3.13 Employing interpreters and link workers in health and social care

Issues surrounding language and ethnicity are complex and contested. At the time of writing, there are suggestions that competence in English should be a requirement of British citizenship, while other people suggest that the diversity of languages in the UK should be a cause for celebration. Clearly, there are implications for service provision. If new migrants are required to learn English, there may be less emphasis on providing translators and interpreters. There is a danger of overlooking the difficulties involved in learning a new language. For many women from South Asia and from parts of Africa such as Somalia, the inhibiting factors may be that English language classes are often held in the evening, when caring responsibilities in the home and the fear of racial attacks or abuse on the streets may prevent them from attending.

The provision of interpreter services in the context of health and social care is patchy across the UK, but there are many examples of good practice: for instance, the Sandwell Integrated Language and Communication Service (SILCS) in the West Midlands of England (Box 2).

Here a range of local health organisations – health authorities, NHS Direct, primary care groups, local authorities and voluntary agencies – worked together to provide a pooled resource for spoken, written and telephone translation and interpreting as well as sign language interpreters. The initiative provides appropriate training for interpreters and translators. It is also important to provide training for staff on using interpreters, as the three-way dialogue can be extremely confusing. Furthermore, there may be different norms and traditions in language which mean that when an interpreter is asked to translate what appears to be a simple question, a much longer dialogue is needed before the question itself is asked. Interpreting is extremely complex in that interpreters must ensure that the patient or client easily understands the language they use. Again other factors, such as class, region, religion and geography, may impinge on the process of interpreting and communication – such that just speaking the same language may not necessarily mean the same understanding will follow. Sometimes people are reluctant to use interpreters who are from the same geographical locality or community for fear that personal information will not be kept confidential. This is less likely to happen where trained interpreters are used but, in some situations, anyone who is perceived to speak the required language may be asked to interpret and these processes are far more likely to remove confidentiality.

More recently link workers, rather than just interpreters, have been employed by health and social care organisations. Link workers are perceived to have a broader role, which includes advocacy. However, it can be very difficult for link workers to be true advocates because of their position within the organisation. Link workers are often employed on fairly low salaries and sometimes on short-term contracts from specific funding for black and ethnic minority communities. This may mean they are unable to complain on behalf of a patient or client or to challenge or demand the delivery of appropriate services on their behalf.

More health and social care organisations are recognising the need to provide written information in a range of languages. Translating information from English to other languages can present a range of problems as a literal translation may have little meaning once translated into Urdu or Punjabi, for example. This is also true of translation to Braille. Some agencies have resisted translating written materials because of a perception that individuals from different parts of South Asia may not be literate in their first language. Several research projects have demonstrated that, while literacy varies depending on the average age of the community, the area from which they migrated, class and gender, large percentages of people from South Asian communities can read translated materials (Robinson, 2002). It is important for such translations to be in a dialect that is easy to understand. Literal translations from English run the risk of being culturally inappropriate; therefore, provision must be made to ensure that translations meet the information needs of black and ethnic minority communities and are culturally relevant. Guidelines on producing written information for black and ethnic minority communities (HEA, 1997) suggest that written materials should be based on research that identifies the information needs of particular language groups first, and then specific communities should be involved in producing the material and checking that it is culturally appropriate.

The use of translated signs and information in health and social care buildings not only provides people from black and ethnic minority communities with valuable information for finding their way around – which can be daunting – but also can be welcoming and reassuring.

The examples of ‘ethnic matching’ and the provision of translators and interpreters demonstrate that responding to a diversity of communication needs is not straightforward. Providing an appropriate response needs careful thought if services are not to end up reinforcing rigid notions of ethnic difference.