Practices in Lewisham, Southwark and Lambeth have shifted almost entirely to remote interpreting, saving more than 1,500 tonnes of CO₂e over the past five years. Charlotte Gascoyne, Head of Sustainability and ESG at Dals, explains in detail
Around one million people live in the south-east London boroughs of Lewisham, Southwark and Lambeth – and a significant share have limited English proficiency.
Census data shows that in Lewisham, with a population of just under 300,000, 18.3% of residents speak a first language other than English. Around 3% report limited English skills and 1.2% say they have none at all. Southwark, home to more than 311,000 people, has a similar profile: 18.5% of residents speak a different main language, 2.9% report poor English and 1.1% no English at all. In Lambeth, with a population of almost 320,000, the figures are 18.3%, 3% and 1.2%, respectively.
These figures may not be the highest in the UK, but they are higher than the national average, underlining just how many residents in the three boroughs face communication barriers that affect daily life and can limit access to essential healthcare services.
In primary care, the implications can be profound. Without interpreting, something as routine as a GP appointment can become a daunting and sometimes unsafe experience. Misunderstandings risk undermining treatment, delaying care and damaging trust between patients and clinicians. Yet the scale of need – with more than 80,000 appointments requiring interpreting each year – also creates a challenge for the NHS: how to meet demand in a way that is reliable, cost-effective and environmentally sustainable.
Since 2020, GPs across the three boroughs, commissioned together as LSL under the NHS South East London Integrated Care Board (ICB), have been working with language services provider Dals to reshape how services are delivered.
Aim
The ICB’s Green Plan sets out how the body will cut its environmental impact and contribute to the wider NHS target of reaching net zero. Central to this is reducing unnecessary travel, making greater use of digital technology and ensuring that services are delivered in ways that are clinically effective as well as environmentally sustainable. For interpreting, this meant moving away from a model where interpreters travelled across London for routine primary care consultations, and instead embedding remote options that were faster, cheaper and less carbon intensive.
Method
The ICB partnered with Dals, a specialist language services provider offering interpreting and translation in more than 500 languages, including British Sign Language. Together we designed a remote-first model that shifted interpreting away from being travel-heavy and requiring advance booking towards being digital, accessible and sustainable.
Telephone interpreting was reaffirmed as the first-choice option. Video interpreting, once limited to pre-booked sessions, was expanded to include on-demand access, allowing GPs to connect instantly with interpreters during consultations. This was repositioned as a digital alternative to face-to-face (F2F) appointments, providing the visual cues and context that sometimes make telephone interpreting unviable in medical settings. For the small proportion of cases that still required a face-to-face (F2F) appointment, practices were directed to Dals’ linguist locator tool, which reduces travel distances, cutting roundtrip journey lengths by nearly 30 miles, on average.
Support for both staff and patients was central. Practice teams received regular training on using the new services, with refresher sessions every 12 to 18 months. Patients were provided with information leaflets in the 20 most commonly spoken local languages, ensuring awareness extended beyond English speakers. A dedicated intranet page brought together resources, updates and surveys, creating a single point of reference for staff.
Outcomes
The results were swift and striking. Before Dals was awarded the contract in 2020, one-third of interpreting appointments were still delivered in person. Over time, as confidence grew, booking patterns shifted decisively away from F2F. At present, 99.5% of interpreting is delivered remotely.
The environmental effect has been significant. Between 2020 and 2025 to date, 339,882 interpreting appointments that would once have involved travel were instead handled remotely. This avoided almost 5.8 million miles of travel and saved 1,529 tonnes of CO₂e – more than three times the 522.58 tonnes of CO₂e avoided with remote appointments in 2020. The carbon reduction is equivalent to the yearly energy use of 205 homes, 3,541 barrels of oil consumed or 20.2 tanker trucks worth of petrol.
Reliability and cost improved too. Fill rates (the percentage of interpreting requests successfully met with an interpreter) are higher for remote options as F2F bookings are always subject to the inherent risks that come with travel. For remote interpreting, fill rates for 2025 so far have reached 98%, compared with 80% for F2F interpreting. For practices, this has meant fewer delays and greater certainty that patients are understood. Costs also moved in the right direction. While a face-to-face booking averaged £54 in early 2025, video came in at £45 and telephone just £7. Commissioners have been able to meet rising demand, while also reducing overall spend and cutting emissions.
As NHS Community Based Care Development Manager for the ICB, Yvonne Joy, explained: ‘For practices, the priority is always on patient safety, accessibility and outcomes. At the same time, we’re working with the sometimes conflicting goals of decreasing our negative impact on the planet by reducing unnecessary travel and servicing an increasing large and diverse population. Our work to shift towards remote interpreting services where possible has allowed us to improve accessibility and patient care, while also having a positive impact on the environment.’
Action
Lewisham, Southwark and Lambeth’s experience shows that systemic change can be achieved when commissioners, providers and frontline teams pull in the same direction. Remote provision wasn’t just imposed from above: it was made workable through investments in technology, backed by regular training for staff and clear communication with patients. By treating sustainability as a central requirement from the beginning, and aligning technology, training and stakeholder engagement, the programme embedded the change.
Future
Demand for interpreting in primary care is set to continue rising as the UK’s population diversifies and healthcare needs grow more complex. The question for health systems is how to meet this demand in ways that are affordable, reliable and aligned with net zero targets.
The case of Lewisham, Southwark and Lambeth demonstrates that remote interpreting can deliver on all three fronts. It has safeguarded access for patients, reduced delays for clinicians, cut costs for commissioners and delivered measurable environmental benefits.
Face-to-face interpreting will always have a role in certain clinical situations, but it no longer needs to be used so frequently.
For other primary care providers, the lesson from the LSL case study is that by rethinking long-standing habits and embracing digital solutions, interpreting can become not only more sustainable but also more effective and efficient. At a time where the NHS must do much more with less while meeting ambitious climate commitments, the LSL case study proves that in most cases, remote access is quicker, cheaper, more convenient and better for the planet.
