Select Committee on Health Written Evidence

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 translation.

  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 of Access

  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 fluent English.

  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 Health Service.

  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 I.

  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 Frontline Staff

  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 Services

  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 services.

  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.

In summary

  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.

May 2003



  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:

Security measures

  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 process.


  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 possible.

Longer-term approach

  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.

Demand aggregation

  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.

Information provision

  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 do so.

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