Portsmouth Hospitals Procedural Document Template s1

INTERPRETING POLICY

Version 6

Name of responsible (ratifying) committee Equality and Diversity Committee

Date ratified 11/11/2013

Document Manager (job title) Head of Patient Experience

Date issued 26th November 2013

Review date November 2015

Electronic location Corporate Policy

Related Procedural Documents Interpreting services; Interpreters, Ethnic Minorities; Key Words (to aid with searching) Visual impairment; Braille; Hearing Impairment; Sign Language; Confidentiality; Communication Methods

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 1 of 14 Version Date Ratified Brief Summary of Changes Author 6 Flow chart updated Fiona McNeight 6 Section 6.1 updated to include child protection cases Fiona McNeight 6 New section 6.2 – Out of hours procedure Fiona McNeight

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 2 of 14 CONTENTS

QUICK REFERENCE GUIDE...... 3 1. INTRODUCTION...... 4 2. PURPOSE...... 4 3. SCOPE...... 4 4. DEFINITIONS...... 5 5. DUTIES AND RESPONSIBILITIES...... 5 6. PROCESS...... 6 7. TRAINING REQUIREMENTS...... 7 8. REFERENCES AND ASSOCIATED DOCUMENTATION...... 7 9. EQUALITY IMPACT STATEMENT...... 8 Appendix 1 – Flow chart...... 9 Appendix 2 – Booking a face to face interpreter...... 10 Appendix 3 – How to use telephone interpreting...... 11 Appendix 4 – Top 10 tips for telephone interpreting...... 12 Appendix 5 – Guidelines for using face-to-face interpreters...... 13

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 3 of 14 QUICK REFERENCE GUIDE

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 4 of 14 1. INTRODUCTION

This policy is designed to support staff working for Portsmouth Hospitals NHS Trust (the Trust) and provides information about how to access interpreting services for people who experience communication barriers. The population of Portsmouth and the surrounding localities is diverse. Portsmouth City Council reports that there are 99 different languages spoken by Portsmouth school children. Over 13% of the population of Portsmouth is from a Black, Minority or Ethnic community.

The Trust recognizes and welcomes its legal duties under the Equality Act 2010 and will ensure that the interpreting and translation services comply with these legislative requirements.

The Trust aims to ensure that all users of its service are provided with a high standard of service and experience, and good communication is fundamental. If the correct meaning is not conveyed via effective communication, there is a risk of inducing feelings of confusion, frustration, isolation, even anger and increase the scope of missing symptoms and hence effecting diagnosis and treatment.

Many people use the terms ‘translation’ and ‘interpreting’ interchangeably, so it is important for this Policy to denote the difference between the two; Interpreting deals with the spoken word; Translation deals with the written word.

This policy deals with the cost-effective and co-ordinated provision of interpreters for staff and patients with none or limited English proficiency, and speech and sensory impaired (hearing) disabilities, within the Trust.

2. PURPOSE

The purpose of this policy is to:-

. Ensure that the service users of the Trust who have limited English proficiency, including speech and hearing disabilities, have access to the communication tools required to allow complete understanding of their diagnosis and any proposed treatment, to enable a full history and details of symptoms to be given, and to ensure that each service user’s communication needs are met.

. Reduce language, cultural and physical barriers to good communication.

. Provide a prompt and efficient service which is equitable and accessible to all service users.

. Achieve the above in the most effective and economical way for the Trust.

3. SCOPE

This policy applies to all staff with patient contact in all areas of Portsmouth Hospitals NHS Trust.

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 5 of 14 4. DEFINITIONS

4.1 Interpreting – The spoken word transferred into another language including sign language. Interpreting can be provided face to face or by telephone. Interpreting does not include advocating for a service user.

4.2 Translating – the written word translated from one language into another language.

4.3 Interpreter – the person who facilitates communication from one language into another language.

5. DUTIES AND RESPONSIBILITIES

5.1 Executive Director

. The accountable Executive Director responsible for overseeing the process for Interpreting and Translation services for the Trust is the Director of Nursing.

5.2 Managers and Staff

. All managers and staff are responsible for ensuring that this policy is correctly followed.

. It is the duty of all Trust staff to ensure that service users with limited English proficiency, and those with a speech or sensory disability, are enabled to understand what is being said to them and to convey their response.

. All interpreting services come at a cost to the organization, and it is each department’s responsibility to ensure that any expenditure represents value for money. If face-to-face interpreters are booked the following should be considered:-

- Cancellation of hospital appointments with less than 24 hours notice by the Trust do incur a cancellation charge by the current provider of interpreting services and this will be cross charged to the department.

- Service users with interpreters booked by the Trust should be seen in a timely manner as the Trust is charged for the entire time the interpreter is present. There may be a cross charge to individual departments where the waiting time appears excessive.

- An alert will be triggered to the Patient Experience Team of any booking for a 1:1 interpreter over 3 hours in length.

- Bookings for 1:1 interpreters will be prospectively monitored by the Patient Experience Team.

- Interpreters should be booked with a minimum of 72 hours notice for planned appointments. It may not always be possible to book an interpreter with short notice.

5.3 Procurement Service

. The Procurement Service is responsible for overseeing the purchasing and supplying of interpreting and translation services

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 6 of 14 6. PROCESS

The Trust’s preferred method of accessing an interpreter is via the telephone and should always be the first option for any staff requiring an interpreter. The Trust does understand that in certain circumstances a telephone interpreter is not an appropriate action and, therefore, a face-to–face interpreter may be used. (see appendix 1)

The Trust has a service level agreement with one provider to provide face-to-face and telephone interpreting.

Where a health care practitioner makes a clinical decision that telephone interpreting is not adequate and that face-to-face interpreting is required, then a booking may be made via appendix 2.

Face-to-face interpreting is the only approach available at the present time for British Sign Language interpreting.

The telephone interpreting service can be accessed by using appendix 3.

The Trust’s corporate interpreting budget does not pay for the costs of translating written materials into other languages. The translation of written documents can be arranged via the Trust’s chosen interpreting service provider and funded by individual cost centres.

6.1 Protection/Safety Issues

Face-to-face interpreters as opposed to telephone interpreting are specifically to be used in the following cases:-

. There is a specific clinical reason (Senior Clinician to determine this) . The patient has mental health/psychological problems requiring support . The patient has a learning disability . The patient is a child (and is deemed to require face to face interpreting by the Consultant in charge of care) . Child protection cases. . The appointment involves discussing prognosis or complex information which is difficult to share. . The appointment will last more than 45 minutes. . The patient has a hearing impairment . Specific maternity cases – discussing scan results, counseling, initial discussions around foetal medicine and counseling regarding termination of pregnancy.

Guidelines for using family members as interpreters:-

Please note the following:-

Children should not be used as interpreters:-

. Their understanding and interpreting ability cannot be guaranteed . They may miss school . Parents may not feel able to speak through a child . This practice can cause long-term damage to the family relationships

Spouses/partners, relatives and friends should also not be used as interpreters:-

. They may have conflicting thoughts/ideas . Confidentiality may be breached . The service user may or may not feel able to speak freely . The untrained interpreter may add or omit information

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 7 of 14 . They may have difficulty with medical terminology . There may be difficulty in giving ‘bad news’ . Misinformation can lead to misdiagnosis . May open the Trust to potential litigation

Guidelines for when a service user refuses an interpreter:-

There may be some service users who simply refuse to use an interpreter, but who may wish to rely upon a spouse, child, family member or friend. The Trust cannot force a person to use an accredited interpreter, however, the frontline member of staff dealing with the situation will need to record accurately in the patient’s notes that the above risks for not using an accredited interpreter were explained, and that the patient decision was not to follow the Trust’s recommendations.

Guidelines for the use of family and carers as interpreters in emergency situations:-

In an emergency situation it may be necessary to use adult family members to help communicate basic information about care or personal history, they should not be used to interpret clinical information, medical terminology or to facilitate decision making about clinical care. In the event of an emergency situation requiring interpretation relating to consent or treatment, decisions must be made in the patient’s ‘best interests’, and should not be delayed waiting for an interpreter. This should be fully documented in the patient notes. The telephone interpreting services is available 24 hours a day 7 days a week and should connect you to an interpreter within 60 seconds.

6.2 Out of hours procedures

Out of hours staff should contact the telephone interpreting service direct (follow Appendix 3).

7. TRAINING REQUIREMENTS

All staff are required to complete Equality and Diversity Training every three years in line with the Essential Training Matrix. This is now available via the Trust’s on line training facilities.

If any staff member is unclear on how to follow this policy they should contact the Head of Patient Experience.

Specific training and information regarding using interpreting services and the Trust’s chosen service provider will be conducted upon request or as identified by the Patient Experience Team.

8. REFERENCES AND ASSOCIATED DOCUMENTATION

As a public sector organisation there are statutory duties that we required to be met under The Equality Act 2010. This policy has been developed and updated in line with the NHS Equality Delivery System.

Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds

The Equality Act 2010: http://www.homeoffice.gov.uk/equalities/equality-act/

The NHS Equality Delivery System: http://www.eastmidlands.nhs.uk/about-us/inclusion/eds/

Portsmouth City Council: http://www.portsmouth.gov.uk/ (For local population statistics)

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 8 of 14 9. EQUALITY IMPACT STATEMENT

Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds.

This policy has been assessed accordingly.

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 9 of 14 Appendix 1 – Flow chart

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 10 of 14 Appendix 2 – Booking a face to face interpreter

For all interpreting needs the Trust has a service level agreement with thebigword.

All booking for face-to-face interpreters should be done through their online bookings system at:- https://gms1.thebigword.com

Each area/member of staff will have their own client code, user name and password to access the booking system. There are three pages of booking information required. The patient’s hospital number must be included in the booking.

If it is not possible to access the internet at a particular time then please call:-

- Thebigword General Service Enquiries: 0800 757 3025

Please ensure that the booking details are completed accurately and that an appropriate contact number is left for thebigword to contact should they need to (ie a phone that is going to be answered).

If a booking for an interpreter is to be cancelled, it is the department’s responsibility to ensure that this is done within 48 hours of the time and date of the appointment.

The Trust will not pay out of the central interpreting budget for any cancelled appointments where the booking should have been cancelled and was not, and there will be a recharge to the department for this.

The Trust is still billed for any cancelled appointments where the cancellation is made less than 48 hours prior to the appointment. The Trust will investigate cancelled appointments where it has to pay and will charge back where appropriate.

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 11 of 14 Appendix 3 – How to use telephone interpreting

Thebigword is the sole supplier of telephone interpreting, a service which will enable you to help any client who may have limited English language skills.

When you need an interpreter please follow the instructions below:-

- Dial 0800 757 3053 / 0800 694 5093

- Enter your access code, followed by the # key - If required, enter your PIN number, followed by the # key - Enter the language code, see below, followed by the # key

- Once connected stay on the line - Take note of the interpreter’s identity number - Direct your conversation to the client and NOT the interpreter

702 Albanian 94 Farsi (Persian 733 Latvian 755 Slovak 91 Amharic 95 French 734 Lingala 757 Somali 92 Arabic 4 German 735 Lithuanian 1 Spanish 727 Bahasa 993 Greek 97 Mandarin 998 Swahili Indonesian 706 Bengali 738 Gujarati 533 Mirpuri 762 Tagalog 17 Bosnian 994 Hindi 741 Nepali 729 Tamil 707 Bulgarian 724 Hungarian 796 Oromo 992 Thai 708 Burmese 995 Italian 98 Pashto 773 Tigrinya 93 Cantonese 96 Japanese 5 Polish 764 Turkish 780 Creole 3 Korean 996 Portuguese 709 Twi (Haitian) 710 Czech 520 Kurdish 749 Punjabi 765 Ukrainian (Kurmanji) 713 Dutch 730 Kurdish 750 Romanian 999 Urdu (Sorani) 712 Farsi 731 Kurdish 997 Russian 516 Welsh (Afgham) (Bahdini)

Dial 700 followed by the # key if you cannot identify the language required Dial 0 followed by the # key for further assistance

If you have forgotten your access code or you have any questions following a call please contact: (please ensure you have the interpreter’s ID no, time of call and language your required)

- Thebigword General Service Enquiries: 0800 757 3025 - E-mail: [email protected] - Web: www.thebigword.com/publicsector

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 12 of 14 Appendix 4 – Top 10 tips for telephone interpreting

Here are 10 Top Tips for successful communication between you, the service user and the interpreter.

Once connected:

1. Identify yourself and your purpose clearly and distinctly – speaking a little slower than usual.

2. Consider the interpreter as a human language link, facilitating communication between languages and cultures. Make sure you direct your questions to your client, as opposed to the interpreter.

3. Give the interpreter a brief outline of the situation.

4. Be prepared to hear accented English from some interpreters. Feel free to ask the interpreter to repeat a response.

5. Allow the interpreter a few moments to introduce themselves to your customer.

6. Let the interpreter know the information that you wish to deliver or obtain from the limited English speaker.

7. Understand that there may be some delay before the interpreter can elicit the information you need from the limited English speaker due to cultural differences, or a need on the part of the limited English speaker to establish trust.

8. Be aware of linguistic differences. Different languages often require a different number of words.

9. Expect occasional periods of what might appear as idle chatter between the interpreter and the limited English speaker as the communication bridge is built. Please be patient; the interpreter will get back to you but feel free to interrupt if you believe it appropriate.

10. Request input from the interpreter as to what extraneous information the limited English speaker is conveying.

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 13 of 14 Appendix 5 – Guidelines for using face-to-face interpreters

Briefing the Interpreter

 Identify the requirement of complete confidentiality.  Outline the purpose, subject, length of the interview  Identify any delicate or distressing issues that have to be covered.  For minority ethnic patients ask if there are any specific cultural factors, which may have a direct bearing on the interview.  Arrange seating appropriately  Introduce the interpreter to the patient at the beginning of the interview  Explain the interpreter’s role  Ensure that the patient feels able to talk openly through an interpreter.

Key points when interviewing with an interpreter

 The Interpreter is there to facilitate communication NOT to act as an advocate  Ensure that the patient has no objection to the interpreter’s presence, especially during examination  Talk directly to the patient  Keep control of the consultation  Pause frequently  Respond to non verbal cues  Check patient understanding  Make use of written materials  Keep language simple and jargon free avoid colloquialisms  Stick to one subject at a time and break what you are saying to the interpreter into manageable chunks.  Be aware that the patient may not want the interpreter to know everything about him /her

For Sign Interpreters

Please also be aware that:

 A sign language interpreter will ideally sit beside and slightly behind the person conducting the interview so that the patient can easily see both the interviewer and the interpreter’s hands.  It is essential that there is adequate lighting so that the interpreter is not obscured by sitting in front of a bright window.

Please ensure that service users with face-to-face interpreters are seen on time and are not kept unduly waiting.

Interpreting Policy: Issue 6. DATE 26/11/2013 Review Date: November 2015 Page 14 of 14