The Use of Phone Interpretation Services

June 2025

Introduction

Phone interpretation lines are used within the NHS to allow non-English speaking patients or patients with limited English proficiency to have appointments, ensuring fair access to NHS care. The UK population according to the 2021 census has 5.1 million (8.71%) people whose first language is not English, 0.9 million (1.47%) people with limited English and 0.26% that don’t speak English, therefore there is a big need for such services. In-person and phone line interpretation are available in both primary and secondary care; however, phone interpretation is used most often due to ease of use and lower cost. To book an interpreter, the patient must request an interpreter, or it must be noted on the patient records that they will require an interpreter for appointments. In urgent or emergency situations such as urgent care or A&E visit an interpreter can be requested but this can lead to waiting for an interpreter to be available.

Photo from Language Interpreters Ltd.

Biases and harms

When patients can’t get good translation support, they may stop using health services because they’re unable to explain their symptoms or understand the treatment they’re given. As a result, some turn to doctors in their home countries instead, asking for medicines to be sent to the UK, which can lead to delays, the wrong treatment, or care that doesn’t work properly.

Analysis and contributing factors

There are several reasons phone interpretation services are not used or not used effectively.

System-related barriers

Access to interpreters:
- Patients may be aware of the service but do not know how to book an interpreter or are unable to communicate that they need an interpreter.
- Interpreters may not be consistently available or have long waiting times, which can cause a delay to care and a breakdown in trust.
- People may feel too shy or not confident enough in English to be able to ask for an interpreter.
- Different sets of patient records may not be connected in a way that can store the correct language information, meaning clinicians can be unaware of any language needs.
Quality of interpreters:
- People have reported that they sometimes felt rushed by interpreters, that interpreters often didn’t understand the medical terms or didn’t understand what the doctor was saying, so were unable to communicate the consultation properly.
- Some interpreters respond to doctors without involving the patient. This can alienate patients from the conversation.
- There are also challenges when interpreters speak a different dialect of the same language, so the patient is unable to understand them fully.
Funding:
- Although the NHS recommendation is to always use professional interpreters, the way that individual Clinical Commissioning Group (CCGs) implement interpretation service varies significantly, so the quality of the services may be drastically different in different areas, with some CCGs providing only a small budget to GPs, limiting the service that is available.

Staff-related barriers

There is no clear and consistent way for staff to support patients with language needs.
Staff may not be aware or educated on the availability or use of phone interpretation services.
Staff often face time pressure particularly in GP or emergency settings, which can be further pressured by long waiting times for the phone interpretation services. In this context, there is a temptation to utilise friends and family members as interpreters, which can lead to poor quality interpretation, as well as raising ethical issues.
Staff attitudes towards patients using interpreters can stop patients from seeking interpreters.

Personal preference–related barriers

Some people may prefer for friends or family to act as interpreters and refuse the use of phone interpretation services.

Mitigation and recommendations

In 2021, The UK government published a guide on using interpreters and translation services in healthcare. This recommended always using professional interpreters to make sure communication is accurate, unbiased and safe. This also helps minimise legal risk, allows family and friends to focus on offering emotional support to the patient rather than translating and builds trust between patients and healthcare staff. Another consideration raised was the importance safeguarding patients particularly in potential violence cases. Although this guide shows the good principals for why a professional interpretation and interpretation services are needed. This has not necessarily translated into medical practice. Clear guidance and education on interpretation services and how to access interpreters on the use of interpretation is required at both a national and local level to ensure staff understand the services available. Staff needs to be supported to use phone interpretation services and given time within appointments to use such services. A funding model should be established by NHS England for CCGs to follow for interpretation services to ensure they are available for patients, and patients should be empowered to use such services and encouraged to access them.