Tax and spend
How much does the UK’s National Health Service really spend on translation and interpreting services? Alina Cincan decided to investigate the evidence.
Sometime in 2020, I came across an article which said there was no reliable or recent data about how much the NHS spends on translation services. It cited a decadeold research paper, which, on closer examination, seemed to have several flaws, some of which stemmed from the fact that the author did not know much about our profession.
It’s a familiar complaint. When it comes to spending public money, some elements of the media (I think we all know which ones) always focus on immigration and how spending money on (usually) interpreters is wasteful and outrageous. So, I decided to look into what this means for the taxpayer; what the real figures are (a fact-checking exercise); and what it means in terms of overall NHS spending.
Of course, there was also one other reason: my own interest in the field, as both my company and I personally provide medical translation services – always privately paid, no public contracts.
Uncovering the information
My colleague and I sent out freedom of information (FOI) requests to all 244 NHS trusts and health boards across the UK (England, Wales, Scotland and Northern Ireland) – for those who don’t know, the Act allows the public to request information that is not routinely published by public authorities. We asked for the spending on translation and interpreting (separately) for each of the financial years between 2015/2016 and 2019/2020 (as these were the five latest complete financial years at the time we started the research). We wanted to focus exclusively on foreignlanguage translation and interpreting, so we asked for these figures excluding British Sign Language (BSL) and Braille. However, most trusts and health boards do not record this information separately. Only a handful were able to provide separate figures for foreignlanguage translation, foreign-language interpreting, and BSL.
We also double-checked all the figures we received and if there were discrepancies we went back and asked for clarification. Sometimes we had to challenge details, provide explanations, or request further information as not all the organisations were clear about the difference between translation and interpreting: for example, one trust mentioned ‘No written (documents) interpretation required’. Overall, this process turned out to be incredibly time-consuming, and is probably the main reason there is not so much information on this topic.
Findings: the total spend and how it’s allocated
The total spend on foreign-language translation, foreign-language interpreting and BSL was £65,962,418 in 2019/2020. This includes spending on Welsh translation and interpreting (outsourced services only, as we excluded the spend on salaried staff). A year earlier, in 2018/2019, this figure stood at £62,409,493. We could not obtain an exact total figure for the previous three years because some of the organisations could not provide the data (most notably because it was recorded on paper). When they report on the figures, some media outlets allege that most of the spending is on ‘translators’. I am pretty confident that this stems from the fact that most of them do not differentiate between translators and interpreters and use ‘translator’ as an umbrella term.
As a provider of medical translation services, Alina Cincan wanted to look at the reality behind some of the headlines.
Regardless, it was interesting to see what the split was in terms of spending, with the caveat that the figures used are based on the few organisations that record all these expenses separately. The figures revealed that 85 per cent of the spending is for foreign-language interpreting and around 13 per cent for BSL, while translation only accounts for about 2 per cent. We excluded Wales from this analysis, as the vast majority of the spend here is on Welsh translation and interpreting and, in most cases, was not recorded separately. Braille spending was either nil or negligible. Except for the NHS organisations based in Wales, translation and interpreting are outsourced services.
I was also interested to see what languages were used and how this varied between different years. Unfortunately, most organisations do not keep such detailed records (only a handful do). Some were able to provide their top three or top 10 languages, others a list of all the languages they can cover; but a thorough and accurate analysis was impossible. What I was able to find out was that over the five-year period we looked at, translation and interpreting were offered in 120 languages, from Afaan Oromoo to Zulu.
Based on a sample of organisations (220 NHS trusts and health boards out of the total 244) that were able to provide complete figures for all of the five years, it seems that spending on translation and interpreting increased by around 6.2 per cent year-on-year between 2015/2016 and 2019/2020. A small dataset we obtained for 2020/2021 seems to suggest that there was a drop in the overall spending of around 21 per cent (which can, most likely, be attributed to the pandemic).
The overall increase seems to be fuelled mainly by the increase in spending on BSL rather than on other types of translation or interpreting. For example, in 2019/2020, the increase in spending on foreign-language translation services was 0.47 per cent, for foreign-language interpreting services 0.4 per cent, while for BSL this was 21.81 per cent.
Looking at this increase (and, in particular, the huge increase in BSL spending), we set out to investigate the reasons behind it. In our exchanges with the trusts, these increases were mainly attributed to three factors: moving to using professional interpreters instead of friends, family or staff; putting national plans in place (for example, Scotland launched its national BSL Plan in October 2017); and seeing more patients every year.
Putting this into perspective
Although there has been some increase in spending on translation and interpreting services, this still represents only 0.057 per cent of a trust’s total expenses. Given the way this expenditure is sometimes portrayed, I think it is important to highlight that in the last financial year we looked at (2019/2020), the total spending means a contribution of less than £1 a year per person. And as professionals in the field, we are very aware of the fact that, in medical settings, accurate communication is literally a matter of life and death.
Our full report can be found here.
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