In a bid to improve the conditions of millions of workers in the global supply chain that furnishes the UK’s National Health Service (NHS) with goods and services worth some £30bn a year, the British Medical Association (BMA) and partners have published an online ethical procurement guide and toolkit.
The Ethical Procurement for Health workbook is the product of a partnership between the BMA, the Department of Health and the Ethical Trade Initiative, an alliance of companies, trade unions and voluntary organisations.
The aim of the guide is to help people in health and social care involved in buying goods and services, at all levels, from strategy and policy setting to marketing and buying, to consider the labour standards of organizations they are buying from: such as how they treat their workers, whether they get paid a living wage, whether their rights are respected, how safe their working conditions are, and the effect of their working conditions on their health.
The workbook comprises guidance notes, templates, tools and case examples, and serves as a “flexible framework” against which organizations can benchmark their procurement practices and find ways to improve them.
It covers a wide range of topics such as risk assessment, self-assessment, auditing, summaries and links to the International Labour Office’s employment standards and codes, and procedure for remedial actions.
Health Minister, Simon Burns urged all NHS organizations to follow the principles set out in the workbook and “identify and tackle abuses of workers’ rights wherever they occur”.
An overview of the workbook contrasts the “uncomfortable paradox” whereby the NHS, in providing healthcare, does so “at the expense of workers’ health in its supply chains”.
By means of example the document describes how most of the 50,000 workers in northern Pakistan, who make around 10 million of the surgical instruments used in the UK every year, are paid less than a living wage, receiving less than 1 US dollar a day for 12 hours of work. They have little job security, and their unsafe working conditions also mean they risk injury from machinery. The industry also employs thousands of children, some as young as seven.
Dr Mahmood Bhutta, advisor to the BMA’s Fair Medical and Ethical Trade group, told the press they hope the guide will help health and social care purchasers make ethical considerations “part and parcel of purchasing decisions so that the lives of workers in the developing world are not put at risk to make products to treat UK patients”.
He said the BMA has commented before on the poor labour standards of suppliers who make goods bought by the NHS, and their use of child labour.
“I have visited Pakistan and have seen workers producing surgical instruments in terrible conditions. Many work twelve hours a day, seven days a week, some suffering serious injuries due to poor standards of health and safety,” said Bhutta.
The workbook overview gives other examples from various countries, including conditions where workers endure long working hours, suffer a high risk sexual and physical harassment, are banned from joining or forming union, have no benefits, and no job or income security.
Unethical employment practices are not confined to suppliers of goods, there is also evidence that these exist in the provision of services to the NHS within the UK, such as firms employing migrant workers on NHS construction sites who make illegal deductions from their wages, and care homes that pay migrant staff nurses less than the minimum wage and force them to work excessive hours.
The workbook overview also calls for NHS organizations to make their supply chains visible, to reveal the employment conditions of the workers, and use this to drive improvement.
“This applies equally to large multi-nationals and small companies who may supply direct to the NHS, as well as national and collaborative purchasing organisations,” it urges, noting that some organizations are already moving in this direction, and starting to demand this information when making purchase decisions.
ETI’s Executive Director, Peter McAllister, said they were pleased to work with BMA in launching the workbook, which breaks down ethical trading into practical steps supported with a “wealth” of tools and resources. He too hopes it will be an “invaluable resource for NHS procurement staff”.
Dr Vivienne Nathanson, Director of Professional Activities at the BMA, said although the NHS is going through a very challenging time in the current economic climate, this “cannot be used as an excuse to continue to exploit overseas workers”.
“It is perfectly possible to use the buying power of the NHS to not only save money, but to improve the plight of those who manufacture the products we use to treat patients,” she urged, pointing out that in fact evidence shows that when you improve people’s working conditions, this has a knock on effect in increased productivity and quality of goods and services.
One example where day to day buying decisions can make a difference is where a number of local authorities in Sweden in 2010 brought in a code of conduct for suppliers, including a contract for the supply of uniforms for healthcare workers. With the right support, within months, the Indian factory making the uniforms was able to show evidence of improved pay and conditions for its workers.
When you add up all the little and big pockets of buying power in the NHS, coupled with motivation to put it to good effect, you begin to get a sense of the huge leverage at play here.
Bhutta said:
“The staff in the NHS, and the public, care passionately about the reputation of the NHS, and considering the billions that the NHS spends every year, even relatively modest changes could go a long way.”
The workbook is available online at www.ethicaltrade.org/ethical-procurement-for-health.
Sources: BMA, ETI.
Written by: Catharine Paddock, PhD