Communication with patients
Building trust with patients and making sure they feel heard is crucial. This is particularly important given the vulnerability and anxieties that patients can feel in maternity settings.
Building trust can be the difference between patients reporting concerns and not seeking help at all. Serious harm can result if patients are not listened to, given the information they need, or the time and support to understand it.
Decision making is an ongoing process focused on the exchange of relevant information that’s specific to the individual you’re treating. Finding out what matters to individual patients, listening to their views and preferences, is crucial. The Montgomery judgment in 2015 made clear that consent is much more than asking for a signature on a form. Taking the time with patients to exchange information and support them to make informed decisions has a positive impact on the quality of their experience and outcome. It also decreases the likelihood of unhappiness, complaints and litigation.
You can find case studies from a midwife and patients about communication on the NMC website.
Care Quality Commission
‘A quarter (25%) of respondents felt they did not have the opportunity to ask questions after their baby was born.
Only 58% of people surveyed said they were ‘always’ given the information and explanations needed in hospital after birth (compared to 60% in 2023).
Fewer people reported ‘always’ feeling listened to by staff providing postnatal care after leaving hospital (75% in 2024 compared with 77% in 2023).’
Barriers to communication
Language and communication barriers can have a detrimental impact on patients’ perinatal experience. They also contribute to wider health inequalities.
In their resource on language and digital barriers to accessing maternity care, NHS Resolution highlights the need to improve access to care for people who don’t speak English or where English is not their first language.
In a blog on the importance of good communication, Healthwatch demonstrates the negative impact that a lack of accessible information has on pregnant patients with learning difficulties. This can lead to patients having difficulty understanding processes and providing their consent for procedures. This is supported by research published by the BMJ on the experience of maternity care for women with learning disabilities. Making reasonable adjustments and adapting to individual communication and learning needs are key to supporting these patients during the perinatal period.
Good medical practice makes clear that you must take steps to meet patients’ language and communication needs. Work in line with Good medical practice by sharing all relevant information about patients with others involved in their care. This includes reasonable adjustments and communication support preferences.
If you are not able to meet people’s communication needs, then you need to raise a concern in line with your workplace policy.
National review of maternity services in England 2022 to 2024
‘NHS services have a statutory obligation under the Equality Act 2010 to have ‘due regard’ to eliminating discrimination and advancing equality, and access to interpreting services is an important way to deliver this.’
How to address language barriers and support your patients
Guidance on how to address communication barriers is provided by a range of organisations.
In their blog on improving access to healthcare for ethnic minority communities, Healthwatch explains that because there are different ways of recording patients’ language needs, information is not always communicated effectively between systems and services. This can lead to patients’ needs being missed. So, it’s important to familiarise yourself with your employer’s policy on interpreter and translation services. It’s also important to record patient language and communication needs so that colleagues sharing care or taking over responsibility of a patient are aware.
You may be in a situation where your patient’s partner, friend of family member offers to act as a translator during your consultation. This may seem like a simpler and quicker option. However, as advised in this government guidance on language interpreting and translation, a professional interpreter should always be offered, rather than using family or friends to interpret. Using a patient’s friend or relative may prevent them from disclosing sensitive health issues or discussing sensitive topics. It may also prevent them from understanding the information you’re sharing or asking questions. As such, it’s important to use a professional interpreter or translation service unless there is a specific reason that it’s not appropriate to do so.
In Wales, be aware of the ‘Active Offer’ approach. This means that health and social care services provide the service in Welsh to Welsh speakers without patients having to ask for it.
Good practice examples
The CQC’s national review of maternity services, highlights actions taken by services to address language barriers:
- The creation of communication cards for patients who don’t speak English as a first language.
- Amending triage guidelines to have a low-risk threshold to invite patients with English as a second language for face-to-face triage due to the fact that language barriers can make telephone triage services less effective.
- Services sending duty of candour letters to patients in their first language following an incident.
Our professional standards
75. You must act promptly if you think that patient safety or dignity is, or may be, seriously compromised.
b. If patients are at risk because of inadequate premises, equipment or other resources, policies or systems, you should first protect patients and put the matter right if that’s possible. Then you must raise your concern in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety.
