Standard operating procedure: commissioning interpretation and translation services in primary and emergency healthcare

This standard operating procedure aims to support primary and emergency healthcare services in Wales when securing translation^{[footnote 1]} or interpreting^{[footnote 2]} services, or reviewing existing services. It is adapted from the NHS England guidance for commissioners: interpreting and translation services in primary care. This document specifically adapts the guidance and standards developed by NHS England, and places this in a Welsh context.

This standard operating procedure is mainly for GP surgeries and emergency care settings. However, it also applies to:

• community pharmacies, dentists and opticians
• hospital sites
• secondary care services including midwifery and mental health services

Interpreting and translation services provide a service for patients, carers and clinicians to help them understand each other when they do not use the same language. Communication barriers between healthcare providers and patients may affect diagnosis, decrease effectiveness of consultations, harm patient experience, affect health outcomes and increase instances of patients not attending appointments.

This standard operating procedure is aimed at providers of NHS care and treatment in Wales, including the bodies they commission to provide health services. This includes, but is not limited to, the following organisations: 

• independent contractors providing NHS services including primary medical services (GP practices), dental services, optometric services and pharmacy services
• NHS health boards and trusts
• providers of public health services, including advice and information

The scope of the standard operating procedure applies to:

• people who are D/deaf, deafened or hard of hearing, and British Sign Language (BSL) signers (it is important to also note the linguistic differences between the Deaf BSL signing community, and those who are deaf, deafened, or hard of hearing)
• people who are blind or partially sighted
• people who are deafblind
• people who have language and communication access barriers arising from disability (including dementia, learning difficulties and mental health conditions)
• people who have language and communication barriers arising from neurodivergence
• people who have language and communication barriers arising from low literacy
• parents and carers who experience language or communication barriers
• people whose preferred language is not English or Welsh (including people seeking sanctuary, refugees and migrants)

It applies to adults, young people and children, and ensures that the communication and information needs are routinely and consistently met.

The standard operating procedure highlights principles of best practice that should be considered when securing interpretation and translation services for NHS patients and carers in Wales.

The Equality Act 2010 (and the public sector equality duty) legally protects people from discrimination in the workplace and in wider society. Under the public sector equality duty, a public authority must^{[footnote 3]}, in the exercise of its functions, have due regard to the need to: 

• eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010
• advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it
• foster good relations between persons who share a relevant protected characteristic and persons who do not share it

The Equality Act 2010 replaced previous anti-discrimination laws with a single act, making the law easier to understand and strengthening protection in some situations. It sets out the different ways in which it is unlawful to treat someone. It provides protection for people discriminated against because they are perceived to have, or are associated with someone who has, a protected characteristic.

The Equality Act 2010 includes a legal duty on all public service providers, including independent contractors working in primary care settings as part of the NHS, to take steps or make “reasonable adjustments” to avoid putting a disabled person at a substantial disadvantage when compared to a person who is not disabled, which may include, for example, people who are D/deaf, blind or deafblind. The Equality Act 2010 is explicit in including the provision of information in “an accessible format” as a ‘reasonable step’ to be taken.

The all Wales standards for communication and information for people with sensory loss (the standards) sets out what people with sensory loss should expect when they access healthcare and applies to adults, young people and children and covers communication, workforce and training, healthcare standards and complaints.

The accessible information standard (AIS) is aimed at GP surgeries and hospitals and defines a specific and consistent approach to identifying, recording, flagging and sharing the information and communication needs of patients with sensory loss.

The UN convention on the rights of persons with disabilities provides an international standard for disabled people’s human rights. Effective and appropriate communication is fundamental to ensuring services are delivered in ways that promote dignity and respect.

In Wales, the Welsh Language (Wales) Measure 2011 makes Welsh an official language in Wales. This means it must be treated no less favourably than English. The Welsh Language Standards promote and facilitate the Welsh language. The Welsh language standards were introduced for social care and more recently for health. "More than just words" is the Welsh Government’s strategic framework for the Welsh language in health and social care. It aims to support Welsh speakers to receive services in their first language.

Whilst not being able to speak English or Welsh is not a ‘protected characteristic’ defined under the Equality Act 2010, a duty of quality has recently been introduced on NHS bodies (such as, local health boards, NHS trusts, and special health authorities) under the Health and Social Care (Quality and Engagement) (Wales) Act 2020. For the purposes of the duty to secure quality in health services, the term ‘quality’ includes, but is not limited to, quality in terms of the effectiveness and safety of health services, and the experience of individuals to whom health services are provided.

In addition, there are new standards that people in Wales can expect when accessing health services. These are comprised of 6 domains of quality:

• safe
• timely
• effective
• efficient
• equitable
• person centred

The standards are intended to apply to all clinical and non-clinical services and settings.

The importance of providing access to interpreters amongst asylum seekers and refugees is specifically highlighted in Welsh Government (2018) guidance for health boards on the health and wellbeing of asylum seekers and refugees.

The principles highlighted below were originally developed as part of a project led by NHS England’s primary care commissioning team. They have been reviewed by a working group established to consider the implementation of recommendations from the HEAR 2 study of access to interpretation services amongst asylum seekers, refugees, and those with English or Welsh not as first language.^[footnote4]

The HEAR 2 study included the following recommendation for Welsh Government: to develop commissioning guidance and standards for interpretation in health and care. These already exist in England and Scotland. This standard operating procedure for primary and emergency healthcare settings supports this recommendation.

The 8 principles outlined below can be used to help agree priorities and ambitions for improvements in local translation and interpreting services.

Principle 1: access to services

Patients should be able to access primary and emergency healthcare services in a way that ensures their language and communication requirements do not prevent them receiving the same quality of healthcare as others.

1. Interpretation and translation should be provided free at the point of delivery, be of a high quality, accessible and responsive to a patient’s linguistic needs.^{[footnote 5]} Patients should not be asked to pay for interpreting services or to provide their own interpreter.
2. Every patient or service user who requires communication support should have this need met by, for example, arranging a British Sign Language interpreter or lip speaker or providing a hearing loop induction system. It is important to have an awareness of other communication methods that may not be as well known, for example, speech to text or live captioning.
3. Appropriate communication support should also be provided to people with sensory loss who may be attending an appointment in the capacity of a carer or as the parent of a child.
4. It is also important to recognise any other language need that a patient with sensory loss may have, for example, the Welsh language or other minority languages. In every instance it is important to ask the individual patient to describe their needs. Patients already have the option to use online systems to book primary care appointments. Healthcare providers should look at how systems can be adapted to meet the needs of patients who require language support (providing BSL video explanations) and indicating the need for an interpreter to be booked by the health provider or NHS organisation.^{[footnote 6]} As good practice, online systems should also have multiple language choice so that the person can receive information in their preferred language (for example, using RECITE ME technology). At the same time, consideration should be given to those not able to access online appointment booking systems. Telephone interpreting may need to be provided by GP reception staff, for example, when a person calls to book an appointment.
5. When an interpreter is required, additional time will be needed for the consultation (typically double that of a regular appointment).^{[footnote 7]}
6. Language preferences and communication needs are to be recorded in the patient’s record and shared with other services when the patient is referred on (for example to secondary care services). A highly visible alert should be used to ensure staff are aware of the needs of the patient in time for them to book appropriate support, in line with the accessible information standard. This should record specific requirements such as those detailed in principle 4, to ensure the correct service is booked.
7. The right of all patients to access interpretation and translation services should be promoted on an ongoing basis.
8. When supporting children with interpreting service, every effort should be made to respect the rights of the child (any person under the age of 18 years and especially those under 16 years of age) and support them in ensuring interpreting services are provided to them under the principles of Gillick competency.
9. The rights of the child to receive healthcare services independently of parental control or decision making must be considered and respected and every effort should be made to empower the child to have an independent consultation if requested. Further guidance on Gillick competency can be found on the NSPCC website.
10. Where the patient has an identified carer (someone who provides or intends to provide unpaid care for an adult or disabled child, defined by the Social Services and Well-being (Wales) Act 2014) then the carer should be able to access language support to understand the discussion between the medical practitioner and patient, with the patient’s consent.

Principle 2: booking of interpreters

Staff working in primary care provider services should be aware of how to book interpreters across all languages, including BSL, and book them when required.

1. Where an interpreter is required, the primary care provider is responsible for ensuring one is booked and has received confirmation from the booking agency.
2. When making the request, there is a need to ensure all specific criteria is confirmed as per agreed with supplier such as:
   • date
   • time
   • duration
   • delivery method
   • language
   • dialect
   • interpreter gender
   • specific interpreter
   • any other requirements
3. Depending on subject matter, more than 1 interpreter may be needed. Advice can be given by the supplier of the interpreter services.
4. It is good practice for the primary care provider to confirm to the patient, in advance of the appointment, the name and gender of the interpreter (if known) that has been booked. Interpretation providers should be asked for these details to be shared in advance through contracts.
5. BSL users often have preferred interpreters, where possible preferences on the interpreter booked should be considered when the booking is made. This is particularly important for appointments of a sensitive nature. You may also need to book an intralingual (relay) interpreter to work with both the interpreter and the Deaf patient where they may have idiosyncratic, non-standard use of language or are language deprived.
6. Interpreters must be registered with an appropriate regulator (see qualifications and regulators) and should be competent and skilled in the interpretation of with medical and health-related terminology.
7. All staff within healthcare services should be offered training to raise awareness of the role of the necessity for interpreting services and how to book them, the positive impact on patients and clinicians of high-quality interpreting, and appropriate types of interpreting for specific situations.^{[footnote 8]} This is particularly relevant when needing consent for treatment. This training should include contact details of the organisation providing interpreting and translation services, how to book appointments and how to make complaints or provide feedback. This should include how to complain as a professional if services could not be delivered e.g. capturing failed attempts to secure an interpreter.
8. When arranging an interpreter, consideration should be given to delivery methods and the needs of the patient.

Telephone interpreter calls

• Telephone interpreter support has been widely used for some time offering support in over 240 languages 24/7. Often delivered through an on-demand arrangement to enable quick and fast support for uses in emergencies or urgent care, telephone interpreting remains a key channel for interpreter support.
• To access this support, individual access codes are required that are assigned to the organisation and personal to the department. Settings will need to ensure these access codes are available. To note: it can take up to a week to put an access code in place and so proactive work will be needed by different settings to make arrangements to obtain the code (either via WITS or through the health board) and to publicise this within the healthcare setting.
• Access codes will need to be confirmed prior to the patient’s appointment.
• Where a new access code is needed, liaise with your supplier (see initial checklist).
• All staff should be aware of the process of how to book a telephone interpreter and there should be a guide available of how to book an interpreter in the healthcare setting in a place accessible for agency or locum staff, for example near the telephone.

Video calls on demand

• Video Relay Service (VRS) where all parties (the patient, clinician and interpreter) are at different locations, connected via a video call.
• Video Remote Interpreting (VRI) is where the patient and clinician are at the same location and the interpreter is at a different location, connected via a video call.
• Video call interpreting, like telephone interpreting, offers support where the interpreter or all parties are at different locations. The added benefit is that all parties can see the interpreter, offering a personalised service.
• To access this support, individual access codes are required that are assigned to the organisation and personal to the department.
• Access codes will need to be confirmed prior to the patient’s appointment.
• Where a new access code is needed, liaise with the health board to engage in their supplier.
• Consider the duration of the call, subject matter and language. This can be used for BSL in emergencies, urgent or unexpected cases. Liaise with your supplier if further support is needed.

Video calls which are pre-arranged

• Where interpreter support is needed for a pre-arranged appointment, this can be arranged through your supplier.
• Where a face to face appointment isn’t feasible (for example, there's no local interpreter or rare language), a pre-arranged video call could be a suitable alternative and grants access to a wider range of interpreters based throughout the UK.
• Consider the duration of the call, subject matter and language. Liaise with your supplier if further support is needed. This can also be used for BSL in emergencies, urgent or unexpected cases.

Face to face interpretations 

• Face to face interpretation can be arranged through your supplier. It requires to be planned in advance so an interpreter can be secured.
• Consider the subject matter of the appointment when requesting a face to face interpreter service, for example, relevant considerations may include gender.
• BSL interpreter support is most often face to face due to it being a visual language and needing to clearly see lip and face movements.

Translation

• This is where a document or written text is translated from one language to another. Your supplier will be able to arrange this.
• Depending on the length of the document, consider the additional time for translation to be completed to achieve the target date.
• Depending on the document or project (such as a public consultation), consider also proof reading.

Principle 3: timeliness of access

Patients requiring an interpreter should not be disadvantaged in terms of the timeliness of their access.

1. Healthcare providers should use appropriate formats and languages to raise awareness that interpreters are available, including the use of nationally developed resources to promote access to services (developed by Welsh Government or WITS). Posters are available from WITS in multiple languages.
2. Patients should not be disadvantaged by waiting unnecessarily longer for appointments to access healthcare services because an interpreter is required, although it is recognised that access to interpreting is affected by availability of suitable interpreters. Where appropriate, consideration should be given to the use of on demand interpretation delivery methods (video or telephone) to reduce waiting times.
3. On registration with a healthcare service provider (or subsequently if their needs change), patients requiring language support should be made aware of the different types of interpreting available to them (face to face, telephone, video remote interpreting or video relay services).
4. Staff within healthcare settings should ensure that patients with specific language or communication needs are called to their appointment by staff in a way which eliminates the opportunity for appointments to be missed (for example, directly approaching a D/deaf patient in the waiting area when the appointment is called, instead of using a public address (PA) system).

Principle 4: personalised approach

In line with industry standards and the recommendations from the HEAR 2 study on access to interpretation and translation services, patients should expect a personalised approach to their language and communication requirements recognising that “one size does not fit all”.

1. Patients should be asked about their language requirements and communication needs at registration (or subsequently should their needs change) and this should be indicated clearly in their patient record. This should include:
   • Language requirements, language preferences and communication needs.
   • Preference regarding gender of interpreter (if they wish to express one). Where patients have requested specific support to meet their needs, this will need to be recorded by the organisation. As such, it may be sensitive personal data, and the organisation would need to handle it appropriately (see the information governance section).
2. Special circumstances may necessitate one form of interpretation over another (for example, specific circumstances may mean it is more appropriate for a patient to always have a face to face interpreter).
3. Good practice indicates that where a patient requires continuity of care, systems are in place to enable the healthcare professional to access the same interpreter where this is practicable. Where there are long-standing arrangements in place, these should be reviewed on an ongoing basis to assess risk and ensure professional boundaries remain.
4. Interpreters should complete their assignment and role to the satisfaction of the patient and the healthcare professional and to the standards set out by their professional body (see the WITS language service providers code of conduct).
5. Consideration should also be given to how the service can support patients so that ideally the whole episode of care is facilitated (for example, booking future appointments at the reception desk immediately after the appointment).^{[footnote 9]}
6. If booking further appointments with interpreter assistance after the original appointment, this needs to be factored into the assignment duration with the support of the health care provider as the patient and professional interpreter are not to be left alone. This is in line with professional guidance and the language service providers code of conduct.
7. Patients should always be offered a registered and appropriately qualified interpreter. Reliance on family, friends or unqualified interpreters is strongly discouraged and would not be considered good practice. For details of recommended qualifications please see qualifications and regulators at the bottom of this page.
8. If a patient expressly desires a family member or friend to act as their “interpreter” the patient should give informed consent in their own language, sought from them independently of the family member or friend. The consent must be noted in the patient’s record.
9. The use of anyone under the age of 16 for interpretation is not acceptable in any circumstance other than when immediate and necessary treatment is required. This must be an exceptional occurrence as safeguarding and competency are serious concerns (refer to Gillick competency guidance outlined in principle 1).
10. Healthcare professionals and primary care staff may use their language and communication skills to assist patients in making appointments or identifying communication requirements (language brokering) but should not, other than where immediate and necessary treatment is required, take on the role of an interpreter unless this is part of their defined job role and they are qualified to do so. Staff trained and used as interpreters must be covered by indemnity insurance (where clinical staff are bilingual they should use their professional judgement to decide whether they are able to competently communicate with the patient).
11. Wherever possible, requests from individuals for a preferred gender, for a particular professional and/or for the same professional to provide support to an individual during a course of treatment, should be met. This will support continuity of care and is likely to improve the experience of the patient, service user, carer or parent.
12. Such continuity is likely to be particularly important where an individual is undergoing particularly invasive, intensive or sensitive procedures and courses of treatment, including care relating to pregnancy, maternity or sexual health, radio and chemotherapy, end of life care and when accessing mental health services. Such preferences should be clearly recorded in an individual’s notes.^{[footnote 10]}

Principle 5: professionalism and safeguarding

High ethical standards, a duty of confidentiality and safeguarding responsibilities are mandatory in health care and this duty extends to interpreters.

1. Interpreters must be registered with an appropriate regulator, be suitably qualified and must have the skills and training to work in health care settings.
2. Interpreters must have undergone appropriate checks and clearances in line with disclosure and barring service guidelines.
3. Interpreters should be trained annually in safeguarding both children and adults. Any interaction requires the interpreters to be trained to an essential level. Interpreting agencies are responsible for ensuring that staff and contractors have access to this training and development free of charge. All safeguarding training should be evidenced on request and must be completed prior to any patient contact.
4. All interpreters should be made aware of the mental capacity legislation.
5. Interpreters must be aware of the safeguarding reporting procedures for children and adults. They must comply with the statutory duties to refer concerns to the relevant agencies as per the organisation’s procedures. Any safeguarding concern for an adult or child at risk should be progressed without delay and in accordance with the duty to report, Wales safeguarding procedures, and local procedures. Professional interpreting services can help to protect individuals from coercion, and those at risk of human trafficking, gender-based violence and other forms of abuse.
6. An information governance (IG) course or the current recommended training by Digital Health and Care Wales should be undertaken on an annual basis by the interpreter.
7. Interpreting agencies are responsible for ensuring that staff and contractors have access to this training and development free of charge.
8. To safeguard and maintain the confidentiality of personal data, the interpreting agency should find a way to meet all information governance requirements when providing interpreting staff information about assignments. A secure online access system may be preferable.
9. Health professionals are responsible for ensuring that any interaction is conducted in a secure environment and cannot be overheard or interrupted. Where the interpretation is being provided remotely, then it is the responsibility of the interpreter to ensure they cannot be overheard or interrupted.
10. Interpreters should introduce themselves to all parties at the start of their assignment and explain the purpose of the role.
11. The interpreter is present only to facilitate communication during the appointment. They should not be asked to undertake additional and ancillary duties during the appointment (those which may be delivered by a carer or advocate). There should not be physical contact or support with intimate or clinical procedures and any such procedures should not be performed in view of the interpreter. Interpreters are not to be left alone with the patient.
12. Interpreters are present to interpret for everyone in that appointment including the patient, parents or carers, any representative or chaperone and healthcare professionals. They are not there to interpret ‘for’ one party only.
13. Any conflict of interest or issues that may arise within the interaction must be declared to the lead healthcare worker supporting the patient. This may result in the interpreter recusing themselves, which is the correct procedure, in line with relevant codes of conduct.
14. Any actions identified by healthcare professionals that are deemed unsafe, of a safeguarding concern or a breach of confidentiality, should be reported to the interpreting agency and where relevant, the registering body.
15. Interpreters should be aware of complaints procedures and how to alert agencies to any concerns regarding clinical conduct and unsafe practices.
16. Where a safeguarding concern is raised about a registered interpreter, the interpreter should self-declare the concern. The healthcare organisation also has a duty to make a declaration to the registration body.

Principle 6: compliments, comments, concerns and complaints

Patients and clinicians should be able to express their views about the quality of the interpreting service they have received, in their first or preferred language and formats (such as, written, spoken or signed).

1. Easy to follow procedures which maintain confidentiality should be in place to enable positive and negative feedback about the interpreting service. The feedback procedure should be available in appropriate languages and formats including written, spoken and BSL signed video. All health boards and NHS trusts should share information about the feedback and complaints process in place.
2. Patients should be able to give feedback directly to the interpreting service, as well as to the health board. To do this, patients will need to know the interpreter’s full name, be made aware of who is the provider agency and details of the registering body. Any response to patients’ comments should be in their preferred language.
3. Settings should ensure a system is in place to enable patients and clinical staff to feed back about the interpreting service they have received. It must be independent of the individual interpreter and practice staff must be aware of how to access, and how to direct patients to this process ^[footnote11]
4. Interpreting agencies should collate and publish data on feedback and outcomes annually in a service satisfaction report. The service satisfaction report should be made available to health boards and trusts, primary care providers and patients on their website.
5. Monitoring of themes and trends should be undertaken by the health board to understand if an individual or agency poses a risk to patients and their families.

Principle 7: translation of documents

Documents which help professionals provide effective health care or that supports patients to manage their own heath should be available in appropriate formats when needed.

1. Documents which are usually available free to patients within practices or hospitals, including when a diagnosis is made or information on an operation required, which may help them to take more control of their health and wellbeing, should be available on request. In community languages or alternative formats, such as Braille, at no additional charge to the patient (healthcare providers may wish to engage directly with organisations that provide such literature). Organisations should have an identified process for obtaining information in alternative formats (including those which are not able to be produced in-house) if needed by a patient. Such processes should ensure minimum delay in receipt of accessible information by the patient. Good practice would be for organisations to have a limited number of the most commonly used patient-facing documents and information readily available (such as ‘in stock’) in the most commonly required alternative formats. Deaf patients should be signposted to the most appropriate BSL translations where they might be available, such as from Public Health Wales.
2. Documents translated for the benefit of patients must be translated by competent and appropriately trained and qualified translators and not by practice staff.
3. Patients should be informed that they are able to request a translation of their summary care record into their preferred language and format (including easy read, Braille and other accessible formats) at no cost to themselves over and above the standard cost of accessing their patient record.
4. Translation of documents can include reading information to the patient in the language required by them, known as sight translation. This also applies to translating the information to the patient in BSL.
5. Where patients register with a practice or other healthcare settings and are in possession of documents in languages other than English or Welsh which relate to their health, these should be translated as soon as possible where there is an identified clinical need. The documents should be included in the patient record in both languages where this is deemed necessary.
6. Where patients have an identified need for language or communication support, consideration should be given to the best way to contact them. For some people, a letter in English or Welsh will not be an effective way to communicate. Alternatives could include text messages or phone calls by the healthcare provider with an interpreter on the line, if needed.
7. Consideration for translated or transcribed letters should also be given to allowing patients to text or email, either in written language or attaching a BSL video. Healthcare staff should have processes in place for the regular checking of emails to ensure that they are responded to in an appropriate amount of time, akin to the response a patient would have on the telephone.

Automated online translating systems or services should be used with caution as there is no assurance of the quality of the translations.

Principle 8: quality assurance and continuous improvement

The interpreting service should be systematically monitored as part of contract management procedures and users should be engaged to support quality assurance and continuous improvement and to ensure it remains high quality and relevant to local needs. For example, the WITS advisory board carry out regular quality reviews, including a focus on complaints and key performance indicators.

1. Clear lines of accountability must be in place between those securing interpretation and translation services, the agency, the interpreter and healthcare professionals using the service. It must be clear who the commissioner is, who the providing agency is, who the clients or recipients of the service are, and a clear trail of which service has been provided and when. Any data shared will need to be done so in line with NHS information governance protocols (see information governance section).
2. Once commissioned, the service should be subject to regular performance monitoring against the service specification to ensure that it continues to meet patient needs (WITS send out monitoring reports on a monthly, quarterly and annual basis). This may include checks to ensure that interpreters are suitably qualified and registered, review of vetting and barring, review of safeguarding training, appointments are being kept, governance is effective, costs are being monitored and the level of compliments, comments, concerns and complaints recorded. Regular audits should be carried out to support service improvement. The ongoing monitoring of themes and trends should be undertaken to understand if an individual or agency poses a risk to patients and their families.
3. Data on service satisfaction should be fed into a continuous improvement plan (CIP) developed by the interpreting service agency. The CIP should be developed with, and made available to patients, commissioners and primary care providers, and should support quality assurance of the service and compliance with these principles.
4. Information governance, confidentiality and data protection are significant features of a high quality and effective service. All agencies will be expected to comply with the information governance requirements set out in the information and governance section at the bottom of the page.
5. Monitoring of information governance and governance issues must be undertaken monthly and action taken where concerns are raised.

Assessing needs and reviewing current service provision

Consider the specific language needs of the population (for both BSL and community languages) using locally available data (including data collected as part of ongoing reporting on the All-Wales Standards for Communication and Information for People with Sensory Loss of NHS Wales data set combining ONS Census data with Local Super Output Area (LSOA) data.

Consider the legal position and whether this is being met by current service provision.

Consider the financial position. The cost of any services commissioned or recommissioned would need to be met from within existing allocations.

Consider how communication difficulties and/or language preferences can prevent people accessing services and how this can be overcome (for example, "Sick of it" published by SignHealth and the HEAR 2 study).

Deciding priorities

Consideration should be given to the following when deciding priorities:

• demography may have changed since services were first commissioned
• health inequalities are the driver to considering priorities for groups of patients who require interpreting services
• consider the range of health services to be covered and ensure that any commissioning plans cover these and avoid disadvantaging specific patient groups
• consider the organisation’s current policy on translation of documents to support people with an impairment (for example, learning disability, blindness) or who speak or sign community languages (for example, translation of foreign medical documents)

Designing services

When designing services you should:

• consider cost effective and efficient ways to provide services (for example, telephone interpreting or app-based support, noting that these must meet commissioners’ governance, quality and procurement guidelines if purchased on behalf of the NHS)
• consider what support is in place or needs to be in place to support D/deaf or deafblind people, referring to the accessible information standard as necessary

Shaping structure of supply

When shaping the structure of supply you should:

• consider commissioning options
• commissioning through primary care and GP clusters, for example, may be preferable if it reduces transaction and administrative costs and represents best value

Managing performance

• Data monitoring should include measurements that support future service planning. You may find it useful to refer back to current contract monitoring records to prioritise data monitoring requirements.^{[footnote 12]}

Potential measures include:

• Number of appointments provided broken down by type, including:
  • language provided (broken down by community language and BSL)
  • type of interpreting provided (face to face, telephone, video)
  • where the service was provided (for example, GP surgery, pharmacy, which ward, outpatients clinic or theatre)
  • reason for interpreting (for example, to book appointment, to attend appointment)
  • patient demographic (for example, age, gender, language required)
• Missed appointments and reason (both by interpreter and patient or carer):
  • appointments attended by an interpreter despite being cancelled, when the agency or interpreter was not informed in time by the healthcare provider about the cancellation
• Feedback from patients broken down by type:
  • compliments
  • comments
  • concerns
  • complaints
• Themes and trends analysis to review issues and complaints.
• A formal quality assurance review.
• Encouraging ongoing feedback as part of service provision can lead to more timely feedback and enables providers and commissioners to respond quickly when issues arise. This could include the consideration of customer satisfaction feedback, and complaints.

1. The interpreting service agency and individual interpreters will be required to comply with information governance requirements. They must demonstrate they can process personal data and sensitive personal data in a secure, confidential manner, giving assurance to patients, clinicians and commissioners about the way they handle patient information.
2. All persons acting as interpreters must complete annual information governance (IG) training, compliant with NHS Wales information governance standards. In Wales, data protection legislation requires individuals who process personal information to undertake regular data protection training. NHS Wales refresher training in data protection is included in the information governance (IG) eLearning course, which is mandated for all staff to complete every two years as a minimum. This includes all employees of health boards and trusts and independent contractors such as GPs and pharmacies.
3. Interpreting service agencies must find a way to enable staff to find out details of assignments in a way which meets all information governance requirements. Where interpreters or translators need access to confidential information, such as the patient’s needs, there must be an appropriate way of accessing and managing these data. For example, this could be a secure online portal for interpreting staff to access their appointments and the information they need to support the patient effectively.
4. Parties handling personal data must comply with data protection legislation: the General Data Protection Regulation (GDPR) and Data Protection Act (DPA) 2018. The following principles must be applied to the management of patient information.

Be used lawfully, any sharing of personal data by the controller must have a contract in place which sets out clearly the legal basis for processing of personal data and the responsibilities each party has in relation to the data and its protection.

A data sharing contract forming part of the wider supplier contract would look to ensure the following areas are addressed:

• That personal data is used fairly in a way that the patient would reasonably expect and that they have been informed about prior to its use.
• That personal data is kept longer than necessary. A retention period should be applied within the contract.
• That personal data is used for the purpose intended, and specified by the controller, with the minimum necessary used to achieve that purpose.
• That personal data is accurate, subject to best endeavours of the contractor.
• That personal data is kept securely and disposed of securely when no longer required - copies of secure destruction should be provided to the controller.
• That personal data is not processed outside of the European Economic Area (EEA). Any proposed processing outside of the EEA should be reviewed with the controller and written permission given before any processing of personal data outside the EEA is undertaken.
• That personal data is processed in accordance with the patient’s rights. With data subjects informed about how to exercise their rights.

5. In order to comply with data protection legislation, patients must be provided with a fair processing notice. This means that they should be provided with information regarding the service and how any data sharing will be facilitated:

• who the data controller is for their data
• the contact details of the controller’s data protection officer (DPO)
• the purposes for processing the data including the legal basis
• with whom their data may be shared and why
• how to exercise their rights under the data protection legislation (such as right of access)
• outline how long the information will be retained
• how to contact the Information Commissioner’s Office (ICO), the UK’s independent body set up to uphold information rights, in the event of a complaint

Please note that the needs of patients using translation services will need to be considered and material that is accessible provided.

6. Contracted agencies will be required to report annually to their commissioner(s) in line with the current expectations set out in:

• their contract
• by standards set by Digital Health and Care Wales (DHCW)
• by the Information Commissioner’s Office

7. Identifiable data should only be shared with the commissioner when appropriate and there is a lawful basis to do so, which includes the patient being aware of that flow of data.

8. Where the interpretation service is acting as data processor, the contract will outline how they will support the data controller(s) in answering data subject rights requests (such as right of access) from patients. Where the contractor is a data controller in their own right, they are responsible for meeting these data protection obligations in their own right.

Interpreting is a specific skill which requires expertise and training. The qualifications below recognise this. At the present time there are limited numbers of suitably qualified interpreters for both BSL and spoken languages.

Qualifications and regulators for interpreters for Deaf people

Organisations must ensure that the communication and language professional holds relevant interpreting qualifications and, in the case of British Sign Language (BSL), has achieved BSL level 6 or equivalent BSL qualification and your level 6 or equivalent interpreting qualification, in line with NRCPD (The National Registers of Communication Professionals working with Deaf and Deafblind People) registration requirements. Those working in health and social care settings should have sufficient knowledge of medical terminology in order to communicate information effectively.

Registration with NRCPD confirms interpreters hold suitable qualifications, are subject to a code of conduct and complaints process, have appropriate insurance, hold an enhanced disclosure from the Disclosure and Barring Service and engage in continuing professional development.  

Qualifications and regulators for interpreters for spoken languages

Translators of documents from English to Welsh and from Welsh to English should be full members (individual or corporate) of the recognised professional body in Wales, Cymdeithas Cyfieithwyr Cymru. The membership must be through examination and must be relevant to the type of translation provided. Members are expected to adhere to the body’s professional code of practice. 

Interpreters from Welsh to English and from English to Welsh should be members (individual or corporate) of the recognised professional body in Wales, Cymdeithas Cyfieithwyr Cymru. The membership must be through examination and must be relevant to the type of translation provided. Members are expected to adhere to the body’s professional code of practice.

Spoken language interpreters should hold a Diploma in Public Service Interpreting (DPSI) health. There are also national private companies which can be used as an indication of the interpreter's qualifications or experience. However, please note, not all qualified or experienced interpreters and translators will be registered with these companies.

Where an interpreter does not hold a DPSI (Health) it may be acceptable to use an interpreter who either: 

• has, as a native speaker, competency in English and another language who also has a minimum of NVQ level 3 in interpreting
• has ILETS level 7.5 (English) and also has a minimum of NVQ level 3 in interpreting
• rare languages: not all languages will have a qualification, seek advice from supplier

These interpreters should also have accredited training in medical terminology in order to communicate information effectively, such as Cardiff University public service interpreting health course, Level 4, 30 credits.

It is advised that the supplier and the client evaluate risk when making decisions around the use of an interpreter. Through evaluation, evidence of any prior experience interpreting in English and the designated language, consideration of the language and subject matter is required. The designated interpreter should demonstrate completion of introductory interpreting courses and working towards the qualifications named above.

Translators

People used to translate written documents should hold at least 1 of the following qualifications:

• an honours degree in the relevant language or a degree in translation
• qualifications and credit framework level 7 qualification in translation such as the chartered institute of Linguists Educational Trust (IoLET) diploma in translation, or Level 6 certificate in translation
• a Masters level qualification in translation
• a recognised post-graduate qualification in translation

It is advised that the supplier and the client evaluate risk when making decisions around the use of a translator.

There are national private voluntary companies which can be used as an indication of the interpreters’ qualifications or experience. However, it should be noted that not all qualified or experienced interpreters or translators will be registered with these companies.

[1] Translation is where a written source document (for example, a letter) is re-produced in another language. This can involve translating a document from one spoken language to another, such as Spanish into English or Welsh or transcribing a document from English or Welsh into Braille, or translating from a written language into British Sign Language (BSL).

[2] Interpreting is where a conversation or discussion (for example, between a nurse and a patient) is reproduced in another language. This might be from Farsi to English or Welsh and vice versa, for example. Or, from BSL into English or Welsh, and vice versa. This may be done face to face or using remote methods such as telephone interpreting or video or visual relay interpreting.

[3] A ‘public authority’ for these purposes is specified in schedule 19 to the Equality Act 2010.

[4] The Health Experiences of Asylum Seekers and Refugees in Wales: how well are interpretation needs met? (HEAR 2) was a collaborative study with 2 aims to:

• investigate demand, experiences, and quality of interpretation services in primary and emergency care in Wales
• assess the feasibility of a comprehensive evaluation of interpretation services in these settings across the UK, including a description of currently commissioned interpretation services

[5] Communication support, such as sign language interpreters, is likely to be considered a ‘reasonable adjustment’ as required under the Equality Act 2010.

[6] In some areas of Wales, my health online allows you to book GP appointments and request repeat prescriptions online using your mobile, tablet or computer.

[7] The Enhanced Service Specification for Asylum Seekers and Refugees states:

Enhanced services are elements of essential or additional services delivered to a higher specification, or medical services outside the normal scope of primary medical services. An enhanced service would provide quality care to asylum seekers and refugees enabling them to benefit from the health and social care system. This can be achieved by primary health care teams devoting additional time and resource to such patients particularly (but not exclusively) on first attendance thus establishing a baseline of clinical history and health care needs. GPs can provide the necessary treatment for much existing disease to prevent deterioration. Routine appointments will be extended to allow for language difficulties and increased morbidity in this population.

[8] In Wales, WITS has developed a specific training module for working with interpreters and translators in the public sector. Its aim is to enhance proficiency when public sector officers and interpreters or translators work together. The training can be accessed via the WITS website. The training specifically covers:

• the role of interpreters and translators
• practical guidance on how to work effectively with linguistics
• a guide to the WITS booking process

[9] Interpreters do not provide advocacy. This is an entirely different role which is not covered within the remit of the principles set out in this document.

[10] Where organisations need to share data, they need to be aware of where ‘free text’ would not routinely be shared and ensure that any preferences are communicated appropriately, in accordance with information governance.

[11] The NRCPD has an online complaints procedure relating to the range of interpreters on their register. Similarly, there is a WITS complaints policy in place to support anyone who has a complaint about their service. Concerns about services received from a Welsh NHS body (such as a local health board, NHS trust or special health authority), GP, dentist, pharmacist or optician, or in relation to the provision of services by an independent provider under arrangements with a Welsh NHS body, can also be made through the Putting Things Right process.

[12] Ensure that data collected and shared complies with information governance guidance.