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‘Media Attacks on NHS Translation and Diversity Spending Completely Miss the Point of the Health Service’

The Express suggested that £100 million of NHS spending on translators should be spent on nurses – but ensuring patients get the care they need is fundamental and a legal requirement, writes NHS consultant David Oliver

A doctor examines patients in hospital room
The NHS is under constant attack over diversity and equality spending, but there is also evidence of ongoing discrimination towards minorities within it. Photo: Jozef Polc /Alamy

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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 article published on 2 April about NHS spending on translators

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.

The Mail article published on 31 March on ‘woke scones’

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.

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The thinly-veiled xenophobia and racism being whipped up by the Express (even against people who pay tax and National Insurance contributions and have precisely the same entitlement to care as native and confident English speakers) is part of a wider set of ‘wedge issues’ being pushed by right-wing media outlets and sections of the Conservative and Reform parties.

They share a similar fixation with ‘woke’ diversity managers or diversity, equality and inclusion (DEI) policies in the NHS or other public services. Several Government ministers have lined up to call for a ‘war on waste’ to remove such posts and policies.

Steve Barclay, when Health Secretary in 2023, wrote to integrated care boards in England instructing them to stop recruiting staff as dedicated EDI managers, arguing that the money should be spent on “frontline staff” instead.

The Express has published a number of articles lamenting ‘wokery’ in the NHS – including, in January in a story headlined ‘NHS spends £40 million on woke non-jobs that could pay for 1,150 nurses’.

Last year, the Spectator ran a FOI-based story showing that, out of an NHS workforce of around 1.5 million people, there were only 800 employees in dedicated EDI roles – yet called for those roles to be abolished.

Again, those employed in such posts account for a small fraction of 1% of the entire NHS workforce or spend. Their presence is de facto required due to the Equality Act and Equality Duty on public organisations and protections in employment law.

NHS organisations do have a very diverse workforce, yet there is clear evidence of ongoing and endemic discrimination towards minorities within it. There is also consistent evidence of discrimination and care inequalities between different ethnic and socio-economic groups the NHS serves.

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The idea that a focus on EDI is somehow a bad thing and a distraction from real work, or that organisations should not employ a small number of people to oversee it, is not so much a dog-whistle as a wolf-klaxon. It is a classic distraction from the real issue – the 14 years of Conservative-led mismanagement of health and social care and of wider public health.

This decline has been well-documented by the Institute for Government think tank; as well former King’s Fund chief executive Professor Sir Chris Ham, who set out in expert detail the rise and decline of the service from the late 1990s through to the 2010 election and the current crisis in performance and public satisfaction.

Blaming our NHS crisis on the cost of translation and interpretation services, and diversity and inclusion managers, foments hostility against people from ethnic minorities, white people with poor English skills, and even those with full entitlement to use our public services and who contribute towards their costs.

They aren’t all rich enough to pay for their own personal translator or digitally equipped enough to auto-translate NHS information documents into their own languages.

I don’t see commentators on the right arguing against hospitals in France or Spain finding translations for ill white British expats or embassies around the world employing translators to help British citizens who have found themselves in a spot of bother with the local law. I wonder why.


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