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Dental mythbuster 20: Using interpreters (language and British Sign Language)
We will review facilities for spoken language and British Sign Language (BSL) interpretation in dental practices when we look at the responsive key question.
This relates to regulation 9: person centred care, particularly these two key lines of enquiry:
- R1. Are services planned and delivered to meet the needs of people?
- R2. Do services take account of the needs of different people, including those in vulnerable circumstances?
These focus on how services are planned and delivered to meet people’s needs, including those in vulnerable circumstances. It could include how the provider is:
- meeting the Accessible Information Standard (AIS)
- providing language interpreters and BSL interpreters where appropriate
- providing printed information in different languages.
Providing interpreters and equality law
The Equalities and Human Rights Commission (EHRC) regulates the Equality Act 2010. Some provisions of this Act are written into CQC regulations.
All providers must have due regard to the protected characteristics defined in the Equality Act 2010. They must work with the person to make any reasonable adjustments and provide support so they understand and can make informed decisions about their care and treatment options. This includes the extent to which they may wish to manage these options themselves.
The Accessible Information Standard (AIS)
The AIS aims to make sure that people who have a disability, impairment or sensory loss have information that they can easily read or understand and support so they can communicate effectively with health and social care services. It covers patients, their parents and carers.
Since 31 July 2016, providers of NHS care must, by law:
- Identify: ask people if they have any information or communication needs, and find out how to meet their needs.
- Record those needs clearly and in a consistent way.
- Flag their file or notes so it is clear that they have information or communication needs and how to meet those needs.
- Share people’s information and communication needs with other providers of NHS and adult social care, when they have consent or permission to do so.
- Meet needs: take steps to make sure people receive information which they can access and understand and receive communication support if they need it.
Private dental providers that are partially funded by the NHS must comply with the AIS. If a provider is fully private, the AIS does not apply but they must abide by the Equality Act 2010.
Arranging interpretation services
NHS England has published Guidance for commissioners: interpreting and translation services in primary care. The document covers both spoken languages and British Sign Language (BSL).
Reasonable adjustment provisions in the Equality Act 2010 relating to disability and the AIS apply to both NHS and private treatment.
- It is unlawful for a dental provider to ask a Deaf person to pay for a sign language interpreter that they arrange (section 20(7) of the Equality Act 2010)
- Whether a dentist has to arrange and pay for a BSL interpreter depends on an individual assessment of what is reasonable. The courts would decide each case. The EHRC services code of practice confirms that financial assistance from an NHS England area team could be a factor in this judgement.
- If financial assistance is available and a practice does not apply for it, the practice could be breaching the duty to make reasonable adjustments and open to legal challenge.
- If there is no financial assistance available the practice would have to consider whether it was reasonable to pay for a sign language. For example, would protecting some appointments for deaf people and booking an interpreter for these be reasonable? If providers do not consider how they might make a reasonable adjustment, they could be open to challenge.
- If a dental practice refuses to supply a BSL interpreter, they should have evidence that they considered the options for making reasonable adjustments properly. For example, by investigating support from NHS England or considering paying for an interpreter.
The AIS does not apply to foreign-language translating, but the Equality Act 2010 does.
Not providing an interpreter can affect patient experience and health outcomes, increase missed appointments and make consultations less effective. Under the Equality Act 2010 it can also be indirect discrimination on the grounds of race.
Where a dental practice (either NHS or private) refuses to provide a language interpreter for NHS care, they must have considered their interpreting provision and come to a conclusion that fulfils a test of ‘due regard’ under the public sector equality duty. If the practice could prove that a policy not to provide interpreters was proportionate to achieve a legitimate aim, then this would not be unlawful. This applies to both NHS and private treatment.
Family members / friends as interpreters
Some practices may allow a family member or friend to interpret for a patient. This is not without risk - there is no guarantee that the family member or friend is able to interpret properly or that they do so. The General Dental Council requires dentists to:
“Communicate effectively with patients – listen to them, give them time to consider information and take their individual views and communication needs into account.” (section 2.1 of Standards for the Dental Team, GDC).
Practices cannot be sure that dentists are communicating effectively with patients if a family member or friend translates for the patient.
Also, family members may struggle to remain calm and translate effectively if there is a medical emergency.
Risks of mistranslation can be reduced – but not eliminated – by monitoring the communication and determining whether any translation appears correct. We advise dental practices that allow a family member or friend to interpret discuss the matter with their defence organisation to ensure they would be covered.
Both BSL or language interpretation
If the dental work was being carried out as NHS work and a case was extreme, Article 8 of the Human Rights Act might be breached. Article 8 cases around ‘bodily integrity’ could apply if, for example, someone had all their teeth extracted without consent as there was no interpreting support.
Providers must ensure that BSL and language interpreters:
- hold relevant qualifications
- have appropriate insurance, and
- have an enhanced disclosure from the Disclosure and Barring Service.
Translating written materials
Practices should respond to the needs of the population they serve. They should consider making written information and leaflets available in multiple languages if this meets patient’s needs.
- Last updated:
- 04 August 2020