This is how it feels to receive a letter you can't understand.
We sent a letter in a different language (in this case, Turkish) because this is how NHS communications arrive for millions of patients in England.
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Two separate populations. The same outcome.
Neither group is refusing care. Both are recorded the same way in your recall report.
people in England and Wales whose main language is not English. More than a million of them speak English poorly or not at all.
adults in England has very poor literacy, reading at or below the level expected of an eleven-year-old. The NHS aims for a reading age of nine to eleven.
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.
The same patient, two recall processes
Mrs Y, 62, due for bowel screening. Main language Turkish. Nothing about her changes between these two rows.
Uptake up, and the gap narrower at the same time
increase in cervical screening uptake, with income-related inequality in uptake eliminated in participating practices rather than widened.
of non-English-speaking patients booked their NHS Health Check, against 54.1% of English-speaking patients. The gap runs the other way when the message is built for the patient.
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