About Interpreting in Health Care Settings

Effective communication between consumers who are deaf and health care providers is essential. When the consumers and health care providers do not share a common language, a qualified sign language interpreter can facilitate communication. A consumer who is deaf could be the patient, a relative or companion who is involved in the patient’s health care. 

What is the legal basis for providing sign language interpreters in health care settings

Guidelines on provision of interpreters within the Health Service are clearly laid out in ‘Doubly Disabled: Equality for disabled people in the new NHS Access to Services’, NHS Executive 1999:

  • where a deaf person uses British Sign Language, check if they require a BSL Interpreter for meetings, interviews, or consultations. Qualified BSL interpreters should be used in any situation where complex and /or technical information needs to be communicated, such as in formal consultation with medical staff. (p32)
  • qualified and accredited interpreters minimise the risk of misunderstanding… and are bound by a professional code of practice which includes confidentiality about assignments. (p33)

This important policy document can be read in full here: policy document. There is also now an NHS constitution which states the seven key principles that guide the NHS in all it does.  On pages 26-27 the right of the patient:

 'You have the right to be treated with a professional standard of care, by appropriately qualified and  experienced staff, in a properly approved or registered organisation that meets required levels of  safety and quality'

If an NHS trust employs interpreters that are not suitably qualified in accordance with the national occupational standards, it may fall foul of its own constitution.  Engaging unqualified and unregistered interpreters does not enable health service professionals to discharge their Duty of Care.

Furthermore, from October 2010 the Equality Act made it illegal for Deaf and disabled people to be discriminated against. This includes protection for Deaf and disabled people at work, when providing goods, facilities and services, including health services, when renting or buying property and in education.  The Equality Act replaces much of the Disability Discrimination Act (1995), but the new Act still mandates the need for making ‘reasonable adjustment’ when providing services for Deaf people. 

How do I know a sign language interpreter will be needed?

The patient, family member or companion, who is deaf, may request an interpreter, or when the health care provider becomes aware that the consumer(s) is deaf (from referral letters or notes provided by another clinician), an interpreter can be contracted.

What areas of health care may require the use of a sign language interpreter?

Sign language interpreters are necessary in any situation in which the information to be exchanged requires effective communication. This will include but is not limited to:

  • Taking a patient’s medical history 
  • Giving diagnoses
  • Performing medical procedures
  • Explaining treatment planning
  • Explaining medicine prescription and regimen
  • Providing patient education or counselling
  • Describing discharge and follow up plans
  • Admitting to emergency departments/urgent care

What is a “qualified sign language interpreter?”

According to the National Registers of Communication Professionals with Deaf and Deaf blind People (NRCPD), a qualified sign language interpreter has met the minimum National Occupational Standards for interpreting. The importance of booking NRCPD Registered Interpreters is explained here.

An interpreter that is registered by NRCPD can provide the best assurance of meeting this standard. Registered interpreters have met national professional standards of competency in the language, interpretation and practice of ethics and professionalism. Some interpreters have additional expertise interpreting in the health care setting and should be sought out initially. ASLI provides on its website a list of members who are available to work in this domain. 

In Mental Health in particular, ASLI recommends that interpreters are engaged who operate under our published Best Practice framework.  See www.asli.org.uk>Guidance for more details.

What is the role of the sign language interpreter?

Interpreters should be regarded as members of the multi-disciplinary health care team. Their role on the health care team is to facilitate linguistic and cultural communication. NRCPD registered interpreters adhere to the Code of Conduct of which confidentiality is a fundamental tenet. Some healthcare facilities request that interpreters also adhere to their own confidentiality policies.  Like other members of the health care team, professional interpreters are mindful about their safety, security and self-care.

Why should family members, friends or healthcare staff not serve as sign language interpreters? 

Someone who has only a rudimentary familiarity with sign language or fingerspelling or who does not possess the training and ability to interpret is not a qualified sign language interpreter. Family members, friends and health care staff are not bound by the NRCPD Code of Conduct, and there is no assurance the interpretation will be complete and reliable or privacy issues will not be compromised.

How can a qualified sign language interpreter be accessed?

Qualified interpreters either maintain a private practice or work through interpreter referral agencies. ASLI maintains a list of registered interpreters on its Web Site (www.asli.org.uk>Find an Interpreter), and local and regional agencies working with people who are deaf can provide information on appropriate interpreter agencies. It is vital that information on how to access an interpreter be readily available at all times the health care facility is open, and staff are knowledgeable about the facility’s policies and procedures regarding interpreters.

While the use of live interpreters is always preferable, recent video conferencing technology enables sign language interpreters to be accessed through Video Remote Interpreting (VRI). This mode of communication has limitations and should be considered carefully.  ASLI publishes guidance on the use of remote interpreting services. (www.asli.org.uk>Guidance)

How do I share feedback with the sign language interpreter?

Like any good working relationship, there are times when the health care provider and interpreter may need to discuss challenges that are anticipated before, or those that occurred during the interpreting interaction. The goal of the discussion is to improve the working relationship between the participants and to clarify any potential communication issues.

How do I file a complaint about a sign language interpreter?

NRCPD has a formal complaint system to deal with issues that occur between an interpreter and a health care provider or a patient who is deaf. Full details of the process can be found on the NRCPD website (www.NRCPD.org.uk)

Should the health care facility document that a sign language interpreter was present?

In the field of health care, documentation in a patient’s chart or progress notes is imperative to verify that services were provided. Like any other service, provision of a sign language interpreter must be documented within the patient’s notes either by the interpreter or by another member of the health care team.