Why do professional interpreters matter?
Patients who do not speak English well, and Deaf people who use British Sign Language (BSL), have the same right as anyone to understand their care and make decisions. Without good interpreting, a patient may not be able to describe symptoms, understand a diagnosis, give valid consent or take medicines safely. Language barriers are a recognised factor in misdiagnosis and medication errors.
Professional standards expect this. GMC guidance on decision making and consent expects doctors to make sure patients get information in a way they can understand, including by arranging an interpreter. The NMC Code asks nurses and midwives to take reasonable steps to meet people's language and communication needs. NHS guidance is clear that interpreting should be free to patients, and that patients should not be turned away or asked to bring their own interpreter.
Who needs an interpreter?
- Anyone who asks for one, even if they seem to speak some English.
- People whose everyday English is fine but who may struggle with complex medical information or under stress.
- Deaf people who use BSL. Written notes and lip-reading are not adequate substitutes for many Deaf people.
- People with additional needs, such as Deafblind people, who may need a specialist interpreter.
Can family members or children interpret?
It is tempting to let a relative help when you are busy or the family offers. In most clinical situations it is not appropriate.
| Risk | Why it matters |
|---|---|
| Accuracy | Relatives are not trained in medical terms or interpreting and may summarise, leave things out or change them |
| Confidentiality | The patient may not want family to know about sexual health, mental health, pregnancy or other matters |
| Safeguarding | In domestic abuse, coercion or exploitation, the person interpreting may be the abuser |
| Filtering | Relatives may protect the patient by softening bad news, or answer on the patient's behalf |
| Emotional burden | Interpreting bad news or intimate details can be distressing, especially for young people |
If a patient with capacity still prefers a relative after being offered a professional, you may accept this for simple matters, but record the offer and their choice. For consent, safeguarding, mental health assessments, bad news or complex information, use a professional interpreter, alongside the relative if the patient wants them there for support. Bilingual staff should only interpret if your organisation has assessed and approved them to do so.
Face to face, telephone or video: which should you book?
| Mode | Best for | Limitations |
|---|---|---|
| Face to face | Long, complex or sensitive consultations; bad news; mental health assessments; most BSL needs | Needs booking ahead; may not be available out of hours |
| Telephone | Urgent or short conversations; simple checks; out of hours | No visual cues; not suitable for BSL; harder for people with hearing loss |
| Video | BSL when face to face is unavailable; urgent consultations | Depends on equipment and connection; less suited to very sensitive talks |
- Specify language and dialect. Arabic, Chinese and Kurdish, for example, have several varieties.
- Ask about preferences for the interpreter's gender, especially for intimate examinations or maternity care.
- Allow more time. Interpreted consultations take considerably longer, and many services book double appointments.
- Book the same interpreter for follow-ups if you can.
- In small communities the patient may know the interpreter. Offer someone from outside the area or by phone.
How do you run a consultation through an interpreter?
- Brief the interpreter: Take a minute beforehand to explain the purpose, any sensitive topics and any difficult news. Ask if they know the patient.
- Introduce everyone: Explain that the interpreter will interpret everything accurately and confidentially, without adding or leaving anything out.
- Arrange the room: Face the patient. For spoken languages the interpreter usually sits beside or slightly behind the patient. For BSL, the interpreter usually sits next to you so the Deaf person can see you both.
- Speak to the patient: Look at the patient and use the first person: "How long have you had the pain?" not "Ask her how long she's had the pain."
- Keep it short: Speak one or two sentences at a time, then pause. Avoid jargon, idioms and abbreviations.
- Check understanding: Use teach-back: ask the patient to explain in their own words what they have understood.
- Close and debrief: Summarise, invite questions, and explain how to get an interpreter next time. After a hard consultation, check in with the interpreter.
Nurse, to the interpreter: "Tell her she needs a CTPA to rule out a PE and ask if she's had any haemoptysis or calf pain." The interpreter talks with the patient for some time. Nurse: "What did she say?" Interpreter: "She says she's OK."
Nurse, looking at the patient: "The doctor would like you to have a scan of your chest." [pause] "It checks for a blood clot in your lungs." [pause] "Have you coughed up any blood?" [pause] "Have you had any pain or swelling in your legs?" [pause; patient answers via interpreter] "Can you tell me in your own words why we're doing the scan?"
Some ideas take longer to express in another language, so a longer interpretation is normal. If it sounds like a separate conversation is happening, politely ask what is being discussed. A professional interpreter should tell you everything that is said.
Tips for telephone and video interpreting
- Use a speakerphone, dual-handset phone or video device in a quiet room, with the access code and language ready before the patient joins.
- Give the interpreter your name, role, setting, the purpose of the call and anything sensitive. Record their name or ID number.
- Ask the interpreter to check the patient can hear clearly, and agree how they will ask you to slow down or repeat.
- Narrate what you are doing, such as "I'm now going to listen to your chest", because the interpreter cannot see the room.
- Finish with a summary and teach-back, then record the language, mode and interpreter ID.
Consent, medicines advice and difficult news through an interpreter
Valid consent depends on the patient understanding the proposed treatment, its risks, benefits and alternatives. Where there is a language barrier, a professional interpreter is essential. Record the interpreter's name or ID and the language. Never ask a patient to sign an English consent form they cannot read without its content being interpreted.
Pharmacist, through an interpreter: "Take one twice a day with food but not with the other one, and stop if you get a rash."
Pharmacist, holding up the box: "This is your new medicine." [pause] "Take one tablet in the morning and one in the evening, after food." [pause] "Don't take it at the same time as your calcium tablet. Leave two hours between them." [pause] "If you get a rash, stop and call us." [pause] "To check I've explained it well, could you show me when you'll take each one?"
For liquid medicines, demonstrate with the syringe. Translated or pictorial information can help, but ask about literacy first, because some people cannot read in their spoken language.
When breaking bad news, brief the interpreter beforehand so they are not taken by surprise, allow pauses, and remember the interpreter is affected too. In mental health assessments, use a professional interpreter wherever possible, because word choice and nuance matter. The Mental Health Act Code of Practice advises that relatives should not normally interpret for assessments under the Act.
Working with BSL interpreters
BSL is a full language with its own grammar, not signed English. For many Deaf BSL users, English is a second language, so written notes may be poorly understood. BSL interpreting is tiring, so long appointments may need two interpreters or planned breaks.
- Make sure the interpreter is visible to the Deaf person at all times, with good lighting.
- Do not talk while the patient is looking at a scan, model or leaflet. They cannot watch the interpreter at the same time.
- Book early, as availability can be limited, and ask about preferred interpreters.
- Never ask a Deaf patient's hearing child to interpret.
- Record and flag the need under the Accessible Information Standard so it is met at every contact, including emergencies.
Under the Equality Act 2010, providers must make reasonable adjustments so disabled people are not put at a substantial disadvantage. Providing a BSL interpreter is a common example. The Accessible Information Standard requires NHS and publicly funded adult social care organisations to identify, record, flag, share and meet communication needs linked to disability or sensory loss. Spoken-language needs are covered by NHS England's interpreting guidance but should be recorded just as carefully.
What are the most common mistakes, and how do you fix them?
| Common mistake or problem | Better approach |
|---|---|
| Talking to the interpreter instead of the patient | Face the patient and speak in the first person |
| Long, jargon-heavy sentences | One or two plain sentences, then pause |
| No briefing before sensitive news | Brief for a minute beforehand |
| Using a relative because it's quicker | Book a professional, and see the patient alone for part of the visit where routine |
| No interpreter available in an emergency | Use telephone or video, deal with immediate safety, arrange a professional as soon as possible, document why |
| Interpreter adds opinions | Politely remind them of their role, and feed back to the provider if it continues |
| Short of time | Prioritise and book a follow-up with an interpreter rather than rushing |
Aisha, 29, attends antenatal clinic at 30 weeks. She speaks Dari and a little English. Her partner offers to interpret to save time. The midwife, Hollie, knows she should ask about safety at home at antenatal contacts and cannot do this with the partner interpreting. She explains that the service uses professional interpreters for everyone and that seeing women alone for part of the appointment is routine. She books a female Dari telephone interpreter, briefs her, and completes the routine enquiry. Aisha says she feels safe. Hollie records the language, interpreter ID and that routine enquiry was completed.
Document every interpreted consultation: that an interpreter was used, the language and dialect, the mode, and the interpreter's name or ID. Record the patient's preferred language so it is flagged next time. If an interpreter was offered and declined, record that and why.
Making interpreted care routine
Most problems are easier to solve with a little planning. Check the record for the patient's language before the appointment, book early, and keep the access codes for telephone and video services somewhere easy to find.
Our course Working with Interpreters covers booking, briefing, three-way consultations, telephone, video and BSL interpreting, consent and medicines advice, with worked examples and reflective prompts linked to your professional standards. Use it alongside your organisation's interpreting policy.
Frequently asked questions
Can a family member interpret for a patient in the NHS?
Professional interpreters should be used in most situations because relatives may change or omit information, breach confidentiality or be involved in abuse. If a patient with capacity insists on a relative for a simple matter after being offered a professional, record the offer and their choice. For consent, safeguarding or complex information, use a professional.
Can children interpret for their parents at the GP or hospital?
No. Children should not be used to interpret health information. The only exception is a genuine emergency with no alternative, and then only for the minimum needed to keep someone safe. A professional interpreter should be arranged as soon as possible.
Do patients have to pay for an interpreter in the NHS?
No. NHS interpreting and translation services should be free to patients, and patients should not be asked to bring their own interpreter or be refused a service because of language. Services are arranged locally, so check how to book through your organisation.
Should I speak to the interpreter or the patient?
Speak to the patient. Look at them and use the first person, for example "How long have you had the pain?" rather than "Ask her how long she's had the pain." Use short sentences and pause for the interpretation.
Can I take consent through a telephone interpreter?
Yes, a professional telephone interpreter can be used for consent if the patient can hear clearly and the information is fully interpreted, though face to face may be better for complex or sensitive decisions. Check understanding with teach-back and record the interpreter's ID and language.
Can I use Google Translate with a patient?
Automated translation can be inaccurate for medical terms and context, so it should not replace a professional interpreter for assessment, consent or treatment decisions. Check whether your organisation has approved any tool and what it may be used for.
What should I document after using an interpreter?
Record that an interpreter was used, the language and dialect, the mode (face to face, telephone or video), and the interpreter's name or ID number. Record the patient's preferred language for future contacts, and note if an interpreter was offered and declined, with the reason.
Related courses
Working with Interpreters
This course explains when and how to use professional interpreters, including spoken language and British Sign Language interpreters, in…
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Sources and further reading
- Guidance for commissioners: Interpreting and translation services in primary care. NHS England.
- Accessible Information Standard (DAPB1605). NHS England.
- Equality Act 2010. legislation.gov.uk.
- Decision making and consent. General Medical Council.
- The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- Does the NHS provide an interpreter?. Healthwatch England.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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