From Recognition to Reality: Tackling Communication Barriers on the NHS Frontline
At this year’s Digital Health Rewired conference, CardMedic’s co-founder and Chief Medical Officer, Dr Rachael Grimaldi, was joined by Pamela Fearns, Chief Nursing Information Officer at Stockport NHS Foundation Trust, and Siobhan Buxton from Nottingham Integrated Care Board. Together, they explored a question that sits at the heart of health equity work, how do we stop talking about communication barriers and start actually dismantling them?
The scale of the challenge
The statistics are striking. Over a million patients in England speak little or no English. Eighteen million people are deaf or hard of hearing. And two thirds of NHS staff report struggling to communicate with patients on a daily or weekly basis. These are not edge cases. They are a structural feature of the system we work within.
The consequences are well documented but still jarring when brought to life. Black women are nearly three times more likely to die during pregnancy or in the six weeks postpartum, with language and communication barriers a significant contributing factor. Maternity-related clinical negligence claims represent the single largest share of NHS litigation liabilities, at approximately one billion pounds annually, and communication failures feature in around half of them.
Siobhan shared findings from a staff survey conducted across Nottingham and Nottinghamshire, which found that clinical teams routinely felt professionally compromised by their inability to communicate effectively with patients. When formal interpreter services were unavailable because of long waits, an absence of the required language, or last-minute cancellations, staff were falling back on family members and consumer translation apps. Neither are an acceptable substitute, and both carry real risks for patient safety and confidentiality.
When the system fails patients
Pam described the cumulative impact of these failures at Stockport. Patients referred for two-week wait appointments, potentially for a cancer diagnosis, were having those appointments cancelled two, three, or four times because interpreters had failed to attend. Patients who arrived for MRI scans or other investigations were being turned away because staff could not communicate basic safety questions around contrast allergies or pregnancy status. Investigations and treatments were being deferred, not because of clinical necessity, but because of a communication gap that no one had adequately filled.
Siobhan put it plainly: poor interpretation is not just a patient experience issue. It is a patient safety issue and a patient rights issue. When a woman in labour cannot understand the care being given to her, or cannot advocate for her baby, the consequences can be catastrophic and preventable.
What good looks like in practice
CardMedic provides access to live human interpreters, a library of pre-written clinical scripts available in multiple languages, sign language videos, easy read and read aloud formats, and a live translation tool. Crucially, it is available across all devices, including offline, which means district nurses working in rural areas with no signal can still download scripts and languages in advance. Pam described the particular value of having CardMedic integrated into Spark Fusion bedside entertainment devices at Stockport, enabling patients to initiate communication as well as respond to it.
For Nottingham, Siobhan described how the team worked to replicate the video-based discharge information normally given to new mothers, building equivalent clinical card scripts so that women leaving the maternity unit received consistent, safe information in their own language, not an approximation filtered through a third-party conversation.
Dr Grimaldi was clear that no single tool will ever be a complete solution. The goal is to ensure that clinicians always have something to hand, that there are backup options available regardless of the time of day, or day of the week, and that the solution can flex across the diversity of settings and scenarios the NHS actually operates in.
Building a blueprint for adoption
The most candid part of the session came when the panel discussed what it actually takes to embed a communication solution into clinical practice. The honest answer is that a strong product and a solid business case are necessary but not sufficient.
Siobhan reflected on lessons from the Nottingham pilot. Funding the tool entirely through the ICB had inadvertently reduced the Trust’s sense of ownership and commitment. Without sufficient senior leadership buy-in from the outset, engagement stalled. When a key clinical champion left, progress slowed significantly. Her advice for future implementations was to co-design, co-own and co-fund, and to build resource into the business case for a dedicated member of staff to drive ward-level adoption in the early months.
Pam’s experience at Stockport echoed this. The business case had originally been put to charitable funds, and was rejected on the grounds that communication support is an essential NHS service, not a discretionary one. That reframing was significant. Once the argument shifted from “nice to have” to clinical risk reduction and regulatory compliance, the conversation changed. Pam had also mapped out the full patient pathway before procurement, documenting the cost, frequency and unreliability of face-to-face interpreter bookings, and building a picture of the financial case for change that went beyond patient experience metrics.
All panellists agreed on the fundamentals. We need to align stakeholders early, including procurement, IT, clinical champions, the equality, diversity and inclusion team and executive leadership. Maintain consistent communication after go-live. Make the tool impossible to ignore by embedding it into existing devices and workflows rather than asking staff to adopt yet another separate system. And measure from day one, because without data, you cannot demonstrate impact.
The takeaway
The session closed with a key point: We can have the best technology in the world, but if it is not in the clinician’s hand at the moment they are standing in front of a distressed patient who cannot understand them, then none of it matters.
Digital equity is achievable. The evidence is there and the tools exist. What it requires now is the leadership, the infrastructure and the genuine commitment to make it standard, not exceptional.
To learn more about how CardMedic can support your organisation, contact us for a free demo.
