Written evidence submitted by the Cambridge Refugee Resettlement Campaign (CRRC) (DTY0100)

About us

CRRC is a registered charity for the purpose of supporting the resettlement of refugees across Cambridgeshire. We are a volunteer-run group of Cambridgeshire residents which was formed in 2015 at the beginning of the current migrant crisis, when the media was filled with images of the misery of the camps and the tragedy of failed attempts to reach them. We wanted to help by welcoming refugees into our community. Originally focussed on fundraising and lobbying local government, we were helped to organise by Citizens UK and became a registered charity in 2017.

We provide a wide range of practical support to resettled refugee families and work closely with the Cambridge City and Cambridgeshire County Councils and other local stakeholders. We advocate on behalf of our beneficiaries for assistance with housing, healthcare, and education. 

Concerns about the availability of NHS dental treatment in Cambridgeshire

As part of the resettlement ‘package’ under the funding instruction between central Government and the local authority agreeing to accommodate refugee families, the local authority is required to provide ‘casework support’.  Casework support includes ‘registering with a local GP, and other healthcare providers in line with identified medical needs.  Prior to shortly before the pandemic, our experience was that the local authority caseworker would register resettling families with both a GP and a dentist for the whole family.

We note the those arriving from shortly before the pandemic, from approximately September 2019 onwards, have been unable to register. Other refugee families arriving under different routes (for example family reunion) have also not been able to find a dental practice able to register them from around the same time.

Following the fall of Kabul in August 2021 and then the invasion of Ukraine in February 2022, significant numbers of Afghans and Ukrainians have settled in Cambridgeshire and it has been, to say the least, extremely challenging to find them NHS dental care. 

It is in the nature of starting a new life in a new country that most refugees will initially register for state benefits while they learn or improve their English and look for work.  Their limited incomes mean that access to free or reasonably priced dental care is of the utmost importance.

CRRC has limited funds available to it and many calls on those resources so when we started to receive significant levels of requests from our volunteers who were assisting the resettling families for help with dental costs for private treatment, we felt it important to understand what was happening to the NHS provision we had taken for granted until the pandemic.  This resulted us in commissioning research into the availability of NHS dental care based on interviews with families we are supporting. The results of this research are published in our report Painful Misalignment: Investigating access to NHS dental care for refugee families in Cambridgeshire published in January 2023.

The virtual withdrawal of NHS provision for new patients across Cambridgeshire has placed us in a very difficult position and has been a significant call on our resources over the last financial year.  Trustees have agreed that, for now, we will cover the expense of an initial assessment with a private practice for recently arrived refugees and then will consider, based on the report, a contribution towards the costs of private treatment. However, we do not think this is sustainable in the long term and believe the burden of paying for basic healthcare should not be falling on the charitable sector.  We would also want it noted that to pay for private treatment we are having to divert resources from spending on training and assistance with getting people into work.

What we found in our research

We conducted interviews with members of 19 refugee families who receive support from CRRC. We found that being registered with an NHS dentist was associated with fewer unmet dental needs, but barriers to accessing care still left many registered families with dental problems:

• Most (83%) families who were not registered with a dental practice reported members with unmet dental needs. Issues included broken teeth, persistent dental pain, bleeding gums and tooth decay. These issues were reported to variously interfere with eating or cause pain or mental distress.
• Conversely, of those families that were registered with NHS dentists, 64% reported no current dental problems.
• However, 36% of families registered with NHS dentists reported unmet dental needs but faced barriers to receiving treatment.

By far the biggest barrier to receiving care reported by the families we interviewed was a lack of available appointments. Additional barriers reported by the refugee families included:

• Lack of adequate translation services. This includes translators during the appointment, and for navigating forms and complex automated phone systems.
• Lack of transportation. Many of the families supported by CRRC rely on public transportation. As refugee families are increasingly being settled outside of cities where public transport links are stronger, this makes getting to appointments more challenging. Additionally, emergency Dental Access Centres are routinely located in urban areas, far away from the villages where the families we interviewed reside.
• The high cost of some dental treatments. As mentioned, the families whom CRRC works with have limited incomes, placing fees for dental treatment such as corrective braces and missing teeth beyond their means, yet the underlying dental issues can cause problems with eating and mental distress.
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Case examples from correspondence to CRRC trustees

To give a flavour of the issues faced please see below extracts from correspondence from family ‘focal point’. (The volunteers who assist families).

Family 22 – Syrian resettlement family – arrived in UK September 2019

Extract from a report from the family ‘focal point’, 28 January 2023

R is still having problems with her teeth and is still not registered with a dentist.  They now have a new contact at the Council, who told R to ring Histon Dentist as they had re opened their wait list.  We have managed to get her on to that list but she has been told it will be a very long wait until she is accepted as an NHS patient.  Over Christmas one of her fillings came out – she was scared to call the emergency dentist because every time she has visited them, they have taken a tooth out and she doesn’t want to lose another one.  She let me make her an appointment, on the understanding that they would only fill the tooth.  In the end they only gave her a temporary filling and told her to see a dentist.

Family 26 – Sudanese resettlement family – arrived in UK July 2021

Extract from an email from a focal point, 06 September 2022

S let me know last week that he's having dental issues but has been unable (unsurprisingly!) to get registered with any NHS practices. I've called around to see if exceptions can be made but haven't had any luck. He's managing at the moment but it's limiting his diet and is obviously probably going to get worse not better - is there any scope for him to have CRRC pay his dental fees?

Family N7 – Palestinian family reunion young man -arrived November 2020

Extract from an email from his focal point, 01 August 2022

I’ve tried this before, several months ago. NHS 111 just tell you to call the local emergency dentist, which I believe must be Brookfields. It is a nightmare. You have to call at 8.15 am. You have to be first in the line because they seem to only have capacity to deal with the first handful of callers. When we did this before I had me and A both calling separately, waiting on the line for four mornings in a row, never making it in time to be seen. After four days of trying, we finally got to a place in the queue where we got told a dentist would call M (on whose behalf we were calling) and they never did. Frustrating!!!!

Family 32 – Afghan family – Resettled in Cambridgeshire March 2022

Extract from an email from the family focal point, 30 July 2022

M and her two young daughters have had a dental report done on the state/problems with their teeth. I have copies of the reports for the three of them and it makes pretty grim reading. To cut a long story short, the two girls need three and 4 extractions respectively and several fillings each. The mother, M, has a multitude of issues with poor previous dental work done on her teeth (in Afghanistan) as well as teeth with missing fillings. I have checked with the dental practice re NHS treatment and they will not take any further NHS patients. For private treatment the cost of an extraction is £165 (adult and children) or £136-272 (adult) or £136 (children) for a filling. I have made clear to the family that CRRC funds for dental treatment are limited. I guess the most sensible option would be to establish a budget and get the most that can be done for that amount of money. What do you think? You have previously agreed to pay for one filling for M which has not yet been done, although the dental report suggests the tooth maybe beyond the point of no return.  Thoughts please.

Family 20 – Iraqi resettlement family – arrived 2018. Family registered with an NHS practice by their local authority support worker.

Extract from a report by the family focal point who accompanied the mother to her NHS appointment on 20 June 2022 (post lockdown)

When we were leaving, W asked to make an appointment for her son A. When they looked up his record, they found that he hadn’t been to the dentist for 3 years and so his file was ‘archived’. They explained that he would now need to fill out a brand new form to create a new patient account for NHS Dental services - essentially starting all over again. They also said that this clinic is no longer accepting new patients so he will have to be seen elsewhere. The receptionist vaguely hinted that he may try this clinic again in a few months to see if they’re accepting new patients, but no guarantees given.

Families 35 (arrived in Cambridgeshire October 2021)  and 46  (arrived Cambridgeshire November 2022 – Afghan families resettled under the ARAP scheme

Note from the family’s focal point, 02 February 2023

Hi - I have had another request for help with dental costs from a Brampton Afghan (Family 35). Her husband works part-time with ********. 

She has been suffering for some time from bad toothache, and the Brampton Hub paid for her initial assessment with a Huntingdon dental surgery (the only one in the area taking on new patients - and only private, of course).

I attach the assessment and cost. Brampton Hub paid for Appointment 1 (assessment, clean, X-ray), totalling £140. The Hub cannot pay any more and have asked if we can help.

I’d like to suggest that we offer £250, leaving £530 for the family to pay. 

(NB: Last month, I submitted a request for family 46, also faced with a huge dental bill – £709, inc. assessment. We paid the assessment (£64) plus £250, the Hub paid £130, the family paid the rest).

Feb 2023