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Protests mount to cuts in translation services in the Netherlands

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d4049 (Published 27 June 2011) Cite this as: BMJ 2011;342:d4049
  1. Tony Sheldon
  1. 1Utrecht

Plans by the Dutch health ministry to axe funding for translation services have sparked an international outcry, with dozens of experts in care for migrants and people from ethnic minority groups backing an open letter calling the decision “incomprehensible.”

The signatories write that it is “incredible” that the Netherlands was considering such a “huge step backwards,” as the country is currently held up as an example of good practice. Many countries were inspired by the Dutch and the “farsightedness of policy makers in your ministry 35 years ago,” they say.

The health minister, Edith Schippers, announced last month that central funding for translation services will cease from January as part of a cuts package, saving €19m (£17m; $27m) a year. An exception was made for women’s refuges. Ms Schippers said that patients should “take someone with them” to help or “hire a translator,” as they themselves are responsible for their competence in Dutch.

The open letter, signed by international experts from the United Kingdom, Canada, Australia, Italy, Austria, and France (www.mighealth.net/nl/index.php/Letter), argues that it is not out of wilfulness that some people could not speak Dutch to a required level. Migrants may not have been in the Netherlands long enough, may lack linguistic ability, or could not afford lessons. “The level of proficiency necessary in a complex and stressful medical encounter is much higher than that needed for everyday purposes,” says the letter.

It goes on to dismiss the suggestion that denying proper healthcare to people with low Dutch proficiency might encourage them to learn, because “acute illness and health crises are not a clinically safe or appropriate time to promote new language acquisition.”

A number of Dutch professional bodies, including the Dutch Medical Association, the Association for Psychiatry, and the Association for Psychologists, have petitioned Ms Schippers, warning that the safety, quality, and effectiveness of care may be compromised.

Every year in the Netherlands 1400 translators speaking 130 languages are used in 166 000 occasions when it is deemed medically necessary. The health ministry’s own 2005 guidelines emphasise that the law requires the care giver to communicate in an understandable language. That is a professional responsibility, not the patient’s.

The Dutch Medical Association’s policy director, Lode Wigersma, warned of communication problems increasing the risk that patients did not get the right treatment. Informal translators such as children or partners must not be expected to translate intimate or confidential medical information, he said.

Mariëtte Hoogsteder, a senior adviser to the Dutch centre of expertise on intercultural healthcare Mikado, said that it supported learning Dutch, but this was irrelevant if someone is acutely sick. “The fact is that there are many [people] in Holland who do not have sufficient command of the Dutch language to engage in complicated medical discussions,” she said.

A pioneer in this field, the GP Hans Harmsen, has written that translators help ensure the right to access to care for all Dutch residents. Financial barriers compromised that right.

MPs have tabled written questions, and a debate in parliament is expected. Ms Schippers’ spokeswoman said, “We must make savings. It is not the job of the ministry to fund translation services.” People must “pay themselves.”

Notes

Cite this as: BMJ 2011;342:d4049

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