3.12 Services for inter-ethnic communications
Another way in which services have attempted to respond to issues of inter-ethnic communication is the provision of services for people whose first language is not English. You may remember this appeared to be the key ‘problem’ in the case study which launched the discussion of ‘difference’ in Section 1. As noted there, poor communication in health services can have serious consequences, leading to misdiagnosis, ineffective interventions and, in extreme circumstances, preventable deaths. Where appropriate interpreting and translating services do not exist, children are often put in the position of translators. At the Royal College of Nursing Congress in 2002, the RCN Health Visitors Forum urged the government to invest in skilled interpreters within the National Health Service (RCN, 2002).
It is not just people whose first language is not English who may want to use interpreters or link workers. Other people may experience difficulty when trying to access health and social care because of language difficulties. Health and social care providers may adopt a particularly ‘professional’ way of speaking which uses elaborate codes, which individuals who use different ways of speaking may find difficult to understand. This may be off-putting not just to users from black and ethnic minority communities but also to people from other backgrounds, for example people who speak with a range of regional and national dialects, people with learning disabilities and those with mental health problems.
However, for people who do not understand or speak English there is a particular need. The next activity explores some of the issues about using interpreters in care services.
Royal College of Nursing motion
‘This meeting of the RCN Congress urges the Government to invest in skilled interpreters within the National Health Service’.
Sandra Rote, RCN Health Visitors Forum, introduced the resolution by noting that the importance of communication was now recognised on pre-registration courses.
She asked how nurses are supposed to deliver care if they cannot talk to patients? She deplored the use of family and friends as interpreters. She mentioned cases where asylum seekers were unable to describe their health needs to nurses and said that many clients did not want to disclose health issues to a friend or family member who could translate.
She praised the work of Language Line but said that interpretation also meant understanding body language and inferences. She said that it was not just a question of more staff but called for interpreters to be on permanent contracts and have access to training. She also said that staff should be trained to work with interpreters.
The first speaker was a school nurse who knew of cases where children were used as interpreters and said this was a major concern for school nurses. She also said that communication meant understanding languages and culture and the real meaning of words.
The next speaker mentioned that translation services were a target in the NHS plan and called upon them to be available for all patients.
A nurse from London said she was privileged to work in an area of great cultural diversity and couldn't practise without good translation services and remain within the code of conduct. She described the situation of using a relative to break bad news to a patient as being unbearable and said an interpreting service was a basic human right.
The next speaker said that interpreting services should include prison service health centres. She was followed by a speaker who said that communication and informed choice were basic human rights and called for sign language to be included too.
A freelance interpreter recalled a case where she was called to translate during a woman’s third appointment with a consultant. When she informed the consultant that the woman was in pain she discovered there was no mention of pain in the notes. The woman, whose husband usually translated said ‘I know he had never mentioned my pain. He thinks it is all in my head.’
The next speaker said that interpretation services were essential to delivering the Congress theme of putting care first and said it was important that interpreters were trained in terminologies.
Another speaker described a personal experience of health visiting a family who she later discovered were living in extreme poverty.
The last speaker said that the profession needed to be sensitive and culturally aware. She said some of Milburn’s millions should be used to train interpreters.
In summing up, Sandra Rote said the provision of such services was a basic human rights issue.
The UK is now an established multi-cultural community. Health care providers need to be able to communicate with people from all backgrounds and ethnic groups so as to ensure the best possible care is provided.
Unfortunately, in some instances, language barriers have compromised care outcomes. Nurses and others find it hard to assess people’s needs in the absence of interpreters. The NHS does not have a national standard for the provision of interpreter services. On many occasions relatives and friends of patients have to be relied upon to act as translators, a situation which guarantees neither accuracy nor confidentiality. The situation has been compounded over recent years by the increase in number of asylum seekers and refugees. These people have often fled their own countries and may have been subject to a high degree of stress, abuse, and even torture. To communicate with these people, even if they did have a good command of English, would be difficult let alone when a translator may be required.
Some areas of the NHS have invested in high quality translation services, for example ‘Language Line’. Language Line provides a telephone-based interpretation service and can assist with translation of text to speech and English text to other languages. The service is able to provide help with over 100 languages, yet it is not a face-to-face service. The NHS plan (England) sets a target of free translation services to be nationally available from all NHS premises via NHS Direct by 2003.
In a few areas of Scotland a number of agencies have come together to provide interpretation and translation services across all public sectors, e.g. health, police, local authorities etc. The Scottish Executive recently published the report Fair for All: NHS Scotland and People from Ethnic Backgrounds (2001). Information provision, access to services, including interpreters, will be progressed by NHSS Boards and a new Ethnic Minority Resource Centre.
A number of Health Boards in Northern Ireland are working with The Equality Commission to publish information booklets in a number of languages and to supply interpreters.