Sir, while working as a general dental and maxillofacial SHO in large urban areas I have regularly encountered non-English speaking patients who require treatment. Obviously verbal communication is paramount in eliciting a history, making a diagnosis and ultimately treating someone. In the previous institution in which I worked a telephone interpretation service was available, as seems to be the case in most NHS hospitals. While being very useful, the service was inadequate for patients with detailed/complex complaints and histories. Also it involves much to-ing and fro-ing between patient and clinician on the telephone with only a non-medically informed interpreter as a link.

On one such occasion I was examining a Portuguese lady with a history of TMD/facial arthromyalgia. Treating such patients successfully can be a challenge at the best of times, but doing so via an interpreter it proved impossible to gather the relevant symptoms and information. On the advice of my consultant I reassured the patient as best I could and made arrangements for a further visit later. At this time we hoped to have an interpreter present in the room. Unfortunately we were informed by the hospital this wasn't the policy and the telephone service was all that was available. I am aware that some hospitals and trusts do provide in-house interpreters on request but this service is limited and certainly not available out of normal hours. I have on occasion had to rely on the interpreting services of other doctors who happen to speak the same language as a patient.

The follow up for the aforementioned patient proved just as frustrating with many things literally being lost in translation. Thereafter, I was shocked to hear that the NHS spends about £55 million pounds annually on translation services,1 with £200 million spent by all departments annually on these. In the current climate of financial crises within the NHS and ongoing cutbacks, such a figure seems extraordinary. Surely this huge budget can be directed towards a more valid and user friendly system?

It is estimated that about 5.3% of the UK population speak another language at home,2 while there are no official figures for the percentage of non-English speaking people in the UK. Everyone has a right to expect medical/dental treatment from the state but recent changes and events have shown us that the system is creaking under the weight of use. Obviously questions of identity and citizenship are involved here, but it seems that there is an element of people not fully integrated to the community as a result of a language barrier and who are potentially missing out on many public services. With regard to the NHS it is an added challenge to effectively treat such patients. There will always be a need for some interpreting services but the current level is excessive. Perhaps the Government should better fund and encourage English lessons for all non-English speakers as it would have far-reaching benefits for everyone.