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Watchdog Highlights 'Language Gap' Risk Across NHS

The NHS needs to provide appointment letters in languages other than English, as the current 'language gap' is putting non-English speaking patients at risk of delayed diagnosis and care, a health care safety watchdog has warned.

Written communications about radiology appointments are routinely sent in English only from NHS trusts, not accounting for the needs of the patient’s first language, the latest Healthcare Safety Investigation Branch (HSIB) report has found.

The report emphasised that, for patients whose first language is not English, there is a risk that they may not attend the appointment or, if they aren't able to understand a specific requirement this could prevent the procedure taking place and it being cancelled on the day. There is then additional risk that the patient can be 'lost to follow-up' and appointments not rescheduled, resulting in diagnosis and timely care delays, and potentially avoidable poor outcomes. 

The HSIB made these findings after undertaking a national investigation into written patient communications generated by booking systems for clinical investigations such as diagnostic tests and scans (X-ray, CT, or MRI). 

The safety impact of sending medical letters solely in English was seen in the reference case the HSIB examined as part of its investigation. A 3-year-old child of Romanian ethnicity was booked in for an MRI to check for and 'rule out' cancer. However, two separate MRI appointments attended by the family were cancelled because they didn't realise there was a fasting requirement for the scan, as both appointment letters were written in English. There was also an 11-week gap between the first and second appointment as the radiology booking team did not receive confirmation of the need to book another one. The third appointment, scheduled a day after the second cancelled one, went ahead and the MRI scan confirmed that the child had cancer. Despite treatment, the disease progressed, and the child sadly died.

The HSIB also conducted a search of a national medical incident database, which revealed that 34 incidents in a year, from March 2021 to February 2022, had been related to issues of keeping track of patients rather than due to a lack of capacity to undertake clinical investigations. In several of those cases, the patient's treatment options and prognosis was adversely affected by the delay. These incidents were reported across the country in different disciplines, indicating that this is a widespread issue and not related to a single trust.

Key Findings

Key Findings from HSIB Investigation were the following:

  • Written communications to patients about radiology appointments are routinely sent in English only
  • Healthcare staff expect that written appointment information will be translated by a patient’s friend or family member
  • NHS England standards do not require written appointment information to be given in any non-English language, other than for people with a disability
  • Confusion about the requirements for appointments can result in delayed care and additional costs if appointments need to be rebooked
  • Information on the language needs of patients are inconsistently captured or not recorded at all
  • While the national NHS system that holds patient information and populates it into many trust systems - the Personal Demographics Service - can store information on patients preferred written communication methods, this information is often not entered into the system
  • Administrative staff are not routinely involved in assessing and testing electronic booking systems before they are implemented

As a result of the investigation, the HSIB has made one recommendation to NHS England on developing and implementing a standard for healthcare providers on supplying written appointment information in languages other than English.

Matt Mansbridge, HSIB national investigator, said: "Our investigation shows that the translation of written communications poses a particular risk for patients if their first language is not English. When compared to services provided for face-to-face appointments, the gap in provision is clear. Unfortunately, that gap has the potential to create delays in diagnosis – sometimes for conditions that are life-changing or life threatening. Multiple changes and cancellations and confusion over what people need to do for appointments is also distressing for patients, who may already be anxious about undergoing radiology scans or tests.

Mr Mansbridge said that some trusts are implementing changes to their written communications. He pointed out that the NHS has a duty to ensure that services reflect and are tailored to the needs of all their patients, their families, and carers.

"Having a consistent translation service that covers all communication supports the patient experience, could reduce the number of missed appointments, and saves cost and resource," he said, and added that the recommendation "is a step forward in ensuring that every patient has the access they need to tests, treatment, and follow-up care".