Memorandum by Language Line Limited (MA2)
Language Line is the leading supplier of language
services to public sector organisations in the UK. We provide
a variety of language solutions that enable public sector bodies
to improve access to their services; these include telephone and
face-to-face interpretation as well as text-to-text and text-to-speech
Amongst those organisations which utilise Language
Line are: NHS Direct, the UK Immigration Service, the National
Asylum Support Service, the Department for Work and Pensions,
numerous local authorities, housing associations and police, fire
and ambulance services.
Language Line is also employed by various NHS
Trusts and Primary Care Trusts across the country to supply telephone
interpretation and document translation services. This means that
Language Line has previous experience of working with maternity
services providers, and has practical knowledge of the problems
encountered by non-English speakers in the Health Service.
Given the nature of our services, Language Line
works almost exclusively with people for whom English is not their
first language, especially those from minority ethnic groups,
refugees and asylum seekers. We have developed a detailed understanding
of the difficulties that face these people when trying to access
public services, especially as a consequence of language barriers.
Focus of Submission
The focus of Language Line's response to the
Committee's inquiry is the current and potential contribution
of professional and confidential language services to equality
in the delivery of maternity services. In particular, it responds
to the request for evidence on the provision of appropriate care
and advocacy services for those who do not speak English as their
first language, usually minority ethnic groups, refugees and asylum
seekers. These are also often people who live in relative poverty,
another group the Committee specifically requests evidence on
as part of the inquiry.
Role of Language Services in Facilitating Equality
Language services play a vital role in ensuring
equality of access to essential public services for minority ethnic
communities and others who do not speak English as a first language.
The inability to speak and understand English constitutes a very
significant barrier to access to care. The provision of language
services is especially important, therefore, when it comes to
health services, and particularly sensitive areas of healthcare
such as sexual health and maternity. Without language services
reliance on friends, family or healthcare staff to provide interpretation
or translation can result in embarrassment, misunderstanding and
breaches of confidentiality.
The use of professional interpretation can reassure
both the healthcare provider and the consumer as to the accuracy
of the information provided. Furthermore, by selecting an interpreter
with relevant experience of health services and an understanding
of medical vocabulary, health workers are more likely to be able
to extract a full and precise medical history and the interpreter
is better placed to explain complex medical terms and procedures
to the patient as directed by the healthcare professional.
Language services can be used alongside, and
often complement, the work of advocates. Professional interpreters
facilitate impartial, accurate and confidential communication
between non-English speakers, service providers and specialist
advisers appropriate to the situation (eg a lawyer). Whatever
the situation, using an impartial, vetted interpreter will guarantee
the confidentiality and accuracy of the exchange. The use of interpreters
is essential to ensure fairness and efficiency in service provision.
Furthermore, language service providers can
provide valuable input on cultural issues affecting the delivery
of services. Language Line has built up built up an important
body of knowledge about the cultural mores of different communities.
For example, some cultures would find it unacceptable for a male
doctor to treat a female patient. Knowledge such as this could
be collated and utilised to help NHS staff build on their current
knowledge and obtain a greater understanding of cultural issues
and tailor their services accordingly. Conversely, language service
providers can increase consumers' understanding of procedures,
processes and cultures in the UK. Language service providers can
prove invaluable in conveying to ethnic minority customers concepts
which do not necessarily exist in their cultures, for example,
national health numbers or the NHS itself.
Language services can, therefore, play a crucial
role in ensuring that no group in society is excluded from health
services or has limited access on the basis of language and culture.
Improving Availability of Language Services
Where NHS Trusts and Primary Care Trusts have
tried to address the issue of language need by entering into contracts
with language service providers, examples of good practice do
exist. These bodies have removed one of the major obstacles to
inequality of access to maternity services for minority ethnic
communities, refugees, asylum seekers and others who do not speak
In order to make this the rule rather than the
exception, Language Line would like to see a comprehensive, nation-wide
system for the supply of language services within the National
A coherent approach to the provision of language
services in the health sector would be beneficial to all parties
involved. It would give health service providers access to a familiar,
quick and easy method of dealing with people with language needs.
It would guarantee that non-English speakers would be able to
access all areas of the health service, including maternity services,
with minimum fuss. This would save the health service valuable
time and money.
The problem of inconsistency in the provision
of language services extends beyond the health sector and is a
problem that exists across all public services. Language Line
believes that Government wide examination of public procurement
processes for language services is necessary and there are a number
of key features that should be incorporated into a new centrally
co-ordinated procedure. These features are listed at Appendix
Whilst improvements are required across the
public sector, however, it is particularly important that organisations
involved in the provision of essential services such as healthcare
lead the way in ensuring best practice in language service procurement.
We would, therefore, urge the Committee to recommend that the
NHS develop a central approach to procurement of language services.
Improving Understanding of Language Services Amongst
As well as ensuring that staff working in maternity
services have access to language services, Language Line believes
that formal procedures should be established to ensure that staff
are aware of the existence, and understand how to utilise, the
language services available to them. Again, there exists considerable
inconsistency here, with some health bodies making full and proper
use of the facilities available to them whilst in others staff
are unfamiliar with language services.
It is not enough to simply enter into contracts
with language service providers. It is essential that all frontline
staff who come into contact with health service users should be
educated about when it is appropriate to utilise language services
and how to maximise the benefits to both the recipient and provider
of the service. By providing clear guidance and using language
service providers to train staff, standards in healthcare provision
and equality in access to maternity services by minority communities
could be significantly improved.
Language Line would urge the Committee to recommend
that, in addition to central NHS guidance on procurement, there
is a need for central guidance to frontline staff on how to maximise
the benefits of language services.
Potential for a Greater Contribution by Language
In addition to day-to-day interpretation and
translation services, Language Line believes that language service
providers can play an important role in providing the NHS, as
well as other public service providers, with valuable and detailed
information on the language needs of minority ethnic communities.
This information can, in turn, help the NHS to tailor and improve
service provision to these communities.
Language Line can collate and analyse demand
for language services, geographically, by sector, by language
and by call length and frequency. This can be extremely useful
in identifying demand for health services by specific groups in
specific areas. For example, we can identify which nationalities
are prolific within a geographic area and how inclined they are
to use different types of public service, including maternity
Similarly, Language Line's statistical information
can help to track the progress of certain minority ethnic groups,
particularly following an influx of asylum seekers. This enables
us to identify, for example, that where there has recently been
increased need for a particular language by the Immigration Service
and subsequently housing services, there will shortly be an increased
usage by that community of the NHS and later Job Centre Plus services.
In addition, information collated about use
of language services by all public sector organisations that utilise
our service can help to identify trends in the needs of minority
ethnic communities. For example, Language Line can identify the
existence of minority communities in a particular area by their
absence as users of a particular service. This knowledge can be
used to ensure that failures in service provision to a specific
group in society can be addressed.
Language Line hopes this submission gives an
accurate picture of the current, and potential, contribution of
language services to facilitating equality of access to maternity
(and other health) services for several of the groups identified
by the Committee in the remit of its inquiry. We are conscious,
however, that equality cannot be achieved until the same level
of access is facilitated nationwide. We, therefore, hope that
the Committee acknowledges the contribution of Language Line and
similar services and urges the NHS to standardise its provision
of this facility in order that no one in the UK is excluded from
health and maternity services on the basis of language need.
Language Line would welcome the opportunity
to submit oral evidence to the Maternity Services Sub-Committee
should the Committee feel this would be valuable.
A NEW PROCUREMENT PROCESS
Language Line's extensive experience of working
with both public sector organisations and individuals with language
needs has informed our view of how a new procurement process should
look. We believe the key features should include:
The current lack of guidance on procurement
means there are no measures to ensure security or confidentiality
in provision of language services. Language Line believes that
minimum requirements should be introduced to ensure the safety
and privacy of public sector workers and customers. This is particularly
important for police work. All staff contracted to provide language
services should undergo the Criminal Records Bureau screening
It is vital that interpreters remain completely
neutral at all times during interpretations. When speaking for
people from their own country of origin, the discipline of impartiality
is of paramount importance. Language Line would like to see all
interpreters adhering to a professional code of conduct such as
its own, which emphasises accuracy, confidentiality and impartiality.
Approved suppliers list
Currently, a public sector body may appoint
any organisation that offers language services, with no guarantee
of its capability or professionalism. The establishment of a list
of approved suppliers would be an effective means of implementing
much-needed quality control amongst providers of language services.
Language Line would like to see a central list of suppliers that
ensures public sector bodies can employ only services that guarantee
confidentiality, security and professionally qualified staff.
It is also vital that methods of managing language professionals
are scrutinised to ensure they are being deployed as efficiently
As an established provider of language services,
Language Line understands the considerable benefits to customer
organisations of an on-going relationship with a provider. Over
time our staff develop a considerable body of knowledge about
each organisation, the procedures and forms that they use and
the types of issue that arise frequently. This enables us to deal
swiftly and efficiently with all enquiries, saving customers valuable
time and money. A minimum contract period, incorporated in procurement
guidelines, would bring improved efficiency and value for money
to all public sector organisations.
The disparate and fluid nature of demand for
language services means that their use is most cost-effective
when demand can be aggregated. Language Line believes that a key
aim of centrally co-ordinated procurement guidelines should be
to facilitate the aggregation of demand. This may be demand amongst
many different public sector bodies within a geographical area
or demand within a decentralised structure such as the National
Health Service. Demand aggregation provides benefits in terms
of both economies of scale and consistent service standards.
There is currently very little information provided
to public sector organisations on the importance and role of language
services. In addition to the establishment of a centrally co-ordinated
procurement procedure Language Line believes there should be greater
provision of information to public service providers on the need
for language services, how to procure them and how to utilise
them to best effect. This is especially important in areas with
particular language needs, where, in Language Line's experience,
there are often workers within organisations keen to utilise such
services but uncertain about the procedure by which they should