Improving the quality of interpretation and translation in primary care services

We were asked by NHS Leeds West CCG to attend a recent event held by NHS England in our capacity as patient leaders. The day centred on the specific communication needs of patients who require British Sign Language (BSL) interpretation or those whose main language is not English. We came with an open mind to help the NHS as it looks to develop quality standards for interpretation and translation services.

As patients it was a real opportunity to see some of the challenges facing patients when accessing services especially if they have any communication barriers. At the same time it reminded us of the difficult job that health and care professionals have to do to ensure they fully understand the needs of those who they are caring for.

Why is this important? To put this into context we’ve come across these remarkable statistics that show the diversity of needs of people from our different communities. Nationally statistics show that:

  • Approximately 1 in 850 of the population requires the services of a sign language interpreter
  • Approximately 250,000 GP appointments require a BSL interpreter
  • The need for language translators varies geographically and by language
  • Nearly 1 million GP appointments require the services of a language interpreter

There are 135,313 non-English speaking people in the north of England – 676,567 translator sessions are required in primary care each year.

Closer to home we found that in West Yorkshire there are 2,100 Deaf signers. If we assume people make five trips to a GP each year we would need 10,500 BSL appointments in West Yorkshire each year. Although that figure may not be 100% accurate it gives an indication of the support needs required by patients.

This is why we need a consistent set of quality standards to help patients take greater control of their health. This is because they can fully understand what their health and care professionals would like them to do to self-manage their condition or what treatment they need and what they can expect. With NHS resources under pressure it is important that we invest in interpretation and translation services as they can help ensure people stay healthy for longer or can access the right services at the right time.

The day itself was well co-ordinated by NHS England with a mix of clear presentations and interactive group work. We went away from the event feeling reassured that the key outcomes of the day were met. This included a better understanding of the needs of different people, an opportunity to feed into the development of the quality standards and find out what the next steps are to develop the quality standards.

What we learnt as patient leaders

  • Difficulties accessing health care for Deaf and non-English speakers increase health inequalities
  • Patients are not aware that they have a right to an interpreter
  • There are qualifications for interpreters/translators and only those qualified at a certain level should be used
  • It is not appropriate to use friends/family or ‘staff’ to interpret in health care settings
  • Patient choice in the type/person interpreting/translating should be accounted for
  • Medical records should contain information that interpreting/translating is needed
  • Somehow a balance has to exist between aspirational gold standard and the reality of costs
  • Different standards of qualification requirements for interpreting and translation professionals was discriminatory

With no previous experience of the ‘signing community’ for Deaf people, I was humbled by the skill, fluency and eloquence of signers and interpreters around my workshop table.

For us the most important take away message was that patient leaders need to consider

  • The need for translators/interpreters in engagement plans to ensure inclusion of these minority groups in consultations
  • Influencing the CCG to include provision of translation/interpretation as a contract requirement

Following an extensive consultation by NHS England a series of eight draft quality standards for a high quality service have been produced.

We look forward to seeing how the quality standards are used by NHS organisations across the country and the effect this could have on helping some of our most vulnerable patients.

As patient leaders we feel we have a duty to speak out on behalf of those whose voice may not always be heard. This is not a criticism of the NHS or other public services and definitely not a reflection on the care provided by health and care professionals. It is simply a reminder that we can all do more.

We hope this blog has made you think about the access needs of different people and, if you live in Leeds, maybe even encouraged you to join the patient leader programme.  We would definitely recommend it.

Tricia McKinney, Ashley Rawlins, Moneer Sharif

Patient leaders on behalf of NHS Leeds West CCG