The NHS: ”failing those who don’t speak English”
Dr. Caroline Wright, an obstetrics and gynaecology trainee doctor in Central London has voiced her deep concerns that the NHS’s resources – or lack thereof – are putting patients whose first language is not English at a serious disadvantage.
Wright maintains that ‘it is well established that language barriers contribute to health inequalities’. The NHS, as it currently stands, does not have the capacity to provide the multi-language support which is necessary to ensure that all non-English patients are properly cared for.
This is becoming more evident in the UK’s larger cities, where migrant populations are growing fast. Both doctors and patients are feeling the strain. Wright comments, ‘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.’
Wright explains, ‘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.’
Many hospitals response to the interpreter deficiency has been to use one-word yes/no computer programs for consultations, or to use staff as interpreters. Both these methods are highly unsatisfactory though: Wright argues that ‘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’.
Another approach is the use of translated leaflets, however this is flawed as cultural differences in health knowledge and understanding are often overlooked.
Wright does acknowledge that her hospital trust is ‘lucky to have a fantastic translation service and dedicated team of in-house interpreters’, however even this service is become more and more stretched. As a result they frequently rely on ad-hoc and agency staff.
Dr. Wright cites that there are times when a patient’s English-speaking partner can go some way to bridging the gap. However, as I learned when talking to a doctor-friend recently, this approach can present serious problems.
The interpreter is legally obliged to relate, without any degree of subjectivity or inference, the literal words of the doctor and the patient. A well-meaning husband on the other hand, cannot always be relied upon to communicate a diagnosis accurately.
This friend, who also works in the obstetrics and gynaecology department, in one of the main hospitals in Manchester, recounted a time when her diagnosis was exasperatingly lost in translation. She had to give some terrible news to a patient of hers; there was a serious complication with the patient’s pregnancy and a high chance that the baby would not survive. The patient, who was a Polish native, did not speak a word of English. The patient’s partner, also a Polish native, did.
On first glance, the doctors were happy that there was someone on-hand to act as an interpreter. However, when the doctor broke the news, to her amazement the patient smiled widely and nodded. The patient wasn’t in denial; she was simply not reacting because her partner had not conveyed the news to her. He thought it was better that, given there was still a chance that the baby would survive, his wife not be put under stress.
The doctor was stunned, and tried to reason with the partner. However, at the end of the day, both the doctor and the patient were helpless.
This situation was brought to light due to the serious nature of the case, however there are many similar incidences which go unrecorded. As doctors get busier, consultation slots get smaller; there is no time available to try to understand hidden motives or reason with spouses. Looking to families to provide this service is not only incongruous, it is immoral.
The answer is pure and simple: ‘more funding for interpreting services is desperately needed and increased numbers of interpreters would allow improved flexibility’. In the case of patients requiring interpreting services, clinic slots must be longer and staffing levels should reflect the time needed to provide ‘good communication’ with high numbers of non-English speaking patients. However, with the current state of the health budget, the outlook for language services funding could appear rather bleak.
Speaking on behalf of her colleagues and patients, Wright states that, ‘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.’