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?

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.

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.

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.

A new commentator on this blog named Tony Wikrent made an interesting comment yesterday, saying, when discussing the purpose of economics:

”Many subscribe to Lionel Robbins’ definition of economics as the allocation of scarce resources among competing ends”

This is where economics goes wrong – right from the beginning. The actual history of Understanding this would radically shift the what economists emphasise. Financial markets and prices would become much less importance, and the creation of science and new technology would become paramount areas of inquiry.

Robbins, whose overall contribution to economics was not nearly as important as I think the London School of Economics like to claim it to be, undoubtedly heavily influenced economic thinking with his 1935 book in which he offered the above suggestion. That idea was taught to me in the 70s. It is still commonly noted. Ask ChatGPT what economics is about and it suggests:

Economics is the social science that studies how individuals, businesses, governments, and societies allocate resources to satisfy their wants and needs, given scarcity. It analyzes production, distribution, and consumption of goods and services, as well as the behavior of markets and economies.

Scarcity is the condition that requires economic choice, apparently, based on a search of the web as a whole. The idea remains in common use then, in itself constraining us all. It was, apparently, Robbins maxim that human beings want what they cannot have, and that notion need not be true, meaning it did not have the power he gave it.

In the 1930s, when Robbins wrote, I am aware that one of my grandfathers earned 30 shillings a week (£1.50) and lived in a tied cottage in a state of both considerable insecurity and poverty. My mother’s descriptions of that upbringing have influenced me, without a doubt. In that situation, then Robbins was to some degree right; human beings did want what they could not have.

But, as Tony Wikrent implies, Robbins thinking (both economic and social) was decidedly static. His presumption was that what was scarcity was a permanent state in which the economy must exist. Post-war development showed that this need not be the case. .

Vastly better housing became available. Incomes rose. The post-war consensus delivered prosperity to vastly more people, me included. The problem of scarcity was not solved, but it altered radically. Three themes became apparent.

The first was that it became possible that we could meet need. It was, and remains, possible for us to ensure everyone in the world could enjoy a life where their needs are met. I am not saying that would be easy. I think it could be done.

Second, that fact did not solve the problem of scarcity. Those with the ability to solve the problem of unmet need chose not to do so. Scarcity with regard to need was imposed instead. It was no longer inevitable, but it continued to exist, nonetheless.

Third, the reason why need was not met was because those with the means to do so chose, or rather were persuaded, that satisfying their wants was a higher goal than was the meeting of the needs of others.

When Robbins wrote in 1935 the whole field of marketing, and the manipulation of human perception that it involves,  was virtually unknown.  Advertising did, of course, exist. But marketing is quite different. It seeks to create wants where none existed, and that activity did not become commonplace until the 1950s. The imposition of continued scarcity was a necessary condition for marketing’s success. Innovation might have created the means to address all needs, but the reality was that it was instead primarily directed at meeting previously unknown wants.

Does that mean that I disagree with Tony Wikrent? It does not. The point he makes is powerful, and appropriate. It does, however, need to be framed and that framing is to be found in the choice that supposedly free markets have made with the power to create technology that we have discovered.

That power has been used to achieve three outcomes. One, very obviously, is consumption beyond the physical constraints that the planet can sustain. As a result, we have the climate crisis.

Second, this power has been used to concentrate wealth in the hands of a few. Technology in innovation has, when subverted to private purpose, and when coupled with the abuse of artificial legal constructs like patents and copyrights, been used to create market power that eliminates competition, suppresses further innovation and delivers massive inequality within society.

Third, as a result, innovation has begun to destroy its own potential to meet either needs or wants as the preservation of the wealth of a few is deemed a higher-order priority than meeting the needs of an increasing number of people, whilst it also destroys the very markets that supposedly fostered its creation.

To put it another way, the whole purpose of market-based economics has become the prevention of the meeting of needs whilst simultaneously creating the means for an increasingly smaller number of people to consume to excess way beyond any conceivable measure of human requirement.

The problem for this economic model is that it is unsustainable. As more and more people are driven towards economic desperation, which is very obviously happening at present, the social acceptability of this form of economics is collapsing. Simultaneously, the excessive use of natural resources that it requires is becoming evermore apparent. Neither, by themselves, would be sufficient to bring this system down. Together, they create a situation where that is likely.

What happens then is the question to ask? This is where I think Tony’s comment is very relevant. Suppose that the whole purpose of industrial and agricultural development was to become the overcoming of the scarcity of resources. Could we find the food to feed the world, the water to sustain it given global heating, and the means of shelter, free from risk, where people might enjoy secure lives of reasonable comfort, free from fear? I think we could. But it does present the most massive challenge to a hierarchy of innovation and power that largely ignores need at present and instead presumes that the accumulation of excessive wealth for a few is the goal of society.

This article was first published in the February 2024 monthly print edition of Byline Times. Subscribe now to get ahead of the curve.

After the infamous 49 days of Liz Truss, Rishi Sunak was identified by the Conservative Party as the safest available pair of hands. He was a Prime Minister who could be trusted to knot his own tie and lace his own shoes, a dependable front-man for the increasingly unbalanced Conservative Brexit belief system. In short, he was Head Boy material.

Boyish and immature were qualities previously observed in Sunak’s male predecessors. Neither David Cameron nor Boris Johnson could quite carry off the role of grown-up, as if at heart both men remained fans of escapades without consequences. 

Cameron had his boyishly unlined face and Johnson his unbrushed hair. He had his arch schoolboy’s vocabulary – the fourth-form Latin and ripe English poppycock – and between them the old Etonian pals looked confident of doing what they wanted and not getting caught. Or not being punished if they were.

Sunak’s boyishness is of a slightly different order. 

Keen, compliant, he too gives off a sense of arrested development – the old school old boy who never grew up. The first clue is the hair. 

Hair statements are a conspicuous feature of 21st Century politics and, in the hothouse of Sunak’s private all-boys boarding school, Winchester College, he’d have understood hairstyles as a form of communication, a way of giving or withdrawing consent. His neat side-parting consents to authority and to the inherently traditional values of any institution founded in 1382.

His daily care with a comb projects a message that once, in his schooldays, was graciously received: Sunak was favoured by the adults and appointed Head Boy. 

As Prime Minister, he retains an unmistakable Head Boy Energy.

Importance Ingrained

In April 2022, Rishi Sunak made a donation of at least £100,000 to his old school. In an interview with Sky News, the then Chancellor said that Winchester College “helped make me who I am as a person and I’m sure it helps me to do the job in the way that I do it”. This sounds true enough, especially because since becoming Prime Minister Sunak has brought in former Winchester chums like James Forsyth as his closest advisors. 

In the same interview, Sunak thanked Winchester for the “opportunity”, like a contestant on The Apprentice. He isn’t wrong to do so, because in Conservative politics an education at a grand English public school is still today a gateway to the big end-of-series prize. 

Sadly for Sunak, achieving his schoolboy ambitions didn’t stop him getting stuck at Head Boy. He applies himself to public speaking, for example, as if no idea or policy is entirely his own, though his attempt at presenting as an adult should be commended considering his age. 

If he continues to do his duty and work hard he’s confident of earning adult approval and an impeccable termly report. Because isn’t that what always happens?

Take a look at the Conservatives’ poll ratings, and his own personal favourability with the public, and it would seem not.

Democracy was not a feature of Sunak’s appointment to the big job, now or then.

There was no public vote to make him Prime Minister and, back in the 1990s, Winchester’s Head Boy was anointed by the Head Man. I’ve asked former pupils what the position involved, but most have only vague memories of a ceremonial function, often involving Latin. No one remembers clearly what these Head Boys did (there were two of them, which Sunak has never managed to mention) and they tended to be ‘anonymous’.

I imagine it all felt much grander and more important to those who were actually chosen; a once-and-forever Head Boyness ingrained for the rest of a Head Boyish life. 

From now on, Sunak was not to be criticised but congratulated. He could have been forgiven, aged 18, for looking at life through the wrong end of a telescope. As Head Boy, his presence around the quads and classrooms was exaggerated in size, at least to himself. Looking ahead, the future appeared smaller and less simple. 

Now, from 2024, he can look back with the telescope the right way round – he’s learned that much at least – and school is magnified to look like the best days of his life. Worth a gift of a hundred thousand pounds, at least.

In his carefully curated biography – let’s call it the ‘Head Boy of Winchester College’ – is a widely-known, self-publicised fact about Rishi Sunak. It’s a boast he doesn’t recognise as a curse. If he did, he’d never have made Head Boy in the first place. Nor, as a schoolboy, could he have ingratiated himself so successfully if he hadn’t mastered an indifference to glaring class injustices or to the texture and traction of contemporary reality, which was refused entry at the Winchester College gates.

Sunak was proud to represent 800 years of elite plunder and token forays into the community. Later, he confirmed his horizons were so narrow and his mind so unquestioning he reliably came back with his gormless £100,000. 

Representation Not Responsibility

The Head Boy, by any old school measure, was someone who made the grown-ups happy. Children at boarding schools, like Sunak at Winchester, often find themselves making an unconscious promise to their parents not to fail or get into trouble. A stonking career compensates for the parental ‘sacrifice’ and justifies the family separation. 

But every step up the ladder is also an unresolved plea for attention and affection – a condition explored in 1970 by the Jamaican writer and politician Lucille Iremonger. Prime Minister Rishi Sunak, like Johnson and Cameron before him, has the Phaeton complex.

Phaeton, in Greek mythology, is a frustrated child of the sun god Helios. He insists on driving his father’s chariot just for one day. When eventually he gets his chance he crashes the chariot, which in the ancient worldview explained why so much of Africa was a desert. According to Iremonger, a hunger for power was the tragic fate of children who suffered a trauma in childhood, and she developed her theory from a study of British prime ministers between 1809 and 1940. Most of them were abandoned by their parents in English private boarding schools. Phaeton’s blind sense of purpose, Iremonger notes, “could lead only to disaster for himself, and possibly for others”.

Pity the eager Head Boy. His character already compromised by boarding school adaptations, he now embraces the corruption of prestige without power. Head Boy is Sunak’s version of Tory immaturity, which like Cameron and Johnson he can use as a reason to be excused. 

In front of the COVID Inquiry, for example, he could convince himself he wasn’t included in significant decisions and that, to the best of his recollection, few communications of any importance passed across his desk. He may have been Chancellor of the Exchequer, but he was light on power and responsibility. The Head Boy always is.

What Sunak’s Head Boy persona does bring with it is a brittle neediness. He needs validation, which is what got him the job in the first place. When he isn’t liked, or when he’s challenged, his Head Boy face drops. He gets tetchy and confused when he can’t find the right answer or when his answer isn’t accepted as right. 

He’s a good boy, he really is. He’s done well and worked hard, so why doesn’t he get the respect his unelected Head Boy status deserves? Why isn’t he loved? He has no idea, and if a playful Christmas video might help he’ll try it. It turns out he’s not very good at playful, not after so many years of pretending to be fully grown-up. 

Due to his immense personal wealth, but also due to his schooling, Rishi Sunak is vulnerable to accusations that he’s out of touch. During his Sky News interview, for example, he appeared unaware of the fact that he was echoing the more hapless contestants from The Apprentice. Those who thank Lord Sugar for the opportunity are the ones about to leave the show.

Thank you for the opportunity, Winchester College. Sorry I couldn’t have done better.

Richard Beard is the author of ‘Sad Little Men: Private Schools and the Ruin of England’

In April, the School of Social and Political Sciences, in collaboration with the Justice and Inequality research priority of the Faculty of Arts and Social Sciences, will be hosting Mike Savage, Martin White Professor of Sociology at the London School of Economics. He has a longstanding interest in the social and historical sources of inequality, within and across nations. From 2015 to 2020 Mike was Director of the LSE’s International Inequalities Institute, and his most recent book is The Return of Inequality: Social Change and the Weight of the Past (Harvard University Press, 2021), praised by Thomas Piketty as a “major sociological contribution to the ongoing global debate on inequality and the return of social class”.

During Mike’s visit, we will be holding two public events: a forum on ‘The Eternal Return of the Rentier? How Our Past Weighs on Our Future’ and a public lecture on ‘The Racial Wealth Divide’ (details below). In addition, we will be holding two closed workshops: one on the hold of finance on public policy (and how to loosen or break it) (April 4-5) and another on the methodological and theoretical challenges facing inequality researchers at a time of escalating inequality (April 16). These events are invitation-only, but spaces are available – please contact martijn.konings@sydney.edu.au for further information.

Public lecture: The Racial Wealth Divide

10 April, 5:30-7 pm
Lecture Theatre 208, Veterinary Science Conference Centre, The University of Sydney

Please register to attend

Over the past decade, escalating wealth inequalities have become apparent across the globe. It is increasingly evident that this is driven not by anonymous forces like “globalization” or “capital”, but by elites who enjoy disproportionate power and influence. This lecture addresses the intellectual and political challenges posed by this trend. Most fundamentally, how should we define, measure, and track this wealth, given that its growth stems at least in part from elites’ ability to stay under public, scholarly, and regulatory radars? How does wealth inequality reinforce racial, gender and other divides, and how does it shape social mobility and life chances across numerous domains? And what strategies could effectively advance the growing public interest in taxing wealth as a means to address entrenched wealth inequalities? This lecture discusses how wealth accumulation is underwritten by legal devices such as the ‘non-domicile’ tax regime; shows the roots of this in British imperial history, and considers the prospects for tax justice.

The post Mike Savage Public Lecture: ‘The Racial Wealth Divide’ appeared first on Progress in Political Economy (PPE).