There were 10 maternal deaths at, or following, delivery at Northwick Park Hospital between 2002 and 2005.
Of these cases, summarised in the Northwick Park report (Healthcare Commission, 2006), it was judged that nine had care and treatment deficiencies. In five of these, there was no interpreter present.
One of the comments in the notes stated: ‘Her ethnicity was noted, and that an interpreter was not required.’ The report does not consider how, or by whom, this decision was taken, but found that ‘a lack of suitable interpreters is one of the key findings running throughout this report’.
I propose that interpreting, translation and language support services are as fundamental to safe health care as clean sheets, albeit a great deal more complex.
I further propose that they should be subject to the same degree of rigorous governance as any clinical discipline in
NHS institutions.
Professional qualifications for interpreters in health care do exist, and registered interpreters are subject to a code of conduct and disciplinary procedures.
Registration brings accountability and signals a commitment to professional standards and patient protection across language and culture – this is the patient’s (and midwife’s) right.
Clinical personnel in maternity care are highly trained, but they are not linguists.
Diagnoses, insights, treatment and care plans are based on what you hear through the interpreter, who should be unobtrusive and facilitating the development of a trusting patient-clinician relationship.
Decisions taken on whether or not an interpreter is necessary seem, from the Northwick Park report, to have been influenced only by considerations of cost and availability.
While too often ‘professional interpreter’ merely means ‘paid for the job’, it cannot be automatically taken to mean ‘qualified’.
Many trusts have guidelines on working with interpreters, but I have not seen any that address interpreters’ skills and
codes of conduct.
I think there are two aspects to improving the multidisciplinary team when it comes to working with interpreters.
Firstly, jointly developed national guidelines are needed on identifying the need for a practitioner and how to plan and support the interpreted session.
Secondly, mutual understanding of each others’ role, duties, constraints, capabilities and professional needs is required.
Joint training is often very helpful, especially when specialist clinicians visit interpreter training sessions, and clinicians often learn as much in these sessions as the trainee interpreters do.
In order to hold interpreters to account – just as midwives are held to account – it is necessary to know who interpreted for the mother, when, where and in which language.
Without this we cannot hope to plan for local training needs, nor challenge the qualifications or performance of an interpreter when it turns out there was a serious misunderstanding.
Audit trails of this sort should show more than simply how much the department spent on interpreters.
Agencies supplying practitioners to the NHS should be providing PCTs with information on their panelists’
qualifications and experience, as well as the hours invoiced.
This auditing would provide the information needed to plan interpreter selection, recruitment and training in the future.
There are chilling examples of linguistically unsupported mothers in the Northwick Park report, and failures resulting from inadequate or no interpreter support being provided.
I hope I have provoked readers into wanting more information about interpreting.
Jan Cambridge
Jan holds a DPSI in both health and legal interpreting, and an MA in linguistics. She is happy to discuss and elaborate on her thoughts about interpreting and can be contacted at:
jancambridge@uwclub.net
References CMACE. (2011) Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-2008.
BJOG 118(s1): 1-203.
Davies MM, Bath PA. (2001) The maternity information concerns of Somali women in the United Kingdom.
Journal of Advanced Nursing 36(2): 237-45.
Divi C, Koss RG, Schmaltz SP, Loeb JM. (2007) Language proficiency and adverse events in US hospitals: a pilot study.
The International Journal for Quality in Health Care 19(2): 60-7.
Lewis G. (Ed.). (2007) T
he Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer - 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH: London.
The European Parliament and the Council of Europe. (2011)
Directive on the application of patients' rights in cross-border health care. (11038/2/2010 - C7-0266/2010 - 2008/0142(COD)). The European Parliament and the Council of Europe: European Union.
Healthcare Commission. (2006)
Investigation into 10 maternal deaths at, or following delivery at, Northwick Park Hospital, North West London Hospitals NHS Trust, between April 2002 and April 2005. Healthcare Commission: London.
Quan K, Lynch J. (2010)
The high costs of language barriers in medical malpractice. School of Public Health, University of California: Berkeley.
