Renata Towlson outlines a pioneering hybrid model of hospital interpreting that could improve patient outcomes

Nottingham University Hospitals NHS Trust is one of the largest acute teaching trusts in the UK. It is located across three sites, has over 18,000 staff and cares for 4-5 million patients each year. Its interpreting and translation services came under scrutiny in 2014 following a patient experience review. There had been complaints, and control over the processes and quality of services was restricted to quarterly review meetings with the outsourced provider. This, and spiralling costs, made for an inefficient service that needed attention for the benefit of patients, with specific consideration for languages.

During my time as a senior procurement officer, my portfolio of corporate contracts included interpreting and translation services, which, following a European tender process, had been awarded to a national framework provider. The annual cost in 2013/2014 was nearly £600,000. However, effectiveness and quality of service did not reflect the expense, resulting in a high level of dissatisfaction from both clinicians and patients.

By gathering data, informal feedback, officially logged complaints and insight from my interpreting practice, it became clear to me that national or global agencies might not have the capabilities to respond to acute local needs. Service review meetings confirmed a gap between local requirements and what was possible for the outsourced company.

While a global provider can succeed by utilising telephone, video and written translation, a localised function – especially where a rapid, face-to-face linguistic response is required – is both qualitatively and economically far more effective. I submitted a business case for an innovative interpreting and translation model that would provide quality improvements to patients and lower the cost to the trust.

This business case outlined the rationale for a fusion (non-homogenous) model of interpreting and translation services. And so, in 2015, a new concept was born that was managed in partnership with local partners, volunteers and a global organisation.
However, engagement with community volunteers and bilingual members of staff, who had been volunteering to interpret for patients, required a governance process.

Following a successful voluntary services recruitment process, I offered in-house basic interpreting training to Level 3 standards. I confirmed that I could not assess their language abilities, that building a medical glossary and vocabulary would be their own responsibility, and that I would not expect anyone to interpret without feeling confident to do so. They had unlimited access to my advice, training and supervision, and direction to professional routes.
 

The pilot project

I ran a 12-month pilot project which resulted in a mandate to set up an in-house bank of interpreters, initially for the most requested language at that time: Polish. An intranet booking system made it easy for all staff to source face-to-face interpreters. A process of development and consulting with service users began. Qualitative feedback and financial data were encouraging, and we extended the pilot to further European languages.

An in-house model developed over time including trained volunteers and a professional pool of bank staff interpreters, some working exclusively for Nottingham University Hospitals (NUH) and some for other agencies as well. Some volunteer interpreters later became paid interpreters.

In cooperation with the International School of Linguists, I built a Level 3 Community Interpreting training programme, available to all bank pool interpreters. Indeed, I invited both volunteers and professional interpreters to workshops so they could benefit from each other’s experiences, lessons learnt, pitfalls and successes.

By March 2024, NUH Interpreting and Translation Services (ITS) employed 87 interpreters and three full-time administrators, who support the ITS manager to deliver a service with ever increasing demands. We also work with several volunteers. The goal is to ensure non-discriminatory access to interpreters and a high-quality service through established procedures and processes. We are able to provide timely linguistic assistance or liaison to anyone requiring it in over 30 languages and dialects.

An internal booking system map and direct line to our interpreters allow a rapid response to urgent requests; liaison between linguists, clinicians and patients for complex, long-term cases; and timely and effective rescheduling of appointments to accommodate sessions requiring face-to-face interpreters.
 

Raising awareness

Two programmes on our service, broadcast on BBC radio and local TV, raised the profile and importance of community interpreting within healthcare, and attracted local bilingual speakers to train to become volunteer interpreters. Among the meaningful stories that followed was that of a doctor from Afghanistan who was seeking asylum in the UK. She contacted me after seeing a communication about us recruiting volunteer interpreters. While awaiting the Home Office decision, she wished to help fellow Pashto- and Dari-speaking patients, and gain experience of how the NHS works.

She was struggling with her mental health due to her family being in danger in her native country and couldn’t feed herself properly as the asylum seekers allowance was not enough to sustain her physically and emotionally. The only assistance she could get was pharmacological, which made her feel lethargic. She was, however, determined to work without pay to keep herself motivated and, in the process, provide vital linguistic assistance to NUH non-English-speaking and limited English proficiency (LEP) clientele.

Her medical background gave her instant kudos during interpreting sessions, and after she was granted asylum she started working as a medical doctor in the NHS. She could not thank me enough for the opportunity I gave her and all the support that came with it.
 

Signs of success

In the period 2015-2021, the trust saved £994,239 compared to the baseline spend in 2014/2015. After nine years, the project continues to respond to patients’ needs – for example, with digital solutions and quality improvements for deaf patients following consultation with Nottinghamshire Deaf Society. Several organisations have contacted me to ask how they might improve their local response to the interpreting needs of their non-English and LEP speakers, leading to nine telephone conferences and one regional conference.

The NUH ITS policy review in 2023 included a provision, in clearly defined (emergency) circumstances, for using bilingual members of staff who share a language with a patient in their care. This is a sensitive area in a multilingual and multinational workforce.
How to tap into existing multicultural human resources and cultivate a supportive atmosphere for language sharing in dynamic settings, without staff feeling underpaid or underappreciated, is a work in progress.

Some bilingual clinicians opted to take on a second role whereby they are employed as bank staff interpreters. They are at liberty to interpret during their standard working hours, but they are not paid an additional fee for this. Their availability for paid assignments is limited to out-of-shift hours. It is also difficult to expect a bilingual consultant to interpret for patients cared for by other consultants due to their own workloads. The sustainability of the fusion project will depend on how well we are able to promote and embed a vision of a truly multilingual workforce.

This initiative contributes to and, indeed, makes a statement about NUH’s culture of inclusivity and accessibility for all; the organisation’s motto is “Everyone is welcome here”. It has allowed the trust to show inclusivity in practice.

On a personal level, it was fantastic to do a project with senior staff, be listened to and have a chance to put my vision into place. I found myself in a position to be creative in a unique, human sciences-linguistic-business- like way. I was able to bring together all the elements required to visualise and realise this project: my own skills and abilities, understanding of the legal requirements, comprehension of patients’ unmet linguistic and cultural needs, and the potential for savings/efficiencies by fusing ‘cottage industry’ with ‘blue collar’ solutions. The key learning points are:

• A multilingual landscape allows for many different levels of linguistic assistance. Therefore we can train people from different occupations and introduce them to the interpreting market. Academic linguistic qualifications are not a necessary requirement to become a seasoned interpreter.
• Local multilingual communities are a great human resource for rare languages and, if approached sensitively, can be a great asset to fill linguistic gaps. Training and ongoing support for them are prerequisites for a success story for all parties concerned.
• The shared language initiative is a visionary concept that requires careful consideration. We need to conduct more in-depth research to better understand factors related to effective concordant language care.
   

In order to sustain the success of this fusion model, some administrative and IT reconfiguration might be necessary to continue to provide meaningful services to non-English-speaking and LEP patients from multicultural backgrounds. The focus of a healthcare community interpreter is that of a spoken word rooted in different cultures. Creating a responsive and effective fusion system is my answer.

Renata Towlson holds a PhD in Education and is a qualified interpreter. She has written and published one book and had five others translated from English to Polish. She recently retired after 27 years at Nottingham University Hospitals NHS Trust and seven years as a lecturer at Szeczecin University.

This article is reproduced from the Winter 2024/2025 issue of The Linguist. Download the full edition here.