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The work of O'Donnell and colleagues1 clearly illustrates how recent immigrants' expectations of the NHS are shaped by their experience of health services in their country of origin. When expectations conflict with the reality of service delivery in the UK, patients become frustrated, staff also find themselves under strain. The need to repeatedly explain the system and to cope with unhappy patients, who are having difficulty negotiating appointment and referral systems, can increase the workload.
In response to the challenge of explaining the NHS to new immigrants, I have recently worked with a small group of (mainly) asylum seeker and refugee health professionals to produce a short film, ‘How to use the NHS’. The film takes the style of a conversation between two old friends. It is made in English with voice-overs in eight other languages, namely: Arabic, Farsi, Kurdish, Urdu, Sylheti, Somali, French, and Polish.
The key messages in the film cover some of the issues highlighted by O'Donnell's article, and others that my own experience suggested might be useful. For example:
The film was launched in Manchester in March 2008. Because we want the film to be used as widely as possible, it is available on the internet (www.blackhealthagency.org.uk/drupal/video) or can be ordered as a DVD from the Black Health Agency at cost price. Copies have already been requested by agencies as diverse as refugee community organisations, Citizens Advice Bureaux, and tutors of English as a foreign language, as well as health organisations. We believe that going beyond traditional healthcare organisations is the key to getting information out to the people who need it most.
A qualitative evaluation of the film was overwhelmingly positive and provided useful feedback on how it could best be used, in combination with information on local services. GPs working in areas with high numbers of new immigrants, asylum seekers or otherwise, might like to direct their new patients to the film in order to ease their transition into the NHS.