Working as an NHS midwife, I’ve seen firsthand how care experiences are affected when the person being cared for doesn’t speak or speaks limited English. My research has indicated that pregnant people are 25 times more likely to die in NHS maternity care when they cannot speak English. Despite these harrowing statistics, very little is in place to help promote equitable care for these women, highlighting why the NHS needs to take steps towards improving healthcare communication.
A systemic issue: the lack of training in maternity
As midwives, it is essential for us to prioritise providing person-centred care, recognising that each individual we encounter requires a unique approach. This demands flexibility in our interactions, including adapting the terminology we use to be more culturally inclusive. For non-English-speaking women and birthing individuals, using interpreters is crucial for effective communication, understanding and receiving essential pregnancy information. When professional interpreters are unavailable, family, friends, and children are often relied on to interpret clinical information, but we shouldn’t rely on people this way. This not only goes against national guidance, but it also causes vicarious trauma to those being used as a replacement for professional interpreters.
We must address the concerning lack of official resources in this field and empower midwives to access essential training. While some NHS trusts offer such education, they are the exception rather than the norm and despite guidance from NHS England and the government, specific training for maternity services is lacking. What’s more, the available guidance is largely unimplemented in numerous trusts. This indicates a systemic issue in healthcare and is something we need to change.
Why improving healthcare communication must become a priority in NHS goals
The NHS is not short of targets. While the current focuses are understandable and justified, it is difficult to understand why there aren’t – and have never been – any targets in place to improve communication, especially when it is so clearly linked to poorer patient outcomes.
It is widely publicised that maternal mortality for Black women is currently almost four times higher than for White women. For women of Asian and mixed ethnicity, it is 1.8 times higher, but we have yet to see a commitment by the government to reduce this figure.
The case for increased accountability in communication standards
The available guidance, including the Accessible Information Standard, does not go far enough. It fails to leave anyone accountable for making communication a priority.
It is imperative to establish accountability for enhancing communication, otherwise, disparities in care will persist. The common assertion that people ‘should have learned to speak English’ is narrow-minded. In my work in a rural setting, accessing language services presents significant challenges for most individuals. To address this issue, we should see communication as a protected characteristic, thereby making it a legal obligation to offer reasonable adjustments and defining the failure to do so as an act of discrimination. With careful drafting and implementation, I believe this approach could have widespread impact and provide crucial protection for many individuals.
It is vital for staff to be empowered to both understand the problem at hand, and understand what tools are available to solve it. Work is being done earnestly to address these communication barriers despite the lack of accountability. For example, solutions such as the health translation app, CardMedic, play a crucial role in this. It offers immediate language support at the point of care when professional interpreters are unavailable, improving communication and eliminating the uncertainty associated with non-healthcare specific digital translation tools by providing clinically validated content in over 50 languages and formats. Additionally, it addresses the safety and confidentiality concerns that arise from using a third party.
Simple and affordable technology like CardMedic has the potential to dismantle communication barriers in healthcare. They are crucial for helping families feel listened to throughout their maternity journey by empowering them to communicate with their care teams. This ultimately improves the patient experience and people’s health literacy as a result.
We still have a long way to go
The need for improved healthcare communication and accountability is evident and urgent. The lack of support and guidance for non-English speaking patients, as well as the lack of training for midwives has led to inequitable care and poorer patient outcomes. It is imperative that we prioritise communication standards within the NHS and establish clear targets and accountability to drive meaningful change. By recognising communication as a protected characteristic and mandating reasonable adjustments, healthcare providers can ensure that all patients receive the care they deserve.
Technologies like CardMedic offer a solution to be used in situations when interpreters are not available to bridge communication gaps, helping to empower both patients and healthcare providers to deliver safe and inclusive care throughout the maternity journey. It is encouraging to see the efforts being made by some companies to address these barriers but there is still much work to be done to challenge inequitable care and improve communication in healthcare settings.
By Maria Rowntree, Community Midwife Team Lead
