interpreter or mediator recorded.

2. No child is used to interpret.

Method. Check the register for any child used.

Evidence to show. Interpreter and mediator use register (HMG-REG-001).

Pass when. No child is recorded as interpreter.

3. A family member interprets only where permitted.

Method. Check each family member use for the reason and the risk level.

Evidence to show. Interpreter and mediator use register (HMG-REG-001).

Pass when. Every family member use has a recorded reason and is not high-risk.

Immediate fail (any one means the criterion is not met). A child interprets a diagnosis for their parent.

Good practice. A trained interpreter is booked in advance for scheduled visits and is recorded in the notes, with a phone or video option for urgent cases.

Partial because. interpreters are used for consultations, but the interpreter’s name and the language are not recorded.

Why it matters. Health problems in migrant and displaced people are often driven by housing, work, legal status and schooling. A clinic that works with those services can address the cause, not only the symptom.

Sample. Review the referral tracking register for the last 12 months, with the handover records for 5 patients.

1. Relevant legal, education, employment, housing and social services are engaged.

Method. Check the register for referrals to each relevant service.

Evidence to show. Referral tracking register (PHC-REG-002).

Pass when. Referrals are made to the relevant services where needed.

2. Each referral is tracked to a result.

Method. Check each referral for the result recorded.

Evidence to show. Referral tracking register (PHC-REG-002).

Pass when. At least 90% of referrals have a result recorded.

3. Handover includes migration and displacement context.

Method. Check each sampled handover for the context included.

Evidence to show. Referral tracking register (PHC-REG-002).

Pass when. At least 90% of handovers include the context.

Immediate fail (any one means the criterion is not met). A patient with no housing returns to the same clinic with the same problem.

Good practice. A social-services liaison meets the team each month to review open referrals and closes any that have not reached a result.

Partial because. referrals are made and tracked, but handover notes do not include the migration context.

Why it matters. A sudden arrival of many displaced people, such as after a border opens, can overwhelm a clinic within days. A plan that can be activated quickly keeps care running for everyone.

Sample. Review the surge response plan, and its last test record.

1. A surge plan exists and can be activated.

Method. Check the plan for the activation route and the staff named.

Evidence to show. Surge response plan for migration-related demand (HMG-PLN-001).

Pass when. The plan names the activation route and the staff on call.

2. The plan sets the extra assessment points and the treatment distribution.

Method. Check the plan for the two elements.

Evidence to show. Surge response plan for migration-related demand (HMG-PLN-001).

Pass when. The plan sets both elements.

3. The plan is tested each year.

Method. Check the test record for the year.

Evidence to show. Surge response plan for migration-related demand (HMG-PLN-001).

Pass when. The plan was tested in the year.

Immediate fail (any one means the criterion is not met). A clinic is overwhelmed with no plan and no staff on call.

Good practice. The surge plan is tested in a drill each year with the local authority and partners, and the results are used to update the plan.

Partial because. a surge plan exists, but it has not been tested in the last two years.

Why it matters. Some health problems in migrant and refugee populations need specific guidance, such as TB screening or mental health after displacement. Using that guidance where it exists, and saying where it does not, keeps the care evidence-based.

Sample. Review the guidance list and 10 records from patients from high-burden countries.

1. Migrant-specific guidance is used where it exists.

Method. Check the guidance list for migrant-specific guidance per condition.

Evidence to show. Evidence for refugee and migrant health (HMG-POL-004).

Pass when. Migrant-specific guidance is used where it exists.

2. Gaps in the evidence are recognised.

Method. Check the list for the gaps recorded.

Evidence to show. Evidence for refugee and migrant health (HMG-POL-004).

Pass when. Every gap found is recorded.

3. Screening is applied as the guidance requires for each population.

Method. Check each sampled record from a high-burden country for the screening.

Evidence to show. Evidence for refugee and migrant health (HMG-POL-004).

Pass when. Every sampled patient from a high-burden country is screened.

Immediate fail (any one means the criterion is not met). TB screening is skipped for a patient from a high-burden country.

Good practice. Staff join a monthly journal club on migrant health, and each guideline adopted is recorded with the date it was reviewed.

Partial because. guidance is used, but gaps in the evidence are not written down or shared with staff.

Why it matters. Staff bring their own beliefs and sometimes bias into care for migrants and displaced people. Regular reflection and support help staff notice this, and look after themselves in hard work.

Sample. Review the reflective practice records and the support offered to staff for the last 12 months.

1. Staff hold structured reflective practice on culture, beliefs and biases.

Method. Check the record for each staff member at the set interval.

Evidence to show. Staff reflective practice record (HMG-FRM-003).

Pass when. Every staff member has the reflective practice recorded at the set interval.

2. Each issue raised has an action.

Method. Check each record for the action agreed.

Evidence to show. Staff reflective practice record (HMG-FRM-003).

Pass when. Every issue raised has an action recorded.

3. Psychological support is available to staff.

Method. Check each record for the support offered.

Evidence to show. Staff reflective practice record (HMG-FRM-003).

Pass when. Psychological support is offered and recorded.

Immediate fail (any one means the criterion is not met). A staff member consistently refuses to treat a particular group.

Good practice. Reflective practice sessions are led by a trained facilitator, and staff have access to confidential counselling outside line management.

Partial because. reflective practice is held, but the issues raised are not followed up with an action.

Why it matters. Migrants and displaced people often move between countries and services, and cannot carry their records with them. A record the patient can keep and show, in paper or electronic form, keeps care continuous.

Sample. Review 10 patient records for the portable health record given.

1. The patient holds their own health information in a portable form.

Method. Check each sampled record for the portable copy given.

Evidence to show. Portable health record (HMG-FRM-004).

Pass when. Every sampled patient has a portable copy recorded.

2. The portable record includes the diagnosis and treatment.

Method. Check each copy for the diagnosis and treatment.

Evidence to show. Portable health record (HMG-FRM-004).

Pass when. Every copy includes the diagnosis and treatment.

3. The patient is shown how to use it at another clinic.

Method. Check each record for the explanation.

Evidence to show. Portable health record (HMG-FRM-004).

Pass when. At least 90% of records show the explanation.

Immediate fail (any one means the criterion is not met). A patient cannot show their diagnosis at a new clinic.

Good practice. Patients receive a portable health summary in their own language, and a copy is offered with each referral to another clinic.

Partial because. a summary is given on discharge, but it does not include the treatment given.

Why it matters. A clinic for displaced people in a formal camp works very differently from one in an urban settlement. Naming the model the facility runs under makes the services fit the population it actually serves.

Sample. Review the service model declaration and the practices adapted to it.

1. The facility names its service model.

Method. Check the declaration for the model named.

Evidence to show. Service model declaration (HMG-FRM-005).

Pass when. The declaration names one service model.

2. The practices are fit for that specific context.

Method. Check the adapted practices against the model.

Evidence to show. Service model declaration (HMG-FRM-005).

Pass when. The practices listed match the model.

3. The declaration is reviewed each year.

Method. Check the review date.

Evidence to show. Service model declaration (HMG-FRM-005).

Pass when. The declaration was reviewed in the year.

Immediate fail (any one means the criterion is not met). A clinic in an urban area plans services for a camp it does not serve.

Good practice. The service model is written in the facility’s annual plan, and the infection control and water practices are checked for that setting.

Partial because. the service model is named, but the practices are the same as for a standard clinic.

Why it matters. Asylum seekers, recognised refugees and stateless people have different rights to care and different paperwork. A clinic that does not know which group a patient belongs to can refuse care it must give, or give care it cannot.

Sample. Review the legal status and access rights register.

1. The legal status categories served are named.

Method. Check the register for each category served.

Evidence to show. Legal status and access rights register (HMG-REG-004).

Pass when. Every category served is named.

2. Access rights are applied per category, not uniformly.

Method. Check the access rights listed for each category.

Evidence to show. Legal status and access rights register (HMG-REG-004).

Pass when. Each category has its own access rights recorded.

3. Staff are briefed on the rights.

Method. Check the briefing record.

Evidence to show. Legal status and access rights register (HMG-REG-004).

Pass when. Staff briefing is recorded.

Immediate fail (any one means the criterion is not met). A stateless person is turned away because staff do not know their rights.

Good practice. Staff can explain to a patient the rights attached to their legal status, and the information is given in writing in the patient’s language.

Partial because. legal status categories are named, but access is applied the same way to every category.