Languages, the census and the National Health Service

‘Welcome to the Head and Neck Outpatient Department. If you want to change the language touch one of the buttons below’. This invitation to choose your preferred language for checking in seems like a perfect use of technology to broaden access to a service and engage with a diverse public.

NHS check-in

However, there are a number of odd things about this check-in screen.

To begin with, the choice of languages. Apart from English, there are seven: Gujarati, Gaelic, Italian, Latvian, Polish and two versions of Chinese. However, these do not seem to be chosen on any obvious basis. According to the 2011 census, the 10 non-English languages with the highest numbers of speakers in the district (those who declared their ‘main language’ as one other than English) were Polish, Greek, German, Gujarati, French, Spanish, Arabic, Chinese, Russian, and Bulgarian. The last of these had just over 100 speakers (out of 134,000 people in the district overall). Italian was a few places behind; Latvian, with 14 speakers, a long way down the list. There were no speakers of Gaelic recorded at all.

There is a reasonable amount of overlap between the languages offered on the screen and the list derived from the census, but even so it raises questions: why Gaelic (spoken in distant parts of Scotland) rather than Welsh, spoken relatively close by? Why Italian but not Greek?

An alternative way of deciding on the languages to offer would be by proficiency in English. For example, in the national census, of the people who claimed French as their main language, only 5% said they knew little or no English. Greek and Spanish are around 10%. On those grounds, one might decide there was little need for a French, Greek or Spanish option. On the other hand, 17% of people whose main language was Arabic or Bulgarian said they had poor or no knowledge of English, so those languages still seem to have a stronger claim to be included.

A second peculiarity of the check-in screen is the way the languages are labelled. ‘Gaelach’ for Gaelic is simply wrong: this word means ‘Irish’. The expected label would be ‘Gàidhlig’ for Scottish Gaelic, or ‘Gaeilge’ for Irish Gaelic. ‘Latvisk’ is the Danish (or Norwegian or Swedish) for ‘Latvian’ but the Latvian for ‘Latvian’ is  ‘latviski’ or ‘latviešu valoda’. Furthermore, the Chinese labels say ‘Cantonese’ and ‘Mandarin’ but the actual distinction should be (and probably is) between the traditional script (used in Hong Kong and Taiwan) and the simplified script used in mainland China. That is the distinction made in the language options in the Hospital Trust’s own website, which shows a different range of options – Polish, Urdu, Gujarati, Turkish and the two versions of Chinese – ‘Simplified Chinese’ and ‘Traditional Chinese’ (see screenshot below). Although in the British context, most of the ‘simplified’ readers would be Mandarin speakers and most of the ‘traditional’ readers would be Cantonese speakers, the real difference is in the form of the script, not the language.

University Hospitals of Morecambe Bay NHS Foundation Trust - languages

This does not inspire confidence in the quality of the translations in the automated check-in, nor does it seem very respectful to the speakers of the languages concerned. Imagine you are a speaker of English, and are invited to press a button labelled ‘Inglish’.

All this raises issues of how the National Health Service – and other public services – engage with multilingualism (and, of course, multilingual literacies). Although in the past, language information has been very scarce in England, this is arguably not so any more. The 2011 census in England broke new ground. Language questions had previously been asked in Ireland, Scotland and Wales, but never in England, and the census authority, the Office for National Statistics (ONS) was not convinced of the case for one. However, the ONS eventually became convinced that there was a need for language information, and the 2011 census included two questions on language: ‘what is your main language?’ and (if the answer to that was a language other than English), ‘how well do you speak English’.

In the consultation period before the 2011 national census in England, many people within the health services were arguing for a language question to be included on the census questionnaire. For example, Peter Aspinall, a senior research fellow at the Centre for Health Services Studies at the University of Kent, urged the National Health Service to press for the inclusion of language questions in the 2011 census, citing ‘pronounced ethnic disparities in health and health care’ Aspinall (2005: 364).

So how is the information gathered being used? It is not necessarily the case that the census is the best way to collect language information, and it can be argued that the quality of the information collected (or of the questions asked) is not of the desired standard. Even so, it is not clear that the information is being used at all. Perhaps the NHS lacks the resources to exploit the language information which we now have. Which leads to the question: who makes decisions about languages other than English within the NHS, and on what basis?

References and sources

Aspinall, Peter J. 2005. Why the next census needs to ask about language: Delivery of culturally competent health care and other services depends on such data. BMJ 331, 363–4

Office for National Statistics, 2011 Census. Table DC2210EWr – Main language by proficiency in English (regional).

Office for National Statistics, 2011 Census. Table QS204EW – Main language (detailed), local authorities.



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