The provision of healthcare goods and services is big business: the NHS alone spends £20 billion on procurement every year. The market for such commodities is global, and increasingly is being outsourced to minimize costs. Unfortunately there is evidence that such outsourcing is harming basic labour rights, and consequently the health of populations elsewhere.

For example, there are documented problems in the manufacture of surgical instruments. Although most surgical instruments are supplied by companies in Europe or the US, at least a fifth are produced in northern Pakistan. Labourers in surgical instrument manufacture are often paid less than US$1 per day, have poor job security, have woefully inadequate protection of health and safety, and many employees are children, some as young as seven.(1).

There are also known issues with textile supplies to healthcare. One study of a healthcare uniform manufacturer in India found illegal working hours and the use of child labour (2). In addition there have been reports of unfair remuneration of cleaners (3) and of construction workers (4) employed on NHS sites, through outsourced contracts. A report by the Ethical Trading Initiative in 2008 suggested a significant risk of abuse of labour standards in a variety of goods and services procured by the NHS (5).

It seems paradoxical to provide healthcare using goods and services that may actually harm health because they fail to protect basic labour rights. However, because the levels of spend are so vast in healthcare, the medical community also has the capacity to change this and to significantly impact upon global trade, and consequently global health (6). Ethical purchasing doesn’t have to mean more expensive, nor does it mean compromising on quality.

Ensure that you and your NHS organisation insist upon fair and ethical trade in the procurement of goods and services.


1 Bhutta MF. Fair trade for surgical instruments. BMJ 2006; 333: 297–99

2 Bjurling K. The Dark side of Healthcare Stockholm: Swedwatch; 2007

3 The Guardian, 22nd October 2004

4 The Guardian, 30th June 2008

5 NHS Purchasing and Supply Agency and Ethical Trading Initiative. Framework for an ethical procurement strategy for the healthcare sector; 2008

6 Bhutta MF. Fair and ethical trade in health procurement. Lancet 2008: 372: 1935-37

7 NHS Purchasing and Supply Agency. Ethical Procurement for Health; 2009

8 NHS Supply Chain. Supplier code of conduct; 2008

9 Department of Health. Health is Global; 2008