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This week, the Express published an article headlined ‘taxpayers billed £100 million for NHS translators – could pay for 3,000 nurses’. The story completely missed the point of what the health service does.
The standfirst went on to explain that taxpayers “pick up the bill” for translation and interpretation” to ensure that the NHS can be “accessed in languages other than English”.
Given health and healthcare access inequalities, surely spending money to ensure people get the right care they need is a good thing – not to mention a legal requirement.
The Express packaged the story to suggest that it had uncovered a scandal. It included data revealed through Freedom of Information Requests (FOI) to 251 NHS trusts and 42 integrated care boards, which “routinely convert standard hospital and health literature into languages including Romanian, Arabic, Urdu, Bengali and Punjabi”.
The article included comments from a Reform Party spokesman, claiming that translation and interpretation services “were simply not necessary” and that artificial intelligence apps, such as Google Translate, could do the job – or that patients could use family members to translate for them.
The Express article followed the Mail’s report last week on National Trust cafés selling “woke scones” (made with margarine and not butter). It was another example of ‘stories’ aimed at stirring up problems, rather than solving them.
Helping those in need be heard appears to be a bizarre issue to weaponise in manufactured ‘culture wars’.
For starters, the total NHS spend in England for the last financial year was more than £180 billion, with a further £20 billion in local government spending on social care. So £100 million on translation might sound like a big number, but it is a tiny fraction of expenditure and would make little dent in nurse staffing across all NHS organisations.
Citizens or legal residents who don’t speak fluent or even basic English are, just like people with hearing loss, learning disabilities or cognitive impairment, as entitled to NHS care as the rest of the population. And there is already considerable evidence that they are not getting it, with health and healthcare access inequalities between different ethnic communities.
Denying people written information in their own language will only make matters worse.
When people who are sick, scared, vulnerable, distressed or have symptoms to discuss, treatments to understand, or complex psychosocial factors to explain, how can the quality and safety of the care they receive be improved if they can neither express nor understand key information?
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There are also legal considerations. To provide valid consent to treatment in common law, patients must have sufficient information about the details, risks, potential harms and benefits of a proposed treatment (which could in some cases involve major surgery, powerful drugs or admission to intensive care). Language barriers must be overcome to make this a reality.
The Mental Capacity Act states that all reasonable efforts must be made to establish decision-specific capacity for treatment or care – which may include overcoming language barriers.
If patients lack capacity, then speaking to those closest to them is a key part of establishing their best interests for further decision-making. Again, this may require translators or clear written information in their first language. We do this for people with hearing loss via written communication or sign language.
Regulatory codes of practice for healthcare professionals are also clear that we must treat people equally, irrespective of characteristics including race, religion or nationality.
Using AI translation apps of variable reliability has its limits in a time-critical or emotionally-charged and challenging situation. And relying on family or friends to translate isn’t always possible as not every patient is accompanied. If they are discussing personally sensitive or intimate information, they may be inhibited from doing so. If there are safeguarding concerns regarding abuse or neglect one could suspect the person translating of being coercive when doing so.