Translation and Interpreting

AGENDA ITEM 4 Guidance for the use of Interpreting and Translation Services APPENDIX NPS01. Version 1.0

GUIDANCE FOR THE USE OF INTERPRETING AND Translation and Interpreting

SUMMARY POINTS

Date: November 2010 Author: Amanda Colman Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0

This Guidance is intended to ensure that  the Trust meets it’s equality and diversity requirements by providing access to information spoken/written and scripted in an appropriate format and/or language, including British Sign Language, for a patient/relative/parent

 interpreting is provided by qualified interpreters to ensure that patients receive appropriate support and information to make an informed decision about their care and treatment especially in situations where the consent of the patient is required.

 a standard process is followed for patients/relatives/parents who require an interpreter BSL or foreign language.

 staff have guidance about how to arrange interpreting services

 staff have best practice guidance when working with interpreters via telephone or face to face

DOCUMENT DETAILS

Author: Amanda Colman Job Title: Patient Experience Manager Signed:

Version No. 1.0 Directorate Reference No. NPS01 Next Review Date: November June 2013

Approving Body/Committee: Equality and Diversity Group Chairman: Minesh Khashu Signed:

Date Approved: Target Audience: All Staff Date Equality Impact Assessment was completed: Enter Date SU

DOCUMENT HISTORY

Date of Version Next Date Director Nature of Change Issue No. Review Approved Responsible

Date: June 2010 Author: Amanda Colman 2 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 Date for Change 9.1.2012 2 Nov 2013 9.1.2012 A. Colman Appendix 2. Action for Hearing Loss. Change of telephone number.

Date: June 2010 Author: Amanda Colman 3 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0

TABLE OF CONTENT

M 1 RELEVANT TO...... 4

2 PURPOSE...... 4

3 DEFINITIONS...... 5

4 ASSOCIATED DOCUMENTS...... 6

5 REFERENCES...... 6

6 CONSULTATION...... 7

7 PROVISION OF INTERPRETING SERVICES...... 7

8 DEFINITION OF INDIVIDUAL ROLES...... 7

9 DISSEMINATION...... 11

10 REVIEW AND REVISION ARRANGEMENTS INCLUDING VERSION CONTROL...11

APPENDIX ONE - EQUALITY IMPACT ASSESSMENT...... 12

APPENDIX TWO – BOOKING AN INTERPRETER...... 15

APPENDIX THREE – TRANSLATION OF WRITTEN DOCUMENTATION...... 18

APPENDIX FOUR – GUIDANCE FOR STAFF ACTING AS INTERPRETERS...... 19

APPENDIX FIVE – WORKING WITH FACE TO FACE INTERPRETERS...... 20

APPENDIX SIX – TELEPHONE INTERPRETING...... 23

APPENDIX SEVEN – TIPS FOR WORKING WITH LIP READERS...... 24

1 RELEVANT TO

1.1 This guidance applies to all staff at Poole Hospital NHS Foundation Trust.

2 PURPOSE

2.1 In line with the Single Equality Scheme and the drive to reduce health inequality, Poole Hospital NHS Foundation Trust is committed to providing interpreting services for patients, including children, whose first language is not English, and patients with hearing impairments, who require qualified interpreters, lip speakers, deaf/blind. Good communication is at the heart of the patient experience. Without an interpreter, in medical context, research has shown that patients who speak little or no English are generally given less information and offered fewer choices. (Bowler 1993, Currer 1986, Homans and Satow 1982). 2.2 Common barriers to communication are: -

 hearing and/or visual/speech impairment;

 language differences, stress;

 poor communication support to meet special needs e.g. lack of information provided in accessible formats;

 some clinical conditions e.g. mental illness, stroke, learning disabilities.

2.3 The majority of patients in the health community served by Poole Hospital NHS Foundation Trust are English speaking. However, it is acknowledged that there is a regular flow of visitors from other countries and an increasing number of residents who do not have English as their first language. Additionally, there is an increasing elderly population who may have a sensory impairment which may result in difficulties with speech, hearing and vision. We have a commitment to the entire population served by the Trust as the statistics show that: -  1 in 7 people in the UK has some level of hearing loss;

 42% of deaf and hard of hearing people who had visited hospital (non emergency) had found it difficult to communicate with NHS staff;

 this increased to 66% for British Sign Language users.

2.4 In the healthcare setting a high standard of interpreting is required by qualified interpreters to ensure that patients receive appropriate support and information to make an informed decision about their care and treatment. This is particularly important where interpreting is required in a legal, mental health, treatment decisions and/or consent situations, relaying of bad news, rationale for investigations and relaying of investigation/test results.

2.5 The Trust also has a duty to consider the provision of information in formats other than written English for people who have special needs. Leaflets in other languages do not replace an interpreter. However, they can provide a backup or reinforcement of information.

Date: June 2010 Author: Amanda Colman 5 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 3 DEFINITIONS

For the purpose of this Guidance the terms: -

3.1 Interpreting

3.1.1 Is defined as the transmission of meaning from one language to another which is easily understood by the receiver. This includes the conversion of spoken language into sign language and vice versa.

3.1.2 Can be provided face to face or by telephone.

3.2 There is a distinct difference between interpreting and an advocacy service. Interpreting focuses on the transmission of meaning as opposed to furthering the views and interests of the service user. For the purpose of this document, Interpreters cannot act as advocates and will remain impartial.

N.B. Professional advocates can be arranged on request through the Patient Advice and Liaison Service (PALS).

3.3 Translation 3.3.1 Is defined as the written or oral transmission of meaning from one language to another which is easily understood by the reader. This includes the conversion of written information into Braille, other languages or a sign language.

3.3.2 Poole Hospital NHS Foundation Trust recognises that the provision of translated material does not replace an Interpreter but can reinforce verbal information where an individual is literate. This may not be appropriate for those with English as a second language, including all sign language users.

3.3.3 Translations – where a patient is likely to be offered leaflets for conditions or other more general information, time should be allowed for the Interpreter to offer a sight translation of such documents to the patient. Consideration also needs to be given to any time needed to translate questions arising from the document.

3.4 Lip Speaking

Is the communication of English in a clearer way for lip readers and this normally falls outside of translation and interpreting. For the purpose of this document, Lip Speakers shall be considered under the framework of Interpreters.

3.5 Deaf Interpreters

Deaf interpreters are deaf people who are skilled in one or more sign languages and English and can assist in working between the two languages where additional atypical or idiosyncratic language use can present a barrier to the normal flow of communication. They are able to bring a rich deaf culture experience to their language facilitation which gives greater clarity to their interpretations for language isolates.

Date: June 2010 Author: Amanda Colman 6 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 4 ASSOCIATED DOCUMENTS

Relevant Legislation and National Guidance: -

• Disability Discrimination Act

• Human Rights Act

• Mental Capacity Act

• Mental Health Act 1983

• NHS Community Care Act

• NHS Consent Guidelines

• Race Relations Amendment Act

• Standards for Better Health

• Equality Act 2006 new updated amended version

• Doubly Disabled

• NHS Constitution

• Equity and Excellence Liberating the NHS 2010

5 REFERENCES

 Association of Sign Language Interpreters www.asli.org.uk

 National Registers of communication Professionals working with Deaf and

Deaf/blind people. http://www.nrcpd.org.uk/

 Poole Hospital NHS Foundation Trust Single Equality Scheme http://nww.intranet.poole.nhs.uk/staff_information/equality_and_diversity.aspx

 http://nww.intranet.poole.nhs.uk/patient_experience/patient_info_steering_group. aspx

 Poole Hospital NHS Foundation Trust Policy for Obtaining Consent for Treatment from Adults and Children Vs 5. - Available from the Legal Services Department

Date: June 2010 Author: Amanda Colman 7 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 4 CONSULTATION The following organisations were consulted in the development of this document: -

• Bournemouth Deaf Centre;

 A representative from Poole and Bournemouth deaf community – Community and Development Manager for SONUS. http://www.sonus.org.uk/

• Qualified British Sign Language Interpreters;

• Interpreters of language for non English speakers.

5 PROVISION OF INTERPRETING SERVICES

5.1 The Trust is committed to providing Interpreting Services for patients whose first language is not English and those with hearing impairments.

7.2 In order to provide equity of access for patients who cannot communicate using spoken English, the Trust can contact appropriately trained, qualified and registered interpreters either directly or via external organisations. 7.3 Interpreting services should be available for: -

• any patient whose first or preferred language is not English;

• any patient with a hearing impairment who requires the use of an interpreter or Lip Speaker;

• parents/guardian/carer of a patient who fall under one of the above categories.

7.4 The Trust also has a duty to consider the provision of information in formats other than written English or where people have special needs. Leaflets in other languages do not replace an interpreter, however they can provide a backup or reinforcement of information. (See Appendix Three).

7.5 The use of these services has a financial impact for the Trust and therefore, needs to be used appropriately and effectively. However, if a patient needs interpreting support then the services described in this Guidance can be booked by following the approved procedure at Appendix Two.

6 DEFINITION OF INDIVIDUAL ROLES

6.1 The Interpreter’s Role To interpret and transfer spoken language into another spoken or signed language, and vice versa and in such a way that effective communication takes place between the participating language speakers/signers.

8.1.2 To have full command of the spoken/signed languages in which s/he interprets. S/he reflects accurately the information and ideas, cultural, meaning context and intention of the speaker/signer.

8.1.3 Is impartial. Whilst s/he promotes effective communication and clarifies language and cultural misunderstandings where appropriate, s/he does not act as an advocate for patients.

Date: June 2010 Author: Amanda Colman 8 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 8.1.4 S/he adheres to a common code of conduct as stipulated by the respective registration body and engages regularly in continuous professional development.

8.1.5 In the case of interpreters for the deaf, interpreters should be qualified to the appropriate level, and registered as a Member of the Register of British Sign Language/English Interpreters (MRSLI). These members will wear a yellow photograph ID badge confirming their status.

6.2 The Role of the Trust

8.2.1 To be responsible for ensuring that the patient or parent/guardian receives a sensitive, professional and accessible service.

8.3 The Role of Staff – working with an interpreter(s)

8.3.1 Engage eye contact with the patient, not the Interpreter. Use short, clear sentences. In the case of spoken language Interpreters, pause frequently to allow the Interpreter to verbally render their words. In the case of sign language Interpreters do not alter your normal rhythm of speech, although you may be asked to pause at times if clarification is required.

8.3.2 Many words or institutional titles and expressions do not translate easily into other languages; be mindful of this, minimise the use of jargon and provide explanations where needed. This will help to minimise the possibility of misunderstandings.

6.3 Giving Advice/Making Suggestions 8.3.1 Provision of additional information and advice to patients is the responsibility of the member of staff and not the Interpreter. Any additional information should be given during the appointment.

6.4 Staff as Interpreters 8.4.1 Staff with language skills may apply to work for an external, approved interpreting agency if they are trained, qualified and appropriately registered. However, such arrangements would be outside of their normal working hours and they must continue to comply with their Trust’s contractual responsibilities and any working time directives. This will ensure that no conflict of interest could arise.

8.4.2 Trust staff may be used to interpret for patients in general conversations and communication of ‘everyday’ information but not in situations where the patient’s consent is required.

8.4.3 If an emergency situation does occur, bi-lingual staff and other interpreters who do volunteer to help must always explain to the patient that they are not qualified interpreters and as such not responsible for any potential misinterpretation.

Date: June 2010 Author: Amanda Colman 9 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 8.4.4 Use of Relatives or Friends

8.5.1 The use of a patient's relative for interpreting is not considered good practice; it may be actively counter-productive and should be avoided where possible. Confidentiality is compromised from the outset. There may be issues that the patient does not wish the friend or family member to know or cultural barriers which inhibit the free flow of information.

8.5.2If the Interpreter is not trained, qualified and appropriately registered, the quality of the interpretation is unknown.

8.5.3The use of children under the age of 16 for interpreting should not be considered under any circumstances.

8.5.4When a child does not understand or use English, parents or relatives should not be asked to interpret for the child and an external Interpreter must be used. Gillick Competency should be assessed by the relevant clinician in these situations.

8.6 Patient Choice/Refusal of an Interpreter Provided by the Trust

8.6.1 The Trust is committed to providing qualified interpreters who are registered with the appropriate organisation. However, patients or a designated advocate should also be able to make choices to enable specific needs to be met.

8.6.2 A patient may refuse the use of an approved Interpreter provided by the Trust in favour of family members/friends or a communication support organisation. However, it should be noted that the quality accuracy of information and confidentiality issues, for informed consent may not be interpreted correctly by unqualified interpreters.

8.6.3 In situations where the patient chooses not to or refuses to use a qualified Interpreter it must be verified that the individual understands the consequences of this, and that the Trust accepts no responsibility for the standard of interpreting or employment or payment of their chosen interpreter.

8.6.4 Clear documentation must be made in the patient’s notes stating that the patient declined to use the qualified interpreter offered/provided. The individual must be aware they can reverse this decision at any point.

8.6.5 In these circumstances it may be decided that in the interests of safeguarding the Trust, will still employ the services of appropriately registered Interpreter (MRSLI for British Sign Language users) to oversee an appointment and ensure that vital information has been imparted accurately.

8.7 Unscheduled Care

Where emergency care is needed, staff may use Trust staff or an accompanying person to elicit and communicate basic information, whilst seeking to book an appropriately registered Interpreter (MRSLI for British Sign Language users)as soon as possible, using the approved procedures at Appendix Two.

8.8 Protection/Safety Issues

Where there are concerns about child protection, vulnerable adult issues or issues under the Mental Health Act, an Interpreter must be used even for basic communication. In the case of a deaf person, who may have atypical or idiosyncratic language use, it may also be appropriate to use a Deaf Interpreter to ensure clarity of communication.

8.8.1 Cultural Considerations and Concerns

8.8.1 Sign Language Interpretation

Sign language users have differing needs in terms of interpretation due to the visual and physical nature of the communication. A preference of male or female Interpreter can be requested but cannot be guaranteed. If there is a reason for the patient wanting to use a specific Interpreter this should be identified at the outset.

8.8.2 Lip Speakers

Lip Readers are by far the largest group within this community. These are people who are hard-of-hearing who rely upon lip-reading to assist communication. These people should be offered a registered Lip Speaker who is trained to deliver the information in a clear, lip-readable and visual form, with clarity of facial expression and lip-pattern. In emergency situations where the services of a Lip Speaker have not yet been secured, the staff member must make every effort to enable themselves to be lip-read and use written communication if appropriate.

8.8.3 Foreign Language Interpreters

Staff requesting the services of Interpreters should take time to establish what particular needs the patient has. These may not only be language needs but also cultural or gender needs. In some cultures it may not be appropriate to provide a male interpreter for a female patient and vice versa. If there are any extenuating circumstances which could have an adverse effect on the appointment these should be discussed before the appointment commences.

8.9 Conflicts of Interest

8.9.1 If an Interpreter identifies any possible conflict of interest before or during the appointment, the clinician will be made aware of this as discreetly as possible and action will be sought as to how to proceed with the appointment.

8.9.2 If the patient objects to an Interpreter, the appointment may not be able to go ahead and Patient Choice/Refusal of an Interpreter applies (8.6). It will be documented in the patient’s medical records that the patient has refused to use the interpreting service provided by the Trust.

8.9.3 If the appointment does go ahead, the clinician must ensure that the patient is fully aware of confidentiality policies, applying to both the organisation and the Interpreter and told who to contact if they have further concerns.

8.10 After the Appointment: Interpreter Support and Feedback

8.10.1 Working with some patients such as refugees and asylum seekers, Trust staff and Interpreters may encounter distressed and often very traumatised patients. They may wish or need to share information about sad or horrifying events. This process can be difficult to manage, not only for the patient but also for both staff and the Interpreter. Both should remain sensitive to the level of distress experienced within the appointment and not hesitate to request or suggest a break if this could be useful. Trust staff and Interpreters should try and support each other by discussing difficult or sensitive issues raised in the course of the appointment and should ensure that they seek support as needed.

8.10.2 Staff should ensure that there are opportunities for debrief with the Interpreter after the appointment.

8.11 Making a Complaint or Giving Feedback

If an Interpreter or a member of staff is unhappy with any aspect of their colleague’s practice, the concern should be quickly discussed with the secondary party, outside the patient’s appointment, and resolved if possible. Clear procedures are available through PALS or the Complaints process for both Interpreters and patients for pursuing unresolved issues.

9 DISSEMINATION

This Guidance will be distributed within a month of ratification as follows: -

• to all managers by email;

• to agencies, individual Interpreters and Communication Support Workers, currently providing interpreting services, by post/email;

• to staff through Grapevine and main Intranet page;

• to the Deaf community through the allocated Sensory Team representative;

• to black and minority ethnic groups.

10 REVIEW AND REVISION ARRANGEMENTS INCLUDING VERSION CONTROL

10.1 This Guidance will be reviewed 3 years from its ratification date and every 3 years thereafter. However, the information contained here and the procedure itself may be updated during this period where best practice, national guidance or local developments indicate that change is required.

10.2 The use of Translation and Interpreting Services will be reviewed annually by the Equality and Diversity Group.

APPENDIX ONE - EQUALITY IMPACT ASSESSMENT

To be completed by following the Trust Equality Impact Assessment Guidance

Date of assessment 7th November 2010

Care Group or Directorate: Enter Directorate or Care Group Name

Author: Enter NameColman - Patient Experience and Patient Advice and Liaison Service Manager Marie Cleary – Human Resources Business Manager Assessment area The delivery of interpreting and translation services for patients Purpose This Guidance ensures the patient experience by supported by good communication by the delivery of specialist interpreting and translation services. Objectives . Ensure patients receive appropriate support and information to make an informed decision about their care and treatment, taking into account our public duties Intended outcomes What is intended outcome of the document

What is the overall impact on those affected?

Ethnic Groups Gender Religious Groups Disabled Persons Other groups Please Select Please Select Medium Please Select

Available information:

Information relating to patients

Patient’s ethnicity data - information regarding the ethnicity of the patient and associated related information. For example first and/or preferred language

Data relating to the patient’s disability – information outlining the nature of the disability and what specific requirements the patient may have in relation to communication.

Information relating to individual patients to support the application of the Guidance is available from Primary Care sources and the Electronic Patient Record. Additional information will collected at the point of delivery of care.

Information relating to Trust public duties

Equality Act 2010 and other relevant legislation stated within the Guidance. Trust Single Equality Scheme Enter text

Date: June 2010 Author: Amanda Colman 13 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 Assessment of overall impact:

The services provided under the terms of this Guidance contribute positively to equality across the Trust. This is due to ensuring the delivery of care is not compromised by a patient’s ability to communicate. Examples of these patients groups may include patients for whom English is not their first or preferred language. This group includes patients who are deaf and who use British Sign Language.

It is important to recognise that there are distinct cultural aspects of communicating in a different language which the Trust needs to recognise and take into account when planning and delivering the patient’s care. For example, the deaf community has it’s own specific culture. This may affect their understanding of written English in practical terms. If this is not understood by those caring and treating such patients then their patient experience may be compromised.

The Guidance ensures that interpreters and translation services can be made available to patients at any stage of their journey through care and treatment. It supports members of staff in understanding the need to deliver such services and the method of ensuring the patient is supported in this way.

The Guidance is specific in outlining the practical arrangements for staff to make sure that patients are not disadvantaged by their communication and language needs. It outlines when and how staff members may access appropriate services.

The Guidance is in a format suitable for training staff. This contributes to the skills and understanding of staff across the Trust in needing to recognise that taking into account and acting upon the language and communication needs of patients is a fundamental dimension to their care and treatment.

The Trust has an absolute commitment to equality and diversity and this is outlined in the Single Equality Scheme. This Guidance positively contributes to the real delivery of a service which takes into account the needs of the patient in relation to their individual protected characteristics under the Equality Act 2010.

There are specific situations where interpreters are required in absolute terms. These include legal, mental health treatment or consent situations. Also the breaking of bad news and relaying of diagnostic results or discussing clinical investigations all require interpreting. This Guidance supports these situations.

The Guidance contributes to good governance in respect of the delivery of care and treatment to patients with specific needs in relation to communication. As such it supports the competency of the organisation to so deliver care and treatment in this way.

Consultation:

What engagement has there been with the people that might be affected directly or indirectly? Who was engaged and how?

Consultation has taken place with key stakeholders in this service.

Key stakeholders include;

Bournemouth Deaf Centre, British Sign Language Interpreters (Members of the Register of

Date: June 2010 Author: Amanda Colman 14 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0 British Sign Language/English Interpreters -MRSLI).

A representative from Poole and Community Deaf Community – Community Development Manager for SONUS.

Representatives of the Bournemouth Interpreters Group (interpreters for non-English speakers).

Members of the Trust Equality and Diversity Group (including representatives from across clinical services).

Equality Lead for NHS Bournemouth and Poole (Primary Care Trust)

Actions: The provision of interpreting and translation services is monitored closely by the Patient Experience and PALS Manager, and results are reported to the Trust Equality and Diversity Group. The results of monitoring will also be included in Trust governance monitoring activity.

The practical application of this Guidance will be included within this monitoring process and any changes required will be implemented to ensure current good-practice is achieved.

APPENDIX TWO – BOOKING AN INTERPRETER

BOOKING AN INTERPRETER

The use of interpreting services aims at improving quality of care and patient experience and as such needs to be done in the most suitable way. Moreover this has a financial impact for the Trust and therefore, needs to be used appropriately and effectively. However, if a patient needs interpreting support then the services described in this Guidance can be booked by following the approved procedures. If in doubt, refer to the Line Manager or seek advice from the Patient Advice and Liaison Service (PALS). There is an expectation that staff or patients will inform PALS as soon as possible when an interpreter is required. PALS will book a face to face interpreter but ideally, need as much advance notice as possible to make the arrangements. There is a shortage of registered British Sign Language interpreters in the area. Their skills and services are also in demand from other organisations.

PALS will book interpreters, including interpreters required urgently, during normal office hours. Contact PALS via telephone (44) 8499 or email [email protected].

In an emergency, out of office hours, weekends or Bank Holidays, the Clinical Management Team should be contacted via telephone (44) 8597 or bleep 0111.

Before requesting the booking of an interpreter consider: -

 that an hourly cost is incurred with face to face interpreting;

 that a cost per minute is incurred using Language Line telephone interpreting services;

 if the patient requires treatment over an extended period of time e.g. greater than one hour; it is important to take steps to ensure the most effective use is made of the interpreter’s time; they may have another booking and will need to leave after the allotted time has been reached;

 giving pre and post operative advice and information during the pre-operative consultation or agreeing how future instructions/information will be conveyed;

 it is not normally necessary for the interpreter to be present throughout the whole of the procedure.

To book an interpreter you will be required to provide the following information: -

 nationality or type of sign language;

 name and correct spelling, if the patient is a child/baby use the child/baby’s name;

 hospital number;

Date: June 2010 Author: Amanda Colman 16 Guidance for the use of Interpreting and Translation Services NPS01. Version 1.0  date, time, venue of appointment and speciality;

 length of time of appointment;

 is this a follow up appointment where limited new information needs to be conveyed? If so, can this be done via telephone interpreting services?

If the patient is required to return for a follow up appointment or subsequent investigation/procedure, book the interpreter at the time of booking the appointment, this will save time later.

Confirm the booking with PALS giving them the information listed above to ensure documentation and logging of the booking for audit purposes.

Urgent/unscheduled care

In urgent/unscheduled care situations consider:

 conveying information in writing for deaf patients. Use simple sentences and words; remember some deaf people have a limited knowledge of written English.

 Steps should be taken to continue to contact a qualified and appropriately registered interpreter as soon as possible throughout the patient’s urgent care episode.

Action for Hearing Loss (AHL) formerly the Royal National Institute for the Deaf (RNID) offers an out of hours, emergency call service. Telephone 0700 341 8352. This number provides access to an on call coordinator who will require the details of the assignment, as listed above, and will contact an interpreter on your behalf. If the coordinator is busy there is an answer phone service with call back service within one hour by a member of AHL staff. They will require the details of the assignment, as listed above, and will then contact an interpreter on your behalf.

Due to shortage of qualified British Sign Language Interpreters in the area, it may be necessary to contact an interpreter out of county. This could therefore mean a delay of several hours before a qualified interpreter can be available on site.

Telephone Interpreting Services

Language Line is a telephone interpreting service that gives immediate access to an interpreter in the case of an emergency or if a face to face interpreter has not been arranged. It is possible to book the interpreting session in advance. If the consultation is likely to last for more than 30 minutes it is more cost effective to use face to face. However, it should be noted that telephone interpreting is not suitable for imparting information of a sensitive nature or for breaking bad news.

The telephone equipment and easy step by step instructions are available from the Clinical Management Team, 24 hours a day, or for maternity patients from the main office on Delivery Suite. Please ensure all documentation is completed as per instructions and the equipment is returned to the office after use.

If an interpreter has not been booked or no interpreter is available in non urgent situations consider: -

 using Language Line in cases of foreign language interpreting;

 changing an appointment time to allow more time for booking an interpreter to be arranged.

In urgent situations consider: -

 using Language Line, especially where consent is required;

Cancellation of Interpreters

Notify PALS as soon as possible if an appointment is cancelled or changed. If an interpreter has been booked there may be a cancellation fee, often on a sliding scale. The nearer the cancellation to the appointment time the higher the cancellation fee.

Every effort should be made to use the services of trained and appropriately qualified interpreters who are bound by a code of conduct and confidentiality code drawn up by the registering organisations, Members of the Register of Sign Language Interpreters (MRSLI) for interpreters for the deaf and the National Register of Public Service Interpreters for foreign language interpreters. If an interpreter is required to interpret where consent or treatment will be discussed, a member of one of these organisations should be booked.

APPENDIX THREE – TRANSLATION OF WRITTEN DOCUMENTATION

TRANSLATION OF WRITTEN DOCUMENTATION

Information for many medical conditions and procedures is already available in other languages, easy read and Braille. It is important before embarking on the translation of an information leaflet that checks are made to see if any appropriate NHS or other nationally available leaflet can be obtained.

All patient information leaflets produced by the Trust must conform to the guidance within the Guidelines for the Production of Patient Information and must contain the phrase “We can supply this information in larger print, Braille, or audiotape or have it translated for you. Please call PALS or the Health Information Centre on 01202 448003 for further advice”.

Arrangements can be made for the translation of written patient documentation e.g. medical records, test results, letters into English from another language.

If the translation of patient medical information is required, please ensure that the most important information is selected. Most translation services charge by the word.

Before a request is submitted for a document(s) or information to be translated, consider the time delay. Some documents may take up to three weeks. Will the information you require still be relevant after it has been translated?

The Health Information Centre or PALS will make the arrangements for these services.

Y POINTS

APPENDIX FOUR – GUIDANCE FOR STAFF ACTING AS INTERPRETERS

GUIDANCE FOR STAFF COMMUNICATING IN THE ABSENCE OF AN INTERPETER

This Guidance is for staff who have foreign language or sign language skills to assist in emergency situations or to help facilitate basic communication between patients and healthcare staff whilst immediately seeking the services of a qualified Interpreter.

Staff must not be asked to interpret clinical information, any medical terminology or to facilitate decision making about care, but to facilitate basic/general communication only such as personal details, discussions/help etc. If more than this is required, an Interpreter must be arranged via the approved procedures at Appendix Two.

Scope of Practice

Staff with linguistic skills can help to facilitate basic information (as outlined above) provided this is within their current role/usual place of work. Staff should not be redeployed to other specialties/departments for their language skills.

Confidentiality

All staff involved in the situations outlined above are bound by the same confidentiality undertaking as for their normal contractual practice.

APPENDIX FIVE – WORKING WITH FACE TO FACE INTERPRETERS

WORKING WITH FACE TO FACE INTERPRETERS

Good Practice Guidance

1 Before starting the interpreting session ensure that: -

• the Interpreter understands the service;

• you clarify your role within the service;

• you allow the Interpreter time to introduce themselves and their role to the patient;

• you arrange seating for the most direct communication between you and the patient and let the Interpreter choose where to sit. People who use sign language or are lip reading need plenty of light;

• you explain the purpose and most likely outcome of the meeting;

• you ensure the Interpreter is aware of the meanings of technical terms or specialist terminology.

2 During the interpreting session please: -

• allow enough time for the appointment;

• keep interruptions and noise to an absolute minimum;

• speak directly to the patient rather than the interpreter;

• avoid ambiguous or complex grammar;

• use “sign-posts” like “for example” or “lastly” to explain the purpose of your speech;

• try to use words which you think the Interpreter and patient will understand;

• avoid colloquial expressions which might be difficult to translate i.e. water works instead of bladder;

• explain the purpose of questions you ask;

• use short sentences;

• rephrase if necessary;

• moderate the speed of speech;

• take extra care in explaining procedures or sensitive issues;

• check assumptions and clarify impressions;

• summarise and check what you have understood;

• avoid separate and exclusive conversations between the patient and the interpreter;

• allow breaks/change of Interpreter if the consultation is expected to be lengthy or particularly difficult/distressing.

3 Concluding the interpreting session please: -

• check with the patient that they have understood everything;

• allow the patient to ask supplementary questions or seek clarification;

• make any necessary follow up appointments and book the interpreter, if required at the time and where possible, confirm this/these appointments with PALS;

• if the session has been particularly difficult or sensitive offer the Interpreter support and notify PALS;

• feedback to PALS if there have been any difficulties.

4 Helpful things to remember: -

• interpreting meaning requires more than word for word processing. Time should be allowed for accurately interpreting unfamiliar concepts;

• please check with the Interpreter before assuming that they are distorting or adding to your meaning;

• trained Interpreters attempt to bridge the communication gap which is made up of cultural knowledge and information as well as language;

• the Interpreter is not an advocate or a community representative and cannot give advice other than on translation/interpreting matters;

• read out documents to be interpreted slowly. Do not pass documents and forms to the Interpreter and delegate responsibility for their explanation;

• be aware that language barriers increase stress all round;

• working with an Interpreter can require additional time and it may be useful to book a double appointment in some situations;

• to be aware of your own racial and cultural attitudes;

• the Interpreter should be treated as a professional.

Fears about confidentiality are a major factor when patients withhold information. However, there may also be cultural reasons for patients to withhold information, including the discussion of a subject considered ‘taboo’, relating information to a member of the opposite sex. Both Interpreter and clinician must be mindful of these possibilities.

APPENDIX SIX – TELEPHONE INTERPRETING

TELEPHONE INTERPRETING

If telephone interpreting is necessary, it should ideally be arranged via a three-way telephone conference call between the Interpreter, the patient and the clinician.

The Language Line equipment can be plugged into a standard telephone socket and needs to be booked with and collected from the Clinical Management Team (CMT) via bleep 0111, or for maternity patients from the main office on Delivery Suite. Please ensure all documentation is completed as per instructions and the equipment is returned to the office after use.

 follow the instructions which accompany the equipment;

 ensure all the equipment is returned to the holdall ready for the next use;

 record its use in the accompanying book;

 return the equipment to CMT office.

Communication over the phone is more difficult than a face-to-face process, and speech needs to be slow and clear. The clinician and Interpreter should check the patient’s understanding at regular intervals as the discussion progresses.

Prepare in advance; what information do you need to give to the patient and what information you require from the patient. Be concise.

It may be helpful for clinicians to avoid the use of unnecessary idioms and metaphors.

Fears about confidentiality are a major factor when patients withhold information. However, there may also be cultural reasons for patients to withhold information, including the discussion of a subject considered ‘taboo’, relating information to a member of the opposite sex. Both Interpreter and clinician must be mindful of these possibilities.

APPENDIX SEVEN – TIPS FOR WORKING WITH LIP READERS

TIPS FOR WORKING WITH LIP READERS

1. Make sure you have the person’s attention before you start and that the Interpreter can face the person at the same level. 2. Keep any background noise to a minimum. 3. Make sure your face/mouth is not covered. 4. Make sure there is sufficient light. 5. Don’t shout. 6. Speak clearly with normal speech rhythms. 7. Give the person time to absorb what is said. 8. Sentences are easier than single words. 9. Write things down if you need to clarify them.

Date: June 2010 Author: Amanda Colman 25