Outcry at child labour behind surgical tools
The British Medical Association (BMA) says that many of the factories where the equipment – including scalpels, forceps, surgical gloves and uniforms – is made are “unsafe, unclean and unethical”.
However, despite previous calls to the Scottish Government to ensure the products used by the NHS are “fair trade” in origin, doctors say little action has been taken.
The union says at least a fifth of surgical instruments used in the NHS is made in northern Pakistan, where child labour is common. It is estimated factories in the city of Sialkot supply two-thirds of the world’s basic surgical instruments, though many of the final users, including Scottish NHS surgeons, are unaware of their origin.
In some countries, including Malaysia and Mexico, the BMA says, labourers are paid less than $1 a day for a 12-hour shift.
Dr Sally Winning, deputy chair of the BMA in Scotland, said: “Many supplies used in the NHS are produced in unhealthy, unsafe and unfair working conditions. Workers are poorly paid and exposed to conditions where they risk serious injury or even death.
“There is also evidence that children as young as seven are helping to make this equipment. It is perverse that people are risking their lives to supply us with equipment to save lives here in Scotland, and we are calling on the NHS in Scotland to adopt new guidance on ethical purchasing.”
Winning claimed the Scottish Government had promised to publish a bill to introduce social and environmental clauses in its contracts with outside suppliers but this is yet to happen.
This has left Scotland trailing the rest of the UK as both the NHS in England and Wales have guidelines on the best ways to source ethically-produced equipment.
The advice also gives tips to health boards on how best to hold contractors to account on human rights compliance and to ensure NHS staff assess tenders with fair trade in mind.
The BMA renewed its support of fair trade supplies at its annual conference last week.
Winning said it was a “misconception” that fair trade products cost more than other goods and that, in some cases, could save health boards cash.
She said: “We discovered that fabric for some NHS uniforms was bought in the Far East, transported to the UK to be dyed and then sent back to the Far East to be produced in these factories where health and safety is totally overlooked.
“We say rather than go down this route, source and buy fair trade goods which, in an example like this, would drastically cut shipping and other transport costs. This could ultimately mean fair trade in the long run is cheaper.”
The Scottish NHS gets its surgical instruments through contracts with multinational companies, but under European Union rules cannot forbid specific regions or countries from supplying Scotland. The equipment is then supplied to individual health boards.
“One of the problems we have is we often don’t know how or where the equipment we use has been made,” Winning said. “It can be difficult to trace the full supply chain. By sourcing goods from one place we not only know where and how it is being made, but can actually save the NHS money.”
In countries such as Pakistan, use of child labour is rife because of the need to increase low family income.
In many cases, despite the dangers of heavy machinery and toxic chemicals, work is essential or the family risks starvation.
Dr Mahmood Bhutta, a surgeon and adviser on the BMA’s Medical Fair and Ethical Trade Group, said more needed to be done to raise awareness of the issue.
He said: “We want to work with the NHS and the industry to make positive changes. Fair trade is not just about the products we purchase, it is also about things that are purchased on our behalf.
“I have seen first-hand some of the conditions these people work in and they are quite horrible. There are lots of people working in rooms about the size of a garage.”
He added: “Ultimately, because health boards are individually responsible for their own budgets, we are hoping they will say ‘I want our hospital to be an ethical hospital and we want to be proud that this is what we do, and that the way we serve our local community is morally strong’.”
A spokesman for NHS National Services Scotland said: “All contracts awarded by NHS Scotland have to meet specific terms and conditions and require that participants operate and apply ethical standards. These conditions apply to all parts of the supply chain.
“Our main NHS procurement body is a member of the BMA Medical Fair and Ethical Trading Group, sharing and developing best practice. The Scottish Government have also recently hosted a number of training courses which specifically focus on the sustainability issues, including ethical procurement, and how to include them in contracting strategies and framework agreements.”
Sharp practice: Pakistan workshops
Sialkot is in Pakistan’s Punjab province in the foothills of the snow-covered peaks of Kashmir.
During the colonial era, British India’s first bagpipe works opened in the city, and today there are still 20 pipe bands operating there. But since the 1940s the area has built a reputation for the making of medical products, and particularly surgical instruments.
Although there are some state-of-the-art facilities, it is estimated that up to 5,000 children work in some of the 3,000 backstreet workshops to which work is outsourced in an industry that can produce up to 200 million items every year.
Human rights campaigners say health and safety measures in many of these workshops are virtually non-existent. A BBC investigation last year also found that substandard surgical tools from Pakistan were potentially putting UK patients at risk of injury and infection.
Faults included rough edges, steel burrs that can splinter during operations and corroded metals. And although all surgical instruments have to meet regulatory standards, only one of the more than 180 NHS trusts and boards contacted in the UK conducted rigorous tests on every tool.