Non-English speaking Croydon residents' experience of accessing services

Healthwatch Croydon report on the local findings from research funded by Healthwatch England on the interpretation needs of people who didn’t speak English.  They interviewed 15 people.

French African patients said they:

• Did not understand the doctor, even with the interpreter.
• Felt embarrassed asking their children to interpret.
• Had difficulty with technology especially navigating through Zoom during the interview, little technical knowledge and had no idea of how to use their device other than for phone calls.
• Found issues with privacy and trust were an issue. Patients doesn’t want family to know their medical issues.
• Had complications due to time lost. They usually get the doctor to write in English and take it to a suitable person to explain. Due to time lapse in getting back the information, complications have been caused.

Latin Spanish patients  said they:

• Had difficulties following up a medical and they feel impotent, as they cannot communicate properly.
• Found challenges with the interpreter as he does not tell patient every detail of what the doctor says. The interpreter just summarises. This affects trust.
• Tried to access a GP but due to language barrier patients’ condition got worse and had to go to A&E, an infection led to hospitalisation. They were going to complain but it is too complex with the language barrier. There is a delay in getting care as a result.

Tamil patients  said they:

• Found barriers particularly with visiting GP surgeries. The language barrier meant they need longer appointments, but this does not always happen. Multiple requests to get information about medication and vaccines.
• Experienced support staff such as receptionists seem to ignore or dismiss easily, mainly due to the language barrier. No interpretation service for reception or booking which causes a barrier and access to care.
• Could not register son at a GP because of language barriers and had to find a private Doctor to assist.
• Were scared to take the vaccine but because of the language barrier she was not reassured.
• Had interpreter could not interpret accurately. For example, ‘numb’ was translated into ‘pain’.
• Lack of availability of Tamil printed materials. They may well be published but they are not getting to the community who needs it.

Ukrainian patients said they:

• Had a lack of accessible information, so neither of them knew they could get an interpreter.
• Experienced misunderstandings between patient and doctor.
• Rely on relatives from Ukraine to send them medication due to language barrier.
• Cannot express themselves and so keeps their mental health issues inside.
• Rely on themselves, due to a lack of support. Where they have had, it they are not confident of being fully supported.

Interpreters said:

• Hospitals make a lot of effort and are welcoming and allow more time.
• Pandemic has worsened the whole situation. Unable to read a patient’s body language as it is not a face-to-face appointment. Difficult to hear and technological glitches.
• Quality of care is improved with interpreter; reduces anxiety, feel cared for. patients sometimes cry with relief at her presence and understanding.
• Not all health interpreters they have met have the health knowledge, which mean there is a variance in standard for the patient.
• NHS in house interpreters would be ideal.

Hospital booking staff said:

• Hospital services are better set up and interpreters can be booked easily usually though Language Line or similar.
• There are many processes that need to happen to make it work, which sometimes involved multiple entries.
• GP referral letter may sometimes have incorrect information. Having more accurate information would make a difference. E-referrals have been successful as they can log language needs.
• Google Translate has been used informally, and as last resort finding a member of staff who is bilingual.
• Putting language in the Accessible Information Standard would help ensure patients are treated as well as anyone else.

Hospital Nurses and Practice Educators said:

• That Croydon University Hospital is a multi-cultural workplace and there is senior support for this service.
• Very good support from IT support in recording and flagging.
• Good to share best practice across departments and learning with care agencies and others on how to access language support
• Prefer to use professionals over families and friends, although family like to interpret Concerns on relying on Google translate.
• 111 and GPs flagging language barrier would help.

GP receptionists and GP at Croydon surgery said

• Google translate is used for booking, unless staff happens to speak relevant second language.
• Easy to book interpreters and we can flag patient notes.
• Professional interpreter can make patients uneasy, but they are happy with the services
• Double appointments are usually booked but interpreter not turning up, being late, or patient not turning up. Fall back on Google Translate or family/friend.
• If Accessibility Information Standard improves access to healthcare, then language should be included in the standard.

The report contains five recommendations.