Clinical investigation booking systems failures: written communications in community languages

National investigation

We’ve launched a national investigation into the safety risk of clinical investigation booking systems failures. Specifically, the investigation explores the use of paper or hybrid (paper and electronic) booking systems and the production of appointment letters.

Our interim bulletin, published in November 2022, highlights a safety risk identified by the investigation to date and presents a safety observation for the attention of NHS care providers.

Background

Paper-based or hybrid booking systems are still used in lots of areas within the NHS, many of them relying on administrative staff to help keep these systems running. NHS England has several national programmes that are looking to embed digital systems, including booking systems, in NHS trusts. However, some vital services still use paper-based or hybrid systems. These may have been developed over time and could leave unintended gaps where patients can be lost in the system.

Reference event

The investigation reviewed the experience of a patient, which is referred to as ‘the reference event’, whose magnetic resonance imaging (MRI) scan was not rescheduled following a cancellation, leading to a delay in the diagnosis of cancer. Hybrid systems were in use, which did not assist staff to keep track of patients. Additionally, the hybrid systems in use did not accommodate, or support, production of appointment letters in non-English languages.

Investigation summary

This investigation explores the:

context and contributory factors to patients being lost to follow up due to administrative functions
safety implications of patient communication being generated solely in English and opportunities to address this risk.

Safety recommendations

NHS England

HSIB recommends that NHS England develops and implements a standard for healthcare providers on supplying written appointment information in languages other than English.

Thank you for completing this investigation and inviting NHS England to respond to the recommendation.

We were deeply saddened by the investigation case and are aware of other safety investigations and Care Quality Commission (CQC) inspection reports that have raised community language translation and interpretation (CLTI) issues. CLTI services are critical for patient safety, supporting equality and reducing healthcare inequalities. NHS England recognises that current issues must be addressed, including those raised in the investigation and we are committed to proactively addressing these issues and improving CLTI services.

We have carefully considered the recommendation to develop and implement a standard for healthcare providers on supplying written appointment information in languages other than English. We appreciate this could help improve services but are concerned it may not be at the pace and scale required. The Accessible Information Standard (AIS) Review, published later this summer, notes that while the content of the AIS is good, it has not resulted in enough change, and traction needs to be increased through other means.

To ensure we identify the most effective policy levers or intervention(s) to address issues and improve CLTI services, we have committed to completing a strategic review this financial year. The review will consider the breadth and complexity of issues across the patient pathway and complete an options appraisal of potential interventions. Addressing issues with written appointment information will be a core component of the review.

The review will inform how we best facilitate improvements to CLTI services and help ensure they meet the needs of communities and support equitable access, experience, and outcomes for all.

This review will be led by the Healthcare Inequalities Improvement Team. We will work closely with the Patient Equalities Team, Patient Safety Team and a range of stakeholders including the Healthcare Safety Investigation Branch (HSIB).

Thank you again, for your investigation and highlighting these important issues.

Actions planned to deliver safety recommendation:

1) Complete scoping and options appraisal, by November 2023.

2) Agree recommendations, by March 2024.

Response received on 24 July 2023.

Safety observations

It may be beneficial for NHS care providers to explore options for the translation of written appointment communications, including pre-attendance guidance, for patients whose preferred written language is not English.

Safety actions

HSIB makes the following safety observations:

It may be beneficial if the ‘preferred written communication method’ field of the Personal Demographics Service system is completed for patients who require written communications in a language other than English.
It may be beneficial if NHS trusts identify mechanisms to appreciate the language needs of their patient demographic and adjust the written communications accordingly.
It may be beneficial to clarify the roles and functions of national organisations in supporting the health inequalities landscape.
It may be beneficial for NHS healthcare providers to incorporate the NHS Service Standard into agreements with third-party developers of electronic clinical investigation booking systems.