Working With Interpreters in Healthcare Settings

Clear communication is a clinical safety issue. When a patient and clinician do not share a language, a qualified interpreter makes it possible to take an accurate history, explain options and obtain valid consent.

This guide is for GP practices, clinics, private healthcare providers, care services and healthcare businesses that work with patients who speak limited English. It summarises the main NHS England guidance and gives practical steps for running interpreted consultations. NHS England's guidance covers England; health services in Scotland, Wales and Northern Ireland are run separately and set their own arrangements. For an overview of interpreting formats, see our guide to types of interpreting.

How many patients need an interpreter in the UK?

A significant number of people in the UK cannot communicate confidently in English in a clinical setting. The ONS Census 2021 language bulletin reports that, in England and Wales, 880,000 usual residents "could not speak English well" and 161,000 "could not speak English at all".

Many more people manage daily life in English but struggle with medical terms, symptoms or treatment decisions. Language preference should therefore be asked about and recorded, not assumed from how well someone handles a reception desk conversation.

What does NHS England guidance say about interpreters?

NHS England's Guidance for commissioners: Interpreting and Translation Services in Primary Care sets out eight principles for high-quality interpreting and translation. It was written for GP surgeries, but the guidance notes that commissioners "may find the contents applicable to other settings, such as other primary care settings or hospital sites". Key points include:

• Interpreting should be "free at the point of delivery", and "Patients should not be asked to pay for interpreting services or to provide their own interpreter".
• "When an interpreter is required, additional time will be needed for the consultation (typically double that of a regular appointment)".
• Language needs should be recorded in the patient's record with a "highly visible alert", and shared when the patient is referred on.
• Patients may state a preference for the gender of the interpreter, and continuity with the same interpreter is good practice where practicable.
• Patients should be told about the different types of interpreting available, such as face-to-face, telephone and video.

Can a family member or child interpret in a medical appointment?

NHS England strongly discourages family members and friends as interpreters, and rules out children except in emergencies. The guidance states:

"Patients should always be offered a registered interpreter. Reliance on family, friends or unqualified interpreters is strongly discouraged and would not be considered good practice."

If a patient still wants a relative or friend to interpret, the guidance says the patient "should give informed consent in their own language, sought from them independently of the family member/ friend", and the consent must be noted in the record. On children, it is explicit: "The use of anyone under the age of 16 for interpretation is not acceptable in any circumstance other than when immediate and necessary treatment is required."

The reasons are practical. A relative may hold back sensitive information, add their own views or be part of a safeguarding concern. Our article on why a professional interpreter is better than a bilingual person explains the wider point.

What qualifications should a healthcare interpreter have?

For spoken languages, NHS England's guidance says interpreters "should be registered with the National Register of Public Service Interpreters (NRPSI) and hold a Diploma in Public Sector Interpreting (Health)". Where an interpreter does not hold the health diploma, it allows alternatives combining language level and at least an NVQ level 3 in interpreting, plus training in medical terminology.

The NRPSI (National Register of Public Service Interpreters) is the UK's independent voluntary regulator of public service interpreters. According to the NRPSI website, there are "around 1,700 interpreters in 100 languages on the National Register". The guidance also expects Disclosure and Barring Service checks, annual safeguarding training and annual information governance training for interpreters.

How to run an interpreted consultation: step by step

1. Record the need. Note the language, dialect, preferred interpreter gender and preferred mode on the patient record.
2. Book the right format. Choose face-to-face for sensitive, complex or long consultations; telephone or video can suit short or urgent ones. See our guide to remote interpreting by video and phone.
3. Double the appointment slot. Book a longer appointment so the clinician does not have to rush.
4. Brief the interpreter. Before the patient joins, explain the purpose of the appointment and any sensitive topics, without sharing more personal data than needed. Our guide on how to brief an interpreter lists what to cover.
5. Let the interpreter introduce themselves. NHS England describes this as "the Interpreter's Declaration": the interpreter explains their role to everyone present.
6. Speak directly to the patient. Use short sentences, pause regularly for consecutive interpreting, avoid jargon and check understanding by asking the patient to explain the plan back.
7. Record the interpreter's details. Note the interpreter's name or ID and the mode used.

What should an interpreter not be asked to do in healthcare?

An interpreter is there to enable communication, not to act as a carer, advocate or clinical assistant. NHS England's guidance states that "Interpreters do not provide advocacy" and that the interpreter "should not be asked to undertake additional/ ancillary duties" during the appointment.

The NRPSI Code of Professional Conduct adds that public service interpreters "shall not enter into discussion, give advice or express opinions or reactions to any of the parties that exceed their duties as interpreters". Clinicians should therefore not ask the interpreter what they think the patient means, or leave the interpreter alone to explain a treatment plan.

What about written information for patients?

Interpreting covers speech; translation covers written material. NHS England's guidance says documents translated for patients "must be translated by competent and appropriately trained translators and not by practice staff", and that automated tools such as "Google-translate" should be avoided "as there is no assurance of the quality of the translations".

The guidance also describes sight translation, in which an interpreter reads a document aloud in the patient's language. Sight translation suits a one-off letter, but standard leaflets and discharge information are better translated in advance. See our guides to translating medical records and machine translation in healthcare.

Common mistakes when working with interpreters in healthcare

• Booking a standard-length appointment. The consultation overruns or key questions are skipped.
• Relying on a relative because it is quicker. Sensitive history, such as domestic abuse or sexual health, may never be disclosed.
• Assuming the language from nationality. Many countries have several languages and dialects; ask the patient.
• Using telephone interpreting for every case. Some patients and topics need an interpreter in the room.
• Talking to the interpreter instead of the patient. It undermines rapport and makes the patient a bystander in their own care.

How TranslationWorks can help

TranslationWorks is a UK-based language services agency that provides professional interpreting and medical translation, working with native-speaking linguists in more than 150 languages. TranslationWorks is certified to ISO 17100, the international standard for translation services. For clinics, healthcare providers and life-sciences companies, we can support patient communication through interpreting and translate patient-facing documents. TranslationWorks is ISO 27001 registered and Cyber Essentials certified, which supports the secure handling of sensitive health information. Tell us the language, setting, date and format you need, and we will reply with a free quote within 24 hours. See our interpreting services and medical translation services, or request a free quote.