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Patient safety investigators have issued a warning to the NHS for writing to patients only in English after a Romanian child died following missed cancer scans.
The three-year-old, of Romanian ethnicity, underwent a delayed MRI scan after it was discovered he had eaten some food beforehand.
When the radiology booking team made the child’s MRI appointment, the NHS booking system produced a standard letter in English asking the child not to eat before the scan, despite the family’s first language was Romanian. Trust staff had handwritten on the patient’s MRI request sheet that an interpreter was needed.
“The family recognized key details in the written information, including the time, date and location of the scan,” the report said.
“However, they were unable to understand the instructions that the child not eat or drink (fasting) for a certain amount of time before the scan.”
The trust has tried to contact the family in English by phone and email but has received no response.
The scan was done the next day and the child was diagnosed. The three-year-old was treated but the cancer progressed and they died.
It is unclear from the report what impact the delay had on their prognosis.
The Healthcare Safety Investigation Branch (HSIB) has urged NHS England to develop and implement new rules on the provision of written appointment information in languages other than English.
Staff told HSIB that while it may be noted on the system that a patient has another language requirement, there is no ability to submit appointment information in another language.
“The NHS trust’s booking system was only able to produce appointment letters in English and there was no trust process or policy to translate written appointment information on a regular basis,” the HSIB said.
The HSIB survey focused on written patient communications used to book patients for clinical investigations.
He said the NHS uses paper or electronic systems or a combination of the two and highlighted how different trusts had different procedures for handling bookings and scans.
The survey found that for patients whose first language is not English, there is a risk that they will miss their appointment or may miss vital instructions, resulting in cancellations.
It also found that patients are not monitored for follow-ups and appointments are not rescheduled. Investigators found 34 national database incidents in one year across England relating to problems tracking patients.
“In many of these cases, the patient’s treatment options and prognosis have been adversely affected by the delay,” he said.
“Research has shown that these incidents have been reported across the country across multiple disciplines, indicating that this is a widespread problem and not related to a single trust.”
The HSIB said NHS staff from several trusts were told the expectation was that “a family member or neighbour” would translate letters for patients.
He also warned that information about patients’ language needs is being captured inconsistently or “not recorded at all.”
The HSIB said the current NHS Accessible Information Standard, designed to meet the communication needs of people with a disability, impairment or sensory loss, excludes interpretation and translation into language other than English.
In response to the report, the Commission on Equality and Human Rights said the HSIB investigation highlighted a “gap that urgently needs to be closed”.
Matt Mansbridge, HSIB National Investigator, said: “Our investigation shows that translating written communications poses a particular risk to patients if their first language is not English.
“When compared with the 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 life-changing or life-threatening conditions.”
In 2021, according to ONS figures, 1.5% of the population in England and Wales did not speak English well and 0.3% did not speak English at all.
