A patient with limited English arrives at A&E with chest pain. No interpreter is available. Staff do their best with gestures and Google Translate. The patient is discharged with painkillers. Three days later, they're back – with a heart attack. Now emergency surgery is required, costing tens of thousands of pounds, not to mention the human cost of preventable suffering.
This scenario plays out across the NHS more often than we'd like to admit. And increasingly, when budget pressures mount, translation services are seen as an easy place to cut costs. The logic seems sound: "Surely they'll learn English faster if we stop providing interpreters?"
The problem is that this assumption has no evidence base. In fact, research shows that cutting professional translation doesn't accelerate language learning – it worsens health outcomes, increases costs, and undermines the very integration we claim to support.
When public services face budget constraints, translator costs are visible and easy to count. What's harder to see – but far more expensive – are the downstream costs of inadequate translation: missed diagnoses, medication errors, unnecessary tests, avoidable readmissions, and lengthier recovery times.
The evidence from healthcare systems similar to the NHS is compelling. A review of 11 studies on translator cost and cost-effectiveness found that most demonstrated better care and outcomes at limited extra cost or even net cost savings, supporting broader use of professional translators despite upfront expense (Brandl et al., 2019).
In a large US hospital "natural experiment," researchers placed dual-handset translator phones at every bedside for patients with limited English proficiency. The result? 30-day readmissions dropped from 17.8% to 13.4%. After accounting for translator costs, the hospital saved an estimated $161,404 per month in averted readmissions (Karliner et al., 2017).
During COVID-19, an emergency department implementing digital medical translation estimated cost avoidance of approximately $19,600 over six months, whilst simultaneously improving communication efficiency (Sharfuddin et al., 2021).
The savings arise through several mechanisms:
Fewer readmissions and complications. When patients understand their diagnosis, medication instructions, and follow-up care, they're less likely to return to hospital. Each avoided readmission saves thousands of pounds.
More accurate assessment and fewer delays. Professional translators enable clinicians to take proper histories, make accurate diagnoses, and avoid unnecessary tests. Ordering every test "just in case" because you can't communicate properly is expensive.
Reduced safety risks. Language barriers are a documented patient safety issue. Medication errors, wrong-site procedures, and misunderstood consent all carry enormous costs – financial, legal, and human (Shamsi et al., 2020; Flores, 2005).
Better use of clinical time. Contrary to popular belief, professional translators often make consultations more efficient. Ad hoc translation using family members, untrained staff, or gesture takes longer and produces poorer outcomes.
"But surely they need to learn English at some point?" Absolutely. But denying translation doesn't speed that process – it simply excludes people from services whilst their English develops.
Research on language acquisition is clear: exposure alone is insufficient. A comprehensive review of content and language integrated learning (CLIL) in Europe – where students are taught subjects in their second language – found mixed or often null advantages compared to mainstream programmes (Goris et al., 2019). Simply increasing L2 exposure is no guarantee of faster language development.
Studies of digital language tools for migrants and refugees show that effectiveness depends heavily on motivation and sociocultural context; fear of stigma can reduce usage (Figueiredo, 2023).
What's notably absent from the literature is any study showing that withholding translators leads to faster language learning. Research instead emphasises the need for appropriate, scaffolded support – not "sink or swim" immersion.
There's also a class dimension rarely discussed openly: immersion without support favours those with existing resources. An educated professional with financial buffers, networks, and time manages better in an immersion environment. A traumatised refugee with limited prior schooling and acute survival needs faces entirely different circumstances. Treating these groups identically in practice entrenches inequality.
A common misconception is that access to translators makes people "lazy" or "dependent”, as though someone using a translator at a GP surgery simultaneously refuses to attend English classes.
Reality is more complex. An asylum seeker may wait months or years for a decision. During that time, formal language instruction may be limited or non-existent. Should they be denied understanding from doctors or social workers during this period?
Someone who has just received leave to remain may be attending English classes whilst simultaneously needing urgent healthcare, participating in legal proceedings, or understanding decisions from the Home Office or DWP. Having the right to an interpreter in these situations doesn't compete with language learning – it ensures the individual can exercise their rights whilst their English develops.
Professional interpretation is a safety and rights issue, not a linguistic reward to be "earned." We don't accept that a deaf person should be denied a BSL interpreter because they "should learn to lip-read better." We shouldn't accept that someone should be denied understanding in their strongest language whilst their English is still developing.
"But they need to learn English at some point."
Of course. But denying interpretation doesn't accelerate that process. What's required is structured teaching, practice, and motivation – not closing doors to public services.
"Interpreters are a crutch – people get stuck using them."
There are no studies supporting this claim. However, there's substantial evidence that lack of interpreters leads to worse health outcomes, misunderstandings, and exclusion. A "crutch" that enables you to participate in society isn't a problem – it's a solution.
"We can't afford interpreters."
Interpreter costs are easy to count. What's harder to calculate is the cost of misdiagnosis, incorrect benefit decisions, lengthier processes, and mental ill health. A patient who doesn't understand their medication and ends up in A&E costs more than the interpreter would have. A child who doesn't receive proper school support because parents couldn't understand the SEND assessment pays in lost potential.
"But our staff speak a bit of Arabic/Polish/Urdu – isn't that enough?"
No. A colleague who speaks some of a language is not a professional interpreter. Interpreting requires training in terminology, neutrality, and confidentiality. Relying on colleagues creates legal uncertainty, places inappropriate burden on staff, and risks serious misunderstandings in complex situations.
When decision-makers consider limiting interpreter resources, it's crucial to understand the full cost picture.
In healthcare, poor communication leads to wrong levels of care, delayed diagnosis, and reduced treatment adherence. It costs more in the long run. In education, misunderstandings between school and home can mean children with additional needs don't receive timely support, increasing the need for more extensive – and expensive – interventions later.
In social services, poor communication risks children coming to harm when authorities can't make proper assessments, or adults receiving the wrong type of support and remaining further from employment. In the justice system, misunderstandings have consequences for both legal fairness and efficiency.
Psychologically, repeated experiences of not being understood create profound feelings of powerlessness. For those already carrying trauma, this becomes another source of stress and ill health. Integration isn't just about learning words – it's about feeling seen, understood, and able to participate. Without interpretation, that possibility disappears.
The evidence points to a clear way forward:
Guarantee access to professional interpretation. Particularly in healthcare, education, social services, and justice. This isn't a cost but an investment in legal fairness, public health, and genuine integration.
Invest in parallel structured language education. ESOL needs to be more flexible, faster to access, and better connected to employment. Workplace language support and digital tools as complements – all of this is needed. But not as a replacement for the right to interpretation.
Build policy on evidence, not instinct. It's tempting to believe "tougher requirements" produce faster results. But when research says otherwise, we must have the courage to change course.
Train and support staff. Healthcare workers, teachers, and social workers need to understand the value of professional interpretation and how to work effectively with interpreters. Methods exist – but they require time and training.
Measure the right things. Integration isn't measured by how many people manage without interpreters, but by how many actually access healthcare, enter employment, understand their rights, and feel able to participate in society.
We live in a time when political decisions are often justified with "it's time people took responsibility." But responsibility can only be taken by those who understand what's expected. Removing the interpreter before language is in place isn't setting standards – it's closing the door.
There's no shortcut to integration through first removing the ability to understand. Research is clear: professional interpretation and structured language education are needed in parallel, for different purposes. One is about rights now. The other is about development over time.
The evidence from healthcare systems worldwide, including those with universal public funding like the NHS, shows that professional interpreter services can pay for themselves through reduced readmissions, fewer complications, and better outcomes. The question isn't whether we can afford interpreters – it's whether we can afford not to provide them.
If we want to build a society where everyone can participate on equal terms, we must start with the most basic right: the right to be understood.
Brandl, E., Schreiter, S., & Schouler-Ocak, M. (2019). Are Trained Medical Interpreters Worth the Cost? A Review of the Current Literature on Cost and Cost-Effectiveness. Journal of Immigrant and Minority Health, 22, 175–181. https://doi.org/10.1007/s10903-019-00915-4
Fennig, M., & Denov, M. (2020). Interpreters working in mental health settings with refugees: An interdisciplinary scoping review. The American Journal of Orthopsychiatry, 91(1), 50–65. https://doi.org/10.1037/ort0000518
Figueiredo, S. (2023). The effect of mobile-assisted learning in real language attainment: A systematic review. Journal of Computer Assisted Learning, 39, 1083–1102. https://doi.org/10.1111/jcal.12811
Flores, G. (2005). The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review. Medical Care Research and Review, 62, 255–299. https://doi.org/10.1177/1077558705275416
Goris, J., Denessen, E., & Verhoeven, L. (2019). Effects of content and language integrated learning in Europe: A systematic review of longitudinal experimental studies. European Educational Research Journal, 18, 675–698. https://doi.org/10.1177/1474904119872426
Karliner, L., Perez-Stable, E., & Gregorich, S. (2017). Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency. Medical Care, 55, 199–206. https://doi.org/10.1097/mlr.0000000000000643
Khatri, R., & Assefa, Y. (2022). Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health, 22. https://doi.org/10.1186/s12889-022-13256-z
Kwan, M., Jeemi, Z., Norman, R., & Dantas, J. (2023). Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature. International Journal of Environmental Research and Public Health, 20. https://doi.org/10.3390/ijerph20065165
Shamsi, H., Almutairi, A., Mashrafi, S., & Kalbani, T. (2020). Implications of Language Barriers for Healthcare: A Systematic Review. Oman Medical Journal, 35, e122–e122. https://doi.org/10.5001/omj.2020.40
Sharfuddin, N., Mathura, P., Ling, E., Bruseker, E., Rajeh, A., Woods, J., Suranyi, Y., & Kassam, N. (2021). Advancing Health Equity During the COVID-19 Pandemic through Digital Medical Interpretation Platforms. https://doi.org/10.21203/rs.3.rs-384431/v1
Vange, S., Nielsen, M., Michaëlis, C., & Jervelund, S. (2023). Interpreter services for immigrants in European healthcare systems: a systematic review of access barriers and facilitators. Scandinavian Journal of Public Health, 52, 893–906. https://doi.org/10.1177/14034948231179279
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