NHS ‘failing those who don’t speak English’: Your comments

Caroline Wright, Royal College of Obstetrics and Gynaecology trainee, questions whether the NHS is offering a good enough service in providing interpreters when a patient does not speak English.

Her view is that it is totally unrealistic to expect all patients to speak English and services to support those needing and wanting to learn English should be readily available within a health care setting.

BBC News website readers have been sending in their comments.

Your comments

As a doctor in the NHS and a member of an ethnic minority, I strongly feel that anyone wishing to reside in another country should have the basic courtesy to learn that language. This applies to ethnic minorities choosing to come to the UK as well as Brits choosing to live over in France and Spain. The resources of the NHS are severely overstretched. The extra money required to fund this would be better put to use by employing more doctors and nurses. Ravi, Leeds

Falling ill on holiday in France, despite being fluent in day-to-day conversation I sought advice from my mother-in-law (who's lived there for 20 years) in order to be able to explain my symptoms to the doctor - why on earth should I expect him to speak a foreign language? It's not the NHS's responsibility to cater to non-English speakers, it is up to them to bring an interpreter if they require one. Megan, Cheshire

It is totally reasonable for anyone who wishes to access the services provided by the state to speak the official language of that state. I have both worked and lived overseas and never once have I been given or offered free access to either state provided services or interpreters. Lets address and tackle the cause rather than the symptoms of the language barriers rather than adding yet more costs to a system under severe stress. Andrew, Bucks

I agree completely with this piece. In most doctor-patient situations trust needs to be built up very quickly and it seems impossible for this to happen without verbal communication. Particularly when terms used at the doctors or dentists tend to be obscure. The idea of being examined by someone you can't verbally communicate with is very scary. Lorna, Manchester

As a foreign national in the UK I am pleased to be able to say that I am very good at English and have never had any trouble communicating with my GP. However, I also think that being on a nearly-native basis in English has had a positive effect on my relationship with my GP as I do not just understand the facts about my health, but I feel I can express myself more freely without having to search for the right words. People with a limited command of English will find it difficult to establish such a relationship of trust. Imke, London

In Spain their health service doctors insist that non-Spanish speakers provide their own translators, which is causing problems for British people who have moved to the Costas but haven't bothered to learn the language. This does not seem unreasonable. The same should apply to the NHS in England. Brian, Surrey

Given the current financial constraints in the NHS, providing additional training for doctors to help them more effectively utilise interpreters hardly seems to be a priority. As this is an English speaking country, surely there must be a reasonable expectation that most patients, who are resident here will speak some English or can bring a friend or family member, who does. Interpreters should only be provided in those instances where the patient is not a resident and in those cases the expense of an interpreter should be borne by the patient. A, Murphy, Wolverhampton

I work for the NHS in the community in central London and recognise and agree with all the issues mentioned in this article. I think more training for staff is key so that we understand how to use the provided interpreting services effectively, and also appreciate the importance for our own practice and for patients of good accessible interpreting services. We will then all be more likely to press for improvements. (The patients usually will not do so due to the language barrier!) I worked in the Hackney area 20-years-ago and was lucky enough to benefit from the training for staff that was provided on 'Working with Interpreters' (a skill in itself), and 'Working in a multicultural setting', (which I found to be eye-opening). I often wish from what I see that my colleagues could have similar training but this is not provided in the central London area where I now work. Anecdotally, from what my patients tell me, it seems as if GPs do not use interpreting services enough. This could also be an area for improvement. Alice, London

I think the NHS does a fine service - translators are usually on hand. If migrants don't bother learning English when they come to live here, then they have to accept there are going to be times when they aren't going to be able to communicate properly. If England was a country where few foreign people spoke the language then it would be different - but English is a global language. Drew, Aldershot

Visitors to this country should be helped in every possible way to communicate with the NHS, especially with regard to acute problems (A&E for example). However, shouldn't people who settle in the UK as residents make an effort to learn English? How else can they integrate into our society? Derek, Surrey

The NHS is massively overstretched and while it is admirable that staff feel disappointed when they are unable to provide the same level of care when language poses a problem, surely the emphasis must be on ensuring that all residents of the country speak adequate English? It's not just a matter of health care - it's about integration. If you cannot communicate with the rest of society then you cannot be a part of that society. Kev, London

Money spent on the NHS should be spent on treatment or drugs - not translation services. Want to live in England? Then learn to speak English - if not take your own translator along. Alan, Truro

Having worked in France, Germany, Thailand, China and Brazil my take on this subject is that if you want to benefit from a particular country you must embrace that countries culture. If I insist on speaking only English then I must accept I cannot make full use of whatever services or facilities the country I may be in can offer. Paul, County Antrim

Treatment must be very difficult without proper communication and must be funded where it is urgent, perfect translation has two risks however. It gives less incentive for any non-English speaker to even try to learn our language and therefore integrate properly. Secondly, it could promote 'health tourism' which is unfair and is a drain on our resources. Councils have printed documents in multiple languages for many years (only in areas with high levels of non-English speakers perhaps). I wonder what effect this has had? Finally, how does our experience compare to other countries? Do nations benefit from widening translation services or restricting them? Aly, London

I find it absurd that there's a call for MORE of our taxpayers money to be spent on multi-language services in the NHS. Yes, we need to ensure that interpreters are available for each language that we might come across, but that doesn't mean that vast swathes of the budget are required to ensure that there are as many interpreters available as there might be patients who haven't learned English yet. That's unsustainable and effectively discriminates against those who can speak English by taking funds away from the core of the NHS as a health service. Richard, London

If there is a large local immigrant community, it would make sense to try to recruit English-speaking members of that community into roles in a hospital, with part of their responsibility being to translate when needed. However, the NHS does not have a responsibility to provide translators for people who move here and choose not to learn English. I have personal experience of the language difficulties for foreigners from when I lived abroad - I reduced those difficulties by learning the local language. David, Surrey

I always felt doctors and nurses with language skills should be given preference over those who only speak English. If a position is being advertised in Leicester (say), selecting people without any knowledge of Indian languages is neglectful and misunderstanding of job requirements. I am not advocating selecting inferior candidates but advocating for superior candidates who have better communication skills and language is major makes part of it. Khalid, Birmingham

I recently visited one of Poland's seaside resorts on holiday with my family. My sister mistakenly brought an empty packet of medication with her. Using phrase-book Polish I was able to get her registered with a polyclinic, get a doctor's appointment and a prescription. Half an hour later and £10 poorer we left the pharmacy with the right medication. My sister works in the NHS and commented that this would have been impossible in the UK even for fluent English speakers. The maddeningly uncoordinated and inefficient bureaucracy that is our NHS thwarts access to care for native and immigrant alike. Andrew, Surrey

I appreciate this viewpoint but I believe that if you are migrating to another country, for whatever reason, it's your obligation to learn the language. This helps you function fully in society socially and commercially but also helps you can be safe when you can understand exactly what's going on. When I lived abroad I was never offered, nor expected an interpreter when I used health services. In addition, the cost of interpreters to the NHS is enormous and unless the NHS finds a better way of managing non-English speaking patients, this cost will only rise.

Where I live there are lots of language courses offered, at different times of the days and free to those on a low income so I disagree that access is a problem. I think the writer may have touched on a bigger issue which the need to improve communication skills. There have been times I've had to remind my doctor to talk in plain English rather than medical jargon and during one recent hospital appointment the nurse spoke to my husband the entire time as if I wasn't even there, even though it was my appointment. Louise, Salford

There is a finite amount of money for the NHS and providing a widespread interpreter service is just not economically viable given the range of languages spoken in the UK today. Money could be better spent on providing frontline services for the elderly and vulnerable, the NHS simply does not have the resources for this and inhabitants of the UK must speak the language or pay for an interpreter themselves, it is completely unfair to expect the rest of the working population to fund this. Michael, Crawley

The tip of the iceberg is not just your ward rounds or even the wider problem of gaining access to translators. The real problem is the social exclusion and poverty that comes from not being able to fully engage with the society you live and depend on. Translation services treat the symptoms and not the cause. We need to invest in teaching settled migrants to communicate effectively in English and make passable English a criteria for immigration even if you do have family here. This is for those peoples own welfare, as well as society at large. Tom, Manchester

I am a healthcare professional. I am bound by my profession to provide full, impartial advice to my patients and gain consent. This is not a grey area. If it is not possible to achieve this due to language barriers, it is not possible to advise or treat patients who are non-English speaking. I feel the NHS is a service to UK citizens. UK citizens must speak a degree of English. The burden of providing a translator is not that of the NHS or UK taxpayer but that of the non-English speaking person seeking NHS care or treatment in the UK. Anon, Kent

The amount of money spent in this country providing free translation services is massive. If you travel to any other EC country and require translation services for what ever reason you have to pay for it yourself. Why should the UK be any different? In a time of severe public service financial cuts, this is one service that we do not need to provide - let the private sector pick up the slack and provide these services at cost to the consumer. Alison, Newcastle

I work in an outpatient department and find the reality of language barriers an area that effectively steals money from the medical services. Interpreters are paid in the region of £50 an hour, regardless of whether the patient actually attends. We could reduce costs by putting non-English speaking patients directly through to see Doctors, but this queue jumping would anger other patients. If the patient does not attend the interpreter is paid for turning up and then rebooked for another appt. If the interpreter doesn't attend then the patient must be sent home and the appt rearranged - again using other time slots. Due to cultural demands the interpreter must be of the same gender. And legally we cannot use a relative to translate. I personally feel that the NHS should discount interpreters but that non-english speaking Out-Patients should contribute to the cost. (Obviously for emergencies these services should be free of charge.) Anon, Manchester

Although interpreters are a way of addressing the language barrier they can often create additional barriers by misinterpreting, omitting and editing information to fit in with their views of what convention a patient-provider interaction should follow. Unfortunately, the patient and the health professional are none the wiser and may receive inaccurate information which can lead to inappropriate and, sometimes harmful medical decisions. N Ahmed, Edinburgh

The health service is unsustainable in its current guise, we no longer have the funds to facilitate health tourism or indeed the agency personnel to support trust's throughout the country. We need to adopt a system such as the French one, where everyone is registered correctly and contributes accordingly. We cannot continue to live on past glories, the world of the 21st century is far removed from the idealistic socialism of Aneurin Bevan in the days of the NHS' inception, no other country in the world offers the like for obvious reasons! Andrew, Reading

It's time there was a nationally coherent, consistent service available across the whole public sector. Ladies who have babies also need many other public services including housing, social services, police and courts, schools and all the others. If interpreting, translating and language support were better organised overall these shortages wouldn't happen. We need an overarching policy from government to maximise resources and raise standards. Jan, Wirral

Caroline's wish to do the best for all her patients is admirable, but this is not a case of the NHS failing anyone. If people who live here don't make the effort to learn English, then they're really failing themselves. Translation already costs the NHS many millions of pounds every year, and there's not a lot of spare cash swilling round right now. People should think of learning English as a way of helping the NHS to save money that would be better spend on patient care. Mat, Sheffield

While I was in my local hospital having my baby, there were a few Nepalese women in also having babies. They seemed to have limited English and so it appeared that the midwives found it easier to communicate when the husbands were there. As these husbands are part of the British Army it seems unreasonable to expect the wives to have a good grasp of English when they are not likely to be anywhere long enough to need it. Plus of course there are those that are born here (British by birth and ancestry) who don't necessarily have a good grasp of English either! Dawn, Surrey