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As a layman do we really need so many disposable instruments? With advances in sterilising technology is it not possible to clean and reuse instruments? It would then be possible to buy fewer but better quality instuments

With regards to tonights episode, theres more to the subject in hand to what the presenter was investigating. There are many questions that come to mind: Why have the NHS made the decision to have surgical equipment made abroad? Because it can be produced in a fraction of the cost compared to production in the UK. The conditions in which the instruments are produced are neither here nor there. Most trades from footballs to surgical equipment are most likely to be produced in such conditions. You have to look at the country as a whole. Pakistan is a third world country where labour is cheap, hence the reason why international countries and companies look to it for production. If companies in richer countries are really concerned about adherence to laws regarding hygiene and safety of surgical products, then they should pay the workers more. Its all too easy to pin the blame and fault on others, bottom line is that if your are so concerned about what comes into the UK, the solution is to PRODUCE IT IN THE UK!!

I'm retired from hospital practice now but that programme sure explains a lot about how the quality of instruments has changed over the years. The staff using the things have NO say in the quality of what they have to use.
Incidentally there is probably a whole programme to bo done in similar vein (no pun intended) regarding the surgical gloves that the NHS procures. I have been told, and could probably find published reference for this, that cheap gloves are washes less in the vulanisation process. This means the rubber contains more of the by-products of vulcanisation which are highly allergenic. Latex allergy has gone from being very rare to very common in the last 25 years and certainly can be fatal. These cheap gloves also tear much more easily which is also a potential hazard to patients and staff. But again, the people using them don't get a choice.

The programme was a little alarmist to say the least. As a medical practitioner, it is important for me to say that all instruments are cleansed before every procedures. The infections, which are not under control, result from other sources and always have done so. It is just that progress in modern science has helped us to understand and name them.

The fact that the programme quotes medical practitioners do not want to show their true identity is what worries me. That seems to really damage the integrity of this so called secret revealing episode.

This programme was truly shocking. I am so glad that I am not awaiting surgery right now. The truly frightening aspect is that with the NHS having to tighten its belt for the foreseeable future these problems can only worsen. Well done Barts Hospital for employing QC - other trusts take note. I would be intrigued to know what is happening within the area I live. Well done Panorama for carrying out the investigation and well done ³ÉÈË¿ìÊÖ for broadcasting it.

It is really sad to see such things happening in Britain. When millions of people pay tax every year. So they can receive the best service that is available out there. The people who are responsible to make sure that the right equipments are brought to UK should explain what is really going and when they going to stop it.

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what next we are all being sold off .from dirty hospitals now this its no wonder hospitals are being sued by these no win no fee claims for negligence .well i going in to hospital son for a opperation i was scared then but after seeing this last night i am more than scared .may be they should pay for me know to go privete if they can't garrantee my safety

A very unfair and biased report from Sam Poling. These people welcomed you and you stabbed them in the back. You mentioned how "Unsafe" Pakistan is but you forget to mention the reason for it being unsafe due to the wests so called war on terror. The clip where the guy attacks the ³ÉÈË¿ìÊÖ as being anti-Islam can be compared to an Asian going to a rough part of the UK and being racialy abused and I dont know what the Waga Border had to do with anything.
The smug look on Sams face when talking to the Pakistanis was clear for everyone to see. Instead of solving the problem you want to criticise and look down on these poor people. But helping them would not make for interesting viewing.

At the end of the day you pay for what you get. The problem here is not with the manufacturers but with NHS. I can go to China and buy 10 types of any product. The amount of money I spend is how good the product will be and there was no difference with Sialkot.

Sam next time you want to go to Pakistan please tell me and I will show you the real Pakistan. Not what you want to show in a negative manner.

Unfortunately I missed the programme but I work in the industry so can imagine the stories content. Just to quickly respond to Amer1234, you may well be right that the report was biased, I'm not sure. But you are 100% right that it is not Pakistans fault, the fault lies with those that buy these instruments. BUT at the same time, if they stopped buying instruments from Sialkot, surely that would only excacerbate the regions "problems"
Child labour is wrong, no question. But when price is continually driven down then suppliers have to look for cheaper manufacturers and in doing so its all too easy to turn a blind eye to the why's and wherefore's.
There are ethical trading paragraphs in most NHS tenders these days but are they qualified? No. There is the Global Compact (check google) which many reputable manufacturers of surgical instruments have signed up to. Does anyone in NHS procurement or NHS supply chain (DHL) know what that means though? No.
Suppliers to the NHS are continually being told to reduce prices, NHS procurement and NHS supply chain do a good job of making sure your tax £'s are spent efficiently but there is no question that it could be done better. So in the face of continued downward price pressure what do you think is going to happen? A; manufacturing is sub contracted to those countries that can do it the cheapest. Why do most of our christmas presents come from China, because they can be made cheaply. They still cost a healthy sum when it comes to us buying them though and here lies the "rub"
Manufacturing has been subbed out to those that can do it for the cheapest price, however end user price remains stable. So whats happening? The companies are maintaining / growing their profit's so they can pay dividends to their shareholders.
The concern is that premium instruments that are truly made in Germany (or the UK) end up having to be made elsewhere and to lower standards in order to only maintain the current price. Thats when we really have a problem. It makes me sick, as an ethical supplier to the NHS of surgical instruments, that other suppliers of so called "German made" instruments are actually distributing instruments that are made in Sialkot, sent to Tuttlingen (Hub of German surgical instrument manufacturing) and are polished a little bit to make them look a bit nicer, that German companies own CE mark is put on that instrument and because it has been polished up, this constitutes re manufacturing so at the same time "Made in Germany" can be stamped on an instrument that was made by a 9 year old child in Sialkot.
We must start to realise that if you want quality, ethically manufactured product of a high standard you have to pay for it. The catchphrase "buy cheap buy twice" has never been so relevant.
It doesn't have to be made in Germany to be a quality product either, if the companies in Sialkot were paid correctly they could spend more money on raw materials and time on the instruments etc but that will require a change in their mindset as well because paying someone more for their product does not mean that those benefits will be passed on to the employees. The Pakistan government has to take some responsibility for allowing these practices to go on unchecked. Much as it pains me to say it, there needs to be some central government regulation.

Yet another example of the "Health Industry", it is structured to "rip off" the tax payer and in every aspect of it the stench of the thieves (pigs and troughs) that surround it is being exposed. The industry is dominated by Multi-nationals, practicing Serious Organised Crime under the banner of healthy capitalism, as this and other episodes have revealed. Maximisation of profit, sourced at £2 and sold to the tax payer for £20. The fact that people died, we ended up with complications and super viruses is the disgraceful aspect, yes but even more so are the legions of costly checks and balances that were to stop this, MHRA? of the 900 companies registered 700 were from..., like the FSA another example of the industry self regulating itself, ha ha useless. Guess what there will be no one responsible for this, we do not do accountability, your local tradesman does not get paid and there are claw backs on non performance and liability. Yet with £Billions lost no one is around, people get bonuses, get knighted as in the NPfIT projects. Drug dealers get their assets impounded but bankers that collude, insider information etc., are involved in global serious organised crime and suffer nothing.

The whole process is supposed to policed, yeah! by self serving "commisioners" of health care products and services. Commisoning is so successful that they are going to free it up through the GPs, no one has told the elected thieves that GP stands for general practioner, they do not know stuff...that is why they are general practitioners, their collective knowledge of disease is very shallow, they are just triage. They are great at taking free samples from Pharma companies, falsifying records and buying cheap smear lollipop sticks as substitutes.

All of this is small money compared to the biggest example the private financing of hospitals, £11B of construction, sold to the taxpayer for £66Billions, another great deal and bonuses for the bankers. These practices are the source of our Debt and innocent people will pay the price, people and families will get repossed. I think we are going through the greatest melt-down of society of our time and the next generation is witness to the lie of society and the betrayal that is at the heart of our kidnapped twisted democracy. The fix is "back to basics", ha ha NO not the John Major sickness, nor the lie of the party system, globalisation and the other codes for betrayal of the citizen.

Personal responsibility for action taken at fanastic salaries, personal responsibility

I missed the programme, but i watched it on the YOU Tube.,

What sam tried to show, was only what sam wanted to show to the whole world.,

What she showed was a reality, YES, i am agree with this, but the "reality" pakistanis/suppliers are forced to do for so manyyy reasons, including Poverty.,

Firstly, its the buyyers who pushed the limits to the end to get the cheaper supplies to cut his costs and other over heads, and ultimately, supplier has to find cheaper ways which some how and often leads them to substandard condition to work with.,

Its the whole chain, not only the suppliers end is a matter of concern.

The comments posted are interesting. Sam helped to create awareness but I think she could have elaborated on more of the issues within the NHS, Purchasing and MHRA (perhaps a part 2!), plus a few positives. Its a complex and sensitive issue needing a holistic approach when telling this sort of story. This additional detail could have helped people understand the topic without getting scared about their next visit to hospital.

Good job Sam but room for more!

firstly.. Amer1234 had a very good point "...A very unfair and biased report from Sam Poling. These people welcomed you and you stabbed them in the back. You mentioned how "Unsafe" Pakistan is but you forget to mention the reason for it being unsafe due to the wests so called war on terror. The clip where the guy attacks the ³ÉÈË¿ìÊÖ as being anti-Islam can be compared to an Asian going to a rough part of the UK and being racialy abused and I dont know what the Waga Border had to do with anything. " I just wanted to second that, it annoyed my too.

Secondly the program was completely unfinished... what next? what are you/we to do about it? Nothing is going to change from this program.
Far too much of the program followed the awful conditions in the factories than chasing the .... buyers and middle-men.

I have surgery on Wednesday - who am I to say to my surgeon "have your instruments gone through a rigorous quality control?"

It would be extremely rude for me to confront the medical staff about this.

To make sense of this subject, Sam Poling needs to know more about how supplier quality is managed in leading manufacturing companies. I've been responsible for this and would be happy to discuss it if she wants an introduction to the subject.

Seven years ago I was diagnosed with cancer. A serious but routine operation followed. Five days later I was rushed back into hospital with a deep seated wound infection. I was in agony, and dying. I was told that I would not last until the following morning unless operated on that night. Thankfully it worked and I am still here to tell the tale, but my chemotherapy was delayed for three months because I was too weak, thus increasing my risk of a the cancer spreading.

The cause of the infection was never traced or explained.

To now hear that it could have been caused by something as basic as poorly made instruments leaves me aghast at our own system's incompetence. At the end of the programme I was shedding tears of rage and frustration. This could have cost me my life ! No doubt many other people have not been as 'lucky' as me.

How can something so vital as surgical instruments be subject to such poor quality control before use ? Will the situation now change ? I suspect not, judging by the responses from some of the official bodies, but I will try to find out in my own area at least and will report back through this blog.

As for the cynical and criminal companies and individuals involved in knowingly putting defective instruments on the market, I hope they are facing dire consequences. I would be interested to hear from the Panorama team whether this is so ?

12th November 2011. It's been a while, but after reading David Aaronovitch's piece in today's Times I felt I had to draw attention to this dilemma. These kinds of unexpected and horrifc emergencies following routine surgery at the hands of some of the world's brightest and best surgeons may well be explained by the tools they use?