:00:43. > :00:46.The tools of a surgeon's trade can mean the difference between life
:00:46. > :00:52.and death. Every single thing needs to work at
:00:52. > :01:00.the time it's handed to you. what if it doesn't? It's an eye
:01:00. > :01:06.instrument. I cannot tell you how bad it is. We uncover The Truth
:01:06. > :01:10.about what goes into our hospitals. Look in here. This is what they've
:01:10. > :01:16.been making. The lies about where they are made. You don't want
:01:16. > :01:19.people to know this is from Pakistan. Child labour in a
:01:19. > :01:26.dangerous industry. And the deception we're all paying for.
:01:26. > :01:30.Would I ever have to admit that it wasn't German steel? Tonight, we
:01:30. > :01:40.reveal Surgery's Dirty Secret. cannot believe anybody in the NHS
:01:40. > :01:45.
:01:45. > :01:52.Every year, millions of operations are carried out in Scotland and
:01:52. > :01:56.across the UK. Our National Health Service is one
:01:56. > :02:00.of the biggest and busiest health care services in the world. Modern
:02:00. > :02:04.surgery has come a long way since the first medical procedures were
:02:04. > :02:14.attempted centuries ago. What has not changed in this time is the
:02:14. > :02:22.
:02:22. > :02:26.importance of the tools used by the surgeon. Paul Srodon is a surgeon
:02:26. > :02:30.at St Bartholomew's Hospital. The operations he carries out are live-
:02:30. > :02:34.saving. We have somebody with a threatening limb situation, you are
:02:34. > :02:38.fighting to save their limb or life, those tools of the trade, they need
:02:38. > :02:42.to be just right. Every single thing handed to you needs to work
:02:43. > :02:46.at the time it is handed to you. It's no good discovering something
:02:46. > :02:50.doesn't work as it should do and have to hand it back and get
:02:50. > :02:56.another one. Any bit of that process nudges that towards
:02:56. > :03:02.delaying a person's recovery, resulting in an incomplete recovery
:03:02. > :03:06.or resulting in limb loss or death. We all assume that surgical
:03:06. > :03:10.instruments are made to the highest of standards. After all surgeons
:03:10. > :03:13.use them in hospitals to help save lives. Over the last year, I have
:03:13. > :03:23.been investigating these instruments. The evidence I've
:03:23. > :03:29.
:03:29. > :03:34.uncovered suggests all isn't well Nottingham is home to Dorothy Brown.
:03:34. > :03:41.She was a nurse for more than 30 years, until two years ago when she
:03:41. > :03:46.became unwell. One day when I was working and I could feel my heart
:03:46. > :03:51.really pounding heart and -- hard and fast. I sat down, I thought
:03:51. > :03:55.there's something wrong here. Dorothy underwent a couple of heart
:03:55. > :04:00.operations to repair a faulty valve. It was after the second operation
:04:00. > :04:07.that things started to go badly wrong. Dorothy didn't know it, but
:04:07. > :04:16.a number of other patients had undergone the same heart surgery
:04:16. > :04:21.and become well. All had developed a -- become unwell. All had
:04:21. > :04:26.developed an infection. I knew I was dying. All I was thinking, was,
:04:26. > :04:31.let me go to sleep now. I'd just had enough.
:04:31. > :04:36.In total, five of the 11 heart patients who contracted the bug
:04:36. > :04:42.died. I managed to get a cop pi of the confidential report into --
:04:42. > :04:45.copy of the confidential report into what happened. It could have
:04:45. > :04:50.been transmitted through small punctures in the surgeon's glove.
:04:50. > :04:56.They are often caused by purely made surgical instruments. If this
:04:56. > :05:01.is the case then poorly made surgical instruments could be
:05:01. > :05:07.killing patients. The trust insists all cardiac surgeons wear two
:05:07. > :05:11.gloves or thick sets. There are no official figures in the UK. We have
:05:11. > :05:19.come across three cases where sub standard instruments have been
:05:19. > :05:23.caused to death or causing serious harm. In the US there are almost
:05:23. > :05:28.1,000 recorded adverse incidents involving badly made surgical
:05:28. > :05:33.instruments every year. I made contact with three NHS
:05:33. > :05:37.surgeons, who told me that sub- standard surgical instruments were
:05:37. > :05:41.all too common. Worried that speaking out could destroy their
:05:41. > :05:44.own professional representations, they refused on-camera interviews.
:05:44. > :05:50.They felt so strongly about what I was investigating, they said I
:05:50. > :05:57.could use their testimony. These are their words.
:05:57. > :06:02.There's not an operating week where nothing goes wrong. Rough edges on
:06:02. > :06:06.the instruments will slice my hands. You know this patient is bleeding
:06:06. > :06:12.longer than he should because your instrument is not working You look
:06:12. > :06:17.at your glove torn by the rough edge of a instrument, and you think,
:06:18. > :06:26."Have I cut that patient's bowl with this?"
:06:26. > :06:30.-- bowel with this?". We are meant to fill out incident report forms,
:06:30. > :06:35.you know an instrument failing. Now because it happens so often many
:06:35. > :06:39.surgeons I know just don't bother. If he filled in a form every time a
:06:39. > :06:45.instrument failed, we would spend the afternoon operating and the
:06:45. > :06:48.morning doing paperwork. I've made contact with one NHS worker who is
:06:48. > :06:54.prepared to be interviewed on camera. He's someone who would
:06:54. > :07:00.normally never speak out in the media. He's so worried about the
:07:00. > :07:10.quality of surgical instruments that he's agreed to talk to me. And
:07:10. > :07:11.
:07:11. > :07:15.effectively blow the whistle on the situation. Now the workshop where
:07:15. > :07:21.he works is down here. This is where all the instruments that have
:07:22. > :07:30.come into the trust get tested. I am guessing this is it. Tom, I'm
:07:30. > :07:33.Sam, from the BBC. Nice to meet you. Tom Brophy is the lead technologist
:07:34. > :07:38.at the bartsand London NHS Trust. He's the last line of defence
:07:38. > :07:44.before the instruments get to the surgeons in the operating theatre.
:07:44. > :07:50.He says the quality of many of the instruments is so bad he's begun
:07:50. > :07:54.dock you meanting the faults he sees. These are eye instruments,
:07:54. > :07:58.used in ophthalmic surgery. For me, I don't know how they have made it
:07:58. > :08:04.that bad. For it to have a trench. That should not be there? That
:08:04. > :08:09.should be flat. That is a trench. There's the tunnel. Look at the
:08:09. > :08:14.burrs. That is used for the eye? Look at the burrs, all the way
:08:14. > :08:19.along. This is so bad, I can not tell you how bad. These defects
:08:19. > :08:23.might seem small, but in the precision work of surgery they can
:08:23. > :08:29.mean the difference of saving an eye or blindness, saving a life or
:08:29. > :08:32.death. Tom Brophy shows me other faults he has picked up, from
:08:32. > :08:38.meticulously checking the instruments through his microscope.
:08:38. > :08:47.There is everything from burrs to sharp metal.
:08:47. > :08:51.You can see how sharp that guide pin is. That is really sharp. That
:08:51. > :08:56.will easily puncture into a surgeon's glove. He often finds
:08:56. > :09:03.fractures and wells on some instruments which can trap body
:09:03. > :09:10.tissue and blood, even after sterilisation. One example was a
:09:10. > :09:16.heart retractor, designed to be used on a baby. That was a 15
:09:16. > :09:23.millimetre burr. Actually along the blade of the retractor, along there.
:09:23. > :09:27.That is like a needle. If we hadn't stopped that, that could be
:09:27. > :09:31.potentially used on a very young baby.
:09:31. > :09:36.Tom Brophy now rejects almost 20% of instruments sent to him.
:09:36. > :09:40.That's one in five of all the surgical instruments supplied to
:09:40. > :09:47.the trust. Some suppliers even send him used equipment, but sell it as
:09:47. > :09:52.new. One instance, there is blood still
:09:52. > :09:56.on the actual instruments. There's actually dried blood on about 11%
:09:56. > :09:59.of the order. So what happened happened they have rerouted
:09:59. > :10:05.themselvess back into the sales market as brand new. I don't know
:10:05. > :10:10.how they get back in. They have. There are over 180 health trusts
:10:10. > :10:15.and boards in the UK. Companies which supply Barts can supply these
:10:15. > :10:19.same organisations up and down the country. With exactly the same
:10:19. > :10:24.surgery instruments. There's no Tom Brophy equivalent here in Scotland.
:10:24. > :10:29.In fact, Barts is the only NHS Trust in the UK where every new
:10:29. > :10:35.instrument is hand-checked by a technologist to British standards.
:10:35. > :10:38.On more than one occasion a supplier has rang me up and said,
:10:38. > :10:42.you rejected, I passed it on to another hospital and they accepted
:10:42. > :10:48.it. My answer to him was, of course they're going to accept it because
:10:48. > :10:53.they haven't checked it. More worryingly, when he spoke to me it
:10:53. > :10:57.was corroding and it was a cardiac instrument. Some suppliers whose
:10:57. > :11:02.instruments are rejected by Barts are selling them on to other UK
:11:02. > :11:08.trusts. Suppliers can be manufacturers or middle men, major
:11:08. > :11:12.companies or one-man bands. There are at least 900 licensed
:11:12. > :11:18.manufacturers who can sell surgical instruments to UK hospitals. The
:11:18. > :11:23.vast majority used 234 our operating theatres are -- the vast
:11:23. > :11:33.majority used in our operating theatres are not made here, but
:11:33. > :11:59.
:11:59. > :12:03.I'm on my way to see Sialkot. It's an industrial city in the Punjab
:12:03. > :12:08.and where two-thirds of the world's surgical instruments are made. One
:12:08. > :12:18.in ten of them is sold to the UK. Only Germany and the United States
:12:18. > :12:30.
:12:30. > :12:36.Few westerners come here. Today, I'm going to see two factories,
:12:36. > :12:39.both visits arranged for me by Sialkot's Chamber of Commerce. The
:12:39. > :12:45.companies make surgical instruments for the UK and are two of the
:12:45. > :12:51.largest in Pakistan. The first factory visit arranged
:12:51. > :12:59.for me is with Hilbro. Outside its chief executive, Muhammad Ashraf,
:12:59. > :13:05.is waiting for me. Asalaam Alikum. Nice to meet you.
:13:05. > :13:10.What we are about to see? It's so noisy. This is the manufacturing
:13:10. > :13:20.process. The manufacturing process. Wow! My goodness! Inside, a massive
:13:20. > :13:25.
:13:25. > :13:29.The clatter of the drills is deafening.
:13:29. > :13:37.All of the workers making surgical instruments.
:13:37. > :13:47.Many here have worked in the industry for years. And these would
:13:47. > :13:51.
:13:51. > :13:55.be for the UK? So, to you do many You sell to a different dealer? The
:13:55. > :14:00.instruments Mr Ashraf's firm makes can pass through several suppliers
:14:00. > :14:06.before reaching UK hospitals. Over three levels and sitting in 26
:14:06. > :14:11.acres of land, Hilbro is one of the biggest factories in Sialkot. Mr
:14:11. > :14:17.Ashraf shows me floor after floor of machinery, which he is very
:14:17. > :14:23.proud of. In one part is a massive vacuum furness, which hardens the
:14:23. > :14:31.metal. One of only three in the whole of Sialkot. Is that acid?
:14:31. > :14:40.Shouldn't they be wearing goggles? It says this! None of them are
:14:40. > :14:42.doing it. But you are the boss! Aside from the obvious health and
:14:42. > :14:47.safety breaches, Hilbro looks impressive.
:14:47. > :14:52.It is nice to see women working here. Clean and spayous, it has
:14:52. > :14:56.some of the latest machinery. Upstairs is the quality control
:14:56. > :15:03.room, the final process before items are shipped around the world.
:15:03. > :15:13.Every instrument is examined under a magnifying glass before being
:15:13. > :15:19.
:15:19. > :15:21.Can I have one of those to take? As Can I have one of those to take? As
:15:21. > :15:25.his sister of get me a sample, the manager makes a surprising request.
:15:25. > :15:33.You don't want people to know this is from Pakistan? Thank you very
:15:33. > :15:37.much. His request for me not to tell anyone that the instruments
:15:37. > :15:45.are made in Pakistan is to become a common thread throughout my time in
:15:45. > :15:53.the country. Just a short walk away is the second factory set up for me
:15:53. > :15:56.to see by the Chamber of Commerce. This one makes surgical instruments
:15:56. > :16:04.for countries all over the world. The UK is one of its biggest
:16:04. > :16:09.customers. Looking around, it seems even more impressive than Hilbro.
:16:09. > :16:16.The staff are all wearing uniforms, and the production process itself
:16:16. > :16:24.looks well-organised. The factory is busy and clean, and the
:16:24. > :16:29.instruments seem to be rigorously checked before being packed. I came
:16:29. > :16:39.to Pakistan to see how our surgical instruments are made. And from what
:16:39. > :16:40.
:16:40. > :16:43.I have seen, it all looks incredibly professional. Well, that
:16:43. > :16:47.have no very clearly was the public face of the surgical instruments
:16:47. > :16:52.industry which the Chamber of Commerce wanted us to see. It is
:16:52. > :16:56.professional, spot last, but it makes me wonder, from what I have
:16:56. > :17:06.heard, what I have been told, whether it is the true face of the
:17:06. > :17:11.industry. And I don't think it is, not by a long shot. But exposing
:17:11. > :17:14.the true face of the industry is not going to be easy. Pakistan is
:17:14. > :17:19.regarded as one of the most dangerous countries in the world.
:17:19. > :17:24.Last year alone, more than 2,500 people were killed in terrorist
:17:24. > :17:34.attacks. As both a Westerner and a journalist, the safest place for me
:17:34. > :17:36.
:17:36. > :17:41.to stay is in Lahore, a or 3.5-hour journey away from Sialkot, but it
:17:41. > :17:44.is a journey and will have to make every day. The area where I'm
:17:44. > :17:54.filming is close to the Indian border, and the disputed Kashmir
:17:54. > :17:55.
:17:55. > :18:01.region. Every day at sunset, flags are symbolically lowered at Wahga,
:18:01. > :18:07.between Pakistan and India. Roadblocks and coils of razor wire
:18:07. > :18:15.add to the already tight security on this stretch of no-man's land.
:18:15. > :18:19.Wahga is known as the Berlin Wall of Asia. It is often a barometer of
:18:19. > :18:24.the tensions between the two countries. This ceremony is seen by
:18:24. > :18:34.few foreigners. This is everything to do with pride, passion and
:18:34. > :18:34.
:18:34. > :19:25.Apology for the loss of subtitles for 50 seconds
:19:25. > :19:30.Previously at this border, shots have been fired and people have
:19:30. > :19:35.been killed. The ceremony is impressive, but the intimidating
:19:35. > :19:37.gestures and underlying aggression reinforce how volatile the area is,
:19:37. > :19:47.and stress the differences of investigating working practices
:19:47. > :19:51.here. Overnight, I have received a phone call from one of my contacts.
:19:51. > :19:57.An owner of one of the smaller factories in Sialkot has agreed to
:19:57. > :20:04.meet me and let me film inside one of his units. Maybe this is my
:20:04. > :20:14.chance to see the private face of the surgical instrument industry. I
:20:14. > :20:24.
:20:24. > :20:29.head down numerous dusty lanes in A local translator comes with me to
:20:29. > :20:33.Regal Medical Instruments. I have been told it provides surgical
:20:33. > :20:43.instruments for several companies in the UK, which in turn supply to
:20:43. > :20:58.
:20:58. > :21:08.Inside are conditions for isn't It is so dark, it is difficult to
:21:08. > :21:23.
:21:23. > :21:33.see. The dust is so thick, it takes It is difficult to know what I am
:21:33. > :21:34.
:21:34. > :21:43.looking at. Surely these can't be surgical instruments? But they are.
:21:43. > :21:53.Which country will this go to, do you know? And how many workers do
:21:53. > :21:58.
:21:58. > :22:03.you have? 40, 45 people working. I going to another part of the
:22:03. > :22:07.factory, it becomes even more difficult to see. Our camera,
:22:07. > :22:15.already struggling to cope with the dark conditions, has to be
:22:15. > :22:20.constantly reset. The electricity goes out. It happens often, I am
:22:20. > :22:29.told. But it is difficult to see how the quality of instruments can
:22:29. > :22:34.be controlled in these conditions. Upstairs, my concerns about quality
:22:34. > :22:44.control are increased. This is where the instruments are supposed
:22:44. > :22:45.
:22:45. > :22:50.to be checked before they're stamped and packed for shipping.
:22:50. > :22:54.This is the most important part of the manufacturing process. This is
:22:55. > :22:58.where it is decided if the surgical instrument is safe enough to be
:22:58. > :23:05.used by a surgeon somewhere in the world. If it passes what should be
:23:05. > :23:10.a rigorous inspection, it is stamped with a quality mark, the CE
:23:10. > :23:13.mark, meaning a product is safe enough to be sold in Europe. Unlike
:23:13. > :23:17.the other factories I have seen, there would appear to be no
:23:17. > :23:21.magnifying glasses, which are essential for identifying
:23:21. > :23:30.microscopic flaws. What checks we see being carried out are made with
:23:30. > :23:40.the naked eye. So, this is the quality control stump? Yes. Can I
:23:40. > :23:41.
:23:41. > :23:51.have a go? Do I have to check it first for quality? They allow me to
:23:51. > :23:52.
:23:52. > :24:02.stamp a setter for sex, used to graft body tissue. -- a set of
:24:02. > :24:16.
:24:16. > :24:20.I have now witnessed the entire process of a surgical instrument
:24:20. > :24:30.being made in this one factory, right down to the stumping of the
:24:30. > :24:33.quality mark which acknowledges a job well done. It looks to me as if
:24:33. > :24:37.Sylvinho real rigorous quality control here. But the only way I
:24:37. > :24:47.can be sure about this is to take some instruments and get them
:24:47. > :24:54.checked. Later, Regal Medical Instruments told me they always
:24:54. > :25:04.focus on qualifying -- on quality. That night, I start recording a
:25:04. > :25:08.
:25:08. > :25:14.video diary to document what I'm finding. I feel absolutely filthy.
:25:14. > :25:21.I just can't believe that... I cannot believe those instruments
:25:21. > :25:28.are made in those conditions, using the equipment that they have, in
:25:28. > :25:38.the places that they're made. And there is no real definitive barrier
:25:38. > :25:39.
:25:39. > :25:44.between those units and the NHS in terms of real quality control. I do
:25:44. > :25:48.not mean giving them a cursory glance, checking that they're all
:25:49. > :25:55.the same length, I mean really checking the instruments, in the
:25:55. > :26:05.same way that Tom Brophy checks his instruments. The following morning,
:26:05. > :26:08.
:26:08. > :26:13.and I'm back in Sialkot. I was about to discover an entirely
:26:13. > :26:23.different face of the surgical instruments industry, one I was
:26:23. > :26:26.
:26:26. > :26:33.completely unprepared for. Driving through the backstreets, I noticed
:26:33. > :26:43.a number of small workshops. In them, there were only a handful of
:26:43. > :26:48.men, making what looked like surgical instruments. I speak to my
:26:48. > :26:52.contact, who tells me the larger medical instrument companies often
:26:52. > :27:00.farm out the work to smaller units so they can fulfil their contracts
:27:00. > :27:10.in time and increased profit. It is called outsourcing, the lowest and
:27:10. > :27:23.
:27:23. > :27:32.Street after street, in every conceivable the bit of space, are
:27:32. > :27:42.workshops. Men sit cross-legged on the ground. There's barely enough
:27:42. > :27:54.
:27:54. > :28:01.light to see their faces. This is what they have been making. Open
:28:01. > :28:11.sewers at the doorways often make filming difficult. Each of these
:28:11. > :28:12.
:28:12. > :28:17.workers, I'm told, will earn just �2 a day. There are more than 3,000
:28:17. > :28:20.outsourcing units like these in the city. Conditions are often so bad
:28:20. > :28:27.that many larger companies do not like to admit to being involved in
:28:27. > :28:37.the practice. I was told that the large factory we filmed at the
:28:37. > :28:37.
:28:38. > :28:45.beginning of the trip, Hilbro, was also using this kind of labour.
:28:45. > :28:55.Renews beat to Hilbro about this, they're quite kaygee. This is one
:28:55. > :28:56.
:28:57. > :29:06.of them now, we will go and see what they do. So, this is one of
:29:07. > :29:07.
:29:07. > :29:17.the outsourcing units for Hilbro? All around me, surgical instruments
:29:17. > :29:20.
:29:20. > :29:23.are being made. This is where most of the manufacturing happens, where
:29:23. > :29:27.the forged metal is taken and turned into tools for the world's
:29:27. > :29:31.hospitals. Even though the instruments which lie on the floor
:29:31. > :29:35.are destined for health services like the NHS, those who will be
:29:35. > :29:44.using them, the surgeons, can have no idea that this is where and how
:29:44. > :29:50.they're made. Do you know which country these are going to? The one
:29:50. > :29:56.on your hand is going to Russia. That one is going to Japan.
:29:56. > :30:03.Germany... Have you got any for the UK at the moment. This one is for
:30:03. > :30:11.England. So, manufactured in Pakistan and destined for the UK.
:30:11. > :30:15.But unbelievably, a different country will be taking the credit.
:30:15. > :30:25.They will be stamped, made in Germany. And it will be stamped
:30:25. > :30:31.
:30:31. > :30:41.I understand, but the stamp does not say, material from Germany, it
:30:41. > :30:46.
:30:46. > :30:51.What he's telling me is true. Surgical instruments, even ones
:30:51. > :30:55.made in the dreadful conditions of the outsources units are allowed
:30:56. > :31:00.bylaw to be stamped with another country's name. According to
:31:00. > :31:04.European legislation, a country can claim ownership if it has helped
:31:04. > :31:11.transform a product. In this case, it could mean providing the
:31:11. > :31:20.original steel. Instruments stamped "made in Germany" sell for a lot
:31:20. > :31:25.more than instruments stamped "made in Pakistan."
:31:25. > :31:30.That was Hilbro, the outsourcing unit. I am delighted about that.
:31:30. > :31:35.That means we can categorically link the outsourcing unit, that one
:31:35. > :31:40.there, which is Hilbro, which then supplies to the larger company
:31:40. > :31:43.Hilbro, which we have seen, the very large face of the surgical
:31:43. > :31:46.instruments industry. We can categorically link Hilbro with the
:31:46. > :31:51.NHS in the UK. There are instruments being used today, on
:31:51. > :31:55.patients, in the UK, which have been made in that outsourcing unit.
:31:55. > :31:59.So it's great to be able to tie all that together.
:31:59. > :32:04.I'm only able to link these workshops with the UK because I
:32:04. > :32:10.came to Pakistan. Responsibility for labour standards rest not with
:32:10. > :32:16.the NHS, but with its suppliers, who can sign up to a code of
:32:16. > :32:19.conduct. Here the people I speak to in Sialkot tell me British health
:32:19. > :32:24.care companies make full inspection visits. Working here is difficult.
:32:24. > :32:28.I've had to move to a second hotel, after my first one was threatened
:32:28. > :32:32.with a bomb attack. The level of security just to get into my room
:32:32. > :32:40.is a frightening reminder of how volatile this country is. When we
:32:40. > :32:49.film in the streets we find ourselves targeted with anti-
:32:49. > :32:59.western sentiment. What do you mean by BBC. Take it away. Get it out.
:32:59. > :33:19.
:33:19. > :33:25.We are constantly stopped by the This is getting ridiculous.
:33:25. > :33:32.Despite the dangers, surely a more robust system is needed at a
:33:32. > :33:37.national level in Britain to ensure proper inspections take place here.
:33:37. > :33:44.It does make you kind of look at the way we view cheap labour, and
:33:44. > :33:53.how we deal with it. I think the NHS has got a big
:33:53. > :34:01.problem here. I really do. Whether the NHS likes it or not,
:34:01. > :34:07.whether the NHS knows it or not, it's involved in all of this. It's
:34:07. > :34:15.party to all of this. It's party to the workers in Sialkot that we met,
:34:15. > :34:24.to the factory owners who can't afford to pay their staff decent
:34:24. > :34:34.wages. If the NHS is party to this, and our taxes are funding the NHS,
:34:34. > :34:39.
:34:39. > :34:43.then I guess we are just as The majority of the world's
:34:43. > :34:48.surgical instruments are made in Sialkot. With the UK buying more
:34:48. > :34:53.than 10 million of them a year. It means most of the instruments
:34:53. > :34:59.being sent to Tom Brophy and used on patients like Dorothy Brown, who
:34:59. > :35:07.I met, are made here. Globally the industry is worth �18 billion a
:35:07. > :35:11.year. Pakistan receives just a fraction of this - less than 8%.
:35:11. > :35:19.The bulk of the money goes to middle companies which sell the
:35:19. > :35:29.instruments on with massive mark- ups. But I was to discover there's
:35:29. > :35:30.
:35:30. > :35:34.another hidden cost of our health While investigating the badly made
:35:34. > :35:44.surgical instruments which could be endangering lives in the UK, I was
:35:44. > :35:46.
:35:46. > :35:52.to find out they also often harm He said, I was working with the
:35:52. > :36:02.press and I was carrying a piece in my hand. I put it under the press,
:36:02. > :36:09.
:36:09. > :36:14.He's also lost the sight in one eye. The irony here is these workers end
:36:14. > :36:19.up going to hospitals to be treated with the very instruments which
:36:19. > :36:29.helped cause the industry in the first place. A surgeon who often
:36:29. > :36:34.
:36:34. > :36:44.has to operate on them agrees to If the hand is missing, we like to
:36:44. > :37:11.
:37:11. > :37:16.Really? Yes. Thank you very much. It was nice to
:37:16. > :37:26.look around your hospital, and oh, thank you very much.
:37:26. > :37:35.Asalaam Alikum. She's lovely! Right, thank you very
:37:35. > :37:41.much. Goodbye. It's not difficult to understand the pressures these
:37:41. > :37:47.men are under to get back to work. Nearly half of the country live
:37:47. > :37:56.below the poverty line. The typical wage in the surgical instruments
:37:56. > :38:01.industry is 7,000 rupees a month, that's �50. Many are paid much less.
:38:01. > :38:11.I've heard things are so bad that outsourcing is not just confined to
:38:11. > :38:12.
:38:12. > :38:21.the city. The industry has now taken over entire villages. I head
:38:21. > :38:26.to a village 20kms from Sialkot. So, it's right in the back streets this
:38:26. > :38:30.one. Yes, the narrow streets of the villages. As I walk through the
:38:30. > :38:40.back lanes I heard the unmistakeable sound of grinding
:38:40. > :38:43.
:38:43. > :38:49.metal. This is in the middle of nowhere, this. I'm being taken to
:38:49. > :38:59.what used to be someone's house. Come and have a look at this.
:38:59. > :39:05.
:39:05. > :39:11.It's packed full of workers, some look very young. The NHS has
:39:12. > :39:21.publicly committed itself to ethical pro-kurment.
:39:21. > :39:25.Manufacturers -- procurement. The NHS can have little way to know
:39:25. > :39:30.whether their scissors,Les and foreaccepts are being made in
:39:30. > :39:36.conditions like these. -- forseps are being made in
:39:36. > :39:41.conditions like these. I can't believe the conditions and
:39:41. > :39:45.the dust and the dirt. Everything is just awful.
:39:45. > :39:48.Some of these instruments will be sent back to the larger factories
:39:48. > :39:53.where they will be checked. Watching the speed at which these
:39:53. > :40:03.instruments are made though, again it's difficult to see how any kind
:40:03. > :40:05.
:40:05. > :40:15.of quality can be maintained. How much would you sell something
:40:15. > :40:16.
:40:16. > :40:22.like this for to the next company? 40 rupees. That is less than 2p an
:40:22. > :40:26.instrument. They will be sold to the NHS for several pounds. These
:40:26. > :40:36.factory owners admit the quality of their work can depend on what they
:40:36. > :40:37.
:40:37. > :40:42.If you are given an order, but the money is very, very bad, will you
:40:42. > :40:48.spend less time on the quality and more time on the countries that are
:40:48. > :40:53.paying more money? So, the less money you get, the
:40:53. > :41:00.less effort you will put into the quality?
:41:00. > :41:03.In other units I notice young faces hard at work. The Chamber of
:41:03. > :41:09.Commerce told me child labour didn't exist in the industry.
:41:09. > :41:18.Whilst I haven't seen lots of children, I have seen children.
:41:18. > :41:22.This is Kabir. Although we were not allowed to film him in his usual
:41:22. > :41:32.workshop, we ask him to show us the machinery he normally uses. He is
:41:32. > :41:43.
:41:43. > :41:53.14 and has worked in the industry These surgical instruments, which
:41:53. > :42:11.
:42:11. > :42:21.Do you wish you didn't work in that If you could do anything, Kabir,
:42:21. > :42:27.
:42:27. > :42:31.anything at all, what would you The fact this is a child's life is
:42:31. > :42:35.shocking enough, but then Kabir shows me the true cost he has paid
:42:35. > :42:45.since working in factories since he was eight.
:42:45. > :42:51.
:42:51. > :42:57.You have crushed your fingers? They Just like this, my leaf was crushed.
:42:57. > :43:07.Your hand was crushed like the leaf?
:43:07. > :43:27.
:43:27. > :43:34.And you have some fingers just In some accidents some kids die, so
:43:34. > :43:41.his fingers were used to put in there, it's not his own fingers.
:43:41. > :43:51.They are somebody else's fingers? Somebody else's fingers. A young
:43:51. > :44:02.
:44:02. > :44:06.kid died in an accident and their So these two fingers....? They are
:44:06. > :44:16.from two different boys. One was younger, one was older. That's the
:44:16. > :44:34.
:44:34. > :44:44.reason one is shorter and one is Any name is Sam.
:44:44. > :44:52.My name is Sam. My name is Kabir. My name is Kabir. Very good! Blue.
:44:52. > :45:02.I am blue. No, blue. Blue. A report estimates that up to 5,000
:45:02. > :45:07.
:45:07. > :45:10.children here are employed making During my time in Pakistan, I've
:45:10. > :45:15.witnessed terrible working conditions, questionable quality
:45:15. > :45:19.control and children working. All in the manufacture of surgical
:45:20. > :45:23.instruments, which will be used on patients in the UK. I want to ask
:45:23. > :45:29.the trade body which represents the industry here their thoughts on the
:45:29. > :45:34.situation. Do you accept that you have
:45:34. > :45:44.problems with this industry that I have described?
:45:44. > :45:46.
:45:46. > :45:50.We are working very hard, but I will not deny the fact that if he
:45:50. > :45:59.has to choose between sleeping and working, the child will choose to
:45:59. > :46:09.work a little bit. What about the lack of quality control? Don't be
:46:09. > :46:17.concerned about that, because a company which stamps the CE mark,
:46:17. > :46:21.they're qualified to do that. want to show him the reason why I
:46:21. > :46:25.started this investigation in the first place - dangerous and poor
:46:25. > :46:33.quality instruments in the NHS. When you say there is no danger
:46:33. > :46:37.from surgical instruments... But if they're made badly...? If we are
:46:37. > :46:44.using the proper stainless-steel... But that's not true. Are you happy
:46:44. > :46:54.with that? It is made in Sialkot. It is very common. I don't know
:46:54. > :47:04.wattages. This is a guide pin, it should be flat. It can puncture the
:47:04. > :47:04.
:47:04. > :47:09.surgeon's gloves. Forceps, with a bit which has come off. Corrosion...
:47:09. > :47:16.This is wrong, I agree. If you operated on somebody and a piece of
:47:16. > :47:20.that was left behind, it could kill somebody. It was sent from Sialkot
:47:20. > :47:24.into a hospital trust in the UK. That might have been done by some
:47:24. > :47:27.unscrupulous manufacturers. what about the practice of stamping
:47:27. > :47:37.a different country of origin on an instrument which was clearly made
:47:37. > :47:52.
:47:52. > :47:59.in Pakistan? The industry is not My time in Pakistan has been an
:47:59. > :48:05.unforgettable one. I have seen pride and passion in a country in
:48:05. > :48:15.turmoil. I have seen skills in an industry the world's health care
:48:15. > :48:16.
:48:16. > :48:25.systems are relying on. But I have also uncovered the exploitation of
:48:25. > :48:29.workers, child labour and questionable instrument quality. I
:48:29. > :48:37.came here not just looking for answers, but possibly looking for
:48:37. > :48:47.someone to blame. It is only when I return home that I discover where
:48:47. > :48:58.
:48:58. > :49:02.Back in the UK, and I want to show my footage to someone firmly on the
:49:02. > :49:07.side of patients when it comes to health care, the world's first
:49:07. > :49:12.professor of patient safety, who has investigated cases of serious
:49:12. > :49:19.adverse incidents in hospitals on behalf of the Government. Do you
:49:19. > :49:23.know what they're making there? were told those instruments were
:49:23. > :49:27.used for cutting away tumours. My God, I find that almost
:49:27. > :49:33.unbelievable. I would not believe that you would make surgical
:49:33. > :49:39.instruments in this kind of condition. I showed the stamping of
:49:39. > :49:42.the instruments to Professor Brian Toft. Surgeons are taking
:49:42. > :49:45.instruments which they believe to be of a high-quality, using them on
:49:45. > :49:50.patients, believing they are doing the best they can, when really they
:49:50. > :49:53.have been made under these conditions. This is unfair on the
:49:53. > :49:59.patients, unfair on the people buying it, and unfair on the people
:49:59. > :50:02.making it. Procurement officers, if they knew this was happening, those
:50:02. > :50:06.surgical instruments were coming from that room into their hospitals,
:50:06. > :50:16.they would faint at the thought of it. And cannot believe that anybody
:50:16. > :50:29.
:50:29. > :50:35.I head to Barts to catch up with Tom Brophy, who has been testing
:50:35. > :50:43.some of the instruments I brought from Pakistan. In this envelope, we
:50:43. > :50:50.have all of the failures. These are the failures? Yes, these are the
:50:50. > :51:00.one has the trust would accept. most of them have failed. Yes, 63%
:51:00. > :51:01.
:51:01. > :51:11.have failed. I can list the reasons why they failed. My instruments
:51:11. > :51:11.
:51:11. > :51:20.failed for having faulty screw heads, pitted metal and burrs.
:51:20. > :51:25.you see that? I can. There were also poorly made guide pins. We're
:51:25. > :51:29.trying to protect the patient and the surgeon. That's going to rip
:51:29. > :51:39.through the gloves of a surgeon. is, there is no need to have it
:51:39. > :51:40.
:51:40. > :51:45.I feel really disappointed that those instruments failed. Having
:51:45. > :51:51.spent time in Pakistan, you can see the workers are really doing the
:51:51. > :51:55.best job they can in really difficult circumstances. It is
:51:55. > :51:59.frustrating, because they have got the skills, there's a willing
:51:59. > :52:03.workforce, but all the while countries like us, and remember,
:52:03. > :52:08.the UK is Pakistan's third biggest customer in surgical instruments...
:52:08. > :52:12.So, all the while we exploit this kind of Labour, we do not pay the
:52:12. > :52:18.right kind of money, and we do not give the right kind of support,
:52:18. > :52:24.then I guess, you ask, is anything going to change? The body
:52:24. > :52:27.responsible for the quality of surgical instruments is the
:52:27. > :52:31.Medicine and Healthcare Products Regulatory Agency. They were
:52:31. > :52:41.unavailable to be interviewed. But in a statement, they told us they
:52:41. > :52:54.
:52:54. > :52:59.One man who's trying to make a change is a surgeon in Oxford who
:52:59. > :53:03.has walked the same street as me in Sialkot. Since his return, he has
:53:03. > :53:13.been lobbying government to ensure there is ethical procurement as
:53:13. > :53:14.
:53:14. > :53:21.well as greater transparency within the supply chain. That's the first
:53:21. > :53:26.time I have seen anything like this since I was in Pakistan. It is
:53:27. > :53:30.strange to see them in such a clean environment. It is quite odd
:53:30. > :53:36.because now that you know where these products could have been
:53:36. > :53:40.manufactured, it puts a slightly different slant on it. Dr Mahmood
:53:40. > :53:44.Bhutta believes it is patients who now have the power to influence NHS
:53:44. > :53:51.purchasing. The reputation of the national Health Service is at risk.
:53:51. > :53:54.You cannot boycott the national Health Service, but what we can do
:53:54. > :53:59.is... Hospitals are accountable to local populations. If people
:53:59. > :54:03.actually care about this issue, and they say, I want my hospital, my
:54:03. > :54:07.surgery, to buy things ethically, not to be engendering these
:54:07. > :54:13.horrendous working conditions, then the voice of the patients must be
:54:13. > :54:16.listened to. But for the NHS to answer patients' questions about
:54:16. > :54:25.ethically made instruments, there needs to be greater transparency
:54:25. > :54:29.within the supply chain. Remember Regal Medical Instruments, the
:54:29. > :54:36.company which allowed me to stamp their instruments with the quality
:54:36. > :54:39.control mark. They told me they did not have a company in the UK. But I
:54:39. > :54:43.found a Regal Medical Instruments in London which shares the same
:54:43. > :54:52.Pakistani fax number. Posing as a buyer wanting to sell on
:54:52. > :54:57.instruments to the NHS, I made contact with a Mr Shahbaz Hussain.
:54:57. > :55:01.What he told me on the phone suggests he would bend the law to
:55:01. > :55:05.secure a contact. -- contract. I have arranged a business meeting in
:55:05. > :55:15.a London cafe. What he doesn't know is that I will be secretly filming
:55:15. > :55:15.
:55:15. > :55:19.him. Sorry, let me get your name. Which one is Shahbaz Hussain? Just
:55:19. > :55:24.to tell you a bit about myself... I tell them I work for a company
:55:24. > :55:34.which will ultimately be selling surgical instruments to the NHS.
:55:34. > :55:52.
:55:52. > :55:56.it a British company? Yes. You're a product manager... Have you got
:55:56. > :55:59.samples with you? If instruments their markings of countries and
:55:59. > :56:05.companies other than where they're made, it makes it difficult to
:56:05. > :56:15.trace the source when things go wrong. I ask them what country of
:56:15. > :56:18.
:56:18. > :56:24.origin markings these instruments will come with. They then tell me
:56:24. > :56:34.the different grades of steel I can buy. Different qualities.
:56:34. > :56:45.
:56:45. > :56:52.that's important for me. What are Presumably German steel is the
:56:52. > :56:56.best? We can stick the German stamp on even if it is from Pakistan?
:56:56. > :57:03.Would I ever have to admit that it was not German steel, that it was
:57:03. > :57:11.actually from Pakistan, would anybody ever know the difference?
:57:12. > :57:16.It is not very easy to judge it. they were offering me lower-quality
:57:16. > :57:19.Pakistan steel for using the NHS, but they will stamp it German. This
:57:19. > :57:29.is illegal. For what they tell me, it is already happening within the
:57:29. > :57:39.
:57:39. > :57:44.industry. So, other people do that? Yes. All the while companies like
:57:44. > :57:48.these are willing to break the rules to make a quick profit, how
:57:48. > :57:52.are those responsible for surgical instruments in the NHS able to act
:57:52. > :57:59.to clean up the industry? Scotland's Health Secretary, Nicola
:57:59. > :58:04.Sturgeon, said procurement was the responsibility of NSS, National
:58:04. > :58:08.Services Scotland. NSS refused an interview, but said it required
:58:08. > :58:12.operators to apply ethical standards. Just as consumers are
:58:12. > :58:18.demanding to know how their tea and coffee is grown, how their clothes
:58:18. > :58:21.are made, surely our Health Service should start to examine where they
:58:21. > :58:28.sourced their surgical instruments from, and make sure that they're
:58:28. > :58:32.trading ethically. Dr Mahmood Bhutta is right, we cannot boycott
:58:33. > :58:36.the NHS, we all needed and we are all paying for it. But after what I
:58:36. > :58:41.have seen, I'm not sure how comfortable I feel about funding an