A local authority recognised that migration was playing an increasingly important role in shaping the city’s population and demand for health services. Changes in global migration patterns, new resettlement schemes, growth in international students and evolving national immigration policy had contributed to a more diverse migrant population with complex and varied health needs.

While the city is widely viewed as welcoming, the Council lacked a consolidated, evidence-based understanding of how migrant communities experience local health services, where barriers to access exist, and how effectively current provision meets need. Insight was fragmented across organisations, and the lived experiences of migrants and frontline services were not consistently captured.

The Council therefore commissioned Caja to deliver a Migrant Health Needs Assessment (MHNA) that would generate a robust evidence base, placing stakeholder engagement at its core.

The central challenge was to engage communities who often face language barriers, trauma, digital exclusion and low trust in statutory systems, ensuring their voices meaningfully informed future priorities and recommendations.

Caja designed and delivered a mixed-methods MHNA underpinned by inclusive, trauma-aware stakeholder engagement. The approach combined quantitative data analysis with rich qualitative insight, ensuring findings reflected both system perspectives and lived experience.

Engagement was deliberately broad and multi-layered. Caja conducted semi-structured interviews with stakeholders across local government, the NHS, primary care, universities, police, public health and the voluntary and community sector. These conversations explored current service provision, observed barriers, examples of good practice and opportunities for improvement.

To ensure migrant voices were central, Caja worked in partnership with trusted voluntary and community organisations to facilitate focus groups with migrants from a wide range of countries and migration routes, including people who had migrated for safety, work, study and family reasons.

Using established community relationships helped create safe, culturally appropriate spaces for open discussion and significantly increased participation from groups who are often underrepresented in formal consultations.

This qualitative insight was complemented by a survey offered both online and in person to maximise accessibility and reduce digital exclusion. Survey design was informed by emerging themes from interviews and focus groups, allowing quantitative findings to reinforce and deepen qualitative insight. Throughout delivery, Caja prioritised clarity, empathy and respect.

Participants were supported to engage meaningfully, language and accessibility needs were considered, and incentives were offered to recognise people’s time and contribution. Insights were triangulated across data sources to ensure findings were consistent, credible and grounded in real experience.

The MHNA delivered a strong, shared understanding of migrant health needs in Sunderland, with stakeholder engagement itself emerging as a key success:

The assessment surfaced consistent themes around access to services, system navigation, language support, mental health and cultural competence, issues that were widely recognised but had not previously been captured in a single, coherent evidence base.

Crucially, migrants reported feeling listened to and respected, with many noting this was the first time their experiences had directly informed local service planning. The findings have provided the Council with a clear and credible platform to inform commissioning, partnership working and service redesign.

Most importantly, the project demonstrated that inclusive, well-designed engagement is not simply a data-gathering exercise, but a catalyst for trust, learning and sustainable system improvement.