Breaking the language barrier

In recognition of the multi-cultural society we live in, the NHS’s core principles set out to “shape its services around the needs and preferences of individual patients, their families and their carers” and to be “responsive to the needs of different groups and individuals within society.” To accommodate the vast range of ethnicities living in the UK today, the need for various forms of translation and interpreting in the health sector is great. But the issue does not just end there; the quality of the translation is also vital. Any inaccuracies caused by a poor translation could, quite literally, result in life or death.

Risky business
When patients cannot communicate with health professionals, not only can this make their treatment stressful and confusing, but may also affect the doctor’s diagnosis. Health professionals need to hear an account of their patient’s illness and medical history in order to make a decision about treatment. If this is not obtained, it could result in failure to identify conditions and failure to take the necessary action. Needless to say, the consequences could be considerable.
    
There is also the negative impact on health professionals to bear in mind. By having no or a poor quality interpretation service, health professionals may be forced to compromise or lower their standards by treating patients without explanation or discussion. In addition, there is the worry of having to perform examinations or treatments on a patient that is distressed because he or she does not understand the situation.

Framework agreements
To ensure the quality of translation and interpreting services, and to control costs, the government established a framework agreement for translation services in the public sector in 2006. The contract was awarded to two suppliers: K International and thebigword. By utilising the frameworks, NHS trusts can benefit from cheaper rates, formalised and negotiated service level agreements (SLAs), appropriate insurance cover and proven quality of delivery. The main areas covered are face-to-face interpretation, telephone interpreting, written translation and British sign language interpretation.

Translation services
The decision about whether to use a face-to-face interpreter should be judged on a case-by-case basis. As a basic rule, the more complex the communication, the more likely the need for face-to-face interpreting. Likewise, if the interview is going to be long, if the patient is vulnerable or if sensitive information or bad news is going to be disclosed.
    
An alternative service is telephone interpreting where the interpreter is at the other end of the line. The translation supplier should respond to calls any time of the day or night and should also be able to connect the call to an interpreter in the required language. The call is connected like a conference call between the patient, health professional and interpreter. This should be utilised when short but important pieces of information need to be communicated immediately. The charges are usually based on the time spent on the call.
    
Written text that needs communicating to the patient, such as a patient record, leaflet, brochure, website content, e-mail, letter or form, will need text-to-text translation in the required language.
    
Some suppliers offer text-to-speech translation. This is where a document is communicated to the health professional or patient orally or by audio in the relevant language. It can be a good option for the visually impaired or illiterate. One method is to send the document to the translation agency with the language required and the relevant telephone number. An interpreter will then call the relevant person to read the content of the document into the required language. Alternatively, the supplier may be able to supply the text as audio.
    
Another service that is useful in today’s multi-cultural environment is ‘cultural understanding’. This is where minority groups give feedback on the cultural sensitivity of a document and highlight any issues that might arise due to cultural differences.
    
In addition to those affected by language or cultural barriers, the deaf community should also have access to an interpretation service. British Sign Language interpreting and lipspeaking allows medical professionals to communicate with members of the public who are deaf or hard-of-hearing.
    
Sign Language interpreters take spoken words and convert them into hand and body movements. Lipspeakers on the other hand are trained to transfer the spoken word into lip movements that deaf people can understand.

Choosing a supplier
­­­­Although the framework offers a transparent and cost effective agreement with its chosen suppliers, there is still the flexibility to commission other organisations as a translation partner. It is important, however, to make sure that the supplier can offer quality translation and interpreting services for the specific needs of the health sector. Knowing a foreign language alone is simply not enough in the medical profession. The meaning of a text or speech must be understood before it can be translated and if the text or speech is full of medical terms and jargon, then it is unlikely that a translator without medical knowledge and experience will be able to do a sufficient job.
    
Suppliers that are members of professional bodies such as the Association of Translation Companies (ATC), the Chartered Institute of Linguists (IoL) and the Institute of Translation and Interpreting (ITI) have to adhere to a strict code of professional conduct and can be a good place to start your search. One such company accredited by ATC and ITI is Derwent International Communications who operate to strict quality processes to ensure consistency and accuracy in their translation service. Ben Wyatt, MD of Derwent International says: “We always stress the importance of quality in our translations, and we are already working towards the new European Quality Standard BS EN 15038.”

A disincentive?
Last year, the issue of translation in the public sector made the headlines. The debate, sparked by Ruth Kelly, the then communities secretary, was over whether or not the amount of translation of official documents acted as a disincentive for immigrants to learn English. She argued that learning the English language was key in helping migrants to integrate, but if material is routinely translated into the mother tongue of foreigners, there will be no incentive to learn English.
    
However, the opposing view is that translation allows immigrants to gain access to services while they learn English and helps ease them into British society. It is unlikely that an immigrant will learn English immediately upon arrival and even more unlikely that they will learn it before they arrive in the UK as the majority will not have access to language learning resources. With this in mind, the translation of certain services will help the non-English speaking communities with the transition into British society.

Prioritising needs
According to a BBC survey conducted in late 2006, it was found that the public sector spent more than £100m on translations services in the previous year. £55m of that was used by NHS Trusts, and perhaps there is cause to look at how expenditure can be reduced in this area. This could be done, for example, by giving priority to more critical needs – such as supplying interpreting services – over not so crucial needs – such as translating ‘stop smoking’ material.
    
With continued globalisation, the need for translation and interpreting in the health sector is unlikely to disappear. If anything, the need will grow. And with accurate communication crucial to situations concerning health, it is extremely important that the translation and interpreting services available to the health sector are of the best quality and tailored to the precise needs of the medical profession.

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