Communicating flaws

The beleaguered London Ambulance Service is taking significant, if belated, steps to overcome the damage to its reputation caused by recent tragedies in which people from ethnic minorities have died.

It has teamed up with telephone interpreters Language Line to provide a 24-hour service that can be used by emergency callers and ambulance crews who are having difficulty communicating with a patient.

It works by LAS operators contacting Language Line and connecting the call to an interpreter in a three-way conversation. Crews can also connect relatives, or even the patient, to the service.

This is the kind of service that might have saved the life of 11-year- old Nasima Begum, whose parents desperately tried to get an ambulance for her. It arrived too late - partly, LAS acknowledges, because the operator had difficulty understanding the call.

LAS is also issuing a handbook on ethnic minority health and cultural awareness, together with an updated version of its multi-lingual phrasebook, with lists of questions in 31 languages, which crews are expected to carry.

These are vital tools for ambulance crews in the capital, where 275 languages are spoken and the ethnic minority population is predicted to reach one- third of the total by 2006.

But concerns have been expressed by both the Commons health committee and the Wells inquiry into Nasima Begum's death about the under-representation of ethnic minorities in ambulance crews. Only 7 per cent of LAS staff are black or Asian.

The new steps are part of the 100-point action plan that emerged from the internal inquiry into the death of Samuel Mogul. An ambulance crew had refused to take him to hospital and he died from stab wounds after a second crew took him to hospital.

Local MP Joan Ruddock was prominent among those who charged that the crew had refused to take him because he was black.

When the LAS board adopted the action plan in March, chief executive Michael Honey said the service was 'stunned' by the failure of the crew to do the job it was trained for.

LAS spokesman Alex Bass admits the changes have been forced by past failures. 'The plan was sparked off by the internal inquiry. We're introducing race and cultural awareness on refresher courses and the handbook is part of this,' he says.

The handbook gives vital cultural and religious information, such as the fact that Jehovah's Witnesses refuse blood transfusions and that it is unacceptable for a Sikh man to remove his turban.

The use of body language and touch is deemed no less important. 'You just cannot say to a Bengali woman: 'All right love, give us your hand,'' LAS community relations manager John Bachelor explains.

Paramedic Ray Perotte says: 'To be able to explain what you are about to do before you do it is very important to reassure patients.'

The Commission for Racial Equality, which has been advising LAS on the changes, offers a cautious welcome for the language initiatives.

But CRE senior officer Pam Smith adds: 'It has to be part of an overall strategy. Phrase books on their own won't be enough.'