Matt Taylor, chief executive of language services provider Dals, argues that there is huge potential to deliver more language services remotely, but adds that there is no one-size-fits-all approach
A key pillar of the recently released 10 Year Health Plan for England’s NHS is a shift from analogue to digital. This is a laudable goal that makes sense in the context of a health service that’s looking to deliver more services remotely, reserving physical appointments for when strictly necessary.
But we don’t need a decade – or even a year, for that matter – to digitise language services within the NHS further. There is much that can and should be done right now, because just as demand for NHS services generally is growing, so is the need for language services.
In the 2021 Census, 1.5% of those in England and Wales said they could not speak English well, and 0.3% not at all. These percentages are only likely to rise, and we cannot simply expect almost 2% of the population to forgo healthcare or accept substandard care.
That might sound dramatic, but research has consistently found that those with limited English proficiency struggle to access services and experience worse outcomes than native English speakers.
Thus, the proposals in the 10 Year Plan to use digital transformation to drive inclusion – in part with apps and tools tailored to patients’ first language – are commendable.
But given that many with limited English struggle at the very first hurdle of connecting with primary care services, we may need to take things a step back.
Laying the right foundations
Just as an emergency department triages patients based on need, the NHS should do the same for language services. Trusts need to develop clear guidelines for both identifying language needs and determining which mode of delivery is most appropriate for each interaction. More importantly, they need to educate their staff on these guidelines and make sure they stick to them.
What we often see is clinical staff relying on a patient’s family or friends as ad hoc interpreters instead of securing professional interpreters, even where these are available. This is problematic for many reasons, the prime ones being uncertainty about such interpreters’ fluency in terms of complex medical terminology, their lack of impartiality and confidentiality.
Though the use of friends and family as interpreters is widely discouraged by NHS trusts unless there is no other alternative, for example, an emergency admission, we sometimes see it happening for reasons such as a lack of forward planning or insufficient information on patients.
But even where a service is unprepared, they don’t need to make do with a friend or family member; a professional video or telephone interpreter can be secured in seconds.
Video on demand opening up new options
Before the pandemic, there were two main choices for language services: face-to-face interpreters and telephone interpreters.
The limitations of the former are that bookings need to be made in advance and taking travel into account, booking times are longer and costs greater. And while the latter has long been available on demand, telephone interpreting lacks the visual cues that can be important in sensitive medical discussions.
While video interpreting had existed for some time, it was rarely used because in the past it also needed to be booked in advance, and there were technical integrations that many NHS services didn’t see value in undertaking for something they used infrequently.
Fast forward to the post-pandemic world, and video interpreting is now widely available on demand and technology has made it more accessible and reliable.
But while the business world has recognised that not every meeting needs to be held in person and that video calls represent a viable middle ground between physical meetings and telephone calls, unfortunately, many NHS services do not yet appreciate their full potential. This is a great shame because early adopters have seen improvements in both patient outcomes and their bottom lines.
One good example comes from the South London and Maudsley NHS Foundation Trust, one of the UK’s leading providers of mental health services. We worked on a project to help it increase the use of video interpreting over three years, with the trust improving fill rates from 95% to 98.8% and reducing costs by 15.9% over the period.
By the end of 2024, 18.9% of its interpreting bookings were taking place via video, a significant percentage given the average across our 100-plus NHS clients is just 2.8%. Importantly, this did not come at the expense of patient care, but rather from having clear processes in place to determine the most appropriate method of interpreting for each situation.
While it’s a useful option, video interpreting isn’t suitable for all interactions. For routine discussions such as delivering test results and making appointments, telephone interpreting continues to be incredibly effective. On the other hand, in-person interpreters remain vital for sensitive appointments relating to maternity complications or cancer diagnoses, for example.
There is so much scope to further digitise language services in the NHS, but the key is making use of it where appropriate and recognising circumstances where it isn’t. It’s not about having a one-size-fits-all approach but rather getting the balance right; this way organisations can provide better care to patients and optimise their resources.
