A woman in her eighties with severe toothache – the pain so severe, she could not sleep. A young pregnant woman experiencing worrying pains in her abdomen. A man in his fifties, a survivor of torture with multiple health problems. These are three of our clients. Refugees selected by the British government for resettlement because they are vulnerable – but who couldn’t access healthcare they needed because they couldn’t communicate with doctors and other health professionals.
How can that be? Health services receive special funding for resettled refugees. It ensures their treatment doesn’t come at the cost of other UK residents’ treatment. And, like all statutory services, they have an obligation to use interpreters to ensure access for people who can’t communicate in English. But this doesn’t always happen.
A dentist’s receptionist told our caseworker that the 80 year old woman would need to bring an English-speaking friend or relative to interpret for her or she could not have the appointment for her toothache. Having only recently arrived and with no English-speaking relatives, this just wasn’t an option. The young woman’s husband dialled 999 and asked for an ambulance. (A Refugee Action caseworker had roleplayed how to do this with him – as we do with all our newly arrived clients on his first day in the UK.)
His English was good enough to get an ambulance which took his wife to hospital. But it wasn’t good enough to understand the health professionals who didn’t use interpreters when they told him his wife was miscarrying. The survivor of torture found himself having to make the excruciating decision of whether to take his English-speaking 14-year-old son out of school and have him hear the trauma of what he would say to his GP or simply give up on receiving the care he needed.
So, why don’t they just learn English? At Refugee Action, we work with thousands of refugees and we have never met one who doesn’t want to speak English. The reality is, it takes a long time to learn a new language and even longer if you have a health problem that gets in the way of your learning. Furthermore, funding for English classes has been cut by 60% since 2010 and our research shows that some refugees can wait up to three years to get classes.
Before refugees are resettled, they undergo a thorough ‘Migration Health Assessment’. Forms setting out their results are sent to Refugee Action and GPs. They tell horrific stories of torture, rape, bullets, bombings, injuries, trauma and also the recommended treatments that bring hope for the future. They’re awful to read but they help organisations like ours plan for a compassionate arrival. If you know in advance a blast has left someone deaf in their right ear, you can brief a volunteer to only speak in their left ear from the first moment they welcome them. If you know someone walks with a limp from a bullet still lodged in their leg, you can plan to avoid long periods of walking. If you know a woman is incontinent following a particularly violent rape, you can plan frequent toilet breaks and allocate a female worker or volunteer to support them. And as well as aiding arrival planning, this information is crucial for health services. What referrals need to be made? What tests are needed? What medicine needs to be prescribed? How quickly after arriving do they need a GP appointment and what are the priorities? But none of this works if the refugees can’t communicate with their doctors.
Our teams work in partnership with thousands of dedicated NHS professionals who invariably do as much as they can for our clients. So, what’s the problem with interpretation? It’s quite simply a lack of information. Our staff and volunteers work with refugees to help them become as independent as possible, as quickly as possible. We roleplay how to book appointments. We accompany refugees to their first appointments, pointing out landmarks en route to help them plan how they can attend independently in future. We make sure they know how to ask for an interpreter, say the language they need and make clear if there’s a special requirement. For example, some conditions a woman might not want to talk about through a male interpreter. But sometimes, this doesn’t work and through no fault of the refugee.
Sometimes a receptionist simply doesn’t know that their service has to provide an interpreter if one’s needed. Other times they get the need but don’t know what procedure to follow to arrange one. Sometimes a GP will use an interpreter and do a great job but then need to refer the refugee to a secondary service who won’t use an interpreter. And the impacts of this are not only that the refugee doesn’t receive the service they need. If an appointment is booked but can’t go ahead and has to be rebooked, everyone loses out.
So why are we hopeful this is going to improve? Refugee Action has been working with health services up and down the country. We’ve met practice managers and commissioners. We’ve engaged with officials, partners and parliamentarians. We’ve told the stories of our clients and set out what we think needs to improve and why. Last year we wrote to Jackie Doyle-Price MP, the Parliamentary Under Secretary of State for Mental Health and Inequalities. She replied confirming to us that the NHS should provide interpretation for all patients requiring it and, responding to a parliamentary question from Nicky Morgan MP, she has now repeated this on the public record. This week we met with officials at NHS England, recommended by Jackie-Doyle Price, who are committed to improving interpretation in the NHS and who are keen to work with us to find solutions. It feels as though the momentum is growing toward resolving this crucial barrier and ensuring vulnerable refugees can access the healthcare services they need.
This blog was written by Jeremy Bernhaut, Refugee Action’s Specialist Resettlement Manager.