The UK has a multicultural and linguistically diverse population, with more than 300 languages spoken nationwide. For many, English is not the primary language, nor is it spoken at home. Because of such diversity, there is vast space for barriers of communication between individuals with limited or no English proficiency (no/LEP) and English-speaking public services professionals. Indeed, study after study demonstrate that barriers of communication negatively affect no/LEP individuals’ access to services such as the healthcare system, conversely increasing obstacles to high-quality preventive and primary care. This disproportionally leads to poor health outcomes, non-adherence to treatment procedures, low understanding of diagnosis and one’s own medical conditions, longer stays in the hospital, higher risk of clinical errors, as well as mistrust in the relationship with healthcare professionals amongst no/LEP groups.
Inequalities of communication in healthcare are more evident in this COVID-19 crisis. Media in Britain are highlighting how language barriers are having an unprecedented impact on treating COVID-19 no/LEP patients. Healthcare professionals are experiencing difficulties in explaining the circumstances, side effects, and long-lasting effects of the illness and containing measures to patients who do not speak the language. They are also worrying about the physical and psychological impact of treating patients who, like all hospitalised COVID-19 individuals, must be isolated and without the presence of family members as a support. On the other hand, no/LEP patients experience significant distress over not understanding what is happening because of language obstacles, or not being able to say if they are in pain or have shortness of breath; they may feel frustrated, disempowered, and vulnerable.
Never before has interpretation in healthcare settings been as pivotal. Granting access to language services in healthcare is vital at all times, to protect minority language communities’ rights to high-quality and effective treatment. However, all the more during this global health crisis, the prerequisite of communicating and sharing information in languages other than English is key to avoid that patients and healthcare workers end up lost in translation, ensuing as a result clinical risks and discriminatory barriers to equal care.
Indeed, the Equality Act (2010) and the Care Act (2014) mandate the use of qualified interpreters to ensure no/LEP individuals’ ‘well-being principle’, or the right to make decisions about one’s own care. Social and healthcare policy and law also provide guidance to medical organisations and practitioners to use interpreters to solve challenges arising by the inability to partially or fully communicate with patients. A primary example is the NHS England’s 2018/19 ‘Guidance for commissioners: Interpreting and Translation Services in Primary Care’, which outlines that healthcare interpretation should be of high quality, free, responsive to patients’ cultural and linguistic needs, and delivered only by trained interpreters experienced in medical terminology and registered with an appropriate regulator. Equally, research has advocated for improving no/LEP patient experience by mitigating language barriers, demonstrating that the use of qualified interpreters leads to widened healthcare access and satisfaction; enhanced understanding of and adherence to treatment; fewer clinical mistakes and improved staff-patient relationship (Yeheskel and Rawal, 2018; Kaur et al. 2014). Thus, interpreters help reducing inequalities between no/LEP and native English-speaking patients, lowering disparity of both access and service (Karliner et al, 2007).
Against such positive impact, public service interpreting (PSI, including healthcare interpreting) arrangements remain ironically inconsistent in the UK. Before 1994, there were no formalisation for interpretation in public sectors (Townsley 2007). Currently, PSI faces the absence of legal regulation, as well as a severe lack of organisation through an overarching body which coordinates the sector, despite the efforts of the Chartered Institute of Linguists (CIOL) and the National Register of Public Service Interpreters (NRPSI) amongst the others – which also promote training, e.g. the Diploma in Public Service Interpreting, a widely accepted but unofficial qualification benchmark. Furthermore, the PSI industry in the UK is notably fragmented, due to the unequal application of standards across geographical boundaries and sectors. On top, the current British economic climate underpins a negative employment scenario for PS interpreters, who suffer from extreme contract-driven and ad-hoc provision of freelance services, low prestige, and lack of national recognition as a professional category (Munyangeyo et al., 2016). PSI is also hampered by the public sector language procurement policy in the UK, which contracts out language services in public settings to commercial agencies, which often undercut fees and occupational standards (Dong and Napier, 2016).
Notwithstanding their key role as enablers of communication in medical care, interpreters are now facing even worst challenges in the UK since the COVID-19 crisis. The widespread lack of personal protective equipment in hospitals, which remains a critical issue for the NHS, means that interpreters also lack proper equipment, taking upon the threat of contagion. Furthermore, interpreters must juggle additional difficulties given by the contingent circumstances; it is very difficult to understand patients who wear respiratory helmets, or to speak with staff members who are fully covered – mouth included – making it complex to both hear and speak, and thus to interpret. The result is that patients may remain confused and without proper care. Many hospitals and healthcare facilities are instead resorting to telemedicine and to video/phone interpreting for avoiding on-site interpreters and contain infections. Demand for remote interpreting services is in fact accelerating (against the general pandemic-driven collapse of the language industry), with interpreters needed to work at unscheduled times and under augmented pressure. This includes difficulties deriving from being far from the space of interaction, e.g. the inability of picking up non-verbal dynamics, paired with the need to ensure an accurate relay of information against the mentioned physical constraints.
The resulting picture highlights that there is a high level of importance attached to interpretation in medical settings, in and beyond pandemic times. The interpreter often represents the only – and pivotal – link for no/LEP individuals to understand what goes on and make informed choices, and for providers to grant them equal care. Amidst contrasting claims in the language industry that the government, after lobbying from stakeholders, has more or less implicitly recognised the status of PS interpreters as part of the ‘essential workers’ list – those whose work is critical in the COVID-19 response – the situation of interpreters in the medical sector remains uncertain. It lingers the feeling that they have been left alone in their professional contribution to the challenge against the pandemic in the UK, and rather invisibilised in their social role as key workers on the frontline of medical emergencies.
As a sociologist, I have often felt ‘alone’ in discussing the value of interpretation within the discipline. Sociology has in fact often underestimated the role of translation and interpreting in making sense of structures, organisations, practices and interactions, neglecting them as a factor in social inequality. It has also widely neglected them as means to contrast inequalities in a variety of settings – from public services to asylum seeking hearings; in services devoted to migrants and refugees, or to victims of domestic violence; widely, in third-sector organisations.
Looking ahead to the future of sociological research, the COVID-19 pandemic may serve to view practices of interpretation under a new light, one which make us rethink of our assumptions about the role of and right to inclusive communication. It is now time to create a space where to address the challenges of looking sociologically at interpretation as another tool to redress wider social problems, bringing together the role that interpreters, service providers, and institutions alike can embody to address discrimination and injustice through mediated communication.
Dong, J., & Napier, J. (2016). Towards the construction of organisational professionalism in public service interpreting. In P. Henry-Tierney, & D. Karunanayake (Eds.), CTIS Occasional Papers, Vol. 7, 22-42. Centre for Translation & Intercultural Studies, University of Manchester.
Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health services research, 42(2), 727-754.
Kaur, R., Oakley, S., & Venn, P. (2014). Using face-to-face interpreters in healthcare. Nursing Times; 110: 21, 20-21
Munyangeyo, T., Webb, G., & Rabadán-Gómez, M. (Eds.). (2016). Challenges and opportunities in public service interpreting. Palgrave Macmillan.
Townsley, B. (2007). Interpreting in the UK community: some reflections on public service interpreting in the UK. Language and Intercultural Communication, 7(2), 163-170.
Yeheskel, A., & Rawal, S. (2018). Exploring the ‘Patient Experience’ of Individuals with Limited English Proficiency: A Scoping Review. Journal of immigrant and minority health, 1-26.
Author attribution details
Deborah Giustini is ECR in Sociology at the University of Manchester, Visiting Professor at KU Leuven, and a practising interpreter. She has a broad interest in sociological aspects of communication and interpretation as a distinctive type of work and employment, with a particular focus on understanding how various dynamics of mediated communication affect stakeholders’ skills, behaviours and attitude against changing market landscapes. Twitter: @deborahgiustini, @OfficialUoM, @uomsoss, @MCRsociology, @KULeuven