Improving equitable maternity care through inclusive communication

What the organisation faced

Epsom and St Helier University Hospitals NHS Trust (ESTH) serves one of the most diverse populations in London and Surrey, with over two-thirds of patients coming from global majority backgrounds with large Arabic- and Tamil-speaking populations.  

In 2024, over 200 women receiving antenatal care did not speak English as their first language. Many had newly arrived in the UK or were seeking asylum. Almost half were high-risk pregnancies requiring frequent, complex interactions across community and acute settings. Staff also cared for women with learning disabilities, low health literacy, and patients requiring British Sign Language (BSL).  

The trust identified several critical gaps in existing provision: 

• Interpreters were often unavailable in emergencies, out of hours, or during long inpatient stays.
• 52 per cent of staff reported interpreter delays, and 34 per cent said access became more difficult out of hours.
• Busy clinics experienced bottlenecks waiting for interpreters, slowing patient flow.
• Staff frequently had to rely on family members, despite the trust's guidance prohibiting this.
• Data showed that non-English-speaking mothers had higher rates of neonatal readmission, particularly related to infant feeding and hypoglycaemia prevention. 

In addition, ineffective communication is cited as a core driver of inequity. National evidence from MBRRACE-UK shows black and Asian women are more likely to die during pregnancy and childbirth compared with white women.  

The trust could see that communication and sensory barriers were impacting access, safety and outcomes, identifying an urgent need for a consistent, safe and accessible communication solution that could complement traditional interpreting services and improve outcomes for mothers and babies.  

The improvement

The trust launched a broad strategy to bridge the communication gap in maternity services. Rather than replacing traditional interpreters, the trust introduced a digital communication support tool – CardMedic - that could complement the service and support routine and urgent interactions with clinically validated content in multiple accessible formats.  

The initiative aimed to enhance clinical communication across all maternity settings, enabling patients to better understand critical health topics such as infant feeding and diabetes management. By providing staff with an alternative to unofficial translation workarounds, the trust sought to improve patient safety and reduce avoidable neonatal readmissions. 

Key elements of the implementation included: 

• Data-led identification: Using BadgerNet data, midwifery teams identified non-English-speaking patients early in their pregnancy journey to share relevant digital content before their first appointment.
• Community provision: Midwifery teams were equipped with mobile devices to ensure the same level of inclusive communication during home visits as in the hospital.
• Clinical alignment: The content was mapped against the trust’s maternity safety priorities, focusing on gestational diabetes (GDM) management, safe sleep, and screening.
• Workforce support: The trust focused on moving staff away from ‘workaround’ solutions, such as Google Translate, toward a clinically validated tool to ensure the accuracy of medical advice. 

Outcomes

The integration of digital communication support to maternity care has led to several key improvements in safety and patient experience: 

• Impact on neonatal care: The trust saw a reduction in neonatal readmissions from 7.79 per cent to 7.17 per cent. This shift is attributed to improved parental understanding of critical care topics such as hypoglycaemia prevention and feeding.
• Reduced clinical delays: By using the platform for initial assessments and triage, staff avoided the typical 35-minute wait for telephone interpreters in urgent scenarios, such as presentations of reduced foetal movement.
• Improved management of gestational diabetes: For the 17.3 per cent of the cohort affected by GDM, the tool facilitated better understanding of glucose monitoring and escalation protocols, reducing the risk of NICU admissions and risks associated with sudden infant death syndrome (SIDS). 

Empowered staff and patients: 50 per cent of staff reported that the tool made communicating with diverse patients significantly easier. It allowed clinicians to provide immediate, safe information without requiring family members to act as intermediaries. 

Inclusive accessibility: By utilising British Sign Language (BSL) videos and Easy Read formats, the trust has been able to better support patients with low health literacy and sensory impairments, meeting the requirements of the NHS Accessible Information Standard.