We need to make inclusive communication standard practice for children's safety: A blog by Rachael Grimaldi

Summary

As World Patient Safety Day approaches on 17 September, with its focus on safe care for every newborn and every child, it's a stark reminder of how communication barriers in healthcare can exacerbate risks and inequalities. In my view, exclusive communication—where language, literacy or accessibility needs are overlooked—poses a significant threat to patient safety, particularly for vulnerable children and their families. Embracing inclusive communication isn't just an ethical imperative; it's a practical pathway to safer outcomes. Drawing from years of observing these disparities, I believe we need to confront the scale of this challenge head-on and commit to dismantling it through systemic changes and supportive tools.

This blog is part of our World Patient Safety Day 2025 series - Safe care for every newborn and every child.

Content

The scale of the challenge: why inclusive communication matters for children

Health inequalities in the UK are a persistent crisis, costing the NHS an estimated £4.8 billion annually in avoidable hospital costs alone.[1] Patients in the most deprived areas live nearly a decade less than those in affluent regions, often enduring fewer years in good health. When we narrow this to children and newborns, the picture is even more alarming.

Consider the evidence: non-English-speaking mothers face a 25-fold increased risk of maternal mortality,[3] directly impacting newborns. Black women are nearly four times more likely to die during pregnancy or childbirth compared to white women, with poor communication frequently cited as a contributing factor.[4] These risks extend to children, where misunderstandings can lead to delayed diagnoses or mismanaged care. For instance, unreported or misunderstood symptoms in maternity settings contribute to 55% of stillbirths linked to undetected foetal movements.[5] The NHS allocates around £75.5 million yearly to interpreting services,[6] yet the true demand could reach £250–£300 million, underscoring how under-resourced and fragmented our systems remain.

In paediatric care, where children's voices are often mediated through parents, these gaps can result in higher readmission rates and preventable harm, perpetuating cycles of inequality from the earliest stages of life.

The challenges for parents, children and staff

For parents, navigating healthcare for their child amid language or accessibility barriers can be isolating and terrifying. Imagine a non-English-speaking parent trying to convey subtle changes in their newborn's behaviour, only to be met with confusion or reliance on ad-hoc solutions, like family members translating. These are methods that often introduce errors and breach confidentiality. Children themselves, especially those with cognitive or hearing challenges, may struggle to express pain or discomfort, leading to overlooked conditions.

Healthcare staff face their own challenges. Time pressures in busy wards mean interpreters aren't always available promptly, forcing reliance on gestures, louder speech or generic online translation tools that lack clinical accuracy. This not only heightens the risk of misdiagnosis but also erodes trust, contributing to inefficiencies like wasted appointments and increased litigation. In essence, exclusive communication creates a vicious cycle where staff burnout rises, parental anxiety escalates and children's safety is compromised.

The safety benefits of breaking down communication barriers

In my opinion, prioritising inclusive communication provides transformative safety benefits. By ensuring information is accessible through multilingual resources, simplified language or sign language, we empower parents to report concerns early. This enables timely interventions that prevent deterioration. For children, this means fewer neonatal readmissions and better management of chronic conditions.

Tools like CardMedic demonstrate how barriers can be broken down effectively: offering pre-scripted clinical dialogues in multiple formats, it supports immediate, accurate exchanges when live interpreters are unavailable. Integrating such approaches aligns with legal standards like the Accessible Information Standard, reducing risks and fostering equity. The result? Measurable improvements, such as early detection of issues in maternity care, lower stillbirth rates and enhanced patient satisfaction, ultimately redirecting resources to frontline services.

Tools for a safer future

To truly advance safe care for every newborn and child, we must embed inclusive communication as standard practice, not an afterthought. This requires a cultural shift: training staff to default to accessible tools, investing in hybrid solutions that blend technology with human support and tracking outcomes to prove the return on investment. Innovations that bridge gaps in real-time exemplify how we can dismantle these barriers, supporting better safety and outcomes for children. On this World Patient Safety Day, let's commit to a healthcare system where every voice, whether it’s a parent, child or clinician, is heard equally, turning potential tragedies into preventable successes.

References

1. Asaria M, Doran T, Cookson R. The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation. Journal of Epidemiology and Community Health. 2016;70(10):990.
2. The Health Foundation. Major study outlines wide health inequalities in England, 15 August 2022.
3. National Register of Public Service Interpreters. Hear Me, April 2024.
4. Birthrights. Systemic racism, not broken bodies An inquiry into racial injustice and human rights in UK maternity care, May 2022.
5. Sands. Stillbirth study investigates fetal movements in pregnant women, 28 September 2018.
6. NHS England. Community languages translation and interpreting services, December 2024.

Further reading on the hub

• CardMedic: Empowering staff and patients to communicate across any barrier
• Improvement framework: community language translation and interpreting services
• Blog - 12 tips for communicating with deaf patients

Opinions expressed in blogs and other content are those of the author. Patient Safety Learning welcomes sharing content and opinions that promotes safer patient care and for the reduction of avoidable harm.  The views expressed on the hub however do not necessarily represent Patient Safety Learning's views or values. References to a specific product or service does not imply a recommendation or endorsement.

About the Author

Dr Rachael Grimaldi is the Co-Founder and Chief Medical Officer of CardMedic, a pioneering digital platform designed to overcome communication barriers in healthcare. With a background as an anaesthetist, Rachael founded CardMedic five years ago to address language, cognitive, visual, and hearing challenges, providing a library of clinically reviewed scripts in multiple languages, Easy Read formats, sign language videos,and live interpreter access in over 200 languages. Recognised in NHS England’s Patient Safety Health Inequalities Framework, CardMedic complements existing services, reducing risks in critical areas like maternity and paediatrics.