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Tim Ballard: The wider consequences of healthcare delivery

9 May, 14 | by BMJ

Tim_BallardIn January we saw the launch of the NHS Sustainable Development Unit’s (SDU) strategy for the NHS. Since its inception, the SDU has tirelessly promoted the wider responsibilities that we have when providing healthcare and social care. At its heart, this strategy reminds us that we need to act if we wish to decrease the environmental impact of healthcare, and, consequently, minimise adverse health effects both now and in the future. This strategy launch was reinforced by the recent IPCC statement, which underlined the effect that anthropogenic climate change will have on health.

In a similar way, the Medical Fair & Ethical Trade campaign asks us to think about the wider consequences of healthcare delivery in our Western democracy. The collapse of the garment factory in Bangladesh in 2013 brought the activities of the fashion industry into the spotlight; the workers who sadly lost their lives worked in unsafe conditions that would simply not be tolerated in the UK. Now it is time to shine the spotlight on the activities of the NHS.

Clinicians are well versed in managing risk, and each discipline has its own approach. What we do know is that risk needs to be managed, rather than attempting to completely eradicate it. The approach to managing risk in relation to infection control is an interesting case in point. Over the years we have moved to a system that uses high volumes of disposable instruments, which has seemed to provide a solution by decreasing the risk of infection, while also managing to control financial costs. Commissioners have driven this process in good faith.

However, the launch of the Medical Fair & Ethical Trade campaign draws our attention to the human price paid by the workers—sometimes only children—used to make these medical commodities. In short, it asks the question “Can we justify exporting our risk and cost management to vulnerable workers overseas without responsibility?” I believe the answer is that we cannot. Now that this activity has been brought to our attention, we must take account of the impact of our procurement decisions.

The advent of clinical commissioning brings to the table the potential to see the bigger picture, rather than simply responding to the bottom line. Along with improving the wider sustainability credentials of the NHS, clinical commissioning groups (CCGs) and NHS England are in a pivotal position to improve standards by including these other important areas in their commissioning specifications and contracts. Simply asking about the sustainability and humanitarian welfare costs incurred in relation to each contract will make the system more accountable and drive up standards.

At a time of financial strain we need strong leadership from our clinical commissioning colleagues, but we also need individual GPs and constituent practices to hold their CCGs to account.

Tim Ballard is a GP trainer in rural Wiltshire. He is a nationally elected member of the RCGP Council and has been the RCGP sustainability lead for the last five years. He was recently elected to be vice chair of the RCGP Council, with a portfolio addressing issues in the wider healthcare system including sustainability and commissioning.

Competing interests: The author has no competing interests to declare.

This blog is part of a series on ethical procurement in the NHS, with other blogs listed below.

Read more at www.bma.org.uk/fairmedtrade

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