Patients having to ask GPs to translate English-only hospital letters

Patients who do not speak English are at risk of delayed diagnosis because hospitals do not provide appointment letters in other languages, a report has warned.

GPs also told Pulse that patients often come to them for translation of complicated hospital letters, which adds to their workload.

NHS England standards do not require written appointment information to be given in any non-English language, other than for people with a disability.

The Healthcare Safety Investigation Branch undertook an investigation into patient communications generated by systems that book patients in for clinical investigations such as diagnostic tests and scans (X-ray, CT or MRI).

It found that NHS trusts are routinely sending written communications about radiology appointments in English only, ‘not accounting for the needs of the patient’s first language’ and expecting a family member or friend to translate for them.

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 also a risk that the patient can be ‘lost to follow-up’ as they aren’t tracked, and appointments are not rescheduled. All of this can lead to a delay in diagnosis and timely care, the report said.

The Equality and Human Rights Commission (EHRC) considered that HSIB’s investigation highlighted a ‘gap that needs to be remedied urgently’.

NHS England told the investigation that there were future plans to scope the issues around community languages, including interpretation and translation.

HSIB’s national investigator Matt Mansbridge 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.

‘Some trusts are implementing changes to their written communications, and we have acknowledged that there is immense pressure and backlogs within radiology departments.

‘However, the NHS does have a duty to ensure that services reflect and are tailored to the needs of all their patients, their families, and carers.’

Professor Azeem Majeed, head of the department of primary care and public health at Imperial College London, told Pulse that NHS trusts should put measures in place to avoid patients going to their GPs for help in translating appointment letters from specialist services as this creates ‘unnecessary work for primary care teams.’

He said: ‘It’s essential that health services are accessible to all patients regardless of their language or cultural background.

‘People with poor English language skills generally have a lower uptake of NHS investigations and interventions, leading to the risk of poorer health outcomes.

‘Making information about appointments in the patient’s preferred language as well as in English is potentially important in rectifying this.

‘Modern translation tools make if fairly straightforward to convert English text to text in other language so this should not be a difficult problem for the NHS to solve.

‘NHS Trusts should not assume that all patients will have a relative who can translate for them; not least, because the investigation may be for a sensitive issue.’

But Dr Amir Hannan, chair of the Association of Greater Manchester LMCs, told Pulse that ‘a lot more’ needs to be done other ‘than sending letters in different languages’.

He said: ‘In the current drive for access, you can see why problems like this arise. The key is for patients to have an understanding and we need to start talking about continuity of care, not just access.

He added: ‘NHS England say that patients can have access but they put no support in place to help them understand test results.

‘This is not about the language but about the lack of understanding – if you empower the patients that is when the workload will start to reduce.’

Last month, Pulse revealed that a major Essex hospital trust failed to send more than 50,000 patient letters to GPs due to an IT fault. As a result, GP practices were asked to accept years’ worth of unsent hospital letters.