Safety and personalised care in maternity services of England for women whose preferred language is not English: a critical race theory analysis of interpreter experiences.

Introduction: Effective communication is central to safe, ethical maternity care. Women with cross-cultural communication needs are more likely to experience intersecting disadvantage, with poor maternal and infant outcomes. A professionally trained interpreter (PTI) can raise the quality of clinical care for patients to approach or equal that for patients without cross-cultural communication needs. The need to improve interpreter services has been recognised at the strategic level of the NHS to improve safety and personalised care. However, evidence for how to achieve this is limited from the UK context. Methods: We explored the experiences of PTIs working in maternity services in England using qualitative interviews. We analysed the data thematically, informed by Critical Race Theory, which argues that inequality is deeply embedded in policy, law and institutional structures and practices. We discussed interim findings with our lived experience group. Results: We interviewed 28 interpreters with a range of qualifications who worked for language agencies or in-house NHS interpreting services. Our analysis constructed three themes: The 'shady' agency; 'You can get anyone and you don't know how experienced they are'; 'you are never part of a team'. We found that institutional practices and outsourcing marginalise interpreters, compromising worker well-being and patient safety. Conclusion: To ensure patient safety, it is essential for the NHS to recognise the professional status of medical interpreters and integrate PTIs into the core clinical team. This will require investment in standardised interpreter training, access to supervision and career development. Embedding interpreters in NHS safety culture is essential for equitable and effective care.