I confess, I’ve done it. I did it more than once and I wouldn’t have had it any other way at the time. In the same circumstances I would do it again.
To what am I confessing? Interpreting for my deaf family in medical situations, of course.
Some people say that the reason why sign language interpreter provision in the NHS for deaf people is so overlooked is because caring family members are so keen to do the job – I can see why that could be true.
I have never interpreted at a routine GP appointment – only at emergencies. I wont go into detail here but I have stood and relayed doctors questions and the answers in life or death situations. I use the term ‘life or death’ with strictest accuracy.
And the reason why? Because there was no choice. Either I did it or the doctor would begin to s p e a k v e r y s l o w l y and run the risk of adding a dangerous communication problem into an already heightened or critical situation while I watched on.
I would challenge anyone who says that they would do different. That they would insist on waiting, possibly hours, for an interpreter to arrive if they could easily step in. Especially when a loved ones health is on the line.
It’s an odd position to be in, stood at the end of a hospital bed, interpreting to a deaf family member in a critical situation. Its unnatural.
Having the benefit of knowing what standards are expected of interpreters, those of impartiality and professionalism, I do my best to demonstrate those attributes but I know that I’m no professional.
Any emotions I feel must be kept in check, even though panic and worry are coursing through my veins.
I also know that above all, if my family member had the choice, it would never have been me in the role of interpreter. I would have been protected from that burden. Their moral code had been violated by the process but neither of us had any choice.
Recently, I was called upon to interpret for a signer during a visit from their GP. I happened to be there by chance and she agreed that I interpret, for that was preferable to having no signer at all, but still far from ideal. What would have happened if I wasn’t there, I wondered?
What also troubled me was that the GP had knowledge that this person was deaf and needed an interpreter but no interpreter was present or even requested. Why?
In any case, given the urgent nature of the call-out, it would have been almost impossible to find one anyway. Once again, I did the job, but it really doesn’t have to be this way.
The NHS budget of billions can have an answer to this problem. Video interpreting services and remote speech to text systems mean that there is simply no reason why deaf people and medical professionals cannot communicate in emergency medical situations, without the need for family to be there. Is setting up a system like this for the NHS really beyond the wit of our health chiefs?
And what of deaf people who have neither an interpreter nor family members available to aid communication? It’s guesswork on the part of the medical professionals and that puts lives at risk.
There are providers on the market who can do the job. Tablet computers can connect to an interpreter or STTR reporter and establish clear communication between deaf patients and medical professionals, probably in HD, probably instantly. Ambulance crews and GP’s should keep iPads in their vehicles charged and ready to go. If the patient is deaf, switch on the ipad and tap the app. It can be as simple as that.
The sooner this happens the better. The dignity of all deaf patients, no matter what communication style they use, can and should be respected in emergency medical situations. Not only that, but if any question a doctor asks a patient is worth asking, its also worth having the right answer. Especially in an emergency.
By Andy Palmer, Deputy Editor.
Andy is Chairman of the Peterborough and District Deaf Children’s Society and teaches sign language in primary schools. Contact him on twitter @LC_AndyP
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Andy, not him, me
July 22, 2014
This is all very well but why the constant emphasis on sign? There are thousands of deaf people out there who do not rely on sign and yet are seriously disadvantaged by the doctor and hospital system.
Although I learnt to sign at the usual early age I happen to live in a region where there are almost no signing deaf people at all. Therefore it’s a waste of time me trying to sign to people who obviously won’t understand a word. This doesn’t mean I can’t, just that the means to do so are non existent unless I talk to myself in a mirror.
This causes me severe problems with the medical profession, most of whom don’t even understand that because I can walk and talk without having to use my hands. They have no idea of the meaning of lipreading, they have no deaf awareness whatsoever. At my last doctor’s surgery they did away with a visual indicator system for the next patient to go in. It was replaced with a voice system using a tannoy system and when I pointed out to them that this completely disempowered deaf people they arranged for the doctor to come and collect me from the waiting room. Like I needed to be singled out for special attention!
On top of this the doctor allocated to me had quite a bad stammer. This could be the script for one of Charlie’s brilliant comedies. The doctor with a speech impediment “talks” to the person with no usable hearing. It happened many times until finally I lost patience with their stupidity and changed to a more forward looking doctor’s surgery. This one has a computer controlled queuing system and a video screen that announces the next patient. That’s a bit more like it!
3 years ago when I went for my cochlear implant operation at Bristol I had to rely on my daughter to act as go-between for me with the medical staff at the hospital. As a result of many phone calls I had a smooth passage through the system. >All arranged by my hearing daughter on my behalfallall< forms of deafness there are potentially millions of people who might sign petitions, write emails and generally make a fuss. Something will happen.
That will make a nice change, won't it?
Andy, not him, me
July 22, 2014
In case you are wondering what that mangled last paragraph means… I must remember not to use angle brackets on here because the system deletes whole paragraphs!
What I said was that if we stop emphasising the help needed by signing deaf people and instead emphasised the help needed by *all* deaf people then all forms of deafness will be included.
This means that there will be many more people with a direct interest in supporting the campaign. I don’t think there are enough signing deaf people to have an impact but if everyone joins in that would be a different matter.
Natalya
July 22, 2014
Andy (not him me) didn’t you see that Andy Palmer asked for STTR as part of this. His experience is clearly with sign language, but I think recognising STTR is exactly inclusive of those of us who don’t sign so well.
Andy Palmer: Thanks for this, couldn’t agree more. I am generally OK at my GPs if I choose who I see carefully because it is quiet and 1:1 but I really struggle in hospitals which are much more panicked and rushed. I also realise I can look like I am understanding and have hideously missed the point or completely misunderstood what was said cos my brain just took a total guess. STTR would really help that as it’d make sure I actually knew what questions were asked and therefore be able to give a suitable answer.
If the NHS invested in this at a wider level it would be used enough to be cost effective and avoid a lot of the issues raised by various reports showing deaf people’s poor health and experiences.
Andy, not him, me
July 22, 2014
I did see STTR mentioned but it isn’t a flexible solution as would be the case with a sign terp or lipspeaker. You couldn’t for example take a STTR into the operating theatre or emergency bay.
It also needs people to be able to read the text and this might not be possible if their specs are not to hand or if their eyes are blurry due to medicines. We have to provide for the extreme cases as well as the everyday ones.
There is also the possibility of doing the same job using a remote service, for example to a screen in Reception. Either interpreting or STTR could be supplied in this way.
We should also be asking for loops at all Reception areas. If there is a TV in the waiting room for the public then we should be asking for subtitles to be provided at all times.
For full equality of access we need more than just an interpreter and a STTR operator. We should be asking for the full equality access package, lock stock and barrel.
Maria Ebbeskog
July 22, 2014
I have read a text in a Swedish newspaper on the net about a deaf foreigner who died because the doctors couldn’t fix a Signlanguage Interpreter in his language 🙁
mjfahey
July 22, 2014
Is it not possible to have some type of visual provided as the norm..new technology can provide video calls and text calls…surely this is the way forward…The swedish story would not have happened if the doctors had access to an international interpreting service via phone or www.
Tali
July 22, 2014
I use STTR for work meetings funded by AtW. Its quite fantastic. I did an experiment once at a work meeting where I used BBM Voice on my Blackberry10 smartphone over wifi for the STTR operator to listen through and I simultaneously read the captions on the browser for almost an hour. It worked flawlessly and was so portable and flexible.
It gives me hope for the future. I envisage a future where I can simply BBM Voice call my stenographer/STTR from my Blackberry10 smartphone when the doctor calls me and I can use it to read what the doctor is saying.
At the end of the day, it boils down to money. Who will fund for this?
Chris
July 23, 2014
Ok, I can’t ignore this. I work for the NHS in primary care IT [gps etc to “normal, non-nhs folk”. Although I dont have hearing problems I have spent a lifetime getting batteries for hearing aids for my brother and then my wife, hence my interest and being on this site. I don’t sign nor does my wife. It always shocks me that clinicians don’t understand lipreading – I could tell a few tales but I wont……..
Anyway, a few questions.
has anyone used speech to text? Is it any good? Would that be appropriate? Could, for example, someone use an iphone app that could convert the gps speech to text?
Technology has moved on at a massive pace and the standard nhs answer is to fling our arms in the air and cry out “the cost would be horrendous”. However an iphone/android app would be simple and cheap. Patients & clinicians will, in a short space of time, all have them. Those that don’t – well they could be provided in the clinic etc.
We all have more computing power in our pockets than was on a desktop pc a short while ago, time to make some use of it other than posting on facetube “just bought a tin of beans, lol”
Thoughts, ideas all welcome. I cant promise anything, but tablets and apps are en vogue at the moment.
Clare Redstone
July 23, 2014
I’m a GP.
I completely agree that BSL interpreting, STTR and lipspeakers should be available.
At the moment, the practical issues are availability, awareness and funding.
(Pour yourself a cup of tea and make sure you’re sitting comfortably as this is going to be a long post. Sorry.)
Availability:
there aren’t enough interpreters and other Communication Support Workers to go round.
– booked appointments. GP receptionists will try to arrange an interpreter if they know someone would like this. There might be a wait of a couple of weeks until there’s an interpreter free. And if someone wants to see a particular GP (as a patient and as a GP, I prefer continuity of care) it’s even more difficult finding an appointment slot when both the CSW and GP are available.
– emergency and out of hours. If there aren’t enough CSWs to cover normal hours and planned appointments, it’s even more difficult to find someone in an emergency or out of hours.
We need funding and courses to train more CSWs to increase availability.
A stop-gap is online interpreting. There are several organisations that provide this, for example InterpreterNow that SignHealth set up. SignHealth themselves say that online interpreting isn’t as good as face to face. But it is very good and I’d be more than happy to use it if face to face CSW isn’t available. There is online STTR available as well but I don’t know details about what is available in emergency or out of hours.
By the way, answering one of Andy, not him, me’s points, you CAN take STTR into the operating theatre and emergency bays, using laptops. For example here’s an article about a medical student in the US using STTR in the operating theatre. InterpreterNow can be used on a laptop as well.
Awareness:
my guess is that while most NHS staff probably have a vague awareness that there are such people as BSL interpreters, most of us don’t know how to arrange them. And most probably have never heard of STTR or lipspeakers nor of online interpreting and STTR. Sign Health produced the Sick of It report and there may have been a little flutter of information going round. But I think one of the best ways of improving services, both in our local areas and nationally, is for us to tell our local NHS staff what’s available.
For example, show them information about InterpreterNow. Explain the only equipment they need is a PC or Mac with a webcam and internet access (laptop does fine) or even iOS or Android device. They’ll need to register with the service. And then they’re good to go. Many GP surgeries use clinical software called EMIS. This should have a button to click to take them straight to InterpreterNow so it’s even easier. (The button “fell off” an update but I’ve let SignHealth know so hope it appears again soon if it hasn’t already.) The software even has a phrasebook in BSL and various spoken languages that can be used if there’s no access to an online interpreter. (I hope you’ll excuse me going on about InterpreterNow. There are other similar services. This just happens to be the one I know most about.)
We can contact our local interpreter and other CSW services and find out how to book them and costs and pass the information on to our GPs.
Funding:
the issues are different for hospitals and for GPs. Hospitals have big budgets. Clinical staff and managers aren’t self-employed. It seems reasonable to me that they could include CSW costs in their budget.
GP surgeries are smaller and the funding is completely different. Now I’m sorry, but I’m going to go on about this a bit because there’s a mass of wrong information around. Despite what the Daily Mail might claim, GPs do not earn Fat Cat salaries. In fact, pay has been falling so much there are now some surgeries where the GP partners have not been paid anything at all for months. And a lot, especially those providing really good medical care in very deprived areas, who are about to become bankrupt unless government changes its mind about funding.
And what isn’t generally known – paying for interpreters and other CSWs doesn’t come from some central NHS “pot.” It varies round the country. And it changed with last year’s NHS reorganisation. I know GPs who have been assured funding would come from a central “pot,” NHS England, only to be told later that it won’t. In Scotland, there’s central funding for InterpreterNow. In England there are some small areas where the Clinical Commissioning Group funds CSWs out of the local area’s funds. In other areas (probably most) GP partners pay for it out of their own pockets. (I’ve explained this below.*) CSWs do not come cheap but nonetheless, many GPs do agree to fund the service. While online interpreting isn’t as good as face to face, it is cheaper. So I can understand why GPs may feel this is all they can provide, even in normal hours for booked appointment.
When the Sick of It report was debated in the House of Lords, I contacted several Lords before the debate. Lord Ponsonby of Shulbrede drew the government’s attention to the confusion about funding. Lord Hunt of King’s Heath took this further and asked about central funding. He also had some other interesting suggestions. Worth reading the debate and SignHealth has some BSL summaries. Unfortunately the government’s reply was “no central funding” so it remains a patchwork.
What can we do?
Raise awareness.
Our health professionals can’t provide services unless they know about them. So let’s:
– show our GPs how easy services such as InterpreterNow are to use. And that the online version isn’t so expensive.
– find out about local face to face interpreter services. And about lipspeakers and STTR. Give our GPs details about how to arrange them. Try to find out about the costs. Mention these things to your GP or nurse and how about asking to meet the practice manager to tell them about it?
Funding.
I don’t think we should take no for an answer. I’d like us to campaign for a protected central “pot” of funding for interpreting and other communication support services.
– ask your MP (write, email, go to an MP surgery)
– how about campaigning together? Something some of the d/Deaf organisations could take a lead on? Websites such as here?
Other suggestions?
(And thanks for reading this far!)
Clare
PS. Hope the links work.
* Info about GP funding.
GP partners are given a certain budget. From that they have to pay all staff salaries and all other expenses such as rent and maintenance of the building, cleaners, toilet rolls, medical equipment and so on. The GP partners are paid what is left. So when they want their patients to have access to a nurse who will help patients with their diabetes or asthma, high blood pressure, losing weight and vaccinate our children, the GP pays that nurse’s salary and the training that helps her keep up to date. And salaries for enough receptionists, health care assistants and all other staff. It’s reasonable that staff have a pay rise each year and GPs honour this, though it means a cut in their own pay.
As for working hours, when they’re not seeing patients face to face in surgery, they’re flat out doing a whole load of other things that are part of our health care. It’s usual to have an early start, work through lunch and work late into the evening and on days “off” such as weekends.
Sorry about the digression, but GPs really are under seige at the moment and if people don’t make an outcry and get some changes, the service will be taken over by big private companies who will need to provide a minimal service for maximum cost so they make the profit they want. See Your GP cares and Put Patients First.
So let’s be kind to our GPs when we’re telling them about the CSW services and asking to provide them! Thanks.
Cathy Alexandeŕ
July 23, 2014
This topic is “pretty hot” given all the problems it entails. It is very sad that we are in this position, and I do feel that “the horse has already bolted”.
For instance I think we should have empowered the deaf community yonks ago by raising literacy levels. This means that when you meet your Dr and he or she is impossible to follow they can type out on their computer and you can read it. Those wìthout legible speech could tap out their anwser too. This is a method I employ when I can’t lipread a Dr and it cost absolutely nothing! This method gives deaf people: independence, empowerment and privacy.
It is sad that raising literacy levels in deaf people has never hit the radar and this is one reason why we have so many problems now. When this simple effective method would solve a lot of ills.
Of course, the BSL lobby will never empower deaf people in this way, instead theg have us battling through the mire for the provision of BSL and the rights to interpreters.
I personally never ask for a terp to be booked at the Dr’s because I know it could be weeks n weeks before an appointment can be made to get the terp, the Dr and me together at the same time, by which time I could be feeling very much worse. Any deaf person who is literate should do the same as me and ask Dr to type out on his computer, it is cost effective because it cost nothing except perhaps an extra 5 mins.
As for funding interpreters or lipspeakers it should not be a problem at all, this country is awash with money, we spend 0.7 of Britains GDP on foreign aid! Why? This is British taxpayers money and therefore should be spent in Britain! It is as simple as that, but oh no the powers that be decide to squander it on hundreds of ridiculous projects abroad!!
Britains situation shows contempt for British people especially for vulnerable groups of which the deaf community is one. It is time we all stood up and “shouted from the rooftops” that we should be put first and demand that foreign aid is unringfenced now!
There are far too many good causes in Britain, not to do so. If we all contacted our MP’s demanding this we might just get somewhere!