Language ability: a neglected dimension in the profiling of populations and health service users

Britain is becoming an increasingly diverse society in ethnic, cultural, and linguistic terms. Race equality as a matter of governance has gained momentum through legal developments and prioritization in policies. However, ethnic inequalities in health and healthcare are marked and persistent and language has been identifi ed as a key barrier to accessing services and effective communication. There is, for example, currently substantial under use of NHS Direct, England's telephonic health and information service, by non English-speaking callers. It is surprising, therefore, that there are no official sources of comprehensive information for the UK population on main spoken languages and competency in English. While such questions are routinely asked in national population censuses in the USA and Old Commonwealth countries, in the UK these are conspicuously absent from the decennial censuses, most of the major Government social surveys, nearly all NHS core datasets, and ethnic monitoring in primary care. The NHS Resource Allocation Weighted Capitation Formula now uses data on language diffi culty 10-15 years out of date. The upcoming 2011 Census offers an important opportunity for NHS organizations to secure the comprehensive national and small area data required to establish the need for language support services, including bilingual support and interpreting and translation provision.