UK National Health Service Spends 40 Times More on Interpreting Than Translation

The annual spend for translation and interpreting at the UK’s National Health Service (NHS) reached GBP 65.96m (USD 82.88m) in 2019/2020. This, according to a new report analyzing data from 244 NHS Trusts and Health Boards in England, Scotland, Wales, and Northern Ireland.

Government spending on language services for individuals with limited English proficiency (LEP) has come under fire by the UK press. But, as the authors pointed out, based on total expenses incurred by more than 100 Trusts and Health Boards, the average spend on translation and interpreting represents approximately 0.057% of those organizations’ total expenditure.

For context, the report stated that “the total spending in 2018/2019 and 2019/2020 on translation and interpreting services (including Welsh as well as services for the Deaf and blind) relative to the UK population is the equivalent of just under GBP 1 per person per year.”

London medical language service provider (LSP), Inbox Translation, which neither holds contracts with the NHS nor participates in any tender process related to the system, carried out the study between February 2021 and March 2022. It analyzed data from 244 NHS Trusts and Health Boards in England (214), Scotland (15), Wales (9), and Northern Ireland (6). To obtain the data, the LSP sent Freedom of Information requests to all NHS Trusts and Health Boards across the UK.

Inbox Translation intended for the study to replace a 2012 report by 20/20health, which offered the only available data on NHS spending in this area. In addition to recommending Google Translate as an option for lowering spend on language services — which has since been deemed not up to task in medical emergencies — the 2012 report did not differentiate interpretation and translation services.

Researchers quickly learned why: 84% of the NHS organizations contacted did not distinguish between interpretation and translation, and could only provide a figure for both services combined. Many organizations’ records also conflated spending on foreign language services with services for Welsh, Braille, and British Sign Language (BSL).

Based on a sample of 39 out of the 244 NHS Trusts and Health Boards, the authors estimated a breakdown of services dominated by interpreting (GBP 56m), followed by BSL (GBP 8.58m). Trailing behind was translation (GBP 1.45m).

In terms of aggregated spend across the four UK nations, researchers looked at 220 organizations able to provide data spanning the entire period from 2015–2020. They found an average yearly increase in spending of around 6.2%, resulting in an increase of 27.22% over five years.

Data from 61 Trusts and Boards in England, Scotland, and Northern Ireland showed that spending increased from 2018/2019 to 2019/2020 by 0.47% for translation services, 0.40% for interpreting services, and 21.81% for BSL.

Push for Access Prioritizes Sign Language

Across all organizations, an increase in LEP patients and a move toward using professional interpreters instead of family members or friends explain the increase in spend. For BSL, however, the jump in spending, a trend the authors expect to continue, can be attributed in part to a national BSL Plan launched in Scotland in October 2017.

The push for accessibility complements recent research correlating greater language access with improved outcomes for LEP patients with Covid-19. On the other hand, LEP patients have also reported lower satisfaction in their encounters with the healthcare system compared to English-speakers, even when using their preferred mode of interpreting.

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Although researchers managed to determine the total spending on all translation and interpreting services, including BSL, Braille, and Welsh, for 2018/2019 and 2019/2020, they noted that there is currently no reliable way to obtain accurate data from all organizations for each service type.

“The main recommendation arising from our research is for more comprehensive and consistent data recording on translation and interpreting services on the part of NHS organizations,” the authors concluded. “If achieved, this could potentially be used by the NHS and service providers to improve service coverage and cost-effectiveness.”