Languages and interpretation: experiences accessing health services among people that do not speak English as a first language

1. Executive summary

This report explores the experiences of accessing NHS health services in South West London for those who do not speak English as a first language. This work builds on insights from our 2025 spring engagement fund, where language barriers were identified as a key issue in accessing health and care services.

To explore this in more depth, we carried out targeted qualitative engagement with local communities across all six boroughs, working with voluntary, community and social enterprise (VCSE) organisations. A total of 32 people from a range of cultural backgrounds and across a number of languages shared their experiences through discussion groups and one-to-one conversations.

Key findings for consideration have been outlined below:

• Language barriers can delay care and lead to inappropriate service use at every stage of care with people putting off contacting their GP, relying on self-care and pharmacies, waiting until travelling abroad to see a clinician, or attending A&E when primary care felt too difficult to access. One person didn’t attend at all because they “didn’t understand how to register with a GP when they arrived in the United Kingdom”.
• Sufficient time and clear communication during appointments is key – we heard about difficulties in describing symptoms, understanding clinicians and next steps and that appointments were not long enough to take in to account the extra time it took when an interpreter was needed. Face-to-face and video consultations were often preferred over phone, as visual cues improved understanding. People valued when “GPs are kind, speaking slower and using simple English. It doesn’t guarantee I understand 100% but as long as I understand follow up actions and what I need to do next it’ll be ok.”
• Written communication and follow-up can be hard for people to understand – letters, prescriptions and aftercare information were sometimes unclear, particularly when only provided in English. “GPs talk and write letters in long sentences and need short sentences to be able to help understand.”
• Interpreter services, booking systems and digital tools present ongoing barriers – many were unaware that interpreters were available or found them difficult to access, particularly for urgent care. Where interpreters were available, they didn’t always speak the same dialect which caused significant additional difficulties “You get what you are given, and you just hope they speak your language”. Digital tools such as the NHS app and other booking systems were helpful for some, but others found them complicated to navigate in English “Having a translator would make me very independent.”
• Experiences with reception staff and hospital settings vary – we heard that the initial interaction with reception staff could make all the difference to the overall experience as it is “not easy to understand what is being asked of me.”
• Reliance on family members is common and can lead to difficulties with many relying on relatives to book appointments, interpret during consultations and translate information, raising concerns about confidentiality and appropriateness. “It would be helpful to book independently but that isn’t possible with only a few words of English.”

Overall, our aim is for this insight to:

• Help to inform service improvements across health and care services to better meet the needs of people who do not speak English as a first language.
• Be shared with providers, commissioners and partners to support future planning and service design.
• Support ongoing work to reduce health inequalities across South West London, particularly for Core20 and underserved communities.

2. Introduction

This report presents feedback gathered through in-depth qualitative engagement activity focused on understanding more about the barriers faced by people accessing NHS services who don’t have English as a first language. These barriers can affect people’s ability to access care, understand health information and navigate NHS services. This emerged as a key theme during our spring engagement fund 2025, where we worked with local communities to explore experiences of accessing NHS services, with a particular focus on Core20 populations and other underserved communities.

In response to this feedback, we developed an engagement programme which aimed to explore these issues in greater depth, focusing on how language barriers affect patients’ journeys through primary care and how access could be improved.

The engagement also explored the use of interpretation services and the lived experiences of communities, building on existing understanding of how interpretation services are accessed and used. This included understanding communities’ awareness of interpretation services and identifying opportunities to improve accessibility for people who do not speak English as a first language.

This report outlines the engagement approach used to help understand  the language barriers experienced by communities living in South West London, and explores the key feedback we heard through our activities.

3. Methodology

3.1. Engagement approach

3.1.1. Phase 1: Spring engagement fund

In spring 2025, we delivered our spring engagement fund which involved engaging with local communities, focusing on our Core20 and underserved communities, to understand their experiences of local health and care services. The aim of this programme was to help us understand their access to and experiences of local NHS services, as well as behaviours related to maintaining healthy lifestyles. Grants of up to £550 were awarded to local communities to deliver community-based engagement activities. This involved working collaboratively with lead Voluntary, Community and Social Enterprise (VCSE) organisations who helped with the delivery of the programme.

Findings from our spring engagement fund can be viewed here in individual borough reports: Croydon, Merton, Wandsworth, Sutton, Kingston and Richmond.

Insights relating to language barriers were then identified and analysed. This analysis informed the design of Phase 2 of our engagement approach which has been outlined in the section below.

We continued working collaboratively with lead VCSE organisations within each borough as we progressed Phase 2 of our engagement approach.

3.1.2. Phase 2: Follow-up deep dive on languages and interpretation services

We drew on a range of insights and information sources to inform our engagement approach. Findings from our spring engagement programme highlighted language barriers as a key challenge for residents accessing services. Business Intelligence (BI) data and information from primary care were also analysed, together with Joint Strategic Needs Assessments (JSNAs), which identified the most commonly spoken languages across boroughs. Reviewing interpretation service requests and usage patterns at borough level helped us identify key languages and communities and informed who we approached for engagement.

Our aim was to conduct in-depth qualitative insight with a sample of people who did not speak English as a first language from a sample of people rather than intended to be representative of all communities across South West London. Community organisations working with these populations were contacted and invited to support follow-up engagement to explore experiences on language and interpretation services. This included face-to-face interviews and facilitated discussion groups. We worked with the community organisations to provide interpreters who are trusted by their community to support conversations in the different languages. Community organisations received £550 to support the organisation and delivery of targeted engagement sessions. Those involved in the engagement activities were offered a £30 voucher as a thank-you for their participation. A question framework was developed and tailored for one-to-one conversations and group discussions.  

3.2. Who we heard from

We engaged with a total of 32 adults aged between 27 and 73 years living in South West London. This included both women and men, with the majority being women (28 women and 4 men). Participants’ primary languages included Urdu, Somali, Spanish, Punjabi, Cantonese, Mandarin, Hindi, Korean and Portuguese.

We heard from people with varying levels of English confidence and health literacy. This included people who were new to the UK, as well as others with more experience of using NHS services. Details of the communities we engaged with have been outlined in the table below.

Table 1 Details of engagement activity across boroughs

3.3 Limitations

The aim of the engagement was to conduct a sample number of conversations rather than to be representative of all views from all communities across South West London. The engagement was designed to gather in-depth qualitative insight into people’s experiences of accessing healthcare and interpretation services where English is not their first language.

While the number of participants was relatively small, consistent themes emerged across boroughs enabling us to identify common barriers and experiences.

4. Detailed findings

4.1.1 Language barriers affect access throughout the patient journey

Language barriers were described as affecting access to care at every stage of the patient journey across all boroughs. People highlighted challenges from GP registration, through to booking and attending appointments, understanding follow-up information, and navigating urgent or emergency care.

People who were new to the UK described initial access as difficult because of language barriers. People told us that when they first registered with a GP, they found it very hard to understand how to sign up and how to book appointments. While some felt they learned how the system worked, routine appointments were still described as difficult to access (Somali Community CIC).

For Spanish speakers in Croydon, confusion around GP registration led to avoidance of care and using other routes to access a GP. One person avoided attending altogether because they “didn’t understand how to register with a GP when they arrived in the United Kingdom”.

We heard about attempting to register online and using a service called GP Pathfinders, believing it was the official way to sign up with an NHS GP. This resulted in booking an appointment with a private provider far from where they lived (Croydon Vineyard).

Confidence navigating services seemed to vary. Some people described learning how the system works, while others continued to rely on support. In Croydon, one person said they could usually “get by with very limited English” and felt confident navigating most parts of the health service but would ask a sibling or family member if something did not make sense (Croydon Vineyard). In contrast, others described confusion about how to access care, particularly for early points of contact (Somali Community CIC; Croydon Vineyard). Navigating the system was also felt as especially challenging for those caring for young children. One person explained that although their “GP practice was trying to help as much as possible”, they still found navigating the system “very difficult, especially as a new mother” (Somali Community CIC).

People described that language needs were not consistently identified or planned for across services. One suggestion was that a shared system to flag language needs across services “would make life a lot easier”, so that “GPs and hospitals know people don’t speak English. This could also allow for translators to be organised before they arrive for appointments” (Multicultural Richmond).

Language barriers were also described as affecting access in urgent situations. In Croydon and Merton, people described uncertainty about who to contact in an emergency when English was limited (Croydon Vineyard; Somali Community CIC). A couple also described delaying calling an ambulance when one of them experienced a stroke because they relied on their daughter to call on their behalf who was unavailable at the time. They stated: “It’s worrying when every minute counts with a stroke” (Multicultural Richmond).

4.1.2 Language difficulties are a key barrier when booking appointments  

Difficulties and inability to book appointments was raised as a barrier across all boroughs. People described difficulty using all booking routes including walk-in, phone and online.

Online booking was often avoided because of language and digital barriers. Some people said they “never use online booking due to digital and language barriers”, while others explained that “it would be helpful to book independently but that isn’t possible with only a few words of English” (Multicultural Richmond). In Kingston, people reported “great difficulty in booking a GP appointment due to not speaking much or any English” (Kim’s Dance School).

“It would be helpful to book independently but that isn’t possible with only a few words of English.”

In Croydon, people said they avoided phone booking because they found it difficult to communicate in English and because phone booking did not allow them to choose the clinician they had built a relationship with (Croydon Vineyard).

In Kingston, phone booking was also described as challenging across boroughs. Recorded messages and questions asked by receptionists were felt to be “confusing and difficult to translate” and “not easy to understand what is being asked”. Walk-in attempts were also described as rarely successful, and GP websites were described as “hard to understand” (Kim’s Dance School).

People described switching between booking routes depending on urgency and their confidence. In Sutton, one person said they try online booking first using Google Translate, but if they cannot understand they then try calling their GP practice (Sutton Mental Health Foundation). Others said they attend the practice in person because using body language helps communication and makes it feel “easier” (Sutton Mental Health Foundation).

4.1.3 Reliance on others for support

Communities across boroughs highlighted reliance on family members and others to access health care services. People described how relatives often helped with booking appointments, attending consultations, translating during appointments or telephone calls, and interpreting written communication.

Lack of confidence or not speaking English at all were described as key barriers to arranging appointments independently. Some people said they asked someone else to contact the GP practice on their behalf, particularly when requesting translation support (Somali Community CIC). In Wandsworth, only one person was able to call and speak directly to the receptionist themself. All others relied on family members, including husbands, sons, or daughters to make the call on their behalf (Happy Homes).

Reliance on family members was also helpful with understanding information from health services which did not make sense and to translate during appointments (Happy Homes, Somali Community CIC, Multicultural Richmond, Richmond EAL, Kim’s Dance School and Sutton Mental Health Foundation).

Depending on others to access care was also described as challenging. Some people who relied on their children said this was “a big, big problem” (Multicultural Richmond). They explained that they had to disclose medical problems to their children so the child could explain them to the GP and then translate the GP’s response back to them.

Reliance on family members also raised cultural and privacy concerns. One person described changing GP practice so they could speak directly with a doctor in Hindi. This decision was prompted by needing to discuss menopause but feeling unable to talk about their symptoms with their son for cultural reasons (Multicultural Richmond).

Some felt that relying on others to interpret limited their access to care. One person said they “always depend on someone to go with them”, usually a family member or local friend, but this was “not always possible” because of work. As a result, they sometimes missed appointments because they “don’t feel comfortable to go alone” (Sutton Mental Health Foundation). This issue was also reported in Kingston, where people described “asking family, going to A&E, or going without” care when they were unable to access their GP (Kim’s Dance School).

4.1.4 People delay or avoid GP care and rely on self-care, pharmacies or use A&E

People described delaying or avoiding GP care because of language barriers in most boroughs, with people stating they rely on self-care, pharmacies, attend A&E when symptoms worsen and waiting until they travelled abroad to see a clinician to obtain medication.

GP appointments were described as “very stressful”, particularly when someone is already feeling unwell. As a result, some people said they try to deal with health issues themselves rather than contacting the GP. This can mean that by the time they do see a GP, they have more than one issue to discuss (Richmond EAL). Others also said they often rely on self-care before seeking medical help (Sutton Mental Health Foundation), with the problem often becoming more serious as a result. Others choosing to self-treat instead, including “waiting until travelling abroad to see a doctor and obtain medication” (Sutton Mental Health Foundation).

Some people described turning to pharmacies or informal advice instead of contacting their GP. People said they may ask a pharmacist for help, ask a friend to recommend medication, or try to manage symptoms themselves before attempting to book a GP appointment (Kim’s Dance School). Some also described sharing medication or guessing medication advice and only trying to contact a GP or attend A&E once they are “really desperate”, describing the long waits for both services as “so damaging” (Kim’s Dance School).

When symptoms worsen, some people said they attend A&E instead of trying to contact their GP. Some explained that they sometimes go “straight to A&E” out of hours because communicating in English is “easier when seeing someone” (Sutton Mental Health Foundation). Others said they try to avoid this because of long waiting times. One person described going to A&E and waiting there for three hours after being told a GP would call back but no call came. A&E staff advised the person to leave and contact the GP again, but they felt unable to explain that booking an appointment was very difficult for them (Kim’s Dance School).

People also said language barriers were one of the reasons some avoid contacting the GP in the first place (Somali Community CIC).

4.1.5 Difficulty describing symptoms and understanding clinicians

People described difficulty explaining symptoms and understanding clinical advice without interpretation support.

Some people said language barriers made it difficult to communicate clearly with their GP. One person explained they had changed GP practice to one which had a Punjabi-speaking GP because they could not understand doctors or reception staff or explain their symptoms in English: “I changed doctors because of that” (Multicultural Richmond). People said they could usually understand simple instructions such as “get a prescription from the pharmacy” but struggled when conversations involved more detailed information or when symptoms worsened.

Many people described finding it difficult to explain symptoms in English. Some said they bring children or friends to appointments or call a family member during the consultation to interpret (Kim’s Dance School). People also said interpreters are needed not only to translate words but to support understanding, as “GPs talk/write letters in long sentences and need short sentences to be able to help understand” (Kim’s Dance School).

Uncertainty about vocabulary also made it difficult for some people to describe pain or symptoms. Some said this means they avoid booking appointments unless the issue feels urgent (Happy Homes). Experiences were described as varying depending on the clinician with some stating they find it difficult to understand while others did not. As mentioned previously, some people also said they call a family member during appointments if they cannot understand the clinician what is being said (Happy Homes).

This was echoed across other groups. In Merton , people highlighted that some medical terms do not exist or translate clearly in their language, and that differences in dialect can lead to serious misunderstandings, for example, one person shared that a word was mistranslated so that “eat” was understood as “fast,” leading to incorrect medical advice (Somali Community CIC). In Kingston, people said that even when information is translated, NHS terminology can still be difficult to understand. Similarly, in Sutton, people described relying on basic or simplified language to explain symptoms, often preparing what they want to say in advance.

“GPs talk/write letters in long sentences and need short sentences to be able to help understand.”

People described preparing for appointments in advance helped. Some said they write down what they want to say and translate it into English beforehand to help explain their symptoms during the consultation (Sutton Mental Health Foundation). This was also highlighted in Richmond: “Every time I rehearse what I’ll say. I’ll look in the dictionary to rehearse words to discuss my symptoms with the GP” (Richmond EAL).

People also valued clinicians who adapt their communication style. One person said: “Most of the GPs are kind, speaking slower and using simple English. It doesn’t guarantee I understand 100% but as long as I understand follow up actions and what I need to do next it’ll be ok.” (Richmond EAL). Some also described relying on tools such as Google Translate or clinicians speaking slowly. Being able to choose a clinician through the NHS App helped some people feel more comfortable asking doctors to repeat information if needed (Croydon Vineyard).

“Every time I rehearse what I’ll say. I’ll look in the dictionary to rehearse words to discuss my symptoms with the GP.”

One person said they had left a previous GP practice because of communication difficulties but felt more comfortable with their current GP, describing them as “very patient, very nice” (Sutton Mental Health Foundation). In Merton, everyone said that without an interpreter or a trusted family member present, it was extremely difficult to explain symptoms or understand questions or what the doctor or nurse was saying. People felt that interpreters were essential to ensure patients could understand their care and make informed decisions (Somali Community CIC).

People also described strategies they use to manage communication during appointments. Some said they check their understanding by repeating information back to the GP: “Many described repeating what they believe the GP has told them back to the GP in order to confirm what the GP wants them to do or what the GP will do.”

4.1.6 Follow-up and aftercare are hard to understand, including prescriptions and next steps

Across boroughs, people described difficulties understanding what happens after an appointment. This included confusion about medication instructions, prescriptions, referrals, and what to do if symptoms do not improve.

Google Translate was often used as a tool to help with interpretation and understanding (Sutton Mental Health Foundation, Croydon Vineyard, Richmond EAL, Kim’s Dance School). Another said they try their best to follow the GP’s advice, but if their symptoms do not improve, they return to the GP to clarify their understanding or for further help (Sutton Mental Health Foundation).

People also described difficulties understanding medication instructions. Some said GPs usually explain how to take prescribed medication, but they do not receive the same explanation from pharmacists. One person said: “Pharmacists don’t say anything, they just hand it over” and another said the only information they receive is “just what’s on the box” (Richmond EAL). Similar experiences were described elsewhere: “They just hand over the medication when aware someone doesn’t speak English” (Kim’s Dance School). People also described finding prescription forms difficult to complete and sometimes relying on trust instead of understanding: “I just trust the GP/pharmacy”. Others said they ask family or friends to translate the information leaflet inside medication packaging (Kim’s Dance School).

“Pharmacists don’t say anything, they just hand the medication over.”

Some people said physical prescriptions help them understand what to do next. People explained that when given a green paper prescription they knew exactly where to go and what step to take, even if they were not completely sure what the medication was for. Several people said that digital prescriptions can make it harder to understand. People suggested that patients should be given a choice so they can still receive a physical prescription if it helps them understand what to do next (Somali Community CIC).

People suggested more GP support would be useful before leaving appointments, to help people understand whether they need to attend another service or follow further instructions, and to ensure information is available in different languages (Multicultural Richmond).

4.1.7 Interpreter services are inconsistent and not routinely offered

Across boroughs, many people described that interpreter services were not routinely offered and inconsistently provided. Most people were not aware that GP interpreters were available, did not know how to request one, or found interpreter support difficult to access, particularly for urgent or same-day appointments.

One of the main findings raised was regarding dialect differences. Members of Somali Community CIC said it can feel like “luck whether the interpreter speaks the same dialect”, and that misunderstandings can occur even when an interpreter is provided. One example described a key word being misunderstood during aftercare advice, which could lead to unsafe guidance. While they could request a male or female interpreter, they could not ensure the interpreter spoke the correct Somali dialect. One person explained: “You get what you are given, and you just hope they speak your language” (Somali Community CIC). In Croydon, one person said they avoided calling their GP practice because Spanish translation was not available. The practice offered translation support in Japanese, Somali, French and Italian, but not Spanish.

Concerns around reliability was also raised. People said it can be “difficult to get an interpreter and sometimes they don’t turn up” (Richmond EAL). Even when people expected an interpreter to be arranged months in advance for hospital appointments, they were often left unsure whether it was confirmed and would be in person or by phone: “You assume you’ll get an interpreter in person, but it can be on the phone” (Richmond EAL). Many people said they prefer face-to-face interpretation because it makes communication easier and clearer (Richmond EAL, Multicultural Richmond).

In Multicultural Richmond, one person said: “I wouldn’t have changed GPs if I knew about the interpreter service”. People said they did not know interpreters were available at GP practices and suggested clearer promotion in surgeries, such as posters and information in relevant languages. Face-to-face interpretation was preferred, with phone interpretation seen as a second option (Multicultural Richmond).

“I wouldn’t have changed GPs if I knew about the interpreter service.”

In Kingston, few had used an official interpreter or been offered one. They explained that interpreters can usually only be booked after a GP appointment is secured. One person described being told: “The receptionist said there’s no budget for an interpreter as they don’t have the system anymore”. People felt interpreters should be offered when appointments are booked and available across all points of contact, including help with understanding follow-up letters and referrals: “Someone to translate all the time” (Kim’s Dance School).

Arranging an interpreter for urgent appointments was noted as a challenge. People said interpreters usually need to be requested in advance and that GP practices cannot normally arrange them on the same day. This was described as making urgent appointments particularly difficult. People felt strongly that without an interpreter or a trusted family member present it was very difficult to explain symptoms, or understand or ask questions, and that interpreters are essential for understanding care and making informed decisions (Somali Community CIC).

It was raised in Wandsworth however, that people would feel comfortable discussing personal issues in front of an interpreter (Happy Homes).

“You get what you are given, and you just hope they speak your language.”

4.1.8 Seeing someone face to face helps people understand

Across boroughs, people described face-to-face contact as helping them understand information and feel more confident when language barriers exist. Being physically present allows people to use body language, facial expressions and visual cues to support communication. People who preferred face-to-face interpretation raised it allowed them to see facial expressions and body language, making communication easier (Richmond EAL).

Some people said they prefer visiting the practice in person because using body language helps them understand what is being said, describing this as “is easier” (Sutton Mental Health Foundation). Others said they sometimes choose A&E out of hours because of this (Sutton Mental Health Foundation).

4.1.9 Written communication can be difficult to understand

People described difficulty understanding written communication from health services, including letters, appointment information and text messages, particularly when these are only provided in English. Low literacy was also described as a barrier including being able to read of write in English and primary language.

Some people said that translating medical information from English can be unreliable and raised how medical terminology and acronyms can be difficult to interpret. One person said: “There’s no way to check if your own attempt at translation is accurate.” Another raised: “You don’t know what the information is to even translate and understand it e.g. dates (is it DOB or the date of the letter?), addresses etc” (Multicultural Richmond).

“There’s no way to check if your own attempt at translation is accurate.”

People also said written communication should be provided more clearly in their own languages as without this, important information can be missed or misunderstood. Some said aftercare instructions would be easier to follow if they were provided in their own language, explaining that without an interpreter, family member or friend, “important information is missed or misunderstood” and “all participants felt aftercare could be clearer and provided in Somali” (Somali Community CIC).

However, in Wandsworth, low literacy was also raised as a barrier. Some said they cannot read or write in either Urdu or English because education was not accessible to them, which makes it difficult to book appointments or read letters (Happy Homes).

“Important information is missed or misunderstood.”

One person described their experience of receiving a hospital letter about an urgent operation in English and not being able to understand the letter. A family member called to confirm the appointment but was told it did not exist and had been changed. Travel had already been arranged to support recovery and could not be changed. The person said they were unsure what to do next and that the situation left them feeling “very disappointed” (Happy Homes).

4.1.10 Reception staff can make a big difference

People described mixed experiences with reception staff when accessing GP services. In some cases, receptionists were seen as supportive, particularly when they spoke slowly or shared the same language. For example, booking appointments was described as “very easy” when reception staff spoke the patient’s language (Happy Homes) and others said they felt comfortable asking for support at their GP practice because staff there were “nice and speak slower” (Richmond EAL). Having reception staff who spoke a person’s language was described as “helpful” (Multicultural Richmond), with one example in Sutton where a Portuguese-speaking receptionist “really helps” (Sutton Mental Health Foundation).

However, experiences varied with some people describing reception staff as a barrier to accessing care. In Kingston, receptionists were described as not always patient or respectful, despite generally positive views of GPs (Kim’s Dance School). Others said that not understanding reception staff could lead to confusion or assumptions about what they were being told (Sutton Mental Health Foundation). People with limited English said they sometimes needed to ask staff to speak more slowly to understand information (Croydon Vineyard).

Another issue was being directed elsewhere without clear explanation. Some people said reception staff would direct them to a pharmacy instead of offering language support, leaving them unsure how to proceed (Kim’s Dance School). Similar experiences were reported in Richmond, where people were sometimes redirected to other services without fully understanding why, particularly when language barriers made it difficult to follow explanations (Richmond EAL). One person explained that when receptionists advised them to go elsewhere after hearing their symptoms, “it is not known whether they are given a reason” due to limited English (Richmond EAL).

4.1.11 Appointment times are not always adequate

People across boroughs described how standard appointment lengths do not always allow enough time to communicate when language barriers exist. This was felt challenging when translation was needed or when people required more time to explain symptoms. Some people described uncertainty about whether they could raise more than one issue during an appointment. One person said: “I once asked the GP to talk about something else who said I needed to book another appointment” (Richmond EAL).

Time pressures were also raised in relation to translation. One person described using their phone to translate in real time during an appointment but being told the GP “didn’t have time” that day, so the appointment was rebooked as a longer appointment for another day. They felt this need should have been recognised and arranged when the appointment was first booked (Sutton Mental Health Foundation). Another person said they felt able to use Google Translate during hospital appointments, but that GP appointments do not always allow enough time to do this (Sutton Mental Health Foundation).

4.1.12 Digital tools and the NHS App create both barriers and opportunities

People’s experiences of digital access varied widely across boroughs. Some described digital tools as supporting access and independence. Others said the shift to digital systems had created further barriers, particularly for people who do not speak English as a first language and those who are not confident with technology.

Some people said they avoid digital tools because they find them difficult to understand. For example, people reported not using the NHS App because they “don’t understand it” and described the NHS Choices symptom checker as “very hard” to use. Despite these challenges people showed interest in learning more, suggesting classes or sessions in their language to explain how to use NHS websites and apps (Kim’s Dance School). Lack of awareness and language barriers also limited use of digital tools including the NHS App. Most said this was because they do not speak English, do not feel confident with technology or had never heard of the NHS App. Some people appeared confused and wanted more information when the app was mentioned (Somali Community CIC). People also emphasised the importance of non-digital options. Some suggested offering more appointments and ensuring services are not moved entirely online (Happy Homes).

Some people shared more positive experiences. One person described regularly using the NHS App to book GP appointments and said the app was easy to navigate even with limited English. They explained that it allowed them to arrange appointments in advance and choose a clinician they trusted, giving them a sense of independence and confidence in managing their healthcare (Croydon Vineyard). However, not everyone was aware of the NHS App.

Some felt that Digital systems made access easier. Some people preferred online booking to emailing because responses are often quick with an “email response with an appointment often the same day or the next” and that booking online was much easier than phoning. However, other preferred being able to declare whether they were available at a suggested appointment time and choose an alternative slot if needed, which they said was easier by app or phone (Richmond EAL). People were also pleased to hear that all GP practices in England may enable booking through the NHS App in the future (Richmond EAL).

One person said they had never heard of it and explained their phone was on a Peruvian contract, so they were unsure whether it would work (Croydon Vineyard).

4.1.13 Hospital experiences: interpreters, navigation and support

People also shared their experiences within hospital settings, with experiences varying. Some said they were offered interpreters or staff support, while others felt uncertainty about whether interpreter support would be available. Some people said they sometimes go to A&E rather than wait for a GP appointment (Happy Homes) but struggle to access interpreter support once they arrive (Somali Community CIC).

When asked about calling 999, some people said they were unsure when it should be used, although they knew they would be seen if they went directly to the hospital (Somali Community CIC).

Some people said hospitals can be difficult to navigate when English is limited. Large buildings, English-only signage and finding the correct department were described as overwhelming (Somali Community CIC).

Others described uncertainty about whether interpreters would be available. One person said they had been offered an interpreter for a planned consultation at Kingston Hospital, which was “very useful”, but because the hospital did not confirm whether the interpreter had been booked, they were worried they might not understand the appointment (Richmond EAL). People also said that even when they know an interpreter will attend, they are often unsure whether it will be in person or provided by phone (Richmond EAL).

Some people described more positive experiences of interpreter support in hospital settings. At Epsom and St Helier, one person described being offered a native-speaking hospital staff member to translate when a formal interpreter was not available. Another said they “always” have a good experience at hospitals, explaining that they are usually offered a translator or staff member to help translate if needed (Sutton Mental Health Foundation).

People also described relying on family members during hospital visits. Some said relatives attend hospital appointments to help translate because they had never been offered a formal interpreter or requested one because they were not aware the service existed (Multicultural Richmond).

Some people suggested that additional support within hospitals could help. For example, volunteers who welcome and guide people at hospital entrances were seen as helpful.

in their own languages, was seen as making information easier to understand and more trusted. This was described as particularly helpful for people who are new to the UK and unfamiliar with how the NHS works.

5. Conclusion and next steps

This report highlights that language barriers is a key factor affecting access to healthcare across South West London. Language barriers are shown to impact the patients journey and outcomes, from initial access through to follow-up care.

Addressing the key issues highlighted in this report will help to support equitable access to healthcare and improve patient experience.

This insight will:

• Help to inform service improvements across primary care services to better meet the needs of people who do not speak English as a first language.
• Be shared with providers, commissioners and partners to support planning and service design where relevant.
• Support ongoing work to reduce health inequalities across South West London, particularly for Core20 and underserved communities.

*Further information about detailed borough discussions and demographic information is available on request.