The issue driving the development of this work is that health and social care in the UK has the potential to damage the health of workers in poorer countries through the procurement of health supplies manufactured under poor labour standards, including child labour and inadequate wages.

Impactt was disappointed to read the Guardian report which focused more on the ‘exposure’ of labour standards issues than on the work of the NHS to develop innovative guidance on tackling those issues. We echo the support of Dr Mahmood Bhutta who revealed the presence of poor labour standards in surgical instrument manufacture in 2006.

Ethical Procurement for Health can be applied to a much broader range of products and services than just surgical instruments. The NHS spends more than £20 billion per annum on goods and services ranging from rubber gloves and surgical instruments to cleaning services and IT contracts. The EPH gives organisations within the NHS the opportunity to influence improvements in labour standards across all healthcare supply chains. As Health Minister Ben Bradshaw noted, Britain’s health service is “in a strong position to influence improvement in labour standards across health care supply chains.”

The Guardian article also suggests the guidelines are voluntary. In a sense they are, but as government agencies, NHS Trusts are obliged to meet all ILO conventions that have been ratified by the UK. The UK Government’s Global Health Strategy (September 2008) recognises a responsibility to harness the opportunities of globalisation to improve the health of people across the world. The EPH provides step by step practical guidance for procurers to meet these obligations.

It must be recognised that all organisations differ and no single approach will be right for all NHS Trusts. The guidance can be used as a tool to develop solutions for each individual organisation which meets their needs whilst working towards improved labour standards in the supply chain. Ethical procurement has to be supported and owned locally if it is to be effectively implemented at the level of individual organisations.

The Lancet stated that this ‘ground breaking’ work could create a model for other countries to follow in ensuring that public procurement was sensitive to labour standards issues. We congratulate NHS PASA and the ETI on the development of this guidance and hope that it will act as a spur for future developments in ethical procurement within the NHS.