Introduction by Croakey: The current Multicultural Framework Review provides an opportunity for the Federal Government to consider “what institutional, legislative and policy settings can best build Australia’s multiculturalism over the next decade”.
This includes reviewing ways in which the Government can more “strategically communicate and engage multicultural Australia, including in languages other than English”, which is critical for equitable access to healthcare as highlighted during the pandemic.
The Review will acknowledge the diversity of Aboriginal and Torres Strait Island cultures, languages and connection to Country. Aboriginal and Torres Strait Islander people and groups will be invited to contribute to the consultation process to reflect on their experience of living in a multicultural Australia. Submissions close on 29 September.
A recent study of an interpretation service conducted in the Royal Darwin Hospital found that the service resulted in a decline of self-discharge numbers. Employing Aboriginal first-language people as interpreters increased interpreter use and resulted in better communication and understanding of their healthcare.
The Royal Darwin Hospital experiences the highest self-discharge numbers in Australia for various reasons, including complex booking systems and that unofficial interpreters are more convenient.
Meanwhile, Spase Veljanovski, Coordinator of Programs and Projects at the Centre for Culture, Ethnicity and Health, a Program of North Richmond Community Health, writes below that health and human services providers are not engaging qualified interpreters as much as they should for culturally and linguistically diverse patients.
Spase Veljanovski writes:
This month, submissions to the Australian Government’s Multicultural Framework Review are closing – the deadline is 29 September. The Review’s terms of reference will consider, among other things, “how the Federal Government can more strategically communicate and engage multicultural Australia, including in languages other than English”.
The most recent Census indicates that many Australians may experience a language barrier when trying to communicate with health and human service providers.
Census 2021 shows that 870,000 people who spoke a language other than English at home reported difficulty speaking English. This is a conservative figure as many more people did not state their proficiency in English.
One solution to overcoming this language barrier is through the engagement of interpreting services.
Australia has a world leading certification system for interpreters – however, interpreters are often overlooked in the planning and delivery of health system changes and are unfortunately underutilised in established health and human service delivery. This can lead to poorer health outcomes for individuals and barriers to effective services.
Through provision of training and participation in sector networks such as the Victorian Refugee Health Network, we hear anecdotes of services refusing to provide interpreters for clients, instead asking for clients to ‘BYO interpreter’.
Interpreting and interpreters
Interpreting is the oral transfer of speech between two different spoken languages. Interpreting can also apply to signed languages. This is often confused with translation which is concerned with written words.
In this article, interpreter is used only to mean one who is qualified to convert speech accurately and objectively into another language and required to act in accordance with a code of ethics. Interpreters are assessed on a range of skills including comprehension in two languages, memory retention and knowledge of Australian systems, including healthcare. Some have specialised training in medical terminology.
An interpreter must remain impartial, not express an opinion and not act as an advocate for a client. For these reasons, family members, friends and bilingual staff cannot be engaged as interpreters.
Interpreters can be engaged over the telephone, via video and even on-site. So what’s stopping us from engaging them?
Barriers and enablers
The first barrier is service providers and clients not knowing about the interpreting service.
While the National Interpreter Symbol – which can be downloaded from the Victorian Multicultural Commission’s website – may appear on client correspondence and at reception desks, often it is not enough in itself to ensure an interpreter is engaged when needed.
A client, advocate or service provider needs to act on engaging an interpreter. Unfortunately, there is not enough community education about the availability of this service, which requires the client, the less empowered party, to make the request.
In recognition of this power asymmetry, there has been a progressive policy shift over the years in requiring government departments and funded agencies to offer an interpreter when needed.
For example, Victorian Government policy states that government departments and agencies, either directly or through funded service providers, “have a responsibility to ensure people with limited English are given information in their own language to participate in decisions that affect their lives”.
This is based on equitable access to services, procedural fairness and duty of care.
In addition, the policy states that organisations “must not directly or indirectly discriminate against people who have limited English proficiency”.
“The failure to identify the need for, or to promote the availability of, language services may create a risk of inadequate procedural fairness. This may result in decisions being reviewed and overturned, incurring additional costs and avoidable delays,” the policy says.
Within funding and service agreements there is a growing expectation that interpreters are engaged when needed.
Since 24 October 2022, some privately employed allied health professionals have access to the Australian Government’s Free Interpreting Services. This is a positive policy shift that supports better health outcomes.
A pilot is being trialled over four years in 32 Local Government Areas across Australia based in areas of low English proficiency.
The Royal Australian College of General Practitioners has recently created a new set of advice for accessing interpreters to boost general practitioners (GPs) uptake of the service. It comes after research suggested that GPs are underutilising the service in primary care for several reasons, including financial concerns.
This is despite the many years medical practitioners have been able to access the Free Interpreting Service when delivering Medicare rebate services in private practice. In addition to the Doctor’s Priority Line there is a Pharmacy Priority Line for community pharmacists to access interpreters at no cost.
While this is not to say there are no resourcing issues, including the availability of interpreters in particular languages, more could be done to inform and educate service providers of these existing services.
Aside from lack of knowledge, the main deterrent for workers to access interpreters is due to a poor previous experience. In short, good practice includes booking the right interpreter, performing a proper briefing, using good communication techniques, and taking the opportunity to debrief with the interpreter to improve future practice.
We are all stakeholders in improving the quality of interpreted conversations. Tips, including suggestions about how to deal with client refusal to accept the offer of an interpreter, can be found here.
This is a good guide for a worker to assess whether a client is more likely, or less likely, to need an interpreter. Another valuable resource is the Health Translations directory which provides direct links to reliable translated health and wellbeing resources produced in Australia. There are currently over 28,000 resources in over 100 languages.
A better organisational response
Health and human services organisations should review or develop a good language service framework.
This includes:
- an up-to-date policy
- a clear and easily accessible procedure for staff to access interpreters
- staff training
- quality improvement measures and dedicated resources.
This will support overcoming the language barrier between organisations and clients and improve communication effectiveness and efficiency for organisations and clients.
Hopefully this will eliminate the request by service providers to ask their clients to ‘BYO interpreter’.
About the author
Spase Veljanovski is an experienced project worker and facilitator in organisational cultural competence, health literacy and language services. He has over 30 years’ experience improving migrant communities’ access to, and engagement with, health and human services.
See Croakey’s archive of articles on health inequalities.
