Language interpreting and translation: migrant health guide

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Main messages

General Medical Council guidance states that all possible efforts must be made to ensure effective communication with patients. This includes arrangements to meet patients’ communication needs in languages other than English.

Language interpreting is the conversion of one spoken language into another. Language translation is the conversion of one written language into another.

Language is very important to providing optimal patient care. Working with language interpreters and translators can reduce communication barriers between practitioner and patient. It has been shown to improve safety with respect to diagnosis and prescription.

A person with good conversational fluency in English may not be able to understand, discuss or read health-related information proficiently in English. They may be reluctant to request or accept professional interpreting and translation services due to fear of costs, inconvenience, or concerns about confidentiality.

Where language is a problem in discussing health matters, NHS England and NHS Scotland guidance stipulate that a professional interpreter should always be offered, rather than using family or friends to interpret. Working with professional interpreters will:

  • ensure accuracy and impartiality of interpreting
  • minimise legal risk of misinterpretation of important clinical information (for example informed consent to undergo clinical treatments and procedures)
  • minimise safeguarding risk (for example for victims of human trafficking, where the trafficker may introduce themselves as family member or friend and speak on behalf of the patient)
  • allow family members and friends to attend appointments and support the patient (emotionally and with decision-making) without the added pressure of needing to interpret
  • foster trust with the patient

It is inappropriate to use children as interpreters.

An interpreter should be present in all situations where there are concerns about child safety or gender-based violence.

Not everyone can read or write in their preferred language or have the level of literacy required to understand health related written information. Check this before offering translated written materials. Visual content like images and diagrams may be more helpful when a person has low health literacy.

Automated online translating systems or services such as Google Translate should be avoided in healthcare settings as there is no assurance of the quality of the translations.

Record a patient’s language and interpreting needs in their healthcare record. Pass on this information when referring them to other health professionals.

What is language interpreting and translation?

Language interpreting is the conversion of one spoken language into another. Language translation is the conversion of one written language into another.

Interpreting and translation can also be used in the context of signed languages and tactile writing systems like Braille.

A person with good conversational fluency in English may not be able to understand, discuss or read health-related information proficiently in English. They may be reluctant to request or accept professional interpreting and translation services due to fear of costs, inconvenience, or concerns about confidentiality.

General Medical Council guidance states that all possible efforts must be made to ensure effective communication with patients. This includes arrangements to meet patients’ communication needs in languages other than English because language is very important to providing optimal patient care. Working with language interpreters and translators can reduce communication barriers between practitioner and patient. It has been shown to improve safety with respect to diagnosis and prescription.

If a patient requires interpreting and translation to access appointments and health-related information, they will also likely require interpreting and translation services for other communications with health services. This includes booking, cancelling and rescheduling appointments, and reading appointment letters. Migrant patients experiencing language barriers may not know how to initiate contact with a health service via an interpreter. They may be detrimentally impacted by health service policies that discharge patients from a service if they do not initiate contact with the service to arrange or cancel appointments.

Language interpreting general principles

Where language is a problem in discussing health matters, NHS England and NHS Scotland guidance stipulate that a professional interpreter should always be offered, rather than using family or friends to interpret.

Working with professional interpreters will:

  • ensure accuracy and impartiality of interpreting
  • minimise legal risk of misinterpretation of important clinical information (for example informed consent to undergo clinical treatments and procedures)
  • minimise safeguarding risk (for example for victims of human trafficking, where the trafficker may introduce themselves as family member or friend and speak on behalf of the patient)
  • allow family members and friends to attend appointments and support the patient (emotionally and with decision-making) without the added pressure of needing to interpret
  • foster trust with the patient

It is inappropriate to use children as interpreters. Children are not likely to have the language competency and health literacy in English or any other languages to discuss complicated health concerns. They may also experience vicarious trauma through listening to and relaying sensitive and distressing information concerning their family member’s health.

It is important to record in the patient’s health record and other associated patient administrative systems:

  • the patient’s preferred spoken language (including dialect)
  • the patient’s preferred written language (including their level of literacy or health literacy in their preferred language)
  • whether the patient requires an interpreter

Include this information when referring patients to other healthcare professionals. This helps other healthcare professionals to become aware of the patient’s language needs and preferences. It will also help health services to understand and respond to the patterns of language accessibility needs within their service.

Identifying a person’s preferred language

If a person cannot verbally tell you their preferred spoken language, use language chart tools to help identify their language:

Where relevant, check the person’s preferred language dialect or variety (for example Mandarin vs. Cantonese, and Farsi vs. Dari).

Offering language services

Migrants Organise has produced a good practice guide to interpreting, which has information for patients about using interpreting services, particularly:

  • to help patients and their families understand why they should communicate with health services through a formal interpreter
  • why interpreting is important
  • how to use an interpreting service correctly

It is available in English, Arabic, Bengali, Chinese and Somali.

Safeguarding and refusal of professional interpreting

Professional interpreting services can help to protect patients from coercion. It can also help healthcare professionals to identify patients with hidden adult or child protection issues, and those at risk of human trafficking, gender-based violence and other forms of abuse.

An interpreter should be present in all situations where there are concerns about child safety or gender-based violence. Face-to-face interpreting should be provided if there are suspected child protection issues. Staff should provide separate interpreters for the child and parent to allow the child’s voice to be heard independently.

The importance of professional interpreting should be explained to the patient. If the patient still insists on using a friend, family member or carer to interpret, this decision should be communicated by the patient in their preferred language and confirmed without the presence of their family member, friend or carer. The decision should be documented in the patient’s healthcare record and signed by the patient.

Requesting an interpreter

It is the responsibility of NHS service providers to ensure interpreting and translation services are made available to their patients free at the point of delivery. Healthcare professionals should check with their employer about their service’s interpreter booking processes.

Since interpreted communication requires the delivery of messages at least twice (once in the original language, and once in the converted language), plan for the interpreted session to take around double the length of time as a session without an interpreter.

Interpreting services can be provided face-to-face, over the phone or via other means like videoconference. NHS Scotland provides advice on determining whether face-to-face interpreting is necessary on a case-by-case basis during the COVID-19 pandemic.

Requesting the same interpreter to ensure continuity of care can be beneficial for appointments related to mental health, trauma, sensitive topics (for example gender-specific concerns), maternity appointments, end-of-life care, child health, other vulnerabilities (for example dementia, learning disabilities), and a series of therapeutic interventions.

NHS 111 (telephone 111) can provide a confidential interpreter covering a wide range of languages for those using the service.

Information about health and health services in Scotland is available on NHS Inform, and interpreting services can be provided on request.

Some non-clinical services also provide language support. For example, the Chinese National Healthy Living Centre also provides a multi-lingual health helpline.

Professional interpreters will have different levels of qualifications and experiences in their respective languages, and not all are trained to work in healthcare settings and competently use health-related terminology. You can check with the language service provider if you can request an interpreter in a specific language who has experience working in healthcare or a higher level of interpreting qualification. In some settings like primary care, interpreters must be registered with an appropriate regulatory body.

The online directories of interpreting and translation professional associations in the UK also provide information about language service providers, their experiences and qualifications:

Practical guidance about working with an interpreter

Before beginning an interpreted session, healthcare professionals should:

  • check the interpreter’s name, language and dialect, gender, and any other requirements against the booking request
  • allow time to brief the interpreter about the session ahead, including health topics and terminology to be discussed, and clinical procedures to be explained. Give the interpreter time to note down any terminology or concepts that are new to them
  • interpreters may require additional time to interpret in sessions that involve detailed linguistic assessment procedures (for example mental health assessments, mental state examinations, speech and language therapy assessments)

During the interpreted session, healthcare professionals should:

  • check there are no conflicts of interest between the interpreter and patient/family before starting the session (for example the patient may happen to know the interpreter in a personal capacity and may not wish to proceed with the session to avoid disclosing their personal health information)
  • speak directly to the patient and make eye contact with them
  • use short and clear sentences, 1-2 sentences at a time, allowing the interpreter to interpret before continuing. Encourage the patient to also speak in this way
  • if working with phone interpreters, provide them with verbal descriptions of the setting and any objects/images discussed
  • allow for pauses in the flow of conversation to clarify any miscommunications
  • Teach back can be a useful tool when discussing information via an interpreter, particularly if the patient has lower literacy levels

After the interpreted session, healthcare professionals should:

  • Allow time for a debrief with the interpreter to discuss any aspects of the session that were unclear or needed further clarification.
  • Record details about the interpreted session in the patient’s healthcare record. This should include the date and time of the interpreted session, a booking reference number where possible, and the interpreter’s full name, language and dialect, and gender. This helps healthcare professionals and patients to express their views about the interpreted session and provide feedback to the language service provider about a specific experience.

Give the interpreter an opportunity to decline proceeding with the session at any point before, during or after the session. Interpreters may experience vicarious trauma or distress when discussing certain health topics or aspects of the patient’s background (for example violence, torture).

For further advice on how to work with interpreters in healthcare settings, refer to guidelines such as:

Feedback about interpreted healthcare appointments

Commissioners should ensure clear processes are in place to allow patients, healthcare professionals and interpreters to provide feedback about their experiences and the quality of language services provided. All parties should be supported to provide and receive feedback in their preferred language and format. Further information about setting up feedback processes can be found in the NHS England Guidance for Commissioners: Interpreting and Translation Services in Primary Care and NHS Scotland Interpreting, Communication Support and Translation National Policy.

Clear documentation of the details of the interpreted session in the patient’s healthcare record can support the feedback process.

Written translations

Health related written documents (for example health information leaflets) in English which are usually made freely available to patients should be translated where needed into other languages at no cost to the patient.

Not everyone can read or write in their preferred language or have the level of literacy required to understand health related written information. A person’s preferred written language may also be different from their preferred spoken language. Check whether a person can read health related information in their preferred language before offering translated written materials.

If written information requires translation, always provide it in plain English to the translator. Audio-recorded spoken interpretation of information may be an alternative to providing translated written materials if the person has difficulties reading their preferred language. Visual content like images and diagrams may be more helpful when a person has low health literacy.

Not all spoken language interpreters are trained in written language translation, and vice versa. Always check this before asking an interpreter to provide on-the-spot ‘sight translations’ of information (that is reading written information out loud in the patient’s preferred language).

Inviting another translator to proof-read a translated document is a good way of ensuring high quality translation, particularly when producing translated materials that will be made accessible to the general public.

Automated online translating systems or services such as Google Translate should be avoided in healthcare settings as there is no assurance of the quality of the translations.

Sources of existing translated health-related information include:

  • NHS.UK, NHS Inform and NHS Heron provide a series of health information translated into other languages
  • Doctors of the World has produced translated health related information
  • EthnoMED is a U.S. website with a range of patient education materials in different languages

While using visual aids should not replace the need for professional interpreting and translation, various tools have been developed to facilitate communication with people whose first language is not English:

Documents provided to healthcare professionals in other languages by the patient or on behalf of the patient should be translated into English as soon as possible where there is an identified clinical need.

Further learning and best practice

The e-GP online e-learning resource for NHS GPs and doctors undertaking specialty training for UK general practice includes training on ‘language barriers’.

NHS England’s Improving the Quality of Interpreting in Primary Care project co-produced a set of principles with patients and clinicians to help reduce health inequalities in primary care settings. This includes the Guidance for Commissioners: Interpreting and Translation Services in Primary Care.

NHS Scotland published an Interpreting, Communication Support and Translation National Policy in October 2020.

The Royal College of General Practitioners (RGCP) provides a guide to working with an interpreter.

The University of New South Wales Effective Cultural Communication in Oncology (ECCO) provide short video examples of best practice, using examples of consultation with an Arabic-speaking female patient and a Chinese Mandarin-speaking male patient.

Public Health England West Midlands conducted a rapid evidence review of interpreting interventions in public health, alongside a stakeholder consultation to inform a language and communication service needs assessment.



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