NHS and interpreting services

Effective interpreting delivered by professionals who are registered and regulated provides better outcomes for patients. Mike Orlov of NRPSI explains why

Individuals who do not speak or understand English should not be hindered from accessing the NHS and need to be provided with effective interpreting. Language barriers contribute to health inequalities and can exacerbate specific ailments due to poor communication between patient and medical practitioner.

And the NHS also needs to be protected to ensure less crippling and costly misdiagnoses when poor interpreting takes place due to the use of below-par, under-trained, ill-equipped or inexperienced bilinguals and linguists. It is a false economy to deploy free or cheap pseudo-interpreting.

Given interpreters provide a key service for patients, carers and clinicians, helping them understand each other when they do not speak the same language, the NHS has to be committed to providing high quality, equitable, effective interpreting so healthcare services are responsive to all patients' needs.

When in a hospital, a procurement manager tells a trained, qualified, accredited, registered and regulated interpreter not to bother turning up for their poorly remunerated engagement we should explore why the engagement was cancelled. If it was cancelled because a foreign language speaking cleaner (a bilingual deemed fit to practice but with no qualifications or experience) had arrived who could carry out ‘interpreting’ for free, we would then have an indication as to why so many interpreters are leaving the profession and why the NHS is suffering with poor interpreting services.

What chance is there of a mother being honest about her ailments if her ‘interpreter’ is her 14-year-old son or daughter? When bilinguals with no training, qualifications or experience are deployed, much to the annoyance of medical professionals, then risk is built into the system.

When many newly qualified interpreters who have no or little experience find themselves in difficult circumstances in a consulting room, we might ask what we should do to attract qualified and experienced people back to interpreting in the NHS. Even an experienced interpreter, but lacking qualifications, does not guarantee quality or risk-free situations.

As outlined by advice from NHS England (Guidance for Commissioners: Interpreting and Translation Services in Primary Care), face to face interpreters should be registered with the National Register of Public Service Interpreters (NRPSI). The same document states very clearly that all interpreters must be registered with an appropriate regulator, be suitably qualified and should have the skills and training to work in health care settings and have undergone appropriate checks and clearance in line with Disclosure and Barring Service (DBS) guidelines; the only appropriate independent and not-for-profit register and regulator in the UK is NRPSI.

Relevant qualifications
Appropriately qualified interpreters should be sourced and provided for use by the NHS where life and death decisions are often made given feedback from patients to doctors, nurses and allied health practitioners.

Relevant qualifications confer status as a recognised, registered and regulated professional practitioner; acceptable public service interpreting qualifications are the most robust and reliable measure of interpreter quality and all interpreters working in the health sector need to be qualified to a minimum level where it is recognised the interpreter is safe to practice and will not potentially cause untold harm through miss-interpreting.

Those newly qualified without experience ought to be mentored by experienced public service interpreters to embed the code of conduct and aid in navigating the issues, problems and challenges of public service interpreting in the NHS.

As NRPSI states, 400 hours of experience ought to be required for those working in organisations where the most serious potential consequences might occur, such as the NHS where life and death decisions are a daily occurrence.

NHS practitioners should not accept pseudo-interpreters delivered by procurement management whose only concern is controlling costs. But when this advice is not followed and untrained, unqualified ersatz-interpreting is delivered by bilinguals then it is no surprise why registered and regulated interpreters do not wish to work for the NHS for low engagement fees.

As an NHS senior manager, procurement manager or a medical practitioner, do not allow unqualified and inexperienced interpreters not only hinder but possibly harm you, your reputation and the quality of your work with patients.

Do not accept: bilinguals with no language or interpreting qualifications and no public service interpreting (PSI) experience; bilinguals with no language or interpreting qualifications but with PSI experience; linguists with language A level (or lower grade) but no interpreting qualifications; linguists with language A level (or lower grade) and with interpreting qualifications; linguists with language degree level (or above) but no interpreting qualifications; linguists with language degree level (or above) with interpreting qualifications; interpreters with level 3 or 4 community level interpreting qualifications without PSI experience; or interpreters with level 3 or 4 community level interpreting qualifications with PSI experience.

Senior NHS management, procurement management and practitioners in the NHS should demand as a minimum: interpreters with 400 hours or more PSI experience and passed some of the required level 6 modules; interpreters with level 6 DPI or DPSI Law or DPSI Health or DPSI Local Gov or equivalent degree level but with less than 400 hours experience but are at least trained to do the job; and interpreters with level 6 DPI or DPSI Law or DPSI Health or DPSI Local Gov or equivalent degree level with more than 400 hours experience but not ascribing to the Interpreter Code of Conduct.

Ideally you ought to be engaging those interpreters who are registered, regulated, have the requisite clearances and have signed up to the Code of Conduct of the National Register: Registered and Regulated Public Service Interpreters (RPSIs) who have level 6 qualifications, all the required experience, approved clearances and ascribe to the Code of Conduct; a NRPSI Registrant.

The National Register was set up in 1994 following a Royal Commission which recommended a register of the most highly qualified interpreters be established to protect the public from the consequences of poor and inappropriate interpreting in the public sector. This remains its core purpose; when an interpreter is working in a public service setting, usually in a potentially life-changing or life-threatening interview situation, they are the only person who understands what both the other parties are saying.

The potential for abuse of the public’s trust is clear if the professional ability and integrity of the interpreter cannot be relied upon. NRPSI was set up with help from the Home Office and the Nuffield Foundation to ensure those used as interpreters in the public sector were: appropriately qualified; with the right levels of experience; and are ready to carry out interpreting assignments.

NRPSI’s core function is to protect the public, and the public-purse, from poor practice in interpreting; risk and complexity cannot be forecast therefore highly qualified and experienced public service interpreters need to be deployed in doctors’ consulting rooms as well as other NHS settings.

The majority of Registrants are on Full Status, qualified to honours degree level (level 6) or above in the skills required to work in a public service setting with the requisite relevant experience. The National Register contains a substantial proportion of the eligible, trained, qualified and regulated interpreters in the UK.

Hitting cost-targets and supply-requirements by procurement management at the expense of quality are not achievements, causing confusion and miscommunication for medical professionals with their non-English speaking patients. More funding for interpreting services is desperately needed and would mitigate against the inherent risks and high levels of compensation when interpreting goes wrong due to poor service-delivery by inadequates.

No amount of saved pounds-sterling will guarantee effective high quality interpreting needed by doctors, nurses, allied health professionals or indeed, the individual who cannot speak English and needs to communicate. It is critical the NHS sets funding for interpreting services on the basis of commitments to best-guidance, to principles and indeed to law; not based on expedient parsimonious frugality. Such attempts to save money have negative domino effects.

A threat to the NHS
Making use of bilinguals or linguists with no interpreting qualifications or experience threatens the public and the NHS. Pseudo-interpreters, bilinguals, and ersatz-interpreters with no or low grade interpreting qualifications and limited public service experience are not acceptable replacements for safe and effective interpreting conducted by registered and regulated professionals.

Interpreting engagements in the NHS need to be carried out by those who are fit-to-practice; interpreters with level 6 Diplomas in Health Interpreting with more than 400 hours experience, with clearances and who ascribe to the Interpreter Code of Conduct.

Well-trained, qualified and experienced public service interpreters contribute to the safeguarding of human rights. Registrants who voluntarily accept the NRPSI Code of Conduct are inspirational beacons to professionalism in language service provision for the public sector.

While NRPSI regulates those interpreters who display the professional self-regard to be on the National Register, NRPSI is powerless to deal with complaints against unregistered interpreters. Were it statutory for interpreters working in the NHS to be registered and thus regulated and if it was mandatory for the NHS to use only registered and regulated interpreters, then the public, and the public purse, would be better protected. NRPSI has proved to be a necessary tool for safe-guarding the quality of public service interpreting; it needs to be a ‘must’ not just a ‘like to have’ for the NHS.

Effective interpreting delivered by professionals who are registered and regulated provides better outcomes for patients, allowing them to manage their conditions and also frees-up medical practitioners to handle more cases. It is simply about providing the best possible care to all in the UK. It is also about helping people to become productive and integrated members of society. The NHS needs to spend money wisely on interpreting so the NHS can be proud of meeting the needs of all British citizens.

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