Communications patients understand

This is the letter we sent you. Here is what it said.

It arrived in Turkish because that is how NHS letters arrive for millions of patients in England. The English text is below, and it is the same letter, word for word.

Türkçe — the letter you received

Sayın Muayenehane Yöneticisi,

Bu mektubu okuyorsanız, kendi hastalarınızla ilgili bir mektup aldınız ve onu okuyamadınız.

İngiltere ve Galler'de ana dili İngilizce olmayan 5,1 milyon insanın her gün yaşadığı şey budur — bunların bir milyondan fazlası İngilizceyi çok az konuşuyor ya da hiç konuşamıyor. Muayenehanenizin gönderdiği her tarama daveti, her kontrol hatırlatması, her sağlık kontrolü mektubu onlara tam olarak bu mektubun size ulaştığı şekilde ulaşıyor.

Sizi görmezden gelmiyorlar. Sizi okuyamıyorlar. Ardından «yanıt vermeyen hasta» olarak kaydediliyorlar.

Biz Appt Health'iz. 150'den fazla aile hekimliği merkeziyle birlikte çalışarak hastalara gerçekten kullanabilecekleri dilde ve biçimde ulaşıyoruz — ve biri yanıt verene ya da merkez hâlâ kime ulaşılamadığını tam olarak görene kadar mesajla, mektupla ve telefonla ulaşmayı sürdürüyoruz.

Appt Recall kullanan merkezler tarama katılımını 18 puan artırdı ve aynı anda en yoksul ve en varlıklı hastaları arasındaki farkı daralttı.

Yirmi dakika, kendi ulaşılamayan hasta listenizin nasıl göründüğünü size göstermek için yeterli.

Saygılarımızla, Hector Smethurst, Appt Health

The letter posted to your practice opens with your name and address. This is the same letter with that block removed.

English — what it said

Dear Practice Manager,

If you are reading this, you have just been sent a letter about your own patients that you could not read.

That is the everyday experience of 5.1 million people in England and Wales whose main language is not English — more than a million of whom speak English poorly or not at all. Every screening invitation, every review reminder, every health check letter your practice sends reaches them exactly the way this one reached you.

They are not ignoring you. They cannot read you. Then they are recorded as non-responders.

We are Appt Health. We work with over 150 GP practices to contact patients in the language and format they can actually use — and to keep contacting them, by text, by letter, by phone, until someone answers or the practice can see precisely who is still unreached.

Practices using Appt Recall have raised screening uptake by 18 percentage points, and narrowed the gap between their most and least deprived patients at the same time.

Twenty minutes is enough to show you what your own unreached list looks like.

Yours sincerely, Hector Smethurst, Appt Health

Complete translation · nothing added, nothing left out

Two separate populations. The same outcome.

Neither group is refusing care. Both are recorded the same way in your recall report.

Population one — language

5.1m

people in England and Wales whose main language is not English.

1.0m+

of those speak English poorly, or cannot speak it at all.

Source: Census 2021, Office for National Statistics — language in England and Wales.

Population two — literacy

1 in 6

adults in England has very poor literacy, reading at or below the level expected of an eleven-year-old.

Age 9–11

the reading age the NHS aims for in patient communications. Most screening and review invitations do not come close.

Sources: National Literacy Trust, based on OECD Survey of Adult Skills; NHS England content and accessible information guidance.

These are different problems and they need different fixes. A translated letter does nothing for the second group; plain English does nothing for the first. Both end up in the same column of your report.

Reaching everyone is not a better first message. It is refusing to stop at the first message.

Four things have to happen. None of them are clever. All of them are work that practices do not have hours for.

Language and format the patient can use

Preferred language taken from the record, plain-English wording at a reading age of nine, large print and SMS where a letter will not land.

Repeated and varied contact

A scheduled sequence over weeks, worded differently each time and sent at different times of day — not one text on a Tuesday morning.

Escalation when a channel fails

An undelivered text escalates to a letter; an unopened letter escalates to a call. Failure of one route triggers the next automatically.

Reporting who is still unreached

A named list of patients no channel has touched, not a response rate. You can act on a list. You cannot act on a percentage.

What the channel data actually shows

Non-English-speaking patients convert lower on every channel. No single channel fixes it, which is why the sequence matters more than the send.

NHS App

21.9% non-English-speaking

25.2% English-speaking

Accessible SMS

12.9% non-English-speaking

17.0% English-speaking

NHS Email

9.3% non-English-speaking

12.8% English-speaking

Best send time

1–2pm non-English-speaking

9am English-speaking

Source: Appt Recall production analytics across 150+ practices. A programme that sends everyone at 9am has chosen the optimal time for one group and a poor one for the other.

The same patient, two recall processes

Mrs Y, 62, due for bowel screening. Main language Turkish. Nothing about her changes between these two rows.

Contacted once

Day 0 · Letter

English, reading age 15

Recorded as a non-responder

Contacted four times, four ways

Day 0 · SMS

Turkish, plain wording

Day 7 · Letter

Turkish, large print

Day 18 · SMS

Reworded, afternoon send

Day 30 · Call

Interpreter line

Booked on the fourth contact