Greenwich & Bexley Community Hospice’s social work team takes a multi-agency approach to supporting one family with No Recourse to Public Funds
Third and final article in our series of case studies on caring for those with no recourse to public funds.
In January 2021 St Christopher’s Hospice launched unique resources to help identify and support one of society’s most vulnerable groups when they are facing the end of life for themselves or someone they care for; people with no recourse to public funds (NRPF). The aim of the resources is for migrant centre workers, social workers, welfare teams and those working in end of life care settings to be better prepared to support people who have no recourse to public funds to help them access the same quality of end of life care extended to the rest of the population.
Here, Glyn Berry, Palliative Care Social Worker at Greenwich & Bexley Community Hospice, describes how, by working closely with other agencies, challenging decisions and asking for help from fellow professionals, she helped ease the pain of a family faced with a tragic premature death, while also facing up to unresolved immigration status and the consequent insecure housing and precarious financial situation.
Glyn first learned of Harry, Rose and their three young children from a consultant at the hospice who also worked at the local hospital where Harry was being treated for advanced liver cancer and Hepatitis B. The consultant had witnessed discussions at the hospital about Harry’s eligibility for free care, given that his immigration status was unresolved meaning he had NRPF. Concerned, the consultant went to visit the family at home and came away even more worried – fearing they had not totally grasped the seriousness of the situation and that their housing conditions were far too cramped and inappropriate for a family of five including a person who was terminally ill with cancer.
Glyn discovered that Harry, in his mid-40s, had come with the family to the UK only 18 months earlier, fearing for his life having been shot by a business rival.
“On my first visit to the family, my priority was to establish the situation and look for quick fixes. It was cold, winter was approaching, they had very little food and no money to buy any. So the most immediate things for me to fix was providing them with food and clothes.
“It’s not always appropriate to do a deep-dive in the first meeting. In this case it definitely wasn’t, as Harry and Rose were like rabbits in the headlights, utterly shocked by what had hit them. I just had to confirm what the situation was and break down what their most urgent needs were.”
Glyn measured the children’s feet, took their clothes sizes and returned to the hospice. There she immediately accessed a small grant fund. She also put out an appeal for warm clothes and shoes.
“We had an amazing response and when I returned with the clothes and shoes you should have seen the children’s faces. They thought it was Christmas.”
Shortly afterwards, Glyn took Harry and Rose’s case to the next hospice Multi-Disciplinary Team meeting. There the whole team discussed the next set of priorities. These included symptom and pain management as well as practical support from the Occupational Therapist and spiritual input from the chaplain.
In fact, faith played a key part in Harry and Rose’s life and on Glyn’s next visit to see them, accompanied by the Modern Matron – (Hospice) Community Services, their priority was to understand how much the family were taking in about the seriousness of the prognosis and coming to terms with its implications.
“They did understand how poorly Harry was, but they believed their prayers would be answered and things would return to normal. We made clear that we respected that but also asked them to consider what they would do if that didn’t happen – encouraging them to hope for the best and prepare for the worst. As a result of that conversation, in which we established trust between us, we are able to have more open conversations in subsequent meetings.”
Very soon after this, Glyn met Nick Watts. Nick, who runs a charity that supports families with NRPF, had started doing some work with the children. They went to meet the family together and Nick, with the support of his legal team, was able to establish that Harry could, because he had submitted a claim on his immigration status, continue to receive free health care, a great relief for the family.
At that meeting with the family, Glyn and Nick agreed to bring together all the different key services – school, GP and district nurses – to ensure care and support was coordinated and to help Harry and Rose feel that they really were being fully supported by all agencies.
“We’d all been working separately for the family, so it was really helpful to join everyone up. All the different agencies were able to put a plan in place and it provided a really positive moment for the family.”
Everyone had a clear role, with Nick focusing on the Home Office to settle the immigration status and the local authority to secure support for the family. Glyn referred to the local authority for the family and with Christmas fast approaching worked to arrange food and presents via donations, as well as another small case grant, to make it as a good a celebration as it could be in the circumstances.
Just a few days after Christmas Harry became very unwell, he was admitted to hospital and died days later. Glyn’s role then was to provide as much support as she could to Rose and the children.
“Rose was in total shock. They were a grieving family who’d had their lives turned upside down. Nick continued to oversee the legalities around the family’s status which were now really urgent as nothing was stable – neither their housing nor income. I took responsibility for looking to find funding for the funeral.”
Given Rose’s strong faith, the idea of a public health funeral was unthinkable. Glyn enquired if other family could help pay and sought help from the local authority or their church, neither of which were deemed to be a possibility but, in the end, Rose’s church stepped in and funded the funeral.
Following the funeral, Glyn’s focus was around supporting the emotional needs of both Rose and the children and in supporting Rose, who needed reassurance to realise that she would be able to manage on her own.
Meanwhile, Nick helped the family find housing and schools out of the area as well as some financial support. Rose’s immigration status remains unresolved though.
There are a number of lessons Glyn says she learned in this case even though she was only working with the family for a few short months. “It really struck me how it must feel to be in a different country for a short period, for your life to be turned upside down and to have no idea how the system works.
“In a case like this you don’t just ask questions once, you check on their emotional status and try to gather the reality of their situation every time you see them.” Glyn also suggests:
- Be aware of time as it is often against you and you need to work fast while always being gentle with people
- Take what time you have to understand cultural diversity and different approaches to death and dying
- Establish what support networks people have and liaise with them as early as possible
- Remember that a decision taken by an official is only their interpretation of the law – be prepared to challenge it and double check everything
- Network as much as you can – there are always people who will have encountered a similar situation who can help
- Consider joining the Association of Palliative Care Social Workers.
St Christopher’s NRPF toolkit provides practical information on ways to identify people in this situation, further case studies and an invaluable guide to the physical, emotional, spiritual and social needs to identify, assess and attend to. You can download the NRPF toolkit and watch the launch webinar.