Optimising the use of Professionally Trained Interpreters in maternity services of England

Background

Language, communication and understanding of information are central to safe, ethical and efficient maternity care. NHS England have stated healthcare providers should obtain language support through professionally trained interpreters (PTIs). However, our preparatory work for this application has demonstrated women report infrequent use of PTIs during their maternity care, often relying on friends and family as interpreters which can compromise confidentiality, disclosure and accuracy.

Challenges in the provision of PTIs are multi-factorial. Midwives report challenges with interpreter availability, and issues of quality and confidentiality. Information obtained from a Freedom of Information request to English maternity services suggests a failure to provide interpreter support to women at each scheduled care encounter increasing the risk of uninformed, unconsented and unsafe care.

Aims and objectives

The aim of this study is to optimise the use of PTIs across the English NHS maternity pathway so that women with cross-cultural communication needs can understand the care being offered, ask questions and give informed consent for care decisions. We will do this through (a) improved understanding of the organisational context around PTI use, and (b) the development, implementation and evaluation of a range of solutions (toolkit) to optimise PTI use in maternity; producing evidence to inform practice change and service development across maternity care.

Objectives

I. To chart the context and practice of PTI use in maternity care consultations across six Trusts with diverse populations. II. To co-design a toolkit of resources to optimise PTI use in maternity care consultations.

III. To implement the toolkit of resources in our six partner Trusts and evaluate its impact on PTI use in maternity consultations. Methods

This is a 36 month participatory implementation case study design informed by Normalisation Process Theory. We will use ethnographic methods (interviews, observation and document review) in six case study sites, analysing the work of communication, how it is co-ordinated, organised, delivered, and experienced between midwives and women with cross cultural communication needs.

Participatory Learning and Action research tools will be used to support co-learning in the co-design workshops as together we critically reflect upon barriers to PTI use, share decisions on what action is required, co-design a toolkit of resources and implement them in the original case study sites. We will evaluate the impact of the toolkit to support better, sustainable approaches to PTI use that can be shared across NHS maternity and other services nationally.

Outputs dissemination and impact

The principle output of this project will be a multi-layered toolkit of resources to support maternity practitioners, women and interpreters in cross-cultural communication consultations. This will be disseminated through the Chief Midwife to every Head of Midwifery in England, the Lead Midwives for Education Network, the NHS Equality and Diversity Council and through the networks of our partner charities.

For maternity practitioners, birthing women and their families our toolkit will facilitate accurate communication and consent, legal, efficient and psychologically sensitive care for women with cross-cultural communication needs. This will have a direct impact on improving equality in outcomes for women and their babies and trust in maternity care.