Interpreters policy (provision, access and use of, for patients, service users and carers)

Contents

1 Introduction

As a general principle, it is the responsibility of clinical staff to promote effective communication between themselves, patients or service users and carers.

All staff involved with patients or service users should take reasonable steps to overcome any barriers to communication that may exist and to enhance quality of life.

There are legal as well as moral obligations to provide interpreting services to people whose preferred language is not English and for people who communicate through sign language.

The Mental Health Act, 1983 imposes a statutory duty for the NHS to provide information to patients or service users about detention, consent to treatment, rights of appeal and other legal matters.

Other national policy guidance such as accessible information standard (2016). Models of Care (2005), Valuing People (2001) and Mental Health and Deafness: Towards Equity and Access (2005) also identifies the obligation to provide effective interpreting services, in the context of the provision of high quality care to meet the needs of diverse groups.

Defining interpretation For the purpose of this policy, interpretation is defined as ‘the conversion of speech from one language to another (including British Sign Language (BSL) and other sign languages).

‘The term ‘interpretation’ emphasises the exchange of connotative meaning between languages so that both effect and meaning are conveyed (Robinson, 2002).

In a health and social care setting this exchange of connotative meaning is particularly necessary, where non-verbal communication, cultural characteristics and explanations are essential components of effective assessment, care and treatment. This is relevant and important in all of the trust’s services.

For the implementation of this policy to be effective it is essential that the accurate recording of ethnic monitoring information, including the patient’s or service user’s language, including sign language and dialect is undertaken by staff.

2 Purpose

The purpose of this policy is to:

• detail the arrangements in place to allow the trust to fulfil its legal and moral obligations in relation to the provision of and access to trained interpreters in a timely and sensitive manner for patients or service users whose preferred language is not English. These arrangements are in accordance with the consent to care and treatment policy, National Service Frameworks, the Mental Capacity Act Code of Practice, the Mental Health Act Code of Practice, Mental Health and Deafness Towards Equity and Access, the Equality Act, EDS2, and other national policy and best practice guidance
• promote effective communication in relation to assessment, care and treatment and to the patient’s or service user’s right of involvement in their own care
• detail the training available to staff who in the course of their work may need to engage the services of an interpreter
• promote engagement with a range of community based befriending and advocacy organisations to encourage social inclusion and contribute to the patients’ or service users’ recovery

3 Scope

This policy applies to all staff. It provides details of how an interpreter can be accessed 24 hours per day and provides best practice guidance for staff when working with an interpreter.

4 Responsibilities, accountabilities and duties

4.1 The trust

The trust is responsible for:

• having systems in place that will allow access to trained interpreter services provided by independent organisations
• the provision of training to any staff that, during the course of their work may need to access the services of an interpreter
• having in place clear guidance in relation to the use of interpreters

4.2 Locality managers or service managers or modern matrons

Locality managers or service managers or modern matrons are responsible for:

• raising awareness of this policy and its contents with any staff they manage
• overseeing and monitoring the implementation of this policy within their area of work
• bringing any issues, which may affect the implementation of this policy, to the attention of the deputy head of procurement
• reporting any concerns that staff may bring to their attention which relate to the conduct of an interpreter with the relevant organisation
• understanding the contracted response time and escalate concerns where this is breached
• making any necessary arrangements for staff to attend any training in relation to this policy

4.3 All other staff

All other staff are responsible for:

• implementing this policy effectively
• reporting lapses in response times to locality managers or service managers or modern matrons. Please see monitoring arrangements section 7
• bringing any issues which may affect implementation to the attention of their locality manager or service manager or modern matron
• requesting an interpreter, following the locally agreed procedure
• the accurate recording of ethnic monitoring information, including the patient’s or service user’s language and dialect

5 Procedure or implementation

5.1 When should an interpreter be used?

The services of an interpreter should be engaged at the point of admission, assessment and any subsequent contact for patients or service users, including daily 1-to-1 time with staff when:

• their language preference is other than English
• the patient or service user has a sensory impairment (Deaf or deaf blind) and requires specialist support

It is also essential to recognise that whilst a patient or service user may be able to speak English fluently, if they are under stress or are distressed, they may have reduced understanding or ability to express themselves in that language and in these circumstances interpreting services should be engaged.

The provision of an interpreter should be made regardless of a patients’ carer or relative’s ability to become the interpreter for them, unless in an emergency situation as detailed in section 5.4.

5.1.1 Consent to treatment and mental capacity

The services of an interpreter should be engaged when discussing care and treatment options and collaboratively agreeing the choice of options when:

• their language preference is other than English
• the patient or service user has a sensory impairment (Deaf or deaf blind) and requires specialist support
• the patient or service user has limited communication skills and uses MAKATON to communicate

If there is any concern regarding the mental capacity of the person, their ability to make choices about care and treatment and they meet the above criteria an interpreter should be brought in to assist with the assessment of capacity and the best interests decision making process.

5.1.2 Explanation of legal rights relating to the Mental Health Act

Services must be sensitive to the capacity of each individual patient or service user to understand their legal rights.

The patient or service user should have their legal rights explained in a way that they can understand. This will include the use of appropriate language and the provision of translated materials. Staff should refer to the trust procedure for informing patients detained under section 132 of the Mental Health Act 1983 of their legal rights.

Staff should ensure a patient understands their right to advocacy and make a referral to advocacy services where required.

It is particularly important that an independent interpreter is made available where it is necessary to inform a nearest relative of their rights during an assessment under the Mental Health Act.

5.1.3 Explanation of legal rights MCA deprivation of liberty safeguards

Services must be sensitive to the capacity of each individual patient or service user to understand their legal rights. Where the patient is detained under the Deprivation of Liberty Safeguards the patient should have their legal rights explained in a way that they can understand. This will include the use of appropriate language and the provision of translated materials in line with the Principles of the Mental Capacity Act 2005 and the trust MCA deprivation of liberty (DoL) policy.

It is particularly important that an independent interpreter is made available to inform patients that they are subject to an authorisation and how it can be challenged.

5.2 Carers needs

If a carer is present at any meeting at the patient’s or service user’s request, or requires a carer’s assessment, and that carer’s preferred language is not English, then an interpreter should be made available to explain care and treatment information to them and to allow their views to be presented.

This provision should be made regardless of whether or not the patients’ or service users preferred language is English, as the patient or service user should not become the interpreter for their carer.

Please refer to 5.4 below regarding the use of family members or carers as interpreters.

5.3 Care planning and interventions

Emphasis should be made on ensuring an interpreter is available at the introduction of new interventions and at all clinically significant meetings.

• Patients or service users have a right to be involved in the planning of their care therefore; an interpreter should be present when the care plan is drawn up.
• The care plan should take account of the language needs of the patient or service user, including arrangements by which interventions will be delivered. This should include an indication of when an interpreter is required.
• A record of the organisation that provides the interpreter, the interpreters name and contact number should be recorded in the patient’s or service user’s care plan or records.

Translation of care plans or other personal documents may be required and this should always be done in accordance with the information governance policy, and all personal details pseudonymised.

5.4 Choice of interpreter

• A decision should be made as to whether video, a face to face or phone interpreter is required, or whether a mix of the two may be best to meet the person’s needs.
• For deaf people video interpretation if video is the choice of communication video interpretation should be made available
• The use of interpreters trained in mental health issues or those relating to other specialist services provided by the trust, is preferable.
• Wherever possible, the patient or service user should be offered a choice of interpreter.
• Consideration should be given to the sex and age of the interpreter and to any implications of religious, ethnic or political differences.
• In the case of need for interpretation regarding spiritual or religious care, care must be taken to ensure that the interpreter is familiar and comfortable with the particular beliefs or faith.
• Under normal circumstances family members, acquaintances, ad hoc interpreters and untrained bi-lingual staff should not be asked to act as interpreters.
• However, there may be emergency situations where family members may be called upon to interpret. The reasons for doing so and not using an interpreter service should be clearly recorded in the case notes. If it becomes necessary to use a family member to interpret then it should only be to illicit very basic information (what happened? Where does it hurt? etc). Clinicians should be mindful of the potential impact of using a family member where there may be cultural or religious beliefs which may conflict with UK laws, this may include female genital mutilation (FGM), forced marriage and domestic abuse. Therefore, if there are reasonable grounds to believe that the patient may have been subject to or at imminent risk to any of these forms of abuse then a family member must not be used. The appropriate safeguards should be put in place until such times as a professional interpreter can be sourced.
• In the case of an emergency, untrained interpreters, including bilingual staff may be used, but only to communicate the minimum information necessary, until a trained interpreter is found. It may be possible to use phone interpreting in such circumstances.
• There is widespread agreement that children under the age of 16 should never be asked to interpret on behalf of family members.
• Where possible, if acceptable to the patient or service user and worker, the same interpreter should be booked to maintain continuity and build up a rapport.
• In order to book an interpreter, it will be necessary to share personal details (name, address etc.) of the person with the interpreter services provider. Permission must be sought from the individual for their details to be shared with an external organisation. The use of a phone interpreter may help facilitate this.

5.5 Booking an interpreter

Services should contact “DA Languages directly, following the guidelines for either face to face or phone interpreting services shown in appendices A to D.

5.5.1 Face to face interpreting

To sign into DA Link, go to the DA website (opens in new window). Click the ‘Sign in’ button underneath the ‘Client Portal’ logo, and then enter your email and password.

If you have not yet received an invite to join the portal, select “Request invite” option and follow the instructions that will appear in your email. Please see appendix A.

5.5.2 Phone interpreting

Call 0330 088 2443 direct from your phone. Enter your ‘Department’s PIN’ (If you are unsure of the department PIN, please contact the procurement department who will be able to provide you with this), followed by the # key; you can then enter the PIN of the language you require (see alphabetised list below). Press 1 for an interpreter, or 4 to speak to a specific interpreter (see next step). Department PIN, once connected, take note of the interpreter ID number (you can use this to connect to the same interpreter for future calls). To connect to any third parties, dial 9 and then the number you wish to connect to. Leave feedback on interpreter at the end of the call. You will have 8 seconds to do this. From 1 (lowest rating) to 5 (highest rating) Please see appendix B and D.

5.5.3 Video interpretation

Sign into DA Link via the client portal option (opens in new window).

If you have not yet received an invite to join the portal, select “Request invite” option and follow the instructions that will appear in your email. Please see appendix C.

5.5.4 Specialist local support

Local councils may have specialist teams for people with visual, hearing or dual sensory impairment these teams would offer advice and signposting and can be accessed via:

• Doncaster council (opens in new window)
• Rotherham Metropolitan Borough council (opens in new window)
• North Lincolnshire council (opens in new window)

5.6 Preparation for meeting

Prior to any meeting staff should:

• consider the time allocated for the meeting. If a session usually takes 1 hour, it may be useful to allocate 1 and a half hours. This will give time for comfort breaks, briefing the interpreter prior to the session and discussion after
• ensure that the room to be used will protect the privacy and dignity of the patient or service user, and that the conversation will not be overheard
• brief the interpreter prior to the session. This may be by phone or by meeting with the interpreter 10 minutes before the session
• give relevant background information and discuss any risks. Discuss strategies of how to respond if the person becomes agitated, angry or aggressive. Arrange for easy access to leave the room if necessary
• inform the interpreter of any sensitive information that may be discussed
• check with the interpreter that they are able and willing to assist in the meeting and understand the purpose of the meeting
• clarify the respective roles and expectations
• discuss any special concepts or terminology to be used in the meeting
• ask the interpreter if they have any suggestions to make on protocol or social observance that may assist in the course of the meeting
• get confirmation from the patient or service user that they are happy to proceed with the meeting in the presence of the interpreter
• arrange for an advocate if required (interpreters are not advocates)

5.6.1 Working with deaf patients or service users

Provide a meeting room which has no background noise or visual distractions, for example, bright colours or pictures, notices on the wall. There should also be adequate lighting but not direct sunlight to maximise access to communication. Discuss any special concepts or terminology to be used in the meeting.

If medications are to be discussed, these may need spelling for the interpreter and explaining the use of these, including colour and shape for the patient or service user. Explain complicated information and avoid jargon.

If a Deaf person has limited language skills a relay interpreter may be necessary to break down the communication between the person and the interpreter. Local specialist advice is available from the project lead or CPN for Deaf People (South Yorkshire). For staff working in North Lincolnshire, the Project Lead or CPN for Deaf People can be consulted for advice.

The project lead or CPN for Deaf People (South Yorkshire) can be contacted on 07770 828452.

5.7 During the meeting

• During the meeting allow time to organise the seating so that there is good eye contact between you, the interpreter and the patient or service user and make introductions. The interpreter will also need some time to introduce themselves to the service patient or user if this has not already taken place prior to the session commencing.
• Use straightforward language as far as possible, speaking directly to the patient or service user. Be prepared to rephrase your sentence, if necessary, rather than repeating it.
• All information should be explained as far as possible in a way that the patient or service user understands which may include the provision of translated materials.
• Check that the interpreter understands the meaning of what you are saying and that the patient or service user has understood correctly. Allow the interpreter the opportunity to interrupt if necessary for clarification.
• Be alert to non-verbal communication.
• Allow comfort breaks for the interpreter and patient or service user. Association of sign language interpreters (ASLI) policy (opens in new window) recommends a 5 minute break every 30 minutes.
• Remember:
  • the responsibility for the meeting is yours
  • the pressures on the interpreter, allow them enough time
  • the pressures on the patient or service user, allow them to express themselves
  • the meeting will feel more laborious because of the extra communication
• The appointment should not be ended abruptly. Check that the patient or service user is clear about the key information and any follow up appointments.
• Check if the patient or service user wants to know or ask anything else.
• Re-assure the patient or service user that confidentiality will be respected.

5.8 Payment

Invoices for payment will be sent to the service manager or modern matron for payment from the service budget.

5.9 Conduct of interpreters

If staff have any concerns about the conduct of an interpreter or if they receive a complaint from a patient or service user they should, in the first instance, speak with the interpreter and try to resolve it at a local level. In the event that this fails to resolve the matter or if the concern or complaint is of a serious nature, staff are to report the matter to the Deputy Head of Procurement.

Complaints about BSL interpreters should be discussed with the interpreter or their organisation in the first instance. If the complaint cannot be resolved, it should be forwarded to the National Registers of Communication Professionals Working with Deaf and Deaf blind People (NRCPD) to be dealt with in conjunction with their complaints and disciplinary procedure.

5.10 Translation of documents

It may be necessary to translate documents. The DA Languages provides a translation service. The translation order form can be supplied by the PACT office.

When undertaking translation work for documents and leaflets our 3rd party supplier can be utilised with support from our Equality, Diversity, Inclusion and Participation team. Our patient advice and liaison service coordinator will ensure that any written material that requires translation is available to be shared with patients and carers.

Please note, where translation of any document that contains personal details all personal details should be anonymised to protect the identity of the individual(s).

6 Training implications

There are no specific training needs in relation to this policy, but all staff who are required to communicate with people for whom English is not their language of preference, and any other individual or group with a responsibility for implementing the contents of this policy will need to be familiar with its contents.

As a trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through:

• team talk
• local Induction
• team meetings
• special meetings
• one to one meetings or supervision
• posters

Trust mandatory equality and diversity training underpins the communication needs of people for whom English is not their language of preference.

DA Languages offers a range of training for staff that includes e-learning. For further information the service can be contacted by the deputy head of procurement

7 Monitoring arrangements

These are the expected response rates and if there are concerns around these please contact service support (appendix E refers). Also if required please contact the deputy head of procurement to raise with provider.

7.1 Number of requests within the trust for the service of an interpreter

• How: Activity reports.
• Who by: Deputy head of procurement.
• Reported to: Equality and diversity steering group.
• Frequency: 6-monthly.

7.2 The most common languages for which an interpreter is required

• How: Activity reports.
• Who by: Patient Advice and Complaints team.
• Reported to: Equality and diversity steering group.
• Frequency: 6-monthly.

7.3 Any occasions when it was not possible to engage the service of an appropriate interpreter

• How: Staff reporting, complaints, PALS and your opinion counts.
• Who by: Deputy head of procurement.
• Reported to: Equality and diversity steering group.
• Frequency: 6-monthly.

7.4 Any dissatisfaction or satisfaction with the service offered by the interpreter

• How: Concerns raised through PALS, complaints or your opinion counts by patients or carers. Concerns raised to or from staff.
• Who by: Deputy head of procurement.
• Reported to: Equality and diversity steering group.
• Frequency: 6-monthly.

7.5 Any occasions where the DA response times exceed the identified target KPI

• How: Staff reporting complaints, PALS, your opinion counts, concerns raised to or from staff.
• Who by: Deputy head of procurement.
• Reported to: EDI and P workstream.
• Frequency: 6-monthly.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

Wherever possible choice of gender of interpreter will be offered. Having access to interpreters should enhance the privacy and dignity of services users accessing RDASH services. When using either face to face or phone interpreting services a suitable room will be used that protects the privacy and dignity of the patient or service user and does not allow others to overhear the conversation.

8.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act 2005 (section 1). Where English is not the preferred language of the patient or service user, using an interpreting service should enhance the assessment of mental capacity.

9 Links to any other associated documents

• Consent to care and treatment policy
• Section 132 informing detained patients of their legal rights procedure
• MCA deprivation of liberty (DoL) policy
• Information governance policy

10 References

• Department for Constitutional Affairs (2007) Mental Capacity Act 2005 Code of Practice. Pub: The Stationary Office.
• Department of Health (2015) Mental Health Act 1983, Code of Practice Pub: Department of Health, London.
• Department of Health (1999) National service Framework for Mental Health Pub: Department of health, London.
• Department of Health (2005) Mental Health and Deafness Towards Equity and Access Pub: Department of Health, London.
• Department of Health (2001) Valuing People, A New Strategy for Learning Disability for the 21st Century, Pub: HMSO, London.
• Department of Health (2005) Models of Care for substance misuse treatment promoting quality, efficiency and effectiveness in drug misuse treatment services Pub: HMSO, London.
• NHS England (launched 2011). The Equality Delivery System Pub: EDS2.
• NIMHE (2003) Engaging and Changing, Developing effective policy for the care and treatment of Black and minority ethnic detained patients.
• Robinson, L. (2002). ‘Intercultural communication in a therapeutic setting’ in Coker, N. (Ed.) (2002) Racism in Medicine: An Agenda for Change. Kings Fund, London.
• Association of Sign Language Interpreters (ASLI) (2006) Code of Practice for Interpreters Working in Mental Health.
• The National Registers of Communication Professionals Working With Deaf and Deafblind People (NRCPD) (2010) Code of Conduct for Communication Professional’s.

11 Appendices

11.1 Appendix A Face to face interpretation

To sign in to DA Link, go to the DA login (opens in new window). Click the ‘Sign in’ button underneath the ‘Client Portal’ logo, and then enter your email and password. If you have not yet received an invite to join the portal, select “Request invite” option and follow the instructions that will appear in your email.

Once logged in, click on ‘Bookings’ from the top menu.

A drop down menu will appear. Click on “Create New Booking”.A new window will appear prompting you to select the service type.

11.2 Appendix B Raising a translation booking

Sign into DA link via the client portal option (opens in new window). If you have not yet received an invite to join the portal, select “request invite” option and follow the instructions that will appear in your email.

Once logged in, click on “Bookings” from the top menu, and then in the drop down, select “Translations”. A new page will open. On this page select the blue button “New Translation”.

A booking form will appear.

Every field marked with a “*” must be completed to proceed.

To upload the document to translate, click on the “Add another source file” button. Then, just drag and drop your file into the box to attach it.

Once the information in the booking form is complete and the file is uploaded, click the green ‘Save’ button: near the top left of the page. When the booking is saved, you’ll receive a job ID number (for example, TMBC_0123456). The Translation team will get back to you as soon as possible and provide you with a cost and estimated turnaround time. We may also request additional information if necessary. If you have any issues accessing DA link, please give our friendly team a call on 0161 928 2533, choosing option *2 for translation, and our project managers will assist you.

11.3 Appendix C Video interpretation

Sign into DA link via the client portal option (opens in new window). If you have not yet received an invite to join the portal, select “request invite” option and follow the instructions that will appear in your email.

Once logged in, click on “Bookings” from the top menu. A drop-down menu will appear. Click on “Create New Booking”.

A new window will appear prompting you to select the service type, “Video Remote Interpreting”.

A booking form will appear for you to fill in. Criteria marked by a * must be completed. Please add in the link of your external Skype, or Zoom or etc. meeting, plus any login details in the requested field. The interpreter will use this to connect to your appointment.

To send the request to a booking co-ordinator, click the “Save” button, your booking coordinator will be notified of your request by email.

11.4 Appendix D Phone interpretation guide and language code

1. Call 0330 088 2443 direct from your phone.
2. Enter your ‘department’s PIN’, followed by the #key, you can then enter the PIN of the language you require (see alphabetised list below). Press 1 for an interpreter, or 4 to speak to a specific interpreter (see next step).
3. Once connected, take note of the interpreter ID number (you can use this to connect to the same interpreter for future calls). To connect to any third parties, dial 9 and then the number you wish to connect to 8.
4. Leave feedback on interpreter at the end of the call. You will have 8 seconds to do this.

11.5 Appendix E Escalation process

11.5.1 Service support

• You have multiple channels to reach out to, to support you with the service.
• Service monitored by the implementation manager and our Client Relations team.
• Any positive or negative feedback please do share that with us so that we can continue to improve the service.

11.5.1.1 Portal access

Portal: admin@dalanguages.co.uk

11.5.1.2 Bookings

• Phone: telephoneinterpreting@dalanguages.co.uk
• Video interpreting: vri@dalanguages.co.uk
• Face-to-face: teamnurture@dalanguages.co.uk
• Written translation: tbc@dalanguages.co.uk
• BSL bookings: teamnurture@dalanguages.co.uk

11.5.1.3 Service feedback

• Feedback about the service: elitsa.kvasova@dalanguages.co.uk
• Issues and complaints:
  • Email: complaint@dalanguages.co.uk
  • Email: louis.buxton@dalanguages.co.uk

11.5.2 Key contacts

11.5.2.1 DA languages

Louis Buxton, Implementation manager:

• Email: louis.buxton@dalanguages.co.uk

Elitsa Kvasova, Implementation Executive:

• Email: elitsa.kvasova@dalanguages.co.uk

11.5.2.1 Rotherham Doncaster and South Humber NHS Foundation Trust

Kelly Millward, Deputy head of procurement:

• Email: kelly.millward1@nhs.net

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Document control

• Version: 6.1.
• Unique reference number: 340.
• Approved by: Clinical policy review and approval group.
• Date approved: 2 April 2024.
• Name of originator or author: Chief nurse.
• Name of responsible individual: Quality and safety group.
• Date issued: 25 April 2024 (amendment).
• Review date: 31 December 2024.
• Target audience: All staff who access the use of interpreters.

Page last reviewed: October 22, 2024
Next review due: October 22, 2025

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