nwren meea access to statutory services: from the perspective of both minority ethnic elders and...

Access to Statutory Services: from the perspective of both Minority Ethnic Elders and External Organisations

Summary report written and produced by NWREN as part of the MEEA Project

NWREN, February 2015, Belinda Gammon

Promoting Equality · challenging discrimination · upholding human rights

Company No.: 5843319 Charity Registration No.: 1116970

The Minority Ethnic Elders Advocacy Project (MEEA)

MEEA Project Language Report

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Contents

Acknowledgements 3

The MEEA Project 4

About NWREN 4

Section 1a: Introduction to the Report 5

Section 1b: Overview 8

Section 2: The method 9

Section 3: The Results 12

Section 4: Conclusions and Recommendations 18

References 22


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This report was produced as part of the NWREN Minority Ethnic Elders Advocacy Project (MEEA):

a pan-Wales project funded by the BIG Lottery. The project would like to acknowledge the

invaluable support given by the following people:

Research Planning - Acknowledgments must first go to Mary Holmes without whose knowledge

and experience of both research and research methods and the Voluntary Sector, this survey

would not have been possible.

Introduction - Further acknowledgments are due to Mary Holmes for contributing the text for

the report’s Introduction (Section 1a).

The Discussion Facilitators and Recorders - Susheela Lourie; Nayan Patel; Jenny Porter;

Idney Fernandes; Helga Uckermann; Gemma Hamblin; Nichola Roberts; Rita Jones and Lindsay

Sullivan. Thanks to the hard work, skills and experience of the Facilitators and Recorders, the

quality of response from the interviewees (MEEA project beneficiaries) exceeded expectations.

Grateful thanks also go to Susan Jones for facilitating the Question Time panel.

Service Providers from Statutory & Voluntary Sectors – who gave so freely of their time,

with special thanks for their honesty and dedication in taking part in the Question Time Panel and

Discussion Group.

Project Beneficiaries & Volunteer Champions – Grateful acknowledgements must go to the

project beneficiaries, without whom, this survey would not have been possible.

Editorial support – thanks go to Professor Robert Moore and Will Wain for editorial comment

and guidance.


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The MEEA project is a pan-Wales project, in which NWREN is working in

partnership with Lead partner, Race Equality First (REF), South East Wales

Regional Equality Council (SEWREC) and Swansea Bay Regional Equality

Council (SBREC). The Project in North Wales, having some 2,400 square miles

to cover, works across each of the six Local Authority areas: Anglesey;

Conwy; Denbighshire; Flintshire; Gwynedd and Wrexham.

The three-year project aims to provide an independent advocacy service to

Minority Ethnic Elders (MEE) aged 50+. It will empower and support MEE to

live the way they want to, ensuring their ability to access services which they

currently may not use due to lack of awareness and barriers of language,

confidence and physical ability. Working closely with organisations in the

statutory and voluntary sector which offer services to older people, the

Project will raise awareness of the particular needs of MEE. Importantly, it

will ensure that MEE are able to influence practice and general improvements

in local services by telling service providers what they actually want and need.

A choir has been established across the North Wales region to learn,

choreograph and video the NWREN MEEA Project’s own cover version of

Pharrell’s ‘Happy’ song at iconic locations across North Wales. The choir has

been dubbed “The Happy Choir” and further plans include learning an

international version of Amazing Grace, along with songs from the project

beneficiaries’ cultures. As more beneficiaries join the project, event planning

will be done on a group by group basis.

About NWREN

The North Wales Regional Equality Network (NWREN) works across all areas

of equality with a range of partners. As a charity we are committed to:

working towards the elimination of discrimination and disadvantage in all its

forms; promoting equality of opportunity and good relations between all

through understanding and addressing issues of discrimination and equality;

working towards upholding the human rights of all people. NWREN mainly

operates across Anglesey, Conwy, Denbighshire, Flintshire, Gwynedd and

Wrexham. Current projects include: BIG Lottery Funding; People and

Places Project which has 3 main strands - the Anti-Hate Crime Project, the

Equality Centre Project and Development of a North Wales Voluntary Sector

Equality and Human Rights Forum across North Wales. Also BIG Lottery

Funding, the Community Voice Project, aimed at helping people to get

their voices heard.

The iDENTiTY Project is a Welsh government funded initiative targeting

young people across Wales who identify with the protected characteristics of

race, sexual orientation and gender reassignment, supporting them through

adolescence to adulthood.

The MEEA Project


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Section 1a: Introduction

This report examines the perspective of MEE groups and individuals (for this

survey, 45 BME individuals took part) and statutory providers, within North

Wales, with regard to the importance and difficulties in the provision of own

dialect interpreting services. This report is an initial step in a longitudinal

study, with the aim of bringing together both the perspectives of service

providers and their MEE clients. It has explored, with reference to own

dialect interpreting provision, the difference between the experience of MEE

when accessing statutory services and the intentions of the providers

delivering those services.

The report hopes to promote better understanding of the issues around MEE

accessing statutory services and to present clear empirical evidence of need

and service limitations. Together, the data are intended to demonstrate need

rather than elicited criticism. The findings in this report are not unique to

North Wales, and they would appear to correlate with replicated findings

across Britain. What may be a unique asset to North Wales is the tangible

level of genuine engagement and co-operation from the participating

statutory and voluntary service providers.

An estimated 4 million older people in the UK (36% of people aged 65-74 and

47% of those aged 75+) have a limiting longstanding illness. This equates to

40% of all people aged 65+ 1(Office of National Statistics 2013). As in all

populations, the likely prevalence of disease and chronic health conditions

increases with age, so it is no surprise that the primary focus of the

participants within this study was on the health care system. (Minority Ethnic

Elders Advocacy project (50 years +)) There was also recorded evidence of a

secondary focus on comparative translation needs within the Criminal Justice

System.

This sometimes rhetorical and fragmentary debate on the importance of

language and own dialect translation services is historically and currently well

documented in both academic and ‘grey’ literature.

As reported by Stevenson and Roa (2014), there are marked differences in

ethnic population vs the white indigenous population when accessing health

care. They suggest ‘intrinsic’ cultural differences, such as language and

literacy, as well as organisational factors in health services, as possible

explanatory factors for this disparity in uptake. They point out that research

on cardiovascular care has shown repeatedly that BME communities have

poorer access to hospital care, although studies on health care seeking

1 The estimate is for the UK, based on Great Britain data from the General Lifestyle

Survey 2011; Office for National Statistics, 2013.


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behaviour have found that they may have a greater likelihood of seeking

immediate care compared with their white counterparts.

Diabetes and associated problems can become more prevalent with the

ageing process. The Department of Health Health Survey for England 2003

(2004) highlighted significant gaps in BME patient knowledge, understanding

and confidence in managing diabetes. These gaps were more pronounced for

ethnic minorities than the white population. Language was featured as a

major barrier to accessing services.

Factors such as modesty; fear; embarrassment relating to examination

particularly by male staff; differing attitudes, perceptions and beliefs of health

and health service; language difficulties – both English proficiency and literacy

in own language – are reported as contributory factors to low uptake by BME

individuals in screening for breast and bowel cancer. (Bansal, et al 2012). The

same language barriers are reported in uptake of cervical screening (Thomas,

Saleem and Abraham 2005).

Gynaecology and obstetric procedures are personal and often emotive. The

director of BME Health Forum Nafsika Thalassis reports that in the study

carried out in 2013 there were “many instances where women who are not

fluent English speakers are not offered interpreters and that even when they

request this service, their request is refused. For the two women in this

project who were not fluent English speakers, this led to a number of

profound misunderstandings about their choices, which have cost implications

as well as resulting in poorer care for the women. This inconsistent use of

interpreting services has negative implications for safeguarding women and

children as well as clinical care.”

These phenomena are not limited to secondary care, Primary Concern, a

report by the BME Health Forum (2008) focuses on understanding barriers

experienced by BME regarding GP access. One of the main issues highlighted

are ‘Communication problems, caused by language and cultural barriers

impede on the doctor-patient relationship. Interpreting services are not widely

available and waiting for an interpreter to be booked limits access to services.

Many people use unofficial interpreters, including children thus jeopardising

the clinical outcome of the consultation.’

To put the issue of need versus provision in context there are a further two

critical factors to consider, primarily the Race Relations (Amendment) Act

2000.

The Act came into force on 2nd April 2001 and requires public authorities to

make the promotion of racial equality central to all activities. The duty is

obligatory, not optional, and a list of specific duties is listed by the Equalities

and Human Rights Commission.


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The general duty of the Act also expects public authorities to take the lead in

ensuring equal access to all: ‘By providing widely accessible interpretation and

translation services we are taking steps to minimise the risk of language

difficulties becoming a barrier to individuals understanding of their own

healthcare needs and treatment.’ This dynamic is further reinforced by the

NHS’s ‘Improving access to Psychological Therapies’ (IAPT) – ‘Non-English-

speaking people may not be able to communicate their needs effectively if an

IAPT service lacks appropriate language capacity. This could mean that

proper and correct assessments may not be made.’

The second consideration is that of cost as statutory budgets are curtailed by

austerity measures (Health in Austerity) 2013. This particularly applies in rural

areas where the density and diversity of the BME groups and individuals

challenges the urban solutions of economies of scale in the provision of

translators.

Within a global economy and the push/pull factors within the European

States, demographic change is inevitable and the evolution of appropriate

services should be pre-equipped rather than reactive in order to cater for

these changes. According to the Black and Minority Ethnic (BME) Leadership

Forum, the UK is set to overtake the USA as the most diverse society in the

western world over the next 35 years. ‘While socially and culturally we have

made great strides in first accepting and then celebrating our diversity, some

parts of our healthcare system have been slow to react to the changing

demographic landscape’.

It should never be said that the “one size fits all” philosophy or “we treat

everybody the same way”, is an equitable or non-discriminatory approach to

translation. Across Britain, there is a plethora of researched and developed

practical translation practices. There appears to be no collation of these

practices as to their overall efficacy, application and possible economic and

social impact. The inherent difficulties and shortcomings of translation

services are sufficiently documented to illustrate the need for convergent

solutions. This does not mean rhetorical “best practice”, but rather the

shared development of generic, tested and peer reviewed multi-platform

materials that reduce the initial barriers to information and the statutory

services.

With the clear dialogue and the open commitment demonstrated by those

responsible for the ‘equalities’ from the statutory sectors across North Wales

and the MEEA Project beneficiaries in conducting the research for this Report,

there is the opportunity to make achievable and maintainable impacts.

Working together with BME individuals and populations, to provide more

equitable access to services and an improved knowledge of provisions

available, is in itself a preventative measure. If issues of language and


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miscomprehensions are addressed at an initial stage, (for both BME and

indigenous English/Welsh speaking populations) it may reduce both costs for

service providers and anxiety of the individuals concerned.

1. Background Information

The research was carried out by NWREN as part of the MEEA Project and

summarises the research findings on experiences of Minority Ethnic Elders

(MEE) across North Wales on accessing healthcare and other statutory

services with a focus on provision of own dialect interpreting services.

1.1 Review of the Existing Literature

Existing literature shows that provision of own dialect interpreting provision to

ethnic minority individuals has been an issue for many years: the report,

“Access to Health: A Minority Ethnic Perspective” dated April 1994 and carried

out in Aylesbury and Milton Keynes, revealed a deficiency in supply. In 2006,

the report, “Health and Care Consultation with the Chinese Women’s Society”

conducted in North Wales, revealed a “need for an interpreter service

standing out as key to services for those with language problems. The

provision of professional interpreters trained to work within the health service

is the king pin of a policy for equal access to health services.”

1.2 The Local context

There are six Local Authority areas in the North of Wales. Regarding Health

Care and Criminal Justice, each of the six LA areas come under a North Wales

centralised management body: Betsi Cadwaladr for Health Care and North

Wales Police respectively. In this research, Gwynedd, Denbighshire and

Wrexham, three out of six Local Authority areas of North Wales were

represented by the Voluntary Sector, North Wales Police and Betsi Cadwaladr.

The Project Beneficiary Participants (45) came from Chinese, European

Portuguese, Hong Kong Chinese, Indian, Irish, and Zimbabwean communities

based in Gwynedd, Denbighshire and Wrexham. Dialects spoken (12)

included Cantonese, Mandarin, Hakka, Malay, German, European Portuguese,

Gujurati, Hindi, Urdu, Punjabi, Swahili and Zimbabwean.

Section 1b: Overview


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2.1 Method

Design – This was a three-phases Qualitative piece of research

i. Initial focus groups ii. Semi-structured discussion groups with beneficiaries

iii. Semi-structured discussion groups with service providers

Both semi-structured discussion groups ii. and iii. were run in parallel.

2.2 The Participants

The Project beneficiary participants came from Gwynedd & Môn, Denbighshire and Wrexham. The Project Beneficiary Participants (45) included Chinese, European Portuguese, Hong Kong Chinese, Indian, Irish, and Zimbabwean communities based in Gwynedd, Denbighshire and Wrexham. Ages ranged from 50 to 80. Dialects spoken (12) included Cantonese, Mandarin, Hakka, Malay, German, European Portuguese, Gujurati, Hindi, Urdu, Punjabi, Swahili and Zimbabwean.

Service providers represented came from the Voluntary Sector, North Wales

Police and Betsi Cadwaladr University Hospital (BCUHB).

For the first phase, contact was made through monthly NWREN MEEA project

Advocafé meetings. Phase 2 took place at the 2014 NWREN MEEA

conference, held at a central location in Llandudno. Project beneficiaries and

service providers attended this conference, during which both groups took

part in a 30 minute discussion group.

2.4 Phase 1

Phase one of the research was carried out via semi-structured focus groups

2.3 Aims and Objectives

1) to formally collate, the incidence of poor access to own dialect interpreting provision, and 2) to ascertain the possible impact/s on minority ethnic elders deriving from the difficulties encountered with comprehension and translation.

Both of the above objectives relate to accessing statutory services. The aims of this research are to use the collated data to advocate and promote a

better understanding of the translation needs of Minority Ethnic Elders (MEE)

with a view to informing future provision and policy decisions across Wales.

Section 2: Method


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which took place in 2014: the first in Wrexham with seven participants, the

second in Gwynedd with 12 participants. The questions posed were:

Which, out of the following, are most important to you:

Social/Leisure/Recreation; Personal Advocacy Services; Health/Fitness; Get

Together Mornings; Adult Education; Welfare/Benefits; Financial/Budgeting;

Personal Grooming; Housing/maintenance; Religious/Cultural; Transport;

Other? The results from this phase were used to guide and develop the

questions for the semi structured discussion groups in phases ii and iii groups

B and C.

2.5 Phase 2

The second phase was carried out during the NWREN MEEA Project

conference, amongst two different groups of participants: project

beneficiaries and service providers. The project beneficiaries, Group A,

numbered 30 participants from Gwynedd, 13 from Wrexham and 2 from

Denbighshire. Languages spoken “on the floor” at the conference included

Cantonese, Mandarin, Hakka, Malay, European Portuguese, German, Gujurati,

Hindi, Urdu, Punjabi, Swahili, Welsh and English. Not all project beneficiary

participants speak English, however, amongst those who do, English speaking

skills vary greatly.

In the service provider group, Group B, there were six service provider

participants, representing Betsi Cadwaladr University Health Board (BCUHB);

Gwynedd County Council; Wrexham County Council; North Wales Police;

North Wales Community Health Council (CIC). The method used during the

conference consisted of semi-structured discussion groups, each led by a

facilitator and a recorder.


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2.6 Phase 2 — The Questions

The following four questions were discussed with the project beneficiary respondents (Group

A):

1. In your experience, what have been or could be the consequences of not having own

dialect interpreting when accessing Health or other Statutory services?

2. In your experience, what have been or could be the consequences if patients and

practitioners are not able to understand one another?

3. In your experience, what has been or could be the impact on patients and their families if

they cannot explain their situation to their families?

4. In your experience, what have been or could be the consequences for patients on their

overall health through not being able to understand their prognosis?

The service provider respondents discussed the following questions (Group B):

1. What are the difficulties you, as a statutory agency face in providing translation services?

2. What suggestions can you think of to overcome current difficulties or improve the current

provision? Please include successful practices that you currently implement.


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3.1 Phase 1

The results across all groups showed perception of a clear gap, reflected by

each group of participants, in provision of interpreting services for minority

ethnic elder community members when accessing statutory services. In

addition, in the few cited examples of service providers supplying interpreting

services, the wrong dialect was used, resulting in, at best, poor service with

accompanying frustration and distress, at worst, leading to a possible life-

threatening situation.

These initial Data were instrumental in the decision to take the research

further and after discussion with the participants and line-management, the

decision was taken to stage a conference at which both Group A and Group B

would take part in a more detailed second phase of research.

3.2 Phase 2 – Project Beneficiaries

For simplicity the questions within this report had sub-divisions but on the

ground, the data captured was all interrelated and co-dependent. Thus the

results have been split into the following categories Physical;

Psychological/Emotional; Financial; Practical.

3.2.2 Physical

i One of the more poignant examples disclosed by Group A was of a family

who had to wait 15 years for an appropriate service: “if you have difficulty

with your GP in primary care – there is no way you’ll ever get to secondary

care”. If you are not understood within the primary care system, you’ll never

even reach secondary care to know if there are problems or not. This raises

the question of the prevalence of incidences of un-diagnosed health problems

which exist in ME populations.

ii One participant reported a case of a complicated pregnancy which, due to

lack of available translation services, was compounded by a delay in advising

termination of the pregnancy, causing potential undue suffering to the foetus

with potential to threaten the wellbeing of the mother. In this case, there

were strong criticisms of wasting time whilst waiting for interpreting support,

leading to deterioration of patient's health.

iii Receiving treatment: participants disclosed some examples of diabetes

sufferers in hospital not understanding the menu and having to wait for family

members to visit them in hospital in order to translate for them. Support was

required for both explaining to hospital staff that they were diabetic and for

translating instructions regarding medicines and/or procedures prescribed.

The situation led to patients being presented with inappropriate food, which

in some cases led to undesirable fluctuations in blood-sugar levels.

Section 3: The Results – Project Beneficiaries (Group A)


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iv Lack of interpreting provision was found to affect both in-treatment and

discharge aspects of the process, as evidenced by one participant’s disclosure.

While in hospital for an operation, she was not given any explanation of the

procedure she was about to undertake, nor, after her operation, was she

given any aftercare information: this led to the patient experiencing

complications after her discharge.

v The above examples highlight participants’ experiences of some of the

dangers inherent both at point of accessing support and receiving treatment.

However, many highlighted fears concerning the transition from hospital or

centre-based health care to home and resumption of self-care, particularly

when an individual is required to continue with specific, prescribed self-

administered health-care routines or prescribed medicines.

The issue of difficulties in patient-to-professional communication during

transitions from hospital to home, was further highlighted by anecdotal

evidence of patients not realising the seriousness and consequences of their

diagnosis, to the extent of discharging themselves and later requiring re-

admission through Accident and Emergency.

3.2.3 Psychological/Emotional i Poor translation affects not just the individual but the whole family and at

times the whole Community. In one participant’s disclosure above, of

patients receiving no treatment or when the condition remains undiagnosed,

family members are often asked to translate, including children or young

adults in inappropriate situations, causing embarrassment and distress.

Participants discussed fears of the dangers inherent in such situations, of mis-

translation of medical terms – thereby placing further stress on the family

member called upon to translate.

ii Participants discussed fears that, during later stages in the health-care

process, the family may worry because they do not know or understand the

prognosis and the patient can become angry and anxious, with raised stress

levels adding to and further exacerbating the patient’s original condition,

causing distress amongst the family.

iii The patient mentioned at 3.2.2.iv was not given any explanations of the

treatment she was about to receive nor any post-op information and on

returning home experienced post-op complications. In the discussion group,

she spoke of how frightening she found this experience.

iv GPs have been known to send patients away because of language

difficulties: one participant disclosed an anecdote of patients having to go

“home” to their country of origin (in some cases, flying up to 6,000 miles) in

order to get consultation and appropriate treatment.

v Other participants spoke of their frustrations, fears and feelings of exclusion


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brought about by not being able to understand or be understood, saying that

this experience is not just limited to accessing the Health Service, but to every

other local authority service. Participants spoke of experiencing such

difficulties when they were given access to interpreting provision in the wrong

dialect, for example, being given Brazilian Portuguese instead of European

Portuguese translation.

vi Many participants made references to the handling of appointments

concerning gender specific problems which are very private for both men and

women, at which a family member is often expected to translate (due to lack

of or inadequate interpreting provision), bringing about embarrassment and

distress for both the patient and their family interpreter – all respondents felt

it entirely inappropriate that relatives are called upon to bear the brunt of

such awkward situations.

vii Several participants expressed lack of trust in the health system, because

they, as individuals, were not understood and in turn they do not understand

medical terminology used by health professionals in relation to their

conditions. It is not difficult to envisage the worry and depression that stems

from this and circulates within the family. It also causes conflict within the

family and an unfair dependency on the immediate community: this is

especially the case where the same few voluntary community interpreters are

very often called upon at all times of the day or night.

viii Participants spoke of how community interpreting relies upon the

goodwill of these few people and the actual translation at times has to travel

through three languages. It is not hard to appreciate how the margin for

error increases, with sometimes dire consequences.

ix One participant told of how a diabetic was very frightened because they

could not explain to the staff that they needed to self-medicate and had to

wait until a family member arrived: a situation that caused considerable fear

and frustration.

3.2.4 Financial

In the example quoted above of GPs sending patients “home” because of

language difficulties, leading to patients, in some cases, flying up to 6,000

miles in order to get consultation and appropriate treatment, this can incur

huge expense, being absent from work and in some cases leading to loss of

employment. Upon return to the UK, they find themselves in the position of

having to re-build their lives from scratch: this has obvious effects on

immediate family.


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3.2.5 Practical

i Appointments have been missed as there was nobody to translate, thereby

leading to further delays in consultation, diagnosis and appropriate treatment,

as well as a waste of resources.

ii One of the biggest problems is, “telling the doctor about your illness and

the medication you are taking”. Participants told of how, in some cases, the

patients come away from surgery and the pharmacy with little or no idea how

and when to take the medication. In certain circumstances, this might easily

be construed as clinical negligence.

iii GPs do not always have awareness of ethnic-specific conditions. For

example: the more holistic perspective held within European and Asian

cultures towards menstruation. Females from both communities in the focus

groups reported difficulties in getting their GPs to comprehend this

perspective. They also reported that it was both unfair and embarrassing to

ask their husbands/partners to help with the translation on such personal,

gender-specific matters.

iv Participants spoke of the assumptions made on behalf of children who

speak English/Welsh, that they would be able to take the place of appropriate

interpreting provision. However, in many cases, children may not have

sufficient knowledge of their parents’ mother tongue to translate or

understand both sides of the communication.

v There were three examples, given by participants, of service user needs

being misunderstood, resulting in the inappropriate interpreter being

provided: namely inappropriate choice of Chinese and Portuguese languages,

with no reference to the correct dialect spoken, when accessing both the

Criminal Justice and Health Care systems.

vi Participants disclosed that they did not know what services or help were

available to them.

vii Within the secondary care system, there were complaints (3.2.2.iv) that

the operating procedure was not explained nor aftercare addressed. In one

case, this led to complications and the patient had to be re-admitted via

Accident and Emergency.


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3.3.1 Difficulties faced by Service Providers

i Uppermost in the discussion were concerns related to feeling at a

disadvantage due to lack of knowledge in the languages being spoken by

ethnic minority groups. These concerns included: fear of things being lost in

translation between GP, patient, translator. Providers expressed a lack of

confidence in accessing the services due to this disadvantage, when using

interpreters, along with uncertainty as to which interpreters would provide the

most reliable and trustworthy service, community interpreters, or only

professional interpreting services.

ii There was a perception amongst Group B participants that providing the

right level of interpreting provision can be time consuming, and a habit of

over-professionalising everything adds to this.

iii Participants stated that, from a health-care point of view, if a GP does not

flag up the need for a translator when referring to hospital, the hospital will

not be able to prepare. This inevitably leads to a waste of resources, in terms

of both time and (public) money, with appointments needing to be

rearranged and therefore wasted. The opinion in the group was that nobody

benefits from this.

iv The participants expressed awareness of a knowledge gap with regards to

speech therapy in non-English/Welsh speakers, for example after a

stroke/brain trauma.

v Group B participants discussed the critical issues of language requirements

at job centres. This has previously been reported by NWREN in the report,

“It’s Just a Feeling” (2008). There is contemporary evidence of these issues

still commonly occurring. They are aware of difficulties faced by individuals

from ethnic minority communities, not given access to own dialect

interpreters when visiting the Job Centre when trying to explain why they are

unable to work. Group B participants referred to how the Job Centre service

“being an insensitive service already”, becomes at times the focus of a

traumatic experience for ethnic minority elders who, not being able to

articulate the reasons behind their obstacles to work find themselves trapped

in difficult circumstances compounded by lack of financial support. Group B

participants believe there to be a correlation between poverty and not

obtaining what is needed and fulfilling the rights of (ethnic minority elder)

individuals.

vi Group B participants spoke of facing hidden dynamics when considering

interpreting provision – not just those of language, culture and gender

sensitivity but differences of dialect, education, and social class: all factors

which relate to the experience of using interpreters.

3.3 Phase 2 - Service Provider discussion group (Group B)


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vii There was awareness, amongst Group B participants that frontline staff

members of their organisations are not aware of their organisations’

commitment to the provision of interpreting services and in cases where

frontline staff were aware, there is a lack of knowledge concerning their

professional and fair use.

3.3.2 Suggestions for Improvement

i More work needs to be done to ensure frontline staff in local authority

organisations are aware of the interpreting services available, along with

training in fair and professional conduct when working with interpreters.

Group B participants also felt that more needs to be done to build trust with

interpreting services.

ii Welsh Government must address ESOL provisions, which at present do not

meet the needs of the community and do not fulfill the requirements of the

Well-being of Future Generations (Wales) Bill. There is an opportunity whilst

trying to implement this Act also to facilitate community cohesion and

relations with community and public bodies.

iii “Language and understanding is at the heart of every social issue”: Group

B participants felt that, in order to enable and empower communities, it is

essential that these needs are addressed.

iv With the merging of local authorities and consequent expected cuts to

budgets, there must be protection of translation and language services. Local

authorities must communicate this with third sector organisations to make

sure minority voices do not go unheard.

v Similar levels of patient protection to those given to deaf and visually

impaired individuals, should also be applied to people who experience

language barriers. We should not wait for a High Court case to highlight the

dangers and risks that can occur because of these.

vi There was much evidence of passionate commitment among the Group B

participants to driving forward the issues discussed in their group. However,

they all expressed real fears that, with austerity times and resultant budget

cuts, the number of people remaining in post to progress this work, e.g.

equality and diversity officers/managers, is decreasing every year. It was

claimed that because of cuts, with resultant redundancies or retirements,

those roles are not being re-advertised, leading to fewer equality and diversity

roles remaining in place. With the resultant reliance on Third Sector time-

critical projects, like the MEEA Project, to progress work on these issues,

there were concerns that without sufficient sustainability built in to such

projects, any progress made will be lost and forward movement on the issues

discussed during this survey will dwindle.


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As outlined in the review of the existing literature, there has long been

evidence of a deficiency in the provision of adequate interpreting services for

BME individuals. Even a cursory literature review reveals persistence of such

deficiencies since at least 1994.

Conclusion 1

In the research results above, it is clear that there are indications of a

correlation between lack of access to interpreting provision and risk to health

and well-being. Service providers are aware, at a strategic level, of their duty

of care to provide interpreting services: “Language is not a choice, it is a

need. People do not choose their language or their circumstances”.

(Thomas, 2014)

It was pointed out, by participants from both Group A and B, that there are

many different languages spoken in North Wales and within those languages

there are specific dialects. These dialects are not homogenous. For example:

a translator who speaks Mandarin may not be appropriate for many of the

Chinese dialects, ie; the service user may not understand Mandarin. Similarly,

an interpreter who speaks Brazilian Portuguese would not be appropriate for

a service user speaking European Portuguese. Indeed, throughout Phase 2,

there were many reports of a “one size fits all” approach to interpreting

provision, in terms of dialect, culture and ethnicity of interpreter offered.

Recommendation 1

There is a need to recognise that North Wales, with regard to all populations’

demography, economic makeup and geographical location, is different from

that of South Wales. Distance alone prohibits North Wales from accessing

facilities, resources and benefits that are taken for granted in parts of South

Wales. Sometimes North Wales has to develop more localised solutions. For

instance, in order to facilitate smooth and clear communication at the MEEA

Project Conference, simultaneous translation was required: this involved

procuring the services of interpreters competent in simultaneous translation

of Cantonese and European Portuguese. Due to the complete absence of an

appropriate translation and interpretation service in North Wales, interpreters

had to travel from South Wales, which had obvious financial implications.

Conclusion 2

The experience amongst the Group A participants was that there is little

realisation, on the part of frontline service provision staff, in both Primary and

Secondary Care, that time, translation and outcome are conjoined. It would

appear that this lack of awareness is universally documented across all

statutory sectors in North Wales, with the Group B participants reporting

concerns that their commitment, at strategic level, to the provision of

interpreting services as a duty of care, is not carried out by frontline staff.

4. Conclusions and Recommendations


19

With their focus leaning towards the health-care sector, Group A participants

disclosed anecdotal examples of how this manifests at each of the three

critical points of progress through the healthcare system. For example, point

of entry – accessing support and assessment; receiving treatment or support;

lastly, the transition from hospital/health-centre based support to home-based

support or home-based maintenance of any new self-care routine.

Recommendation 2

The above conclusion points to a need for training within and across all levels

of the health-care system. There is a need to develop feasible, economically

practical and appropriate bespoke awareness-raising training solutions

focussing on all aspects across the range of Protected Characteristics as listed

under the Equality Act of 2010 (age; disability; gender reassignment;

marriage and civil partnership; pregnancy and maternity; race; religion and

belief; sex; sexual orientation). It would be worthwhile for all statutory and

voluntary sector organisations across North Wales to explore this possibility.

Conclusion 3

Group A participants reported that, in order to apply for a translation service,

the service user must be able to read and understand written English/Welsh:

participants disclosed that they did not know what services or help were

available to them. (It must be stated that this information is available on

BCUHB website – but only in English and Welsh.)

Recommendation 3

Group A participants asked for multi-language buttons on the BCUHB website,

that would enable service users to make an Application for Interpreting

Provision when they wish to access the health service. The cost of translating

such a small set of instructions into a multitude of languages is small and

would allow service users to progress their enquiry to the next level.

Conclusion 4

Section 2, introducing the participants (p.9), describes the levels of English

proficiency amongst Group A participants as varying greatly. This group

stated during the research, that even though they do speak English, when

they are unwell they naturally prefer to communicate in their first language.

Meanwhile, Group B participants expressed concerns that ESOL provisions do

not meet the needs of the community or the Well-being of Future Generations

(Wales) Bill: it is important to note that whilst this report emphasises a lack of

own dialect interpreting provision, a short-term need, there is also a need, in

the longer-term, for further investment, by the Welsh Government, in

increasing provision amongst BME communities of ESOL classes. This group

felt that such joint commitments would provide opportunities for facilitating

community cohesion.


20

Recommendation 4

There needs to be a better understanding with regard to the provision of

ESOL classes: in these difficult times, even though ESOL has parity with

Essential Skills training, safeguarding of funding for ESOL classes is essential.

In the case of elders who have joined their families in Wales, there is an

obvious cost implication, with the possible added cognitive disadvantage of

having to learn a new language as an elder. The recommendation is that

provision of ESOL should be reviewed at both regional and Welsh Assembly

Government level. In addition, lack of language skills/fluency is often cited as

a reason for the mentality of ghettoisation or lack of integration.

Conclusion 5

The shortage of interpreters was universally commented upon, which

surprised the agencies who were making their best efforts to meet this need.

In her opening speech, Sally Thomas from BCUHB outlined their current

interpreting provision.

“The Health Board provide interpretation services via a contract with

Wales Interpretation and Translation Service (WITS). The Health

Board have developed a protocol to guide staff using this service.

WITS was created in 2009 following Welsh Assembly Government

supported research. (2007/8) Historically there had been difficulties

in securing high quality and cost efficient linguistic services across

Wales.

The WITS service is designed to provide a "one-stop-shop" to

improve access to public services for people whose first language

may not be English or Welsh. BCUHB reported that staff awareness

of the policy requirement is raised regularly. BCUHB recognise that in

practice interpretation support is not always actioned in a timely

manner: they are working to address this.”

As suggested by BCUHB, their existing ongoing mandatory training is striving

to further strengthen the extent to which equality is understood and

integrated into work across the organisation. Increased engagement with

people with protected characteristics creates a better understanding and can

inform improvements.

Recommendation 5

The disparity between the findings and the activities of agencies (such as the

BCUHB and others) is important data. It illustrates a need for the

development of a generic protocol across agencies to encourage and

empower service users to request interpretation services. As in the case of


21

Health, the need was highlighted for increased awareness with General

Practitioners and frontline staff in primary care in ensuring that, together with

service users, the correct language and dialect is identified. (2014)

The North Wales Public Sector Equality Network (NWPSEN) work together to

deliver shared objectives. This forum could provide an excellent forum in

which to address some of these issues.

Conclusion 6

In carrying out this research, we attempted to take an innovative approach

that would challenge the concept of the “one-size fits all” philosophy by

bringing together service users and service providers to discuss difficult issues

that stand on opposite sides of the same coin. What transpired was a clear,

open and honest communication, wherein it was found that the service users’

difficulties reflected the service providers’ worries and concerns.

Recommendation 6

Using and building on this experience of open, honest and clear

communication, we would strongly recommend that the statutory and

voluntary agencies tackle issues of lack of interpretation services in a joined-

up and unified fashion. This would involve all sectors under one united

agenda, with clear agreement on how it will be funded, ensuring that the

issues are informed by the existing expertise within both the voluntary sector

and local communities, for example; establishing a bank of trained community

interpreters from across the region. All present at the conference agreed to

reconvene on 11th November 2015: further, earlier sessions are urgently

recommended prior to this date to continue dialogue and build on connections

made on 9th December 2014.

Closing Comments

Crystal (1999) defines dialect as: “A language variety in which the use of

grammar and vocabulary identifies the regional or social background of the

user.” Professor Crystal outlines the different ways in which dialect can

define the speaker: regional dialect “conveys information about the speaker’s

geographical origin; a social dialect conveys information about the speaker’s

class, social status, educational background, occupation or other such

notions.” There are also rural and urban dialects: the point being that

dialect is a broad term which, within itself, holds many possible permutations.

The author of this report considers that this demonstrates the importance,

when giving BME elders language support in North Wales, of providing

appropriate own dialect interpreting services: the overwhelming message

from Group A participants was that “a one-size fits all philosophy is wholly

inappropriate” and indeed has long been out of date.


22

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