Ethical Procurement for Health

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Third year medical student Usama Hussain explains why the ethical procurement of medical equipment is vital, and the actions necessary to achieve it.

With NHS expenditure for goods and services in the billions, it hardly seems fair that improvements to our healthcare come at the expense of those who help to provide them. Yet mounting evidence suggests that infringements on the rights of employees in the supply chains involved are resulting in just that.

With  the NHS’s considerable spending power comes the opportunity and responsibility to become a leader in ethical procurement. Currently, over £30 billion per annum is fed into supply chains operating on a global scale; millions are employed to provide the commodities required by our healthcare system. However, little is done to challenge the unethical practices of many suppliers in developing nations, such as unsafe working conditions and remuneration which fails to reach the living wage threshold, subsequently allowing the erosion of workers’ rights. These directly influence the health of employees in a negative way. While there is an undeniable need for all NHS organisations to adopt ethical procurement policies, this is not limited to institutional-level involvement. Healthcare professionals can also have important roles in helping to achieve ethical standards.

Why is this an issue?

The lack of ethical procurement within our health service is of significant concern because of the numerous labour rights violations involved in the manufacture of several products.  The majority of surgical instruments used in the NHS are produced in northern Pakistan and, in a process that employs approximately 50,000 manual labourers, most receive salaries which, at less than US$1 per 12-hour day, are below the living wage. Additionally, a distinct lack of job security and the risk of acquiring serious injuries from machinery in unsafe working conditions, illustrates how unethical practise can lead to compromises in many different aspects of an individual’s health. This is without even considering the extensive use of child labour forces where children as young as seven are employed full time.

Malaysia, the largest global manufacturer of medical gloves, could see dramatic improvements in the health of its labour workforce if ethical procurement policies were implemented. An investigation into the nation’s second largest medical glove factory revealed that many employees were migrants being forced to work over 80 hours per week, all while risking sexual and physical harassment.

Such exploitations are not exclusively found in developing nations, as there have been multiple issues with the provision of services to the NHS in the UK. Migrant workers are a particularly vulnerable demographic; there have been reports of illegal wage deductions on NHS construction sites, and instances of care home nursing staff receiving earnings below minimum wage while working excessive hours.

What is “Ethical Trade”?


“Ethical trade” refers to the responsibility of purchasing organisations to respect the rights of disadvantaged individuals in the supply chain. Employees have the right to safe working conditions, where they are free from the risk of avoidable harm to their health, and should receive at least the legal minimum wage. Furthermore, they should be free to join and form unions in order to collectively fight for their rights. Organisations should also work to eliminate child labour. Applying these principles means that purchasing organisations will be in line with the values of ethical trading.

Given the complexity of supply chains, boycotting simply is not the answer. This a process of continuous improvement. Loss of a contract only further reduces money going to a supplier, and tends to make bad working conditions even worse.

Who can play a role?

Achieving effective ethical procurement is not easy, and requires commitment on many levels. The establishment of a multi-stakeholder team within an organisation can be the best means for assessing and driving improvement.

Staff directly involved in procurement will play a pivotal role as their purchasing decisions can directly achieve change. Even though commitment at a senior level is key, end users of medical products are also important contributors; the voice of doctors, nurses and other healthcare professionals can be very powerful. An often overlooked party that can provide valuable insights is the general public, who are the ultimate recipients of NHS services and products manufactured through various supply chains.

Suppliers are the other major stakeholder within this equation. They need to develop greater transparency, as well as improve labour conditions, in order to drive progress towards ethical sourcing of services.

UCLU Medsin’s campaign on the ethical procurement of health serves as a great opportunity for medical students to become actively involved in change, while exploring current global health issues. It involves campaigning for hospitals to source their goods ethically and integrate consideration of labour standards into their purchasing decisions.

Does ethical trade cost more?

Ensuring workers are reimbursed with a liveable wage and safe working conditions while suppliers take steps towards eradicating child labour forces may mean that the cost of goods for the NHS rises, leading to the possibility of more costly healthcare.

While efficiency of savings in the provision of healthcare is important, the social and environmental consequences of purchasing decisions and subsequent risks to reputation and security of supply must not be overlooked. A purchasing strategy focused entirely on cost can propagate the exploitation of vulnerable people within the supply chain, and the erosion of basic labour rights. The human cost outweighs the financial cost. The improvement in quality due to increased productivity, worker retention and boosted morale should also not be discounted when considering the complex cost-benefit analysis.

Can ethical procurement make a difference?

Ethical trade is internationally recognised as a key to global development because it lifts people out of poverty, improves their long-term quality of life and reduces wage disparities across supply chains.

Day-to-day procurement decisions can have a real impact. This was recently illustrated when procurement directors from Sweden instituted labour rights clauses into a regional contract for healthcare reforms. Subsequently, with the appropriate support, a manufacturing facility in India was able to provide better pay and reduced working hours for its employees within a matter of months.

The NHS can do the same. We all have a responsibility towards ethical procurement.

By Usama Hussain

MBBS Year 3, intercalating in Clinical Sciences

If you want more information about the campaign, including joining, Usama can be contacted via email: