“Where shall we go?” Albanian and Arabic speaking communities’ views on speaking up about NHS services

During summer 2021, Healthwatch Oxfordshire supported two community researcher volunteers to reach out to Arabic and Kurdish speaking refugee women and to members of the Albanian community in Oxfordshire. This work was part of a regional engagement project by the Care Quality Commission in which they asked local Healthwatch to reflect the voice of two seldom heard communities in their area. In particular, the CQC wanted to understand more about people’s experiences of NHS health and social care, and about any barriers faced in raising concerns and having their voice heard. They spoke to ten Arabic speaking women, and seven members of the Albanian community.

Knowledge of the CQC and other routes to comment or raise concerns about care was non-existent or limited - people did not know where and how to raise concerns and that more information on how to do this was needed. Barriers to raising concerns included fear of repercussion, fear of causing harm to health professionals, reticence and sense of loyalty to the UK. People weren’t sure that their voice would be heard, or that speaking up would make a difference.

People would like more information about how and where to speak out, in their own language, and delivered in accessible and culturally acceptable ways. People said they would like organisations to reach out with information about the NHS, and pathways to engage, both via trusted health professionals e.g. GPs, and by meeting people in their own communities.

Experience of working with community researchers was positive. This approach can bring benefits when building trust and reaching seldom heard communities. However, this approach takes time and must be properly resourced and supported.

Access to and navigation of NHS services was varied. Some found the health and care system difficult and confusing to navigate. People needed information and support to access NHS services, particularly if new to the UK.

Language and computer literacy presented additional barriers for some. People spoke of being reliant on family and friends for booking appointments, registering and navigating health care. Expectations of, awareness and understanding of health and care, treatment and diagnosis was influenced by experiences of systems in people’s country of origin.  

Clear communication with and by health services and professionals was key in accessing and navigating support. Quality of communication influenced people’s experience of health and care. Language barriers presented significant challenges, and interpreter support was mixed and not always offered, sometimes leaving people reliant on family and friends to interpret. People’s experience of care was affected by the quality of communication with, and information received from, health professionals.

Feeling understood, listened to, respected and heard was important to people’s sense of safety and satisfaction. Cultural competence on the part of health professionals was seen as important in feeling heard and understood.

Experiences if NHS health and social care services were mixed. People valued the care and support they received from health professionals and the NHS. Most were satisfied with their care. Less positive experiences included accounts of not feeling listened to or heard, sometimes perceived as influencing diagnosis, care and treatment.

Expectations of health professionals were sometimes influenced by experience of treatment and care in country of origin. There was a lack of knowledge about social care, and some stigma expressed about accessing mental health services. Health and wellbeing was affected by wider determinants. This included housing, employment and immigration difficulties, and experiences of discrimination from those in authority in the wider support system.

The report includes four recommendations.