Post Title

Darzi Fellow Dr Ella Caine writes about her experiences on the programme, how she used the opportunity to shine a light on health inequalities, focusing on the provision of interpreting services in South West London maternity services, and makes her recommendations to support ongoing work.

Having worked as a midwife for nearly 24 years, alongside helping to educate the next generation as a lecturer at the University of East Anglia, I was on the lookout for a new challenge when the opportunity arose to participate in the Darzi Fellowship.

The Fellowship, which is sponsored by South West London Integrated Care System (ICS) and the Health Innovation Network (HIN) South London, involves studying for a postgraduate certificate in healthcare leadership while addressing a challenge in maternal health inequalities. The challenge I chose to address was provision of interpretation services for women and birthing people who do not speak English.

This group experiences significant differences in health outcomes in the UK compared to English speakers. Furthermore, a language barrier can increase misunderstanding and even fear during what can already an intense and life-changing period. Within this group there are further challenges experienced by members of refugee and asylum seeker communities, who not only face language barriers but have often had traumatic prior experiences. My aim was to shine a light on the difference in provision between the four South West London Trusts and beyond, highlighting best practice and suggesting improvements.

Even for native English speakers, navigating NHS maternity services and labour can be confusing. While efforts had been made to improve alternate language provision, it is predominantly available by telephone and online, and is often problematic during emergencies or unexpected situations.

My first few months were dedicated to immersing myself in the four maternity services in South West London, which each provide care in the births of over 3,000 babies per year. There are also significant differences in demographics and wider contexts between the trusts, and my first challenge was familiarising myself with the South West London landscape, as well as identifying and engaging with key stakeholders.

Another important challenge was engaging with the women and birthing people who used maternity services whilst speaking little or no English. To do this I collaborated with third-sector organisations and community groups to reach them through trusted and established channels. It was not always clear in advance who would turn up to sessions, so I had to remain flexible. I also took the ethics of my research very seriously. Sponsorship by the HIN and South West London ICB ensured fair reimbursement for participation, obtaining consent and engaging with participants in an open, honest and transparent way. Overall. I felt very privileged to be welcomed into these spaces and to be trusted by these communities.

Findings

While it was challenging to work on the project in an unfamiliar part of the country while studying at the same time, after an intense year I was able to provide a comprehensive summary of the support available and make a series of recommendations.

While all trusts used phone-based translation services through Language Line, some also employ video interpreters, which added a more relational touch. However, not all interpreters understood maternity care and its terminology, leading to gaps in understanding, and some women and birthing people using the services felt uncomfortable with male interpreters during their care.

There are new innovations available, such as CardMedic, which consists of virtual cards with common questions to aid communication between staff and people accessing maternity services. CardMedic is in the pipeline for some London Trusts, once funding progresses, and is being trialled by another London maternity service.

Beyond London's borders, I encountered Trusts that offered multilingual doulas who stayed on hand throughout labour, offering emotional and linguistic support. In my opinion, this is the most comprehensive level of support available in labour, though it is resource-intensive. This initiative was offered through a voluntary sector organisation and anecdotally led to high levels of women’s satisfaction.

Key recommendations

It was a difficult but immensely rewarding journey, and I am pleased to have participated in serious engagement already on how to address the problems outlined and improve services. Maternal health inequalities, though deeply ingrained, are not insurmountable. By working together to highlight and tackle inequalities when we find them, we can bridge the gap and ensure that everyone, regardless of background, receives the support they need and deserve.