NHS 'failing those who don't speak English'

Patients need to be able to understand

When a patient does not speak English interpreters are needed, but they are not always available.

In this week's Scrubbing Up, Caroline Wright, Royal College of Obstetrics and Gynaecology trainee, questions whether the NHS is offering a good enough service.

It is well established that language barriers contribute to health inequalities.

As the migrant population in Britain continues to grow, a greater number of our patients will be non-English speaking or have limited English.

Although we approach this challenge with humour, caring for a large number of patients with limited English can be stressful, time-consuming, risky and - as communication is so fundamental in the doctor-patient relationship - unsatisfactory.

For the patients on the receiving end, it's even worse.

Flaws in delivery

Interpreters are available of course, but there are flaws in the service.

In obstetrics and gynaecology, my area, these problems are only amplified. Emergencies are common, urgent consent is often required and admissions are often unpredictable.

Many complaints are of a sensitive nature which can limit translation not only through relatives but also through professional interpreters, who are often from the same communities as the patients themselves.

Additionally, there are huge differences in women's expectations of childbirth and in health beliefs depending on their cultural background.

This week in my practice, I totally failed to give a non-English speaking Polish lady any information about her condition as there were no interpreters available until much later in the day, when I was tied up in theatre.

It wasn't an emergency, so not a priority but it still felt substandard to me.

I dealt with an angry Somali partner who was kept waiting while we waited for an interpreter.

He felt that his English was good enough to carry his wife through the consultation, eventually I saw them and we managed.

An interpreter might have helped with the language barriers, but I'm sure would have thrown up other difficulties as we ended up discussing some sexual difficulties which they may not have otherwise disclosed.

Some would advocate that those living in England should learn to speak English and yes, in an ideal world all my patients with limited English proficiency would be interested in learning, tuition would be available on every corner at all times of the day, with fantastic creches so women with families or busy working or family lives could access it.

Comprehension problems

My view is that it is totally unrealistic to expect all your patients to speak English.

However, services to support those needing, wanting and having the time to learn English should be readily available and I believe we should do more to promote them within a health care setting.

Although this is something often deemed controversial, poorer health outcomes, decreased comprehension of diagnoses and reduced satisfaction with care are all associated with limited English proficiency and cannot be ignored.

Just as we are beginning to face the taboo subject of obesity, women in particular need to be informed in a non-pressurised way of the improvements that speaking English could have on their health care and particularly on a birthing experience.

The reality is that the migrant population is increasing, the non-English speaking population is increasing and extending down the generations. It is a huge problem in healthcare delivery and the NHS needs to deal with it.

Heavy demand

In our trust, we are lucky to have a fantastic translation service and dedicated team of in-house interpreters, but due to the nature of inner-cities the service is totally over-run and frequently needs to use bank and agency staff.

Various tactics are being piloted such as using 'yes/no answer' computer programs and increased use of staff as interpreters.

Asking closed questions when taking a history in my eyes is just poor communication and using an already stretched team of staff also raises concerns.

Translated leaflets are often not the answer if there are cultural differences in health knowledge and understanding.

More funding for interpreting services is desperately needed and increased numbers of interpreters would allow improved flexibility.

Adequate time also needs to be allowed to use the interpreters, so that clinic slots are longer and staffing levels reflect the time demands that good communication with high numbers of non-English speaking patients really require.

Staff can't be expected to become fluent in the many different languages we encounter either. But training in working with interpreters should be more available, alongside better information for staff regarding differing health beliefs and behaviours dependant on culture and background.

The language barriers we face on our ward rounds are just the tip of the iceberg in terms of the real barriers to health faced by those with limited English proficiency.

The NHS needs to do more to support doctors and health care professionals in facing these challenges and improving care for this group.