The NHS Translation Crisis: Can Bilingual Nurses Save the Day?

Somewhere on a hospital ward in the Midlands, a nurse leans across a bed and tries, for the third time, to explain what a cannula is. The patient gives a nod. She gives a nod in return. What was just agreed upon is unclear to both of them. Once more, a bilingual healthcare assistant is paged from a different floor. She’ll come, eventually. She does it every time.

In a way, this is how the NHS translation system operates. The NHS translation system is also at fault. Both things are true at once, and that contradiction sits at the heart of a problem the health service has been circling for years without quite being willing to name. Around the country, translation and interpreting services for community languages are wildly inconsistent. Some trusts have polished video-interpreting platforms. Others rely, frankly, on whoever happens to be on shift.

On paper, the legal obligations are fairly obvious. The Equality Act, the NHS Act, the various accessibility frameworks — all of it points in the same direction. Communicate inclusively, or take responsibility if you don’t. However, the same patterns continue to be discovered by investigations conducted by what was formerly known as HSIB, now known as HSSIB. One case, raised in 2023, still hangs over the conversation: a Romanian-speaking family whose child was referred for an MRI requiring general anaesthetic. The translation was delivered orally. The letters that were written did not. The family understood the date, the time, the place. They overlooked the part about fasting. The scan was cancelled. The referral got lost. Eleven weeks passed. The scan was cancelled a second time. The child died. The report was careful — it didn’t claim earlier imaging would have saved them — but the patient safety failure was undeniable.

There’s a sense, talking to people who work in this space, that everyone has known this for a long time. The new framework from NHS England acknowledges as much, putting responsibility on ICBs and trusts who, in theory, know their local communities best. In actuality, “local commissioning” tends to be synonymous with “patchy.”

Where the slack is picked up is interesting. The picture that emerges from a recent qualitative review that compiled 18 studies involving 416 nurses from eight different countries is strangely familiar to anyone who has worked in a British hospital. In general, nurses enjoy working with qualified interpreters. Additionally, they complain about how long everything takes, struggle with unreliable video link-ups, worry about accuracy, and feel excluded when an interpreter takes over the conversation. They therefore improvise. They lean on bilingual colleagues. They ask family members to translate, knowing perfectly well they shouldn’t.

It’s hard not to notice how much of the NHS now runs on these quiet workarounds. The bilingual nurse who speaks Urdu and gets pulled into every ward round involving a Pakistani family. The Polish-speaking healthcare assistant who somehow ends up doing safeguarding interviews. They’re not paid for it. They’re rarely trained for it. They just do it, because the alternative is worse.

Whether bilingual nurses can really “save the day” is, honestly, the wrong question. They’re already holding things together. The real question is whether anyone with budget authority is willing to admit it, formalise it, and train for it — or whether the system will keep relying on goodwill until the next inquiry finds another family who understood the time and the place but missed the part that mattered.