Refer to the Helen Bamber Foundation

Please note the Helen Bamber Foundation is closed for the Festive Period - 1st December until 16th December inclusive. Please submit your referral from the 17th December onwards. Thank you for your understanding.

MOIC referrals are temporarily closed between 2nd May - 16th June 2023.

If the person you are referring is in mental health crisis and/or at risk to themselves we would advise that they call the Samaritans mental health helpline on 116 123 or attend their local A&E.

We do not consider referrals for those under the age of 18. For those whose age is disputed by the Home Office, we go by the age given by the individual being referred.

We cannot offer our services to anyone who is currently in an Immigration Removal Centre or Prison.

Please complete the sections below.

Who is submitting this referral?

Please select *

It is essential that the Helen Bamber Foundation can communicate with you before we can process this referral.
Therefore, please refrain from discharging the patient until a decision on this referral has been made.
Otherwise, we may not be able to accept the referral.

What service are you referring for?

Please select *

The Foundation’s MOIC Service may include provision of therapy, legal protection support, housing and welfare advice and casework, specialist counter-trafficking support, a medical advisory service and access to our community and integration programmes.

Individuals referred to the Foundation for a Medico-Legal Report only will not have access to our wider range of services.

Previous MLR (Medico-Legal Report)?

MLR Document

Drop document(s) here, or click to manually upload.

Privacy Notice

The Helen Bamber Foundation needs to store, use and share your personal information in a number of ways so that we can consider your referral for support within our Model of Integrated Care. This means that we are a data controller of your personal information. We process your data in accordance with the General Data Protection Regulation and the Data Protection Act 2018.

This document tells you what information we hold about you, how and why we share it and how we keep it safe.

1. What information do we collect about you and why?

We need to collect some personal information from you so that we can understand your needs and support you in the best possible way as part of your referral to the Helen Bamber Foundation. We collect information about your:

Legal issues and immigration status so we can help you with your immigration application.
Housing and financial situation so we can secure accommodation for you and make sure you are receiving the financial support you need and are eligible for.
Physical and mental health to help you access the appropriate medical treatment and therapy. This medical information also helps us to provide legal support, for example when a doctor writes a medico-legal report for you.
Interests and level of education so we can better understand what services and activities you would like to engage with, and whether we can make that possible.
Contact details to arrange appointments with you, keep you informed and updated about anything we are supporting you with, and discuss any concerns or difficulties you might be having.
Legal representative, GP (or other healthcare professional) and other key workers’ contact details so that we can work together with those supporting you.

We also use this information to tell people and organisations about the work that we do so that they will support our work. This is called research information. For example, the Helen Bamber Foundation will tell people how many people are referred to us and how many people we are able to accept into our service. When we do this, we never give any information to anyone which will identify you such as your name or your address without your permission.

2. How do we collect this information?

From the referral form – the referrer provides the information we request so we can carefully consider how we may be able to help you. We ask that the referrer explains to you why they are doing this and asks for your permission before making the referral.
Directly by you e.g. when you have an appointment at our Foundation, contact us by email or phone or send us your documents.
Directly by others e.g. when your solicitor sends us an update about the status of your application, or when we receive information about your housing from the council.
When we request it – we may contact your solicitor, GP, health professional, support worker or other local authority officers (e.g. social workers or benefits team) to request information about you.

3. Who do we share your information with and why?

The Helen Bamber Foundation is committed to providing the highest quality care for you, this includes at the referral stage. Sharing information with other supporting organisations is vital to help us identify and meet your needs in the best possible way as we process your referral. We share information with:

Your legal representative so they can provide information about your immigration application or other legal matters.

Your GP or healthcare professionals to understand the medical treatment you are are receiving and the support you need.

Information Local authority officers as necessary (for example, lawyers, social workers, and benefits team officers) in the offices of the local authority where you live. This helps us understand your housing needs.

The Salvation Army (and its contractors), Hestia, Migrant Help or other organisations that may be able to help with your accommodation and/or support. We may tell them that you have been referred to us so that, for example, you can stay living in London and come to the Helen Bamber Foundation.

The Home Office as necessary. We will never talk about your referral or treatment at our Foundation unless you tell us that we can.

Other organisations that can support you for example when we provide onward signposting where we are unable to accept your referral. We will not do this without your consent.

4. How do we keep your information safe?

Your personal information will be recorded and stored securely in paper and/or electronic files as necessary, for as long as you are actively engaging with our service. Only the Foundation’s staff and volunteers can access your information, and they have been trained to operate in accordance with our data protection policies.

Your file will be electronically archived and eventually securely destroyed in accordance with the UK’s data protection legislation and the Helen Bamber Foundation’s retention policy. If you would like to see our retention policy, please contact us: 0203 058 2020

5. What is the lawful basis of our processing your data

When we process data concerning your housing and financial situation, interests and level of education and contact details we will do so because:

you have consented, or it is necessary for us to comply with a legal obligation to which the Foundation is subject, or it is necessary to protect your or someone else’s vital interests, or where it is necessary for the performance of our work carried out in the public interest.

However in situations (ii)-(iv), where possible, you will be told if any disclosure is to take place.

When we process data concerning your legal status and immigration history and physical and mental health we will do so because:

you have given us explicit consent to do so, or
processing is necessary to protect your or someone else’s vital interests in a situation where either you or that third party are physically or legally incapable of giving your consent, or
the processing is necessary for the establishment, exercise or defence of legal claims or whenever courts are acting in their judicial capacity, or
processing is necessary for reasons of substantial public interest.

Sometimes we will need your consent to be able to provide you with our services. If this is the case, we will let you know at the time we ask for that consent.

6. Changes to our Privacy Policy

We keep our privacy policy under review and any changes will be communicated to you. We will provide notifications about changes to this policy by email or other appropriate channels. This privacy policy was last updated in line with the General Data Protection Regulation (GDPR) on 25 May 2018, and was subsequently revised on 4 February 2022.

7. Contact us

If you have any questions about our privacy policy or the information we hold about you, please contact us at 0203 3058 2020.

8. Your Rights

Under certain circumstances, you have rights under data protection laws in relation to your personal data. You have the right to:

Request access to your personal data (commonly known as a “data subject access request”). This enables you to receive a copy of the personal data we hold about you and to check that we are lawfully processing it.

Request correction of the personal data that we hold about you. This enables you to have any incomplete or inaccurate data we hold about you corrected, though we may need to verify the accuracy of the new data you provide to us.

Request erasure of your personal data. This enables you to ask us to delete or remove personal data where there is no good reason for our continuing to process it. You also have the right to ask us to delete or remove your personal data where you have successfully exercised your right to object to processing (see below), where we may have processed your information unlawfully or where we are required to erase your personal data to comply with local law. Note, however, that we may not always be able to comply with your request to erasure for specific legal reasons which will be notified to you, if applicable, at the time of your request.

Object to processing of your personal data where we are relying on a legitimate interest (or those of a third party) and there is something about your particular situation which makes you want to object to processing on this ground as you feel it impacts on your fundamental rights and freedoms. You also have the right to object where we are processing your personal data for direct marketing purposes. In some cases, we may demonstrate that we have compelling legitimate grounds to process your information which override your rights and freedoms.

Request restriction of processing of your personal data. This enables you to ask us to suspend the processing of your personal data in the following scenarios: (1) if you want us to establish the data’s accuracy; (2) where our use of the data is unlawful but you do not want us to erase it; (3) where you need us to hold the data even if we no longer require it as you need it to establish, exercise or defend legal claims; or (4) you have objected to our use of your data but we need to verify whether we have overriding legitimate grounds to use it.

Request the transfer of your personal data to you or to a third party. We will provide to you, or a third party you have chosen, your personal data in a structured, commonly used, machine-readable format. Note that this right only applies to automated information which you initially provided consent for us to use or where we used the information to perform a contract with you.

Withdraw consent at any time where we are relying on consent to process your personal data. However, this will not affect the lawfulness of any processing carried out before you withdraw your consent. If you withdraw your consent, we may not be able to provide certain services or communications to you. We will advise you if this is the case at the time you withdraw your consent.

If you wish to exercise any of the rights set out above, please contact us on info@helenbamber.org For more information about your rights in relation to the way in which we process your personal data, please contact reception.

You will not have to pay a fee to access your personal data (or to exercise any of the other rights). However, we may charge a reasonable fee if your request is clearly unfounded, repetitive or excessive. Alternatively, we may refuse to comply with your request in these circumstances.

We may need to request specific information from you to help us confirm your identity and ensure your right to access your personal data (or to exercise any of your other rights). This is a security measure to ensure that personal data is not disclosed to any person who has no right to receive it. We may also contact you to ask you for further information in relation to your request to speed up our response. We try to respond to all legitimate requests within one month. Occasionally it may take us longer than a month if your request is particularly complex or you have made a number of requests. In this case, we will notify you and keep you updated.

9. Right to complaint to the ICO

You have the right to make a complaint at any time to the Information Commissioner, the UK supervisory authority for data protection issues. They can be contacted by calling 0303 123 1113. We are registered with the Information Commissioner’s Office and our registration no. is ZA593047. We would, however, like to have the chance to deal with any issues you may have before you contact the ICO – so please do get in touch with us with any queries you may have.

Download HBF Privacy Policy

I have read the Privacy Notice and would like to continue with my referral? *

The person I am referring has read and understands the Privacy Notice and they have given consent for the referral to be submitted? *

Yes
No

Referrer contact details

First Name * Surname * Role * Name of Organisation * Phone number * Email * Postal Address *

City/County * Postcode *

Personal details

First name/s * Last name * All other names used or known as Date of Birth * Gender * Phone number * Email address Contact Address

City/County Postcode

Disabilities Physical Disability
Learning Disability

Disability Details

Country of Origin * Ethnicity Religion Date of last Entry into the UK Primary Language * Any other languages spoken Interpreter Required *

Preferred Interpreter Gender *

Preferred Clinician Gender *

The Individual's Experiences

My Experiences

Victim of Trafficking? * Victim of State Torture? * Victim of Other Extreme Cruelty? * Please provide a brief account of your experiences, including approximate dates and locations where known *
(max: 3000 characters / 500 words) Please provide a brief account of this person's experiences, including approximate dates and locations where known *
(max: 3000 characters / 500 words) Characters remaining: 3000.

Legal Protection

We prioritise referrals for people who currently do not have status in the UK and therefore have ongoing legal protection needs

Do you have a solicitor? * Does this person have legal representation? *

Type of Legal Representation? * First name Last name Name of Firm/Organisation Phone number Email address

Legal Status in the UK? *

We prioritise referrals for people who currently do not have status in the UK and therefore have ongoing legal protection needs. Unfortunately we are unable to consider referrals for people who have refugee or humanitarian protection status, indefinite leave to remain or UK citizenship.

Asylum Claim Stage? *

Upcoming Appeal Date

Further Details

Have you been referred to the National Referral Mechanism (NRM)? * Has this person been referred to the National Referral Mechanism (NRM)? *

NRM Stage? *

Is this person involved in the criminal justice system as an informant, witness or defendant in relation to their trafficking experience? *

Please set out why you think a Medico-Legal Report will make a material difference in your client’s case *

Please upload any and all legal documents related to your client’s asylum claim. Including: Screening Interview, Substantive Asylum Interview (SEF), Home Office decisions (refusal letters), Rule 35 Reports, Witness Statements, Expert Evidence, Tribunal Determinations, any submissions or representations made on your client’s behalf, etc

Document File(s) (Max 20Mb / 10 files - per upload)

Drop document(s) here, or click to manually upload.

Support Worker

Do you have a support worker? * Does this person have an assigned support worker under the NRM? *

Support Worker Details

First name Last name Phone number Email address

Housing & Welfare

What type of housing are you living in? * What type of accommodation is this person living in? * Current Address

Same as Contact Address?

City/County Postcode

Statutory Support Received? *

Do you feel safe where you are living? * Further Information

Is the person destitute or otherwise at risk? *

Further Information

Do you have children (under 18)? * Does this person have children (under 18)? *

Location of Children *

Mental & Physical Health

Do you have a GP? * Does this person have a GP? *

GP Details

First name Last name GP Surgery Address

City/County Postcode Phone number Email address

Do you have concerns about your mental health? * Does this person have mental health concerns? *

Please provide further detail (including diagnoses where made)

Do you have concerns about this person's risk to themselves, including self-harm and suicide? *

Please provide further detail

Have there been past incidents of self-harm or suicide attempts? *

Please provide further detail

Has your GP referred you for Therapy? * Has this person had contact with Mental Health Services? *

Please provide further detail

Are you currently receiving therapy or counselling? * Is this person currently receiving therapy or counselling? *

Please provide further detail

Do you have concerns about your physical health? * Does this person have physical health concerns? *

Please provide further detail

Does this person have any scarring or physical injuries attributed to their experiences of ill treatment? *

Please provide further detail

Have you suffered a head injury? * Has this person suffered a head injury? *

Please provide further detail

Are you or do you think you might be pregnant? * Is this person pregnant, or do they think they might be pregnant? *

Disclaimer: We may be unable to process your referral without up-to-date medical records. Please upload medical records below.
Document File(s) (Max 20Mb / 10 files - per upload)

Drop document(s) here, or click to manually upload.

Other Support Organisations Involved

Please provide details, including contact information, of any other Organisation(s) supporting you Please provide details, including contact information, of any other Organisation(s) supporting this individual

Additional Information

Please provide any additional information and clearly state why you would like support from the Foundation. *
(max: 3000 characters / 500 words) Please provide any additional information and clearly state why you think this person would particularly benefit from the Foundation's support. *
(max: 3000 characters / 500 words) Characters remaining: 3000.

Documentation

Consent Form

Download HBF Consent Form

Please download and sign the Consent Form, then upload a photo or scan of the signed document.

Without this signed Consent Form we will not be able to proceed with the Referral

Please download the Consent Form, and have the individual read and sign it, then upload a photo or scan of the signed document.

Drop scan or photo of completed Consent Form here, or click to manually upload.

Attach Additional Documents

To make a decision on a referral we need to be satisfied that we have a full understanding of the individual’s legal protection, welfare and housing, safeguarding, medical and therapy needs, and Conclusive Grounds Decision.

Where insufficient information is provided it will delay the processing of the referral.

Document File(s) (Max 20Mb / 10 files - per upload)

Drop document(s) here, or click to manually upload.

To finish and submit the referral, please press the button to the right