Northern Ireland Health and Social Care Interpreting Service Orla Barron Health and Social Inequalities Manager Belfast Health and Social Care Trust

Belfast Health & Social Care Trust

    Belfast Health & Social Care Trust is one of Europe’s largest health Trusts It provides acute and community services to 345,000 people in Belfast and to a wider community across NI through its regional specialist services Borne in 2007 – amalgamation of 6 Trusts in Belfast as result of Review of Public Administration Whose overall purpose is to “improve health and well-being and to reduce health inequalities”

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Context

Since EU enlargement, NI has witnessed a sizeable demographic change - now home to a much more diverse population  One of most significant inequalities for ethnic minorities /migrants is language barrier to accessing health and social care  In 2007 BHSCT took on ownership and management of NI Health & Social Care Interpreting Service  From a legal perspective, failure to provide an interpreter in health and social care could constitute indirect racial discrimination

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Legislative Framework

Integral to Good Friday peace Agreement in Northern Ireland was introduction of comprehensive equality and human rights legislation to the Statute.

 Section 75 of the NI Act 1998 meant that equality considerations must be mainstreamed into every function that Public Bodies carry out: service provision, policy formulation, employment & procurement.  9 groups of people are protected in the legislation: Those of different Religious belief, Racial Group, Political opinion, age, gender, marital status, sexual orientation or those with/without disability and those with/without caring responsibilities.

Legislative Framework

 Human Rights Act 1998 : people should be able to access the highest attainable standard of physical/mental health  Race Relations Order –not addressing the significant barrier of language could constitute ‘indirect racial discrimination’.It is unlawful for a public authority to discriminate against a person on the grounds of race or ethnic or national origins, or in the course of carrying out any functions of the authority which consist of the provision of healthcare.

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Background of NIHSCIS

The Northern Ireland Health and Social Care Interpreting Service was launched in June 2004 NIHSCIS is a product of the Regional Health and Social Services Interpreting Project for Black and Minority Ethnic Groups . Driven by Department of Health and Social Services and Public Safety (DHSSPS), Office of First Minister and Deputy First Minister, The Department of Culture, Arts & Leisure and the Department of Education.

Aims to significantly improve access to Heath and Social Care for Patients who do not speak English as a first or competent second language

NI Health and Social Care Interpreting Service

       24 hour service Face to face Interpreting only Free-of-charge to HSC Practitioner and Patient Over 150,000 requests received 278 Trained, professional, quality controlled interpreters 34 languages NIHSCIS Team Consists of the Manager, Administrator and 3 Operators

Main Activities of NIHSCIS

Provide free, ongoing training for Interpreters – health & social care-related • Provide training for Health and Social Care Staff • Create central register of Trained Interpreters • Manage Regional Interpreting Service for Health & Care Services • Increase awareness and promote service to ensure staff are cognisant of responsibilities & service users their rights

WHY IS THERE A NEED FOR INTERPRETERS?

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Ethical Case Business Case

INTERPRETERS: Ethical Case

Not providing Interpreters means a significant proportion of minority ethnic groups do not have access to the same services in the same way as the rest of the population – impacts on equality of access.

Governance issue – someone cannot give informed consent to a procedure or treatment unless they can understand the information provided to them The Ethical Case can also be illustrated by the potential consequences of not providing a trained Interpreter. In the worst-case scenario misdiagnosis or misunderstanding could seriously aggravate an illness, or cause the death of a patient

INTERPRETERS: Business Case

    There is a strong business case for supplying Interpreters as costs are quickly recovered in the medium term Communication barriers prolong appointments, takes more staff time, with a strong potential for misdiagnosis, misunderstanding and non-consent to examination, treatment or care There are cases of persons who were not provided with Interpreters returning to see their GP on numerous occasions and going through various treatments until their condition was addressed Refusing to provide an Interpreter leaves Health and Social Care open to Litigation

DANGERS OF USING UNTRAINED INTERPRETERS

Interpreting is a specific skill and profession. Using an untrained person as an ‘Interpreter’ is bad practice and can be dangerous

Dangers include:

 Lack of fluency in English or the other Language   Inaccurate Interpreting/lack of Interpreting Skills No obligation to maintain confidentiality, honesty and impartiality    Lack of knowledge in the subject matter and terminology Possible misuse of trust, power and information Conflict of Interests

NIHSCIS Top 10 Languages

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Polish Lithuanian Portuguese Chinese – Cantonese Chinese – Mandarin Slovak Russian Tetum Latvian Hungarian

Statistics –Requests per Year

NUMBER OF REQUESTS 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 18151 29811 34191 40177 7707 823 2004 2005 2006 2007 2008 2009 NUMBER OF REQUESTS

Increasing demand

Health and Social Care Trust 1 Jan-31 March 2009 1 Jan-31 March 2010 Belfast HSC Trust 2024 Southern HSC Trust Northern HSC Trust South Eastern HSC Trust Western HSC Trust 4491 1351 394 798 Total per quarter 9,058 2862 5646 1491 391 1004 11,397

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The Future

Continue to increase capacity of service 2008/2009 – met 87% of all requests. Work to reduce non-provisions Develop range/ scope of languages to meet evolving demographic profile Ongoing engagement with key stakeholders – stakeholder forum Revamp Code of Practice Upgrade software/database technology Consider provision of sign language interpreters – another minority language Showcase good practice – NHS Scotland Facilitate review of service to continuously monitor our progress

Personal Testimonies

“ The importance of an interpreter became apparent to me

when I saw the Polish lady who was due to undergo surgery, visibly relax when the interpreter arrived. She could finally communicate effectively & ask the questions she wanted. At such a stressful time, there was one less worry”…

General Surgery staff nurse “

The Interpreters are professional, caring, sensitive and responsive. They strive to provide a personalised and accessible Service to all Patients.The Service has improved access for disadvantaged groups, removed language barriers and eliminated the major cause of dysfunctional health encounters

” ….

Health Visitor “It was my first time having a baby and I was really worried. I was so relieved when the midwife got an interpreter and felt very reassured by understanding what was going on & that my baby was ok”..

Maternity patient

To conclude, a few quotations

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It is health that is real wealth and not pieces of gold and silver.

Mohandas Gandhi

Communication leads to community, that is, to understanding, intimacy and mutual valuing.

Rollo May

Knowledge is power. Information is liberating. Education is the premise of progress, in every society, in every family.

Kofi Annan