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Populations are constantly changing. It may not be very obvious, but there is complex interplay between births, deaths and migration that creates a local population dynamic which can be difficult to predict. While this has always been the case, there has been much more mobility within the UK and internationally in recent years. This has important implications for many of the social factors that can influence health: household size and overcrowding; social support; family cohesion and minority community issues.

Historically, migration has been a major factor in population dynamics in Scotland. However most of this migration has been emigration rather than immigration. Since 2004, that has changed somewhat. Table 1 shows the Scottish population by ethnicity taken from the 2001 Census. In all there were over five million people living in Scotland. Of these, 501,263 (9.9% of the total population) described themselves as being from white minority ethnic groups and 101,677 people, or just over 2% of the population, described themselves as from other minority ethnic groups.

Table 1: Scottish population by ethnic group
  % of total population % of minority
ethnic population
Base
White Scottish 88.09 na 4,459,071
Other white British 7.38 na 373,685
White Irish 0.98 na 49,428
Other white 1.54 na 78,428
Indian 0.30 14.79 15,037
Pakistani 0.63 31.27 31,793
Bangladeshi 0.04 1.95 1,981
Chinese 0.32 16.04 16,310
Other South Asian 0.12 6.09 6,196
Caribbean 0.04 1.75 1,778
African 0.10 5.03 5,118
Black Scottish/ black 0.02 1.11 1,129
Any mixed background 0.25 12.55 12,764
Any other background 0.19 9.41 9,571
All minority ethnic population 2.01
All population 5,062,011
Source: 2001 census

However, these figures do not take into account the unprecedented entry of workers from Eastern Europe into Scotland from the 10 accession countries that joined the European Union (EU) on 1 May 2004 – Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia. People from Cyprus and Malta already had full rights to work in the UK while those of the others (the so called A8) have some restrictions placed on their ability to find work and claim benefits. As movement within the EU is free, obtaining accurate information about the numbers of people from the A8 countries working in Scotland is difficult. What systems there are, such as the Workers Registration Scheme (WRS) and National Insurance registrations, present an incomplete picture.

Of all A8 nationals entering the UK, some 7% of the total have chosen to come to Scotland. Estimates of the number vary, with official figures suggesting 40,000 – 50,000 registered for work in Scotland. Unofficially, the number may be around 100,000 with perhaps 30,000 in Lothian alone. During 2004 to 2006, the years from which we have better figures, Polish immigrants represented 65% of the total, with Lithuanian (11%) and Slovak (10%) being the next largest groups.

The population is young, with over 80% aged between 18 and 34 years. Over half (56%) are male. The largest proportion find work in the hospitality and catering industry (29%) followed by food/ fish/meat processing (14%). In Lothian, there are populations in each council area involved in a range of businesses and industries and representing a significant proportion of those in employment (Table 2). Typically, they do not have dependants and 55% of workers indicated on their WRS application form that they intended to stay in the UK for less than three months, with only 14% intending to stay longer than one year. This is certainly changing as more families come to Scotland to join partners already here or establish relationships and have children. However, the fact that the population is very mobile and turns over quickly does need to be understood by public services such as the NHS. For instance, essentially fit young men intending to be in Lothian for only a short while are unlikely to see registering with a GP as a high priority – especially if their language skills are limited.

Table 2: Total number of National Insurance allocations by
Great Britain, Scotland and Lothians
2002/03 2003/04 2004/05 2005/06 %change
2002/03
to 2005/06
Migrants as a
% of working
age in
employment
GB 349,240 370,750 4,397,370 662,390 90 2.5
Scotland 14,520 15,500 22,850 41,370 185 1.8
Edinburgh 4,530 4,880 6,040 11,670 158 5.1
West Lothian 190 230 340 1,140 500 1.4
East Lothian 140 120 200 300 114 0.7
Midlothian 100 80 130 210 110 0.5
Source: UK Department of Work and Pensions

Table 3 summarises the source countries of new residents entering Scotland specifically. Whilst Polish migrants form the largest proportion, non-European countries follow them most closely. Migrants make up the largest proportion of working age people in employment in the city regions.

Table 3: Overseas nationals entering Scotland and allocated a National Insurance Number

Table 3: Overseas nationals entering Scotland and allocated a National Insurance Number

An added complexity arises from the Fresh Talent Initiative. This scheme, which does not operate in other parts of the UK, seeks to retain and attract talented workers to address Scotland’s decreasing population. Since June 2005, over 3,000 international graduates from Scottish educational institutions have applied through the scheme to remain in Scotland, many of whom will have remained in, or relocated to, Lothian.

Clearly, migrant workers now make up a significant proportion of the Lothian population and the numbers continue to rise. At present, although the migrant population is predominantly young, fit and healthy, every clinician in Lothian is likely to have encountered migrant workers over the past few years. Their use of services within the NHS reflects the age structure with family planning, maternity care, obstetrics and gynaecology, out-of-hours, accident and emergency and general practice being the health care needs that have to be met. However, the group demographics will change and we are already seeing migrants settling, the birth of children, older family members migrating to assist with childcare needs and demand for paediatric and other services.

The NHS in Lothian – and indeed all those involved in the business of public health – need to be aware of the large changes in our local population and how the population’s needs could change over time. We can expect that patterns of chronic diseases will emerge in these migrant groups that may reflect the underlying epidemiology of disease in their countries of origin. For example, hepatitis or cervical cancer rates are higher in Eastern European countries than in the UK. We are certain to see differences in lifestyle factors, such as the very high rates of smoking in Polish migrant workers. NHS Lothian has responded to this recent wave of A8 migration and, having a relatively large minority ethnic population, continues to place high priority on safeguarding their health. Some of the changes already made are outlined in Box 1. There is also a range of websites, such as one with information about services in Scotland in Polish (http://www.polishinformationplus.co.uk/index.aspx), which can assist professional and local people alike.

key points

  • Clearly migration and health is not just a Lothian issue. We will continue to link with other NHS Boards and public organisations that are working in this area.
  • Improved access to health services and better delivery of healthcare is needed for migrant workers and all other minority ethnic populations in Lothian.

Box 1: Specific developments of note include:
  • Interpretation and Translation Services (ITS) – Polish is now the number one language requested with demand jumping between 2006 and 2007.
  • A Polish speaking clinical support worker is employed for several sessions per week at the Family Planning service at Dean Terrace to facilitate care for the 15% of clients that require it.
  • In maternity services big efforts have been made to optimise the use of interpreters and translated material. An audit of births to Eastern European mothers is being undertaken. Findings from this and focus groups of Polish women who have had children here will inform Lothian’s developing maternity strategy and help us continue to improve care.
  • NHS Lothian has produced a lot of translated material including how to register with a GP. Information in the media stresses the importance of international workers registering with a GP. We are planning a section in Polish on our NHS Lothian website;
  • Staff training on ethnic diversity is key and as health services are distinctly different in other countries, effort is being put into improving the cultural competence of NHS Lothian. Staff can access continuing professional development (CPD) opportunities to help understand the perspective that international workers may have on healthcare. Public Health, maternity services staff and Napier University have recently been awarded a grant to investigate this further in maternity units.
  • Links with the Polish community have been fostered with stands at Community events and presentations to social clubs.
  • West Lothian CHCP has developed an action plan for Minority Ethnic Health. This health and local authority initiative is for all ethnic minority groups in West Lothian. It looks at the wider health issues for migrant workers with issues around schools, employment and housing practice, access to leisure and recreation facilities, alcohol and tobacco use and difficulties in accessing English classes, employment advice and higher education. Some workers are undertaking jobs or working in environments that are unfamiliar to them. This presents obvious dangers, for example, if they are working in industrial processes with heavy equipment when their previous work experience was in a professional role.
  • NHS Lothian employs an increasing number of Eastern European workers in various manual and professional roles and seeks to be an exemplary employer.