There is a conversation happening right now about the cost of language services in the NHS. Posts circulate, numbers are quoted, and the question is asked: why can’t we just use an app? It is worth slowing down — because behind those numbers are patients, and in some cases, the stakes are not inconvenience or frustration. They are life and death.
First, a terminology point
The word “translation” is being used to cover two very different things. Translation is written: a document rendered from one language into another. Interpretation is spoken or signed, in real time, between people.
They require different skills, different training, and different kinds of expertise. And in healthcare, it is largely interpretation — not translation — that is under discussion when people talk about language services costs. You cannot replace a skilled medical interpreter with a translation app. They are not doing the same job.
The app problem
Machine translation tools have improved significantly. For casual use — finding your way around a new city, reading a menu — they can be genuinely useful. In clinical settings, they are not a safe substitute.
Language is not a string of words to be swapped out one for one. It carries tone, register, cultural meaning, and contextual inference. In healthcare — where the goal is not just communication but informed understanding — that nuance is not optional.
What the evidence says
MBRRACE-UK — the national confidential enquiries into maternal deaths and morbidity — has consistently identified language barriers as a contributing factor in adverse outcomes.
The 2024 Saving Lives, Improving Mothers’ Care report found that most migrant women “did not receive adequate support for their language needs.” The December 2024 perinatal confidential enquiry into stillbirth and neonatal death among migrant women with language barriers confirmed the same systemic failure.
This is not a soft finding. It is a direct, evidence-based link between interpreter access and whether patients and babies survive. A well-supported birth — where a patient understands what is happening and can give true informed consent — also reduces readmissions, complaints, and litigation costs for the NHS. Professional interpretation is a clinical investment with a measurable return.
Where the real problem sits
If language services in the NHS are expensive and inconsistent, the question worth asking is not whether interpretation is necessary — it clearly is. The question is why the system delivers it so poorly.
Large agencies win NHS framework contracts — often on price — without always having the interpreter resource to actually deliver. They operate as intermediaries. Restrictive contracts can prevent Trusts from sourcing elsewhere even when a provider cannot meet demand. There is frequently little transparency over what is being charged and what the interpreter at the end of that chain actually receives.
The answer, too often: less than minimum wage once travel time is factored in. Unpaid holding periods. Zero-hours contracts. No guaranteed work. This is the structural failure that deserves scrutiny — not the Trusts meeting a legal and clinical duty, and not the patients for needing care in a language they can access.
What good looks like
Good health interpreting is not just about language transfer. It is about a trained, qualified professional who understands clinical context, handles sensitive conversations with care, and can navigate the space between a healthcare provider and a patient with precision. For informed consent, for safeguarding conversations, for mental health assessments — tone and subtext matter enormously, and no algorithm can be trusted to carry those accurately.
At TranslationsInLondon, we work exclusively with human linguists — no machine translation, no AI-assisted output, no shortcuts. We hold ITI Corporate Membership (No. 00030335), and every project goes through a full TEP (Translation, Editing, Proofreading) workflow. In health and life sciences work, that rigour is not bureaucratic process. It is patient safety.
The bottom line
Language services in the NHS cost money. So does a misdiagnosis. So does a readmission. So does a safeguarding failure. So does a patient who could not give informed consent because they did not understand what they were agreeing to.
The evidence is clear. The solution is not apps. It is qualified, fairly paid, properly contracted interpreters — and a procurement system that prioritises quality and accountability over the lowest headline fee.