NHS warned over writing to patients only in English after child dies

The Healthcare Safety Investigation Branch (HSIB) has urged NHS England to develop and implement new rules on supplying written appointment information in languages other than English.

The three-year-old, of Romanian ethnicity, was referred for an MRI scan to rule cancer in or out, and needed a general anaesthetic.

At the time, medical professionals suspected that the region of the child’s body under investigation was non-cancerous.

Staff at the trust hand-wrote on the patient’s MRI request sheet that an interpreter was required as the family’s first language was Romanian.

But when the appointment for the child’s MRI scan was made by the radiology booking team, a standard letter was produced by the NHS booking system in English.

Staff told the HSIB that while it may be noted on the system that a patient has another language requirement, there is no facility to have appointment information sent out in another language.

The scan was booked by staff and a letter was sent to the child’s parents including the appointment details and pre-appointment instructions.

“The NHS trust’s booking system was only able to produce appointment letters in English, and there were no trust processes or policies to routinely translate written appointment information,” the HSIB said.

“The family recognised key details in the written information, including the time, date and location of the scan.

“However, they were not able to understand the instructions about the child not eating or drinking (fasting) for a certain amount of time before the scan.”

The trust tried to contact the family in English by phone and email but no response was received.

When the family attended the appointment for the scan, the child had already eaten, which meant the scan had to be cancelled.

In a further delay, the radiology booking team at the hospital did not receive confirmation of the need to rebook the scan. Eleven weeks passed before it was noted that the scan had not taken place.

When the scan was then rebooked, a letter was again sent to the family in English with the appointment details and information about the need for fasting.

The family was also contacted by phone and email in English but no response was received.

When the child arrived for the scan, it was found they had eaten and the scan was cancelled and rebooked for the following day. It was carried out and cancer was diagnosed.

The child received treatment but the cancer progressed and they died. It is unclear from the HSIB report what impact the delay had on their prognosis.

The HSIB investigation focused on written patient communications generated by systems that book patients in for clinical investigations such as X-ray, CT or MRI.

It said the NHS uses either paper-based or electronic systems or a combination of the two and highlighted how different trusts had different procedures for managing bookings and scans.

The HSIB found that for patients whose first language is not English there is a risk that they may not attend the appointment or they could miss vital instructions, leading to cancellations.

There is also additional risk that the patient can be ‘lost to follow-up’ – they are not tracked and appointments are not rescheduled, the HSIB said.

Investigators found 34 national database incidents in one year across England related to issues of keeping track of patients.

“In several of those cases, the patient’s treatment options and prognosis was adversely affected by the delay,” it said.

“The search showed that these incidents were reported across the country in different disciplines, indicating that this is a widespread issue and not related to a single trust.”

The HSIB said NHS staff at several trusts told it the expectation was that “a family member or neighbour” would translate letters for patients.

It further warned that information on the language needs of patients are inconsistently captured or “not recorded at all”.

The HSIB said the existing NHS Accessible Information Standard, which is designed to meet the communication needs of people with a disability, impairment or sensory loss, excludes non-English language interpretation and translation.

In responding to the report, the Equality and Human Rights Commission said the HSIB investigation highlighted a “gap that needs to be remedied urgently”.

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 with 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.”

Latest data from the Office for National Statistics (ONS) shows that, in 2021, 7.1% of the population in England and Wales (4.1 million people) were proficient in English but it is not their main language.

A further 1.5% (880,000 people) could not speak English well and 0.3% (161,000 people) could not speak English at all.

An NHS spokeswoman said: “Access to, and standards of, community language written translations or interpretation can sadly be a factor in poor health outcomes, including in the case highlighted by this report.

“It is the responsibility of local NHS services to provide or commission translation and interpretation services, but NHS England will be looking at how improvements can be made more broadly including in the availability of translation of NHS letters and will provide a detailed response to HSIB’s report.”