A STUDY ON PUBLIC SERVICE TRANSLATION IN CROSS-BORDER HEALTHCARE

Transcription

1 A STUDY ON PUBLIC SERVICE TRANSLATION IN CROSS-BORDER HEALTHCARE Final Report commissioned by the European Commission Directorate-General for Translation Prof. Claudia V. Angelelli Chair in Multilingualism and Communication Heriot-Watt University

2 GENERAL OBJECTIVES Language needs in our multilingual & cultural societies Responses (or lack thereof) to meet these needs

3 SPECIFIC OBJECTIVES: National and local language policies facilitating cross-border healthcare patients rights to language access Patients rights to language access as inherent rights or enabling conditions Cost of language support and/or social cost of non-economic integration Identification of responses (lack thereof) to meet language needs Good practices in place

4 RESEARCH DESIGN & JUSTIFICATION Two conditions established by DGT: timeline and budget Five Member States Qualitative and quantitative methods Triangulation and validation of results

5 QUALITATIVE METHODOLOGY Document analysis Interviews Non-participant observations 207 informants 128 sites

6 Germany: Berlin, Bonn, Boston, Cologne, Coppenbrügge, Cuxhaven, Germersheim, Kehl, Mainz, Munich, Osnabrück Greece: Athens, Chania, Farkadona, Katerini, Larisa, Litohoro, Trikala Cities and towns per Member State Italy: Bologna, Reggio Emilia, Forli, Milan, Modena, Naples, Regione Lombardia, Rome, San Chirico Rapparo (Regione Basilicata), Verona Spain: Benidorm, Gandía, Lalín, Madrid, Santiago de Compostela, Tui, Valencia, Vigo, Vilajoiosa United Kingdom: Aberdeen, Belfast, Cardiff, Dungannon, Edinburgh, Glasgow, London, Swansea

7 Types of sites visited per Member State Sites Germany Greece Italy Spain United Kingdom National Contact Point National Ministry of Health Regional Ministry of Health / Regional Health Authorities University T&I Programmes Policy-maker offices Lawyer offices Consumer right office/ngos Community centre Hospital (urban) Hospital (rural) Healthcare centre T&I Professional Associations Software Developer T&I agencies Cultural mediation agencies TOTAL

8 Informants interviewed per Member State Informants Germany Greece Italy Spain United Kingdom National Contact Point Policy makers Lawyers NGO s officers Healthcare providers Healthcare Administrators Researchers in Healthcare communication Insurance companies 1 N/A N/A N/A N/A T&I Association Presidents Medical Association Representatives Social Worker T&I Agency Owners/Managers Institutional T&I Management Free-lance translators Free-lance interpreters In-house interpreter Software developers Cultural mediators Patients and family members T&I students TOTAL

9 QUANTITATIVE METHODOLOGY Questionnaire 1 (policy) Total Responses Received: 41 Total Cases Used: 19 Questionnaire 2 (practice) Total Responses Received: 290 Total Cases Used: 290

10 LEGISLATION/ DOCUMENTARY ANALYSIS RQ1: What are the language policies in place at the local and national level in the five Member States (MSs) participating in this study to support the implementation of EU law related to patients rights to access cross-border healthcare? (SO 1) RQ2: Are patients rights to access cross-border healthcare respected in principle or in effect and are they legally enforceable and sanctioned? (SO 2)

11 RQ1 & 2: KEY FINDINGS Language: Universal Declaration of Human Rights & EU Charter: bone of contention UK: Equality and Diversity Law Germany: informed consent Spain: protection to regional languages Sources: Legal framework and MS Transposition of Directive 2011/24 EU

12 RQ 3: LANGUAGE PROVISION WHAT? HOW? BY WHOM? Documentary evidence Interviews Non-participant observation

13 DELIVERY MODELS OF LANGUAGE PROVISION

14 Who provides language services (Q2: 3.6) 80% 70% 60% 50% 40% 30% A: only private sector interpreting agencies B: volunteer services as well as private sector agencies C: paid full time interpreting staff as well as private sector agencies D: I do not know 20% 10% 0% DE EL ES IT UK Total

15 90% Use of ad-hoc solutions (including family members and staff) (Q2: 3.7) 80% 70% 60% 50% 40% Yes No 30% 20% 10% 0% DE EL ES IT UK TOTAL

16 Language service rating (Q2:4.1) 70% 60% 50% 40% 30% A: Highly effective B: Adequate C: Inadequate D: Flawed 20% 10% 0% DE EL ES IT UK Total

17 RQ 4 REAL COST/SOCIAL COST INTERVIEWS + QUESTIONNAIRE 2 Real cost Spain SUMMA passed out/passed away Fees per hour/minute Salary (interpreters in Spain) Cost of inefficiency (unnecessary expenses due to miscommunication) Social cost: Epinal (4 deceased patients) 911 call (wrong address) Portland, Oregon (deceased patient lawsuit) Consent Form (Germany)

18 COST In the Member States of this study language provision in healthcare is not included as a line item in any national budget. Cross-border patients frequently have to pay for their own translations. The cost for providing professional language services is recouped in the medium to longterm

19 Northern Ireland Health and Social Care Interpreting Service Requests 95, ,547 84, ,656 Number of Requests ,177 49, ,811 34, , , Year

20 RQ 5: GOOD PRACTICES IMI (Internal Market Information) Educational programs NGOs EU Platform for prescriptions Databases Consent forms (Germany) Resource sharing (IMI) Legislation (UK) Administration (UK) Use of professional language providers (ES, UK)

21 CONCLUSIONS European legislation does not mandate language support for patients of cross-border healthcare. Language support is needed to fulfil the requirements of the Directive (such as access to information and to safe and high quality crossborder healthcare in the Union).

22 Conclusions (cont.) Language support/provision for cross-border healthcare patients is neither guaranteed nor provided in an even manner across the MSs and sites observed in this study. This calls into question the rights and protections for EU citizens. Except for the UK, language support/provision is not embedded in national legislation (exceptions being the protection of specific regional languages in Italy and Spain, and consent forms in Germany).

23 Conclusions (cont.) English is commonly regarded as a lingua franca. Informants share an assumption that if one possesses some English language ability they can communicate effectively. It has been noted that many stakeholders (at all levels) do not understand, read or speak enough English.

24 Conclusions (cont.) There is no consistent provision of translation for documents needed for cross-border healthcare (medical records, reimbursement, etc.). In almost all cases the responsibility for the translation of all documents is placed on patients. Except for the UK, language provision in the context of healthcare is not recognized as a core service and it is not a line item in the budget. Ad hoc bilinguals perform these services when professional support is not provided.

25 Conclusions (cont.) Language provision is perceived as costly and not always essential (especially when compared to other medical needs such as supplies). Healthcare providers perceptions of confidentiality and privacy differ from those of T&I professionals and from those found in codes of ethics discussing language provision (e.g. some healthcare providers prefer family members as language brokers due to their familiarity with the patient s language and culture).

26 Conclusions (cont.) In three of the five MSs studied we identified two prevalent assumptions regarding language, culture and language provision: 1) language and culture are not intertwined and can thus be separated; 2) translators and interpreters deal only with language ( the words ), not culture.

27 Conclusions (cont.) In the absence of formal language services the health and safety of EU patients may be put at risk. Missed appointments, misdiagnosis, return visits, etc. result in increased costs over medium to long-term, while language-provision cost is recouped in less time. Quality language provision cost is perceived as less costly than non provision.

28 IMPLICATIONS Policy and policy makers Budget Language support Education Healthcare providers (HCP), administrators and patients Conceptualizations of equality, access and non-discrimination

29 RECOMMENDATIONS: Information by NCPs Extent of professional language service provision Awareness raising Professional development for Healthcare providers Professional development for language providers Language provision

30 The findings of this study unequivocally demonstrate that language diversity is a defining characteristic of the EU. Currently in four of the five MSs studied, healthcare institutions lack a comprehensive legislative response to language diversity. Since equal access to healthcare is a right to be guaranteed in the EU, this raises the question of why professional language provision in healthcare is inconsistent or at worst absent when these services do exist and are essential to ensuring equality.

31 THANK YOU FOR YOUR ATTENTION QUESTIONS? COMMENTS? Also send c.angelelli@hw.ac.uk