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GPs debate the merits of large NHS investment in translation services

23 February 2007

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In December, it was reported that the NHS was spending £55m each year on translation services. In this week’s BMJ, two doctors practising in inner London go head to head over whether language services in the NHS should be curbed (BMJ Volume 334 pp 398-9).

Kate Adams, a GP in Hackney, believes that doctors should encourage patients to learn English to avoid future public health problems.

“Many people who have lived in the UK for more than 20 years speak little English,” she writes. “These patients are vulnerable to depression and related psychological responses to alienation. Can we really say that this is in either their interests or the interests of the wider community?”

“In the UK, the legal right to translation services is unclear. Citizenship must balance rights against duties, and may include a right to a reasonable standard of health care that will, in certain circumstances, entail the use of a translator. But should there not also be a corresponding duty to learn the language of the adopted community which has granted the rights?” asks Dr Adams.

“However we decide to respond to this, health professionals need to encourage their patients to learn English, thereby helping them in the process of integration, otherwise we will be storing up public health problems for the future,” she warns.

“Translation services will always need to be available for elderly people whose English is poor, and for new arrivals, but at a time when the NHS is facing a huge financial crisis, is it in anyone’s interests to see the costs of translation services increasing?”

Dr Adams believes high-profile campaigns are needed to encourage people to learn English. If doctors can prescribe gym classes for depression, is it really so far-fetched to suggest we should also be prescribing English classes?

But David Jones, a GP in Tottenham, argues that more, not less, spending is needed on language services.

“It is clearly a disadvantage not to speak the majority language of the country in which you live,” he writes. “But it is inappropriate for doctors to encourage patients to acquire English language skills.

“The GMC’s 2006 publication, Good Medical Practice, clearly states: ‘To communicate effectively, you must: make sure, wherever practical, that arrangements are made to meet patients’ language and communication needs.’ But all too often no such arrangements are in place.

“This is not because such arrangements are impractical, but because provision for translation and interpreting in the NHS is patchy and often not adequate or not used,” writes Dr Jones.

“Current NHS interpreting services may also have negative health and social care consequences because they are so poor,” he adds. “For example, a new study from the United States has shown that adverse clinical events are more likely to result in physical harm in patients with limited English proficiency.

“All doctors working in the NHS, certainly in the inner cities, understand quite clearly that care for non-English speakers regularly falls short of the GMC’s expectation of good communication with patients. We must not let the politicians persuade us that it is the patients’ fault,” says Dr Jones.