Providing adequate preparation for complex cases

Settlement and health services may have little or no information on the clients’ needs prior to arrival. One Victorian service provider has noted that they do not receive information that a person has a disability, is sick, or in need of specialist support.

In the words of two participants at the RCOA consultation:

We have clients who are getting off the plane and need a wheelchair and we don’t know that they need a wheelchair. They’re met at the airport and having to carry family members on their back and that kind of thing”, and another, “often we have seen that people are actually quite sick when they come by plane and once they get here they have to attend multiple medical appointments. We don’t really know until the time they jump on the plane and then on the other end we have to get ourselves ready. But that’s not giving us enough time to respond, that’s one of the critical things.

These concerns were repeated in late 2016 in another consultation held by RCOA in Geelong, when a service provider mentioned:

One of the [issues]… is that we’re often not notified when people have some kind of disability, so the actual notice of any health issues or disability supports is really poor… We’ve had cases where people turn up and the family is carrying someone because no one was told that they need a wheelchair. And if we knew that we could have arranged for something to do that. So the more information [the better]. Screening is one thing, but I think to have that awareness would be helpful.

Since October 2017 health alerts are provided to service providers notifying them of the needs of people with disabilities upon their arrival to Australia. The alerts are categorised as either:

Potential medical issue: indicating the nature of the serious medical problem that the person with a disability has at the time of evaluation that may resolve prior to arrival in Australia
Critical medical issue: indicating that the person with a disability has a serious medical condition that requires medical follow-up immediately upon arrival in Australia. Receiving a critical medical issue alert will usually result in a travel escort accompanying the person with a disability to Australia.

Health alerts are triggered by an Immigration Medical Examination or Departure Health Check and are communicated to the service provider upon designation.

While the alert system is very valuable, it is not fail-safe. For example, in a review of the Syrian and Iraqi children attending a specialist immigrant health service, of the six children identified with life‐threatening medical illnesses on arrival in Australia, only one of these six children had an offshore critical medical alert.

Previously issues could be reviewed by health staff prior to arrival (with the exception of people arriving through the Special Humanitarian Program), but the Department of Social Services (DSS) now only generates health information for new arrivals designated as “high risk”. Health providers can access health reports via the new HAPlite system, but access to HAPlite records is not possible without individual HAPlite numbers and DSS does not provide those numbers to health care providers directly. There is real concern among health providers that many refugees with a disability may not be identified until after arrival and needed equipment will be delayed.

Those who are sponsored are particularly at risk of their disability not being picked up early. The sponsor is responsible for referring the person to a GP. While theoretically GPs will have access to health reports on HAPlite, in practice they are unlikely to know about the health portal.

Matching the needs of the entrant with the local capacity is particularly important. Settling people with specific health or therapeutic needs in rural and regional areas that do not have access to a tertiary hospital or necessary specialised health or disability services can be highly problematic.

Recommendation 1: Ensure accurate information transfers between services

That the Department of Social Services, Department of Home Affairs and contracted services should work to implement a system that ensures accurate and timely health information transfers from assessments offshore to health and settlement service providers providing on-arrival support.

Recommendation 2: Avoid settling people living with a disability in rural areas where needed services are not available

The Department of Social Services should limit or avoid settlement of entrants living with a disability in rural and regional areas that do not have access to a tertiary hospital or necessary specialised health services.