Dispelling the myth

I often come across news items highlighting the escalating costs of translation and interpreting services to the NHS, which concerns me as more often than not the British media tends to portray translation and interpreting for the NHS as an expensive and largely unnecessary evil.
These unhelpful and inaccurate depictions of the situation can be harmful, not just to the reputation of the translation and interpreting profession as a whole, but also to the service provided by the NHS in terms of patient care. Media often fails to report that without the services of professional translators and interpreters, the NHS cannot provide a quality translation and interpreting service to those most in need of them. As the NHS is only too aware, patient care is the prime objective and not being able to communicate with patients and their families is a barrier to this success.
This debate often overlooks the fact that failure to use qualified professionals can be far more damaging in terms of errors and distress and can actually end up costing far more in terms of money, time caused by diagnostic delays and problems. Care must be taken to ensure that negative media reporting of the situation does not damage the NHS’s own perception of the benefits of professional translation and interpreting services.

More investment, not less
Since NHS organisations are not required to report planned or actual spending on translation and interpreting services, it can be very difficult to monitor figures, but a widely accepted figure reported early in 2009 was £50 million a year, with a statement that the figure is set to rise further. As with many other areas of the NHS, more investment is needed for translation and interpreting services, not less. If the NHS is to meet targets for improving patient care the use of qualified, professional translators and interpreters must be a prime consideration in future budget planning.
Many NHS professionals, no doubt, already have direct or indirect experience of the risks involved in using a patient’s family member as an intermediary for communicating complicated, sensitive and confidential medical information. At ITI we hear of cases where a young child had to tell her non-English speaking grandmother she had cancer, or how a patient’s condition was misinterpreted by a friend, resulting in the incorrect diagnosis and treatment. Using friends, family, staff and unqualified translators and interpreters is a risk, and generally the risk is the patient’s.
What I want to do is suggest some solutions to the situation. These may not be easy to digest, but speaking from a view point of someone who can appreciate the situation from both sides of the fence – healthcare providers, and translators and interpreters – it is clear to see that change – and further investment – is absolutely necessary.

What to look for
When working with translation companies it is important to be sure they have or are working towards a recognised certification standard such as ISO or the recently introduced European Quality Standard BS EN15038 and that they are member of a professional body such as ITI. You also need to ensure their translators and interpreters are qualified and, again, members of a professional body.
Employing freelancers can be a simple process. ITI, for example, offers a free to use internet directory of UK-based, qualified members who work in a combined total of over 150 languages. Creating a relationship with locally based freelancers within your immediate ethnic communities will be a rewarding experience for all concerned.
When dealing with languages you do not understand it can be difficult to ascertain the quality of translation and interpreting taking place. It is therefore essential to verify the credentials of your chosen ‘professional’. This is a challenge as there are an estimated 10,000 people in the UK who market themselves as ‘professional translators and interpreters’. Obvious checkpoints are confirming qualifications, references, and again, memberships of professional bodies. Employing a member of a professional body will provide you with a translator or interpreter who has at least met stringent admissions criteria and who signs up to a Code of Professional Conduct.
A professional will always be happy to provide evidence of qualifications and memberships; interpreters, for example, will often hold the Diploma in Public Service Interpreting (DPSI).

Helpful remedies
One approach could be to create regional in-house translation and interpreting departments within the NHS. A good example of where an in-house arrangement works well is Coventry Primary Care Trust, according to one ITI interpreter member who is based in the Midlands. Initially, the Primary Care Trust had its own in-house translation and interpreting service and Coventry City Council had another. The two departments merged in 2006 under the aegis of the City Council, but with funding from both bodies, thereby guaranteeing a high degree of continuity in level of service.
Another option is to create PCT language champions to become the focus for patients and staff when language may become a barrier. Such individuals can keep abreast of local community needs and new language requirements in the area. They can also improve relationships with language providers.
ITI members tell me the process would work far more efficiently if the NHS were to include languages and/or dialects required on both paper and digital patient records. This would ensure healthcare providers are able to identify a suitable interpreter easily and swiftly and in some cases assistance to the patient would be provided in a timely manner. Additional information including the preferred gender of the interpreter and the nature of the request – interview, counselling, crisis or other – would also be beneficial.
Another simple but effective solution would be to provide training to healthcare practitioners on how to work with interpreters. Some simple basics would help ensure the process runs smoothly. Here are some examples of best practice in a situation requiring an interpreter:

  • introduce everyone and define their roles
  • establish some ground rules to ensure communication only occurs between the interpreter and the patient 
  • stress that the interpreter can only communicate what is said and cannot offer any additional information or advice
  • speak directly to the patient and not to the interpreter
  • maintain eye contact with the patient, if culturally appropriate
  • speak clearly and naturally
  • summarise the discussion at regular intervals to ensure the patient has understood everything
  • ask yourself whether you believe the patient understands and if you have obtained all relevant information. How will you know and by what measure can you be sure?

After the discussion it is good practise to obtain feedback from the interpreter – particularly regarding any difficulties in the interpretation or with any personalities – and to check that the interpreter has not been traumatised in any way. Remember that conveying sensitive information can be distressing for the interpreter as well as the patient.
Translation is no less of a problem. In fact, a mistranslation of a document can have dramatic and long-term consequences. A mistranslated instruction sheet could be dangerous to patients and NHS staff, whilst mistranslated patient notes could lead to diagnostic and even patient identification problems.
Duplication of translated material seems to be a growing concern with reports that PCT’s may be translating documents for their own local communities, reportedly without reference to colleagues in other areas.

Smoothing the process further
As healthcare providers and their suppliers use more technology in both their business processes and day to day medical recording, the opportunity for unprecedented improvements in patient/carer communication will deliver efficiency without increasing costs.
Face to face interpreting should always be used for complex situations or when discussions are likely to be lengthy. This ensures a more caring, personal service and creates a greater understanding of the communication process because the interpreter is able to identify and respond to cultural body language and religious beliefs that may not be obvious to NHS staff.
Telephone interpreters should be considered in emergency situations for immediate assistance to help establish facts. It is also the case that some patients may actually prefer to use telephone interpreting as it is more anonymous. However, it is remote and not recommended in all cases.
With recent technological developments, the potential for video interpreting is worth exploring. Video is no substitute for face to face interpreting, but it can provide a practical compromise between face to face and telephone interpreting. Video could also work well for sign language and perhaps even lip speaking, while text to speech is advisable for the visually impaired or illiterate.

The future
With increased patient mobility we could find that there are more non-British EU citizens choosing to come to the UK for their treatment, much in the same way as we are witnessing more UK residents travelling abroad for medical care. The best way forward is to consider the advice offered in this article – always use qualified professionals; train staff in how to work with interpreters; invest more, not less; identify PCT language champions to keep abreast of local community needs and new language requirements; and finally, forge strong relationships with language providers.
ITI has 3,000 members, all of whom demonstrate their commitment to the profession by joining the organisation and adhering to a strict code of conduct. This is essential in an unregulated profession.
There are various levels of membership ranging from fellow (FITI), qualified member (MITI) and corporate membership. To become a MITI, translators and interpreters must successfully complete the rigorous application process where only those who can prove their educational qualification, experience and commitment succeed.

For more information
For further information visit the ITI website at www.iti.org.uk. The Directory of Members offers a list of qualified members.