Panorama's surgical probe missed a trick

Panorama (Surgery's Dirty Secrets, BBC1 8.30pm) last night probed the manufacture of medical instruments, asking whether the NHS is doing all it can to protect the health of its patients. It failed to ask what it could be doing to protect the poor and vulnerable people making the instruments.

2017 update: read about the latest Ethical procurement for health guidlines

Investigating claims that that substandard instruments could be causing death or serious harm to patients, the programme makers travelled to the city of Sialkot in Pakistan, which manufacturers a staggering two thirds of the world's surgical instruments.

Beyond the official manufacturers' clean and efficient factories, we were taken to backstreet slums and shown images of dirty, ramshackle workshops. In one instance, quality control was so lax that the reporter herself was allowed to add quality stamps to a few of the instruments.

The notion that an instrument made under these conditions might actually cause further harm to an already sick and vulnerable patient would clearly alarm any of us, as actual or potential future users of the NHS.

Yet surely we should be equally alarmed about the conditions of the people making those instruments, many of whom are poor and vulnerable themselves, and who risk their own health and safety for the benefit of NHS patients?

The footage showed people clearly working in extremely difficult conditions. Many of them were sitting on the floor to work, soldering metal with bare hands and feet and with no safety wear. Open sewers flowed only a few feet away. As the programme did point out, workers earn poverty wages, and child labour is endemic in the industry.

For the NHS, ethical sourcing should be just as much about protecting the people who make its equipment as it is about the patients who are treated with it.

The good news is, there is a wealth of experience from within the private sector that shows that it is possible to create a virtuous circle of improving workers pay and conditions and quality.

The good news is, there is a wealth of experience from within the private sector that shows that it is possible to create a virtuous circle of improving workers pay and conditions and quality. And retailers from the food, fashion and other labour-intensive industries are gaining experience all the time at increasing traceability down the supply chain, keeping a tighter grip on subcontracting and monitoring workers' conditions.

They are also learning that issues like child labour cannot be tackled in isolation, but require digging deep into its root causes, alongside other inter-related issues including low wages for adults.

Critically, they are learning that the solution to many of these problems lies not in cutting and running from trouble - which would leave poor workers far worse off - but to stick with their suppliers and help them make progressive improvements over time.

Much of this experience has already been distilled in the form of a ground-breaking new set of guidelines called Ethical Procurement for Health: a practical online toolkit to help UK health organisations improve the working conditions in which goods for the NHS are produced.

This was published last month jointly by ETI and the British Medical Association (BMA), members of whose Medical Fair and Ethical Trade Group have worked tirelessly to put this on the agenda of NHS procurers across the UK over the past few years.

The government should lend its support to these new guidelines and ensure that NHS procurers everywhere are empowered to act in the interests of workers as well as patients.