Who pays for an interpreter?

The scenario

Emma, practice manager

“I have a new patient with hearing difficulties booked in for an appointment in two weeks’ time. I’m new to managing a practice and haven’t been required to handle this situation before. I wondered what provisions I might need to take, what financial implications there might be, and if there is anything else that I might need to be aware of?”

The advice

Sue Clark, clinical consultant at the Optical Consumer Complaints Service (OCCS)

When it comes to any client-facing business, communication is key. However, in an optical practice, this goes further than providing excellent customer service. Clear communication with patients is essential when discussing matters concerning eye health. So, what’s the answer when communication is limited due to a language barrier or patient disability?

Interpreters are able to provide a channel of communication where it is limited between patient and optician. This can be crucial when discussing diagnoses and treatments, medical advice and payments. However, there are financial implications to using an interpreter, which are likely to be especially apparent to optometrists. With this in mind, you may be wondering who pays for this service? The answer to this question is dependent on context.

Catering for those with disabilities under the Equality Act

The Equality Act 2010 requires that all service providers (public and private) make what is called ‘reasonable adjustments’ when it comes to services for people with disabilities, in order to ensure that they are not given a substantial disadvantage when compared with someone without a disability.

Approximately 11 million people in the UK are deaf or hard of hearing, and there are 151,000 British Sign Language (BSL) users. A patient who is deaf can be described as having a disability, and they are therefore protected under the Equality Act, requiring reasonable adjustments to be considered.

Reasonable adjustments refer to changes that can be made to practices in order to cater for a person’s disabilities. These changes only need to be made if it is reasonable to do so; for example, if the changes are necessary to communicate important information between patient and optician, and are affordable and practicable.

Clear communication with patients is essential when discussing matters concerning eye health

If an optician does not fulfil their duty to make reasonable adjustments, and has no valid excuse as to why these adjustments could not be made, the Equality Act deems this unlawful discrimination. Patients can ask the optometrist to make these changes, and can make a discrimination claim if they refuse.

Is an interpreter a reasonable adjustment?

The Act states that those who use services should not have to pay for reasonable adjustments. Therefore, the optometrist must decide whether an interpreter qualifies as a reasonable adjustment, and arrange funding if so.

Whether an interpreter counts as a reasonable adjustment depends on a number of factors, including cost. On average, interpreters cost around £15 per hour, so a reasonable adjustment in this case may be to block-book patients on a day on which an interpreter is working at the practice.

If the services of an interpreter are too costly (for example, if there are no interpreters in the area and therefore travel expenses must also be considered, or if it is not economical because there are very few patients with deafness) then it may not qualify as a reasonable adjustment. But if this is the case, the optometrist should still seek alternative methods for providing accessible information for patients who require it.

What about public funding?

The NHS Accessible Information Standard Guidance for Community Optical Practices states that NHS service users should receive information in a suitable format, where possible of their choice. The Standard is a legal requirement that only applies to needs that relate to a learning disability, sensory loss or other impairment – not those who may require foreign language translation.

The guidance, last updated in July 2016, says that the NHS does not provide financial support for implementation of the Standard, therefore implying that interpreters must be funded by the provider and despite acknowledging that this limits the level of care for some optical practices: “NHS England’s view, in summary, is that the Standard simply clarifies existing duties on providers and professionals under the Equality Act 2010, therefore the Government and NHS England have provided no additional or specific funding to assist providers, such as optical practices, with implementation of the Standard. This is regrettable as it will rule out some providers being able to offer higher levels of support.”

However, the Standard also suggests that some support may be available on a case-by-case basis on a local level: “Where it is concluded that using a communication support professional is a reasonable adjustment, and where the patient is NHS funded, you may wish to contact your local area team and/or commissioner to find out what support they can offer.”

Both private and publicly funded optical practices are likely to have to provide their own funding for an interpreter’s services if this is necessary in order to cater to patients’ disabilities in line with the Equality Act.

However, if it is not possible to finance these services, alternative arrangements must be made to ensure that information is accessible to those who require communication support. Alternatives can range from providing written material, to allowing a patient to bring a friend or family member as an interpreter to their appointment. There is a risk of miscommunication with the latter option, so this must be approached with caution.

Sufficient alternative communication should alleviate the need for an interpreter, allowing an optical practice to provide cost effective support for patients.

The author would like to acknowledge the AOP and the Healthcare Regulators EDI forum for their help with this piece.