Medical Interpreting

Access to DHB Services in Emergency Situations with NZSL Interpreters

A Report from Deaf Action NZ

March 2017

In March 2016 Kim Robinson had a 64 hour wait for a NZSL Interpreter when he entered hospital in an emergency situation. Other members of the Deaf Community recounted similar experiences. This prompted Deaf Action to contact each District Health Board to ask for assurance that each DHB could provide access to NZSL Interpreters 24 hours a day, 7 days a week.

Responses were received from 18/20 DHBs. Of those who replied, only seven were able to provide assurance that they could provide interpreters 24 hours 7 days a week. Three identified areas that required attention, one being the provision of a booking system for normal working hours (9am – 5pm) and undertook to make modifications as result of our letter, while the remaining eight did not provide assurance around access to interpreters.

Deaf Action recommends that as a matter of urgency, all DHBs, particularly those who were not able to guarantee full access to an NZSL Interpreter review their policies and procedures to ensure that they have effective services that are accessible to the Deaf community at all times utilising technology if required.

Current research into the experiences Deaf people have within the health systems needs to inform future practice.

Report

In May 2016, Deaf Action sent a letter to all District Health Board (DHB) in New Zealand to ask for assurance that their DHB is able to provide access to sign language interpreters 24 hours 7 days a week.

This followed the experience of a patient, Mr. Kim Robinson, at Whangarei Base Hospital who, earlier in 2016, was not able to access a NZSL Interpreter for 64 hours during an emergency situation. When he shared his experience with the Deaf community on Facebook he was overwhelmed by the number of people in New Zealand who said they experienced similar difficulties. It became clear to Deaf Action that this issue required attention.

A forum took place May 2016 in Auckland. Over 30 Deaf people, interpreters and family members shared their experiences. From this, It was clear that the procedures for accessing NZSL interpreters are confusing and inconsistent across DHBs. This creates stress and uncertainty at times when a Deaf person is vulnerable or at risk. Without NZSL Interpreters in place, we Deaf people are unable to provide information about our health, nor are we able to provide informed consent to any treatment or course of action.

Therefore, members of Deaf Action want to know how each DHB can confidently ensure Deaf people across New Zealand are guaranteed access to interpreters in emergency situations.

DHBs will know their obligations under the Health and Disability Consumers’ Code of Rights, in particular to Right 3 Dignity and independence; Right 4 Proper Standards; Right 5 Effective Communication; Right 6 Information.

We acknowledge that the spread of the Deaf community and the availability of qualified NZSL Interpreters varies throughout New Zealand has an impact on accessibility. We also acknowledge that the Deaf community is often referred to as a ‘low incidence, high need’ community however this does not lessen our need to access health services.

With improved technical developments and service adaptations we know it is realistic to expect this to provide opportunities for 24 hours 7 days a week access and NZSL interpreters.

Methodology

A letter was sent to twenty DHBs throughout New Zealand in May 2016. Responses were received from 18 DHBs, an 90% response rate. Eight were from DHBs with a population over 300 000 with the remaining ten from those under 300 000.

We also did not hear from Taranaki DHB who we believe has strived to improve their ability to provide access. The remaining non-responder was the Tairawhiti DHB.

Findings

1. Eight DHBs were able to assure us they are able to provide Deaf people access to NZSL Interpreters 24 hours 7 days a week. These DHBs include Waitemata, Counties Manukau, Waikato, Wairapapa, Hutt Valley, Capital Coast, Canterbury and West Coast.
   
   Five demonstrated this by sharing details of their processes while three have a Disability policy which includes an interpreting policy also. This policy guarantees that a person asking for an interpreter will have access to one. However, this is dependent on the time of the day and the availability of interpreters.
2. Three DHBs asked for guidance or are open to a discussion on how to improve access and services to the Deaf. As result of our letter Auckland and Northland DHBs undertook an immediate review and implemented improvements while welcoming further advice. Lakes DHB also reviewed their policies and asked for advice to strengthen their ability to provide a safe 24 hours 7 days a week service.
3. Seven DHBs demonstrated shortcomings which need to be addressed in order to provide effective 24 hours 7 days a week services.
4. DHB’s used a combination of in-house interpreter booking services and external agencies.
5. Three DHBs (Capital Coast, Hutt Valley and Wairapapa) collaboratively committed to improve access to all services for NZSL Users in both emergency and non-emergency situations in order to improve the experience and safety of deaf people using their health services.
   
   Initial research is now complete with the findings informing future development. These DHBs also refer to a Deaf Leadership group which provides guidance. In addition, these DHBs provide training to staff to ‘manage’ the situation safely until an NZSL Interpreter arrives.
6. Not one DHB referred to the Video Remote Interpreting (VRI) service which has been available since 2009. One DHB referred to the use of skype as a useful tool at times when it is not possible to have an interpreter present on site.
7. Several DHBs demonstrated how they access NZSL Interpreters Monday – Friday 9am – 5pm however they did not explain what takes place after hours and where a policy or procedure was provided this was not evident.
8. There is confusion around the role and professional expectations of a qualified NZSL Interpreter leading to the expectation that communicators can fulfil the same role. Several DHBs referred to local interpreters when in fact there are no qualified interpreters living within the region. In some cases using family members or friends as communicators was seen as acceptable.
   
   Several referred to staff members or family members who are brought in to act as interpreters which suggests they are not qualified NZSL Interpreters.

Deaf Action Recommends

1. All DHBs make a commitment towards providing effective accessible services to the Deaf community at all times by reviewing their policies and procedures. Some DHBs will benefit from adopting a collaborative approach.
2. DHBs to work with their local Deaf and NZSL Interpreting community to develop local solutions.
3. DHBs to ensure there is access to the Video Interpreting Service via Skype while understanding face to face interpreting is the preference of the community. http://www.nzvis.co.nz
4. DHBs to implement an alert system (potentially on their NHS number) to indicate where an NZSL Interpreter is required.
5. Deaf community to be encouraged to provide feedback when services have gone well and not so well. Feedback mechanisms to be clarified.
6. NZSL Interpreter community to consider how national interpreting services may be provided to all DHBs between 8pm and 8am.
7. Repeating the monitoring process in 2019.

We also want to acknowledge that Northland DHB has taken positive steps to ensure Kim Robinson’s experience does not occur again.

New Initiatives

Deaf Action also wants to make you aware of the following initiatives currently taking place as these will help inform good practice.

1. Capital Coast, Hutt Valley and the Wairapapa DHBs undertook a research project on the experiences Deaf people using New Zealand Sign Language have when accessing Health Services. This is overseen by the Director of Disability Strategy and Performance, Strategy, Innovation and Performance Directorate Capital Coast DHB and will be published in 2017. For further information call 0800 DISABILITY
2. Auckland University of Technology Sign Language Section was funded by the NZSL Board for their project: Negotiating healthcare through NZSL: Experiences of Deaf New Zealanders.

The aim of this project is to create a corpus of authentic stories from Deaf people discussing their experiences of understanding health information. This will be available in 2017.

Deaf Action NZ

Deaf Action began in July 2015 as a voluntary organisation to advance the human rights and to represent the interests of Deaf, deaf and hard of hearing people in Aotearoa New Zealand. It is a growing group of Deaf community members who, together, provide leadership for the human rights of Deaf people. We want to make sure that the services Deaf people use are accessible and accountable as well as ensuring Deaf people can achieve their goals in education and employment. Citizenship is important to us as is New Zealand Sign Language (NZSL) which we hope will be an ordinary language in New Zealand in the future.

Deaf people are primarily visual beings, whose eyes are their portal to the world of information and knowledge. Thus, sign language and visual strategies must be made available to Deaf people as a birth right.

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