NHS interpreting service problems contributed to patient deaths

Rana Abdelkarim died after suffering a bleed after giving birth at Gloucestershire Royal Hospital

Problems with NHS interpreting services have contributed to patient deaths, an investigation has found.

The BBC has found interpreting issues were a contributing factor in at least 80 babies dying or suffering serious brain injuries in England between 2018 and 2022.

Some staff have resorted to online translation tools to deliver serious news to non-English speaking patients.

NHS England said it was reviewing if and how it could make improvements.

Rana Abdelkarim and her husband Modar Mohammednour arrived in England after fleeing conflict in Sudan, both speaking little English.

It was supposed to be a fresh start but they soon suffered a devastating experience after Ms Abdelkarim was called to attend a maternity unit for what she thought was a check-up.

'She's passed away'

In fact, she was going to be induced, something Mr Mohammednour said he was completely unaware of.

"I heard this 'induce', but I don't know what it means. I don't understand exactly," he said.

Mr Mohammednour said he was promised a phone call from the hospital to let him know when his wife was ready to give birth so that he could be there with her but that call never came.

His wife suffered a catastrophic bleed which doctors were unable to stem and she died after giving birth to her daughter at Gloucestershire Royal Hospital in March 2021.

"They called me and said to me, 'you have to come hospital very quick' and then he said 'we tried to keep her alive but she's passed away'," the father-of-two said.

Modar Mohammednour and daughter Rana, named after her late mother

Mr Mohammednour now looks after his two daughters alone, the youngest of which is named after her mother, Rana.

He said better interpreting services would have helped him and his wife understand what was happening.

"It would have helped me and her to take the right decision for how she's going to deliver the baby and she can know what is going to happen to her," he added.

The Healthcare Safety Investigation Branch (HSIB) found there were delays in calling for specialist help, there was no effective communication with Ms Abdelkarim, and the incident had traumatised staff.

Gloucestershire Royal Hospitals NHS Foundation Trust has apologised and said it had acted on the coroner's recommendations to ensure lessons have been learned to prevent similar tragedies.

It added it was committed to delivering the safest possible service.

Serious interpretation failures

Under the 2010 Equalities Act, people who don't speak English have the right to be provided with an interpreter when they are dealing with public sector organisations in instances such as asylum applications and social services.

The National Register of Public Service Interpreters said "poorly managed" language services were "leading to abuse, misdiagnosis and in the worst cases, deaths of patients".

It was Ms Abdelkarim's death which led the BBC to write a Freedom of Information (FoI) request to HSIB which revealed serious interpretation failures are linked to about 80 babies coming to harm.

The BBC's File on 4 programme asked HSIB to review all investigations from 2018-2022 that involved cases of babies dying or being diagnosed with a severe brain injury in the first seven days of life.

The FoI found that of the total 2,607 reviewed cases, 80 included references to interpretation or communication problems due to language difficulties in the recommendation section of the report, which it therefore considered to be a contributing factor to death or brain injury.

Professor Hassan Shehata of the Royal College of Obstetricians and Gynaecologists

The data came as no surprise to Prof Hassan Shehata from the Royal College of Obstetricians and Gynaecologists who said there is a disproportionate risk of poor birth outcomes in women of colour.

He said the service was "failing some of the most vulnerable people in society".

"Add to that the language barriers, which will further exacerbate the risk with women struggling to access, engage with maternity services and communicate their concerns to healthcare professionals," added Prof Shehata.

'I couldn't understand them'

When Rula (not her real name) woke in hospital the day after giving birth to her first child, she was shocked to learn her womb had been removed.

She had suffered a life-threatening bleed shortly after labour at the Princess Royal Maternity Hospital in Glasgow in April 2022.

Staff could not initially contact a telephone interpreter for Rula, who is from Syria, and spent 15 minutes using Google Translate to try to make her understand she was going back to theatre for the emergency operation, before a phone interpreter was found.

She said: "Sometimes I could understand them, sometimes I couldn't. But I begged them, please don't remove my uterus."

When Rula woke the next day an interpreter had been summoned to deliver the devastating news in person. "Because most interpreting services was provided over the phone, I couldn't understand them. They couldn't understand me," she added.

NHS Greater Glasgow and Clyde said a telephone interpreter had been made available throughout her labour but it appreciated this had been "extremely challenging" and it would like to apologise for any concerns she experienced.

It said it was "not routine to use face-to-face interpreters due to Covid", adding her claims were investigated but not upheld.

Rula, who had wanted more children, now wishes she had been sent an interpreter the day before. She has been left wondering if it could have made all the difference.

'Wild west' Executive director of the National Register of Public Service Interpreters, Mike Orlov, told the BBC the level of qualifications in the profession varied hugely, making standards "extremely patchy".

Mr Orlov has likened the NHS to the "wild west", where all trusts are encouraged to operate their language service needs independently and there are many instances where family members or friends are deployed in hospitals.

NHS England said the service was vital for patient safety and a review would identify if and how it can support improvements in the commissioning and delivery of services.