Immigration Ethics

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Managing language and literacy barriers

Patients with limited English language or literacy can find it difficult to engage with NHS services. NHS providers have certain obligations to reduce inequalities between patients accessing services, which may apply to language interpretation needs.

Refugees and asylum seekers may need ongoing language interpretation support to engage effectively. If you treat refugees and asylum seekers, it is good practice to:

  • use professional language interpreters with these patients
  • consider your patient’s preferences and other factors when selecting an interpreter
  • understand how to make best use of an interpreter throughout the treatment encounter
  • inform your patients and ensure that reception staff promote the option to use an interpreter
  • be aware of local arrangements for language interpreting services, including funding.

 

Professional language interpreting

Use of professional language interpreters is particularly recommended for refugee and asylum seeker patients.

In many cases, refugees and asylum seekers may not have English-speaking friends or relatives who can offer support. Using a friend or relative as an interpreter may also prevent patients from disclosing sensitive health issues, making it difficult to provide safe and effective care.

Face-to-face interpreting is generally preferred to support interaction between all parties. However, telephone interpreting can be helpful in remote areas, for less common languages or if a patient prefers to remain anonymous.

 

Selecting an interpreter

Whenever possible, it will be helpful to find out if your patient has preferences regarding gender and political or cultural background when selecting an interpreter.

For example, it may not be appropriate to use an interpreter who is from an ethnic or political group that has been involved in violence or oppression in the patient’s country of origin, as this may undermine trust.

It is also helpful to use a professional interpreter who is trained to work in the healthcare setting. This is particularly important for appointments related to sensitive topics, including sexual and gender-based violence.

Interpreters from embassies or official agencies of the patient’s home country should not be used. This could put people fleeing persecution at risk, if they return, and may jeopardise the safety of their relatives.

 

Making effective use of interpreters

Using interpreters in patient consultations can present challenges.

  • Consultations can be longer than normal. You should make sure you allow enough time for an appointment involving an interpreter.
  • It can be more difficult to build rapport with your patient. You can address this by looking and speaking directly to the patient, rather than to the interpreter.
  • Phone appointments may be difficult. You should book a three-way call with an interpreter rather than relaying messages via an interpreter. This allows the patient to ask questions, improving understanding and engagement.
  • Patients may need follow-up care. In this case, you should explain the need for multiple appointments and make sure the patient understands when the next appointment is. Asking the patient to repeat back any instructions for follow up care or medication while the interpreter is present can also be helpful.
  • Aim to use the same interpreter for the whole treatment encounter, including booking follow-up appointments at reception.

You may also find additional training on the use of interpreters in consultations useful.

 

Raising awareness with patients and reception staff

Refugees and asylum seekers may not know they can request language interpretation, particularly when registering for the first time. Posters in reception areas can help raise awareness, if they are displayed in a variety of languages.

It is important that staff who are responsible for making appointments know how to book an interpreter and offer this option proactively, if possible. Keeping a language ID chart at reception can help staff identify what language a patient speaks.

 

Funding for professional language interpreters

We are aware that professional language interpretation services can be costly. There are a variety of payment arrangements across the UK healthcare system, particularly in primary care.

In England, we recommend that GP practices urge their commissioners to fund these services. We have produced guidance to support practices serving atypical populations, including practices with a high number of patients who do not speak English. It may be helpful to refer to NHS England guidance for commissioners on interpreting and translation services in primary care.

 

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