Consultation outcome

Tackling modern slavery in NHS procurement: government response

Updated 5 June 2025

Executive summary

This is a joint government response from the Department of Health and Social Care (DHSC) and NHS England.

The National Health Service (Procurement, Slavery and Human Trafficking) Regulations 2024 (‘draft regulations’) are a proposed set of rules which will introduce a broad legal duty to consider modern slavery and human trafficking risk in the procurement of goods and services for the purposes of the NHS in England. They are intended to build upon the commitments already included in government policy, as set out in PPN 009: tackling modern slavery in government supply chains (previously PPN 02/23: tackling modern slavery in government supply chains).

The regulations will introduce a duty to public bodies to:

• assess the risk of modern slavery
• take reasonable steps during pre-procurement and procurement stages
• include mitigation measures in contracts to manage identified modern slavery risk

Public bodies are required to have regard to relevant guidance published by NHS England or DHSC, which will detail the potential reasonable steps that might be implemented. Draft guidance on tackling modern slavery in NHS procurement was published with the consultation.

Introduction and context

In the report Global Estimates of Modern Slavery: Forced Labour and Forced Marriage published by the International Labour Organization, it is estimated 50 million people live in modern slavery across the world. Modern slavery exists in every country, including the UK, with instances of forced and child labour documented within the supply chain of the health and social care sector.

The government is committed to eradicating the crime of modern slavery and human trafficking both domestically and abroad. Different departments are responsible and lead on their respective aspects of modern slavery regulation, as follows: 

• the Home Office is responsible for the Modern Slavery Act 2015, including the ‘Transparency in Supply Chains’ provision
• the Department for Business and Trade (DBT) leads on wider business regulations and trade measures, including responsible business conduct, non-financial reporting, free trade agreements, import and export controls, and supply chain resilience
• the Foreign, Commonwealth and Development Office (FCDO) is responsible for the UK’s international approach to eradicating all forms of modern slavery in line with achieving Sustainable Development Goal (SDG) 8.7
• Cabinet Office is responsible for procurement legislation, including the new Procurement Act 2023, which came into force in February 2025, and for setting procurement policy for central government departments. This responsibility is confirmed in the Government response to House of Lords Modern Slavery Act 2015 Committee report, ‘The Modern Slavery Act 2015: becoming world-leading again’. This report discusses the UK government’s response to the House of Lords Committee report on the Modern Slavery Act 2015. It highlights the government’s commitment to becoming a world leader in tackling modern slavery again
• the Independent Anti-Slavery Commissioner also has a UK-wide remit to encourage good practice in the prevention, detection, investigation and prosecution of modern slavery offences and the identification of victims

‘PPN 009: tackling modern slavery in government supply chains’ (PPN 009) details the requirements that ‘in-scope organisations’ of this procurement policy note (PPN) must take to ensure modern slavery risks are identified in their procurement activities, and how these risks should be managed in government supply chains. ‘In-scope organisations’ are:

• central government bodies
• executive agencies
• non-departmental public bodies
• NHS bodies

The NHS has a significant role to play in combatting modern slavery through taking steps to ensure that NHS supply chains and business activities are free from labour abuses.

The Health and Care Act 2022 introduced 2 legal duties relating to modern slavery in supply chains in the health service.

The first, at section 47, required the Secretary of State for Health and Social Care to undertake a review of modern slavery in NHS supply chains. The Review of risk of modern slavery and human trafficking in the NHS supply chain was presented to Parliament in December 2023, making the recommendation for the Secretary of State to continue implementing modern slavery regulations, which are the subject of this document.

Section 81 of the Health and Care Act 2022 inserted section 12ZC into the National Health Service Act 2006 (the NHS Act 2006) for the Secretary of State for Health and Social Care to make such regulations as the Secretary of State thinks appropriate with a view to eradicating the use in the health service in England of goods and services that are tainted by slavery and human trafficking (‘our legal duty’).

Regulations will apply to public bodies procuring goods or services for the purposes of the NHS in England. DHSC and NHS England will also issue statutory guidance, which will set out the detail of how to comply with the regulations. Public bodies must have regard to any relevant guidance issued by DHSC or NHS England in carrying out their duties under the regulations.

The draft regulations require relevant bodies to assess risks of modern slavery and, where risk is identified, take reasonable steps during both pre-procurement and procurement stages to address that risk. Reasonable steps to mitigate assessed risk are presented in the guidance as a range of options to implement within procurement activity, contracts, framework and dynamic markets. Draft guidance was published alongside the consultation.

The principles that government departments and other public bodies should adopt for engaging stakeholders when developing policy and legislation are set out in the Cabinet Office 2018 consultation principles.

Approach and methodology

DHSC conducted an online consultation on tackling modern slavery in NHS procurement on GOV.UK between 21 November 2024 and 13 February 2025, which gave public bodies, suppliers and interested members of the public an opportunity to consider and provide feedback on the draft regulations and policy.

We have engaged officials across government, including Cabinet Office and Home Office, as the respective policy owners and leaders in government, to encourage feedback, discussion and alignment across regulatory and policy frameworks.

A number of virtual events were held during the consultation period, during which attendees were invited to find out more information about the draft regulations and guidance alongside communications sent by both DHSC and NHS England, consisting of:

• 5 public webinars with over 550 representatives registered from across the NHS, local government, the independent healthcare sector and the supply chain
• recorded webinars available to NHS staff
• workshops to inform and upskill, attended by 40 procurement professionals from the ‘health family’. Communications were sent to over 1,000 subscribers to DHSC and NHS England bulletins
• a written ministerial statement issued by the Minister for Secondary Care confirming the government’s intentions to make regulations

In addition, events were attended throughout the health system, across central and local government, to raise awareness of the regulations and consultation, engaging upwards of 500 public procurement professionals.

Overall, we received 40 responses. While all respondents provided answers to all closed questions, many chose not to provide substantive comments to all open-ended components of questions. We did also receive letters from a number of organisations, which we have considered in our consultation response.

We extend our thanks to all respondents for their time and effort in participating in the consultation.

Table 1: total number of consultation responses by stakeholder group

Stakeholder	Number of responses
An individual sharing my personal views and experiences (such as a patient, carer or member of the public)	1
An individual sharing my professional views	4
Arm’s length body	2
NHS contracting authority	2
NHS Central Purchasing Body including commissioning support units and framework providers	6
Non-NHS Central Purchasing Body including framework providers	1
Other contracting authority	1
Supplier (including private sector, small and medium-sized enterprises (SMEs) and voluntary, community and social enterprises (VCSEs))	11
Trade association	6
Trade union	1
Community interest group or equivalent organisation relevant to modern slavery causes	3
Other	2
Total responses	40

Responses to survey questions

Survey approach

Views on the draft regulations and draft guidance were collected through an online survey. The survey included a mixture of quantitative ‘agree or disagree’ questions and free text open-ended questions. The consultation sought views on a wide range of considerations including whether respondents felt proposals:

• were sufficiently clear and consistent
• were proportionate and relevant in relation to framework and dynamic markets
• were aligned with existing policy set out in PPN 009 and in the document ‘Procurement Policy Note 002: The Social Value Model’ (on the publication page PPN 002: Taking account of social value in the award of contracts)
• were complete and sufficient
• presented any challenges to implementation for suppliers and trade associations
• required any further support or considerations - for example, unintended consequences

Caveats and handling notes

We estimate our engagement activities informed over 1,000 individuals about the consultation. Forty responses were completed and submitted, with an average of 21 full responses to individual questions. For each question a significant number of responses were null, ‘don’t know’, or ‘neither agree nor disagree’. The majority of those engaged throughout the consultation process chose not to respond to the consultation.

Due to the small number of responses, the summary is high-level and excludes quantified responses to questions and direct quotes. Instead, findings focus on the sentiment of responses and address any concerns raised.

Method of analysis

Written consultation responses were analysed using mixed methods. Closed components of questions were analysed with multiple-choice qualitative techniques. Open-ended components of questions were analysed using qualitative techniques involving breaking the text down into categories, coding responses and considering positive or negative sentiments to draw out common perspectives among the respondents.

Throughout the consultation, respondents provided full responses to some open-ended qualitative questions but left others blank. Therefore, for each of the questions the government response will set out how many of the total 40 respondents to the consultation returned a response to each question.

We have provided a high-level statistical summary of responses to questions, where relevant. Summaries of the position raised in response to this consultation are not exhaustive and set out the most common and pertinent positions raised in response to the consultation questions and government proposals.

For the purposes of any percentages provided in the government response, where the respondent has failed to provide a position to quantitative ‘agree or disagree’ questions (in other words, selected ‘neither agree nor disagree’ and ‘don’t know’) the responses have been qualified as ‘other’. Percentages may not total 100% when added up, as percentages have been rounded to the nearest whole number.

This document provides a summary of the consultation responses received and the government response. It does not attempt to capture every point made in submission to the consultation, nor does it cover comments on aspects of policy that fall outside the scope of this consultation. This document sets out the changes the government has or will make in response to the main points raised in the consultation. Where no change or a different change has been made the reasons are explained.

Summary of question responses and government response

In the following section, we review the central themes identified in consultation responses to individual questions and provide the government’s response in respect of the draft regulations, guidance and next steps to be taken.

Due to the detail of responses received, we provide a high-level overview of responses in this section and provide a complete government response to this overview.

Do you agree or disagree that the regulations address the Secretary of State’s statutory duty in section 12ZC of the NHS Act 2006?

Of the 40 respondents:

• 26 (65%) agreed that the draft regulations address the duty
• 5 (12.5%) respondents disagreed
• 9 (22.5%) respondents returned a response score ‘other’
• 16 respondents provided further views, evidence or experience to support their answer

Some raised concerns about the focus on supplier actions rather than addressing root causes, the need for greater stakeholder engagement, and the lack of accountability mechanisms to incentivise change beyond reporting.

Other views included calls for stricter, holistic approaches to labour exploitation including holding corporations and public authorities liable for not preventing modern slavery as well as calls for import controls.

There was a recommendation to ask Cabinet Office to centralise efforts and extend the requirements to the whole of government. Two respondents suggested the requirements should be extended to works (building and construction).

There was a request to carefully consider the feasibility in relation to dynamic markets. Some respondents also highlighted the need for increased resources, training and expertise to effectively implement the regulations.

Government response

DHSC recognises the draft regulations and accompanying guidance are the first step in addressing modern slavery. We intend to continue working towards the government’s commitments to tackling modern slavery, beyond implementation of the regulations, including consideration of actions to address its root causes.

The draft regulations and guidance focus on information-sharing and collaboration with suppliers in a bid to influence the behaviours and level of risk of modern slavery in supply chains. Improving the focus on information-sharing will help to mitigate exploitative practices and identify any incidents. Where incidents are identified, the draft regulations and guidance include provisions for allowing the contracting authority and supplier to appropriately address the incident. Whistleblowing and reporting lines exist in the UK and are established for workers or members of the public to report incidents of modern slavery. One of these reporting lines is the Modern Slavery and Exploitation Helpline, which offers information, advice and guidance on issues related to modern slavery and exploitation. The helpline allows individuals to report concerns, seek advice and access support services confidentially or anonymously. 

We will look to ensure there is adequate signposting to reporting mechanisms and will feed into cross-government efforts to ensure these mechanisms are relevant.  

The powers inserted into section 12ZC of the NHS Act 2006 by section 81 of the Health and Care Act 2022 require the Secretary of State to make regulations with a view to eradicating the use in the NHS in England of goods and services that are tainted by slavery or human trafficking. The powers in this primary legislation do not go beyond the procurement of goods and services for the purposes of the NHS. Modern slavery is a complex issue that cannot be tackled through a singular legislative measure. There are existing legal measures in place to tackle modern slavery both in terms of criminalising modern slavery and addressing it through commercial levers. The Modern Slavery Act 2015 provides for penalties for modern slavery offences, including slavery, servitude and forced labour. The Procurement Act 2023 further strengthens the ability to exclude suppliers involved in modern slavery, with a mandatory exclusion ground for suppliers or connected persons convicted of certain offences under the Modern Slavery Act 2015 (schedule 6 paragraph 23 of the Procurement Act 2023).

We support the request to centralise efforts. Following the implementation of these regulations and guidance for goods and services for the NHS, we will continue to support working across government to strengthen efforts to develop a standard approach throughout government.

We recognise the feedback related to feasibility for dynamic markets. We will review the relevant sections of the draft regulations and guidance to ensure an appropriate level of responsibility for risk management at dynamic market and framework level.

Training and expertise are important for the successful implementation of the regulations and guidance. A programme of training, guidance and ongoing support will be developed to enhance the existing offer to procurement professionals and suppliers.

Do you agree or disagree that the guidance is sufficiently consistent with the regulations as drafted?

Of the 40 respondents:

• 26 (65%) agreed that the guidance is sufficiently consistent with the draft regulations
• 6 (15%) respondents disagreed
• 8 (20%) respondents returned a response score ‘other’
• 18 respondents provided further views, evidence or experience to support their answer

The majority of respondents agreed that the guidance on tackling modern slavery in NHS procurement aligns with the draft regulations, but there are calls for:

• increased clarity
• practical actionable steps
• stronger mechanisms for enforcing compliance

Some concerns were raised about the focus on reporting rather than engaging workers and identifying exploitative practices to prevent modern slavery. There were also requests for:

• clearer criteria for risk categorisation
• more detailed instructions on supplier engagement
• better integration with technology to support public bodies in complying with the regulations

Furthermore, there were suggestions for clarifying the opportunity to deviate from requirements outlined in the draft guidance if sufficient market engagement is conducted. Some respondents also proposed the addition of case studies or model templates for procurement and contract management processes, while others highlighted the need for a better understanding of specific risks and reasonable steps to address them in the modern slavery assessment tool (MSAT).

Government response

Details of risk categorisations, instructions on supplier engagement and some worked examples are included in PPN 009. In line with recommendations and commitments made in the review of risk report, NHS England has built a risk identification methodology to support a standard approach to product level risk management in the health system. Alternative risk identification tools can be used by procurers outside of the health system. A suite of tools and guidance documents will be developed and provided to procurement professionals and suppliers to supplement the existing guidance and tools. These materials will include further support on practical actionable steps, case studies, model templates and consideration of how technology might be used to further support compliance.

The draft regulations and guidance focus on information-sharing and collaboration with suppliers in a bid to influence the behaviours and level of risk of modern slavery in supply chains. Whistleblowing and reporting lines exist in the UK and are established for workers or members of the public to report incidents of modern slavery. The Modern Slavery and Exploitation Helpline being an example of one of the existing reporting lines in the UK. An improved focus on shared information will mitigate exploitative practices in the first instance and identify any incidents in the second instance. Where incidents are identified, the draft regulations and guidance include provisions for allowing the contracting authority and supplier to appropriately address the incident.

The guidance provides that public bodies can deviate from the minimum reasonable steps when determined that a change in approach is relevant and proportionate. Market engagement should be carried out to demonstrate and justify a change in approach. This justification must be documented by the procurement body. We will review the guidance to ensure clarity.

Do you agree or disagree that regulation 3 clearly defines the goods and services in scope?

Of the 40 respondents:

• 27 (67.5%) agreed that Regulation 3 of the draft regulations clearly defines the goods and services in scope
• 4 (10%) respondents disagreed
• 9 (22.50%) respondents returned a response score ‘other’
• 14 respondents provided further views, evidence or experience to support their answer

While most respondents agreed that Regulation 3 of the draft regulations clearly defines the goods and services in scope, one area of discussion was the decision not to include ‘works’ (construction) in the regulations. Some respondents suggested that it would be beneficial to include works for completeness.

A number of respondents requested clarity on the goods and services covered by the draft regulations. Two respondents specifically called for more explicit examples of the types of goods and services that should be considered in-scope or exempt as per Regulation 3(2), as well as clearer guidance on how to identify and assess modern slavery risks in complex procurement scenarios.

One framework provider saw the benefit of the increased focus on modern slavery in their offerings, as a broad customer base would benefit from the enhanced emphasis on ethical procurement practices. However, it was noted that smaller suppliers may find additional legislation burdensome.

Overall, while there is general agreement that the draft regulations apply widely across the health system, respondents highlighted the need for more concrete guidance on risk categorisation and exclusions to ensure consistent implementation and compliance.

Government response

The draft regulations have been developed in line with the powers set out in section 12ZC of the NHS Act 2006, which do not extend to works. See the response on works against the question prior in this report relating to section 12ZC for further detail.

The draft guidance will be reviewed for clarity on how to identify and assess modern slavery risk in complex procurement scenarios - in other words, where works and services are being procured under one large procurement.

We recognise the potential impact these requirements may have on smaller suppliers, where greater engagement and activity is required to ensure modern slavery risk is appropriately managed and mitigated. Section 12 of the Procurement Act 2023 places an obligation on public bodies to have regard to the barriers small to medium-sized enterprises may face. The reasonable steps set out in the guidance are to be considered by procurement professionals and implemented in a relevant and proportionate way. The market’s capability, capacity and maturity in relation to managing modern slavery risk should be assessed through early market engagement to inform the development of the procurement and subsequent contract.

Do you agree or disagree that a proportionate and relevant reassessment of risk should be required during the term of the framework or dynamic market to ensure modern slavery risks are identified in line with the duties and guidance?

Of the 40 respondents:

• 29 (72.5%) agreed that a proportionate and relevant reassessment of risk should be required during the term of the framework or dynamic market
• 4 (10%) respondents disagreed
• 7 (17.5%) respondents returned a response score ‘other’
• 29 respondents provided further views, evidence or experience to support their answer

The majority of respondents agreed that a reassessment of modern slavery risks during the term of a framework or dynamic market is necessary to ensure compliance with duties and guidance. This is felt to be a proportionate and risk-based approach, acknowledging that supply chain changes and evolving business practices can create new risks that require attention.

Some concerns were raised about the administrative burden and additional costs of reassessments, and resource-intensive activities like supply chain mapping. Some respondents highlighted the need for clearer guidance on the risk assessment duties expected of service providers.

Some respondents suggested that a mandatory 2-year review period might be too long, advocating for more frequent assessments in some cases, such as when a change in supply chain or non-compliance by a supplier is discovered. Respondents called for clearer instructions on trigger points for reassessment during a contract, including more information on what constitutes a trigger event and how often contract reviews should take place.

Another perspective highlighted the need to engage with workers and move away from reliance on questionnaires and reports, which may not always highlight accurate risks or preventative actions. Some respondents proposed collaborating with trade unions to understand which suppliers have conducted union-busting activities, as a means of identifying higher-risk supply chains.

Some asked for ‘proportionate’ to be further detailed and explained, given its subjective nature. Some respondents questioned whether a fixed timeline for reassessment is appropriate as market conditions can change. They recommend that reassessments should take place when new evidence becomes available, or instances of modern slavery are identified.

In conclusion, while the majority agreed that regular risk assessments are important to manage modern slavery risks, there were concerns about the administrative burden, the need for clearer guidance on reassessment, and calls for an approach that engages with workers and complements publicly available information.

Government response

The reassessment of risk may require additional activities from procurement professionals and potentially suppliers where risk increases. This aligns to the approach of managing risk in existing contracts in PPN 009. A risk assessment tool has been developed for NHS organisations to enable quick initial assessment and re-assessment of risk, minimising the administrative burden.

Public bodies have a responsibility to appropriately address any risks identified in their procurements or contracts, to support the government’s commitments to tackle modern slavery. Should the level of risk increase following reassessment, the contracting authority should review and implement relevant and proportionate recommended actions. This may include supply chain mapping as per the reasonable steps outlined in the contract management section of the guidance. Where high risk is identified, the guidance recommends a reasonable step may be to conduct an MSAT, or equivalent, at tier 1 of the supplier’s supply chain (and requested to at least tier 3 level) for those suppliers relevant to the delivery of the contract.   

We will consider developing supplementary guidance to provide further guidance on service provider risk assessment duties.

The 2-year timescale for re-assessment of risk is a recommended minimum frequency, with earlier reassessment required when evidence of a change of risk, its validity or an incident is identified. The draft guidance identifies 3 example trigger points for reassessment when ‘there is reason to suspect that the most recent risk assessment is no longer valid’ in relation to indications of poor practice, other sector related procurements indicate a change of risk, or when suppliers report a risk. Updates to the guidance will be considered if other appropriate triggers are identified.

We recognise the need to engage directly with workers and will consider how we can collaborate with trade unions to bring in the worker voice.

Do you agree or disagree with the proposed measures within the guidance for end of framework or dynamic market activities in relation to reassessment of risk?

Of the 40 respondents:

• 22 (55%) agreed with the proposed measures
• 6 (15%) respondents disagreed
• 12 (30%) respondents returned a response score ‘other’
• 19 respondents provided further views, evidence or experience to support their answer

While the majority of respondents agreed with the proposed measures for reassessing risk at the end of framework or dynamic market activities, a significant number of respondents raised concerns about the practicality of sharing the outcomes of risk assessments. Other concerns included the burden on framework providers to conduct annual risk reviews during transition, particularly in low-risk categories, and a lack of clarity regarding the purpose and use of end-of-agreement reassessments.

Several respondents suggested that regular re-assessment of risk is necessary but should be undertaken in consideration of the level of risk associated with the framework and the contract period. Some suggested that the burden placed on public bodies could be disproportionately high and exceed what is outlined in relevant procurement policy notes (PPNs). It was also highlighted that national and regional procurers should provide oversight to ensure that the risk assessment and mitigation steps have been taken in individual NHS trusts.

Critics argued that the proposed measures could be unworkable for frameworks as owners may not have up-to-date contact details for buyers or the ability to share information directly. For dynamic markets, concerns were raised that these are not contracts so there are no terms and conditions through which to stipulate requirements beyond compliance with exclusion measures.

The importance of engaging stakeholders throughout due diligence processes is reinforced, through engagement, issues such as freedom of association, withheld wages, excessive overtime, and oppressive targets can be addressed. Some also suggested that risk assessments should be conducted further down the supply chain.

Overall, respondents agreed on the importance of reassessing risk at the end of framework or dynamic market activities but raised concerns about practical implementation and the need for clear guidance on the purpose and use of these assessments.

Government response

We appreciate that dynamic market owners may not always have the ability to contact buying organisations and the difficulties this may present when sharing the outcomes of risk assessments. Notification of assessment outcomes may be hosted alongside other dynamic market documentation on any relevant platform for buyers to access. The draft guidance will be amended to reflect this.

Framework providers are recommended to conduct risk reassessments every 2 years, or more frequently, where appropriate and relevant (as per the triggers identified in the draft guidance). Reassessment can make use of the NHS risk assessment tool, or equivalent, which has been designed to ensure minimal additional administrative burden.

End-of-agreement reassessments provide the opportunity to identify the level of risk present for existing contracts to ensure appropriate risk management activities continue, or to inform any planned re-procurement of the framework. These reasons and benefits of end-of-agreement reassessment will be included in updates to the draft guidance.

We recognise that in some instances, particularly where high risk is identified, the recommended actions may confer greater responsibilities on public bodies than those required under the relevant PPNs. It is our intention to ensure the improved management and mitigation of risk in NHS supply chains where there is increased risk of modern slavery.

We appreciate the suggestion that national and regional procurers might be well placed to provide oversight of NHS trust activities. This will be considered as part of the future development of our approach to tackling modern slavery.

We recognise the need for further clarity on how the requirements should be applied to dynamic markets and will review the relevant sections of the draft regulations and guidance to provide clarity.

We agree that consistent and thorough engagement with stakeholders throughout the procurement and contract management stages is of paramount importance, including due diligence activities. The draft guidance will be reviewed to reinforce this point.

Do you agree or disagree that the guidance is sufficiently consistent with existing policy set out in PPN 02/23 (now PPN 009): tackling modern slavery in government supply chains?

Of the 40 respondents:

• 27 (67.5%) agreed that the guidance is sufficiently consistent with existing policy set out in PPN 02/23 (now PPN 009)
• 4 (10%) respondents disagreed
• 9 (22.5%) respondents returned a response score ‘other’
• 17 respondents provided further views, evidence or experience to support their answer

There is a call for further legislative measures that apply directly to corporations such as a Business, Human Rights and Environment Act, import controls and complementary policies to reduce modern slavery in NHS supply chains.

Concerns raised by some respondents include the potential burden on suppliers, particularly small and medium-sized enterprises (SMEs) and the suitability of the MSAT. There is a request to ensure alignment with other relevant guidance such as the Home Office Transparency in supply chains (TISC) guidance and United Nations Guiding Principles on Business and Human Rights.

It is suggested that more detailed guidance may be needed to clarify roles and responsibilities, accountability and consequences for insufficient action to mitigate modern slavery risks. One respondent requested that there is an explicit reference to auditing, to enhance the approach to addressing risks.

Another important concern raised by some respondents is the need to ensure the regulations are aligned and co-ordinated with existing NHS England procurement policy initiatives, particularly the NHS Evergreen sustainable supplier assessment. Clarity is needed as to whether the proposed NHS regulations would be for existing contracts or only be for new procurement activity.

There were also requests for a comprehensive programme of upskilling on the MSAT, supply chain mapping, and social value (including modern slavery specific questions) for both NHS contracting authorities and suppliers. Additionally, it was suggested that the importance of effective contract management to manage the action to mitigate the risks of modern slavery should be stressed in guidance.

Some respondents also highlighted the need to ensure:

• transparency of the risk assessment methodology and the data it is based on
• clarity on the criteria used and consideration of other relevant labour standards issues beyond modern slavery. Too much data can prevent effective decision-making, and so a mind map or comparable equivalent may be useful

Overall, while there is general agreement that the guidance is consistent with existing policy, some respondents called for further action and clarity in various areas to effectively address modern slavery in NHS supply chains.

Government response

A few responses to this consultation mentioned and encouraged wider reform. The powers inserted into section 12ZC of the NHS Act 2006 by section 81 of the Health and Care Act 2022 require the Secretary of State to make regulations with a view to eradicating the use in the NHS in England of goods and services that are tainted by slavery or human trafficking. The powers in this primary legislation do not go beyond the procurement of goods and services for the purposes of the NHS. We will share the feedback for further legislative measures, beyond the scope of these regulations, with other government departments.

The MSAT was developed by subject matter experts, and in consultation with government departments, non-governmental organisations (NGOs) and businesses from a wide range of industries. The tool is owned by central government and made accessible on a public platform. Buyers can ask suppliers to complete the MSAT as a reasonable step, where appropriate and proportionate to do so.

Completing the assessment will help organisations assess the capacity of the supplier to manage and prevent the risk of modern slavery. It will help suppliers understand their risk, develop improvement plans and better prepare for future tender responses. The MSAT will help both the buyer and supplier to work in partnership to improve protections and reduce the risk of exploitation of workers in supply chains.

Suppliers will be at different stages of their journey to improving ethical practices in their supply chains, and we expect to see suppliers demonstrate continuous improvement in how they mitigate the risks. The assessment provides links to useful guidance and practical tools throughout to support suppliers in the completion of the assessment and when making improvements going forward.

The updated TISC guidance provides support for organisations on what anti-slavery activities to undertake, how to respond to modern slavery incidents and what to include when drafting a modern slavery statement (as required by section 54 of the Modern Slavery Act 2015).

The NHS England draft guidance provides support for public bodies when managing modern slavery risks in procurement activities and engaging with suppliers for the purposes of the health service. The TISC guidance sets best practice for suppliers and will be helpful for public bodies to include as a benchmark when assessing businesses activities and when collaborating to improve them. We encourage all interested parties to review and implement the best practice recommendations in the TISC guidance. The draft guidance will be updated to include reference to the TISC guidance and recommendations, where appropriate.

We will consider how roles and responsibilities might be more clearly defined in the draft guidance or future support for the implementation of the regulations. Audits might be an appropriate and relevant risk management activity and are included in the draft guidance as an appropriate action in response to an incident. Audits will be added to the draft guidance as a suggested optional recommendation to be considered when assessing or monitoring risk, as requested.

We recognise the need to ensure regulations and policy requirements are aligned with existing NHS England policy, including the Evergreen sustainable supplier assessment. The assessment enables suppliers to engage and align with the NHS net zero and sustainability ambitions and includes consideration of modern slavery (in relation to the completion of the MSAT).

The Evergreen assessment is a voluntary self-assessment and reporting tool. It established a single route for sustainability information and data-sharing between suppliers and the NHS and is not designed to be a scored or evaluated requirement in procurements. Exceptions to this are set out on the webpage. The draft regulations and draft guidance are intended to establish consistent practice in relation to modern slavery risk management. The assessment requests information in relation to MSAT completion, publication of modern slavery statements and actions to identify and mitigate modern slavery risks. It requires evidence of these activities such as URL links, and there is no duplication of effort in relation to activities undertaken.

The new regulations and guidance will apply to new procurements only and will not retrospectively apply to existing contracts. This is set out in the introduction of the draft guidance: “The regime makes it possible to continue with existing procurements and contracts and will not apply retrospectively”.

We have responded to requests for training and skills enhancement in our response to feedback received for the question prior in this report relating to section 12ZC. We recognise the importance of contract management activities when ensuring the continued management and mitigation of modern slavery risk, with proposals set out in regulation 7 and reasonable steps proposed for contract management as set out in the guidance. We will review the guidance to ensure this is appropriately covered in the recommendations.

The NHS risk assessment is based on the characteristics set out in PPN 009, and draws on publicly available risk data, such as:

• the Global Slavery Index
• the United States Bureau of International Labor Affairs List of Goods Produced by Child Labor or Forced Labor
• the human rights indicators of the United Nations Office of the High Commissioner for Human Rights

The NHS risk assessment tool provides a risk rating of high, medium or low to determine appropriate reasonable steps to undertake as set out in the guidance. The supply chain can refer to the characteristics of risk set out in the publicly available PPN to identify the potential sectors that are likely to be rated as higher risk.

Do you agree or disagree that the guidance is sufficiently consistent with existing policy set out in PPN 06/20?

Of the 40 respondents:

• 24 (60%) agreed that the guidance is sufficiently consistent with PPN 06/20
• 6 (15%) respondents disagreed
• 10 (25%) respondents returned a response score ‘other’
• 15 respondents provided further views, evidence or experience to support their answer

Some respondents called for a refresh of the social value guidance and model to address outdated policies and expand on modern slavery risks beyond the scope defined by relevant PPNs. They stated the importance of seeing modern slavery addressed in the new National Procurement Policy Statement, ensuring alignment with the existing guidance.

The draft ‘Tackling modern slavery in NHS procurement’ guidance is welcomed as it goes beyond PPN 06/20 by explicitly stating the need for NHS procurement processes to identify, assess and mitigate modern slavery risks across all stages of procurement.

Some respondents highlighted concerns about striking a balance between environmental, price, quality and social value considerations in procurement. Additionally, there were calls to address wider exploitative workplace discrimination and other practices that may contribute to workers becoming modern slaves.

There was general agreement that the guidance aligns with existing policy, but some suggested the need for updates to social value guidance and model, more specific guidance on addressing modern slavery risks in procurement processes, and a better understanding of how tier 1 suppliers should address risks further down the supply chain.

Government response

The new National Procurement Policy Statement came into force on 24 February 2025. An updated version of the Social Value Model was published under PPN 002: taking account of social value in the award of contracts on 13 February 2025. Both refer to and include provisions for the management of modern slavery risks. We continue to work with Cabinet Office on the implementation of the Social Value Model.

We are committed to addressing all manner of exploitative workplace discrimination. These regulations and guidance mark the beginning of our efforts to tackle modern slavery in NHS supply chains and set our intentions to continue to work throughout government, with suppliers and alongside interested bodies to establish a standard approach. We are conscious that this work must be considered alongside other important policy areas such as environmental impacts, social value and overall value for money.

We will consider how we might work across government to engage with industry in the further development of a standard risk assessment approach. We will also give thought to the development of supplementary guidance covering how suppliers might address risks of modern slavery further down the supply chain.

Do you agree or disagree that the ‘reasonable steps’ detailed within the guidance are sufficient to mitigate risks of modern slavery in NHS procurements?

Of the 40 respondents:

• 19 (48%) agreed that the ‘reasonable steps’ are sufficient
• 8 (20%) respondents disagreed
• 13 (33%) respondents returned a response score ‘other’
• 27 respondents provided further views, evidence or experience to support their answer

More than one respondent stated that alignment between this guidance and forthcoming updates to section 54 of the Modern Slavery Act (TISC guidance) will be crucial. Respondents also asked for alignment to existing standards such as the UN Guiding Principles on Business and Human Rights and OECD Guidelines for Multinational Enterprises on Responsible Business Conduct.

Some advised that accountability mechanisms are essential to ensure that supply chains are free from forced labour, while some acknowledged that not awarding NHS contracts may not be enough to stop the UK from being supplied with goods made with forced labour. Further legislative advancements are necessary to address this issue effectively.

A common theme was thorough early market engagement between contracting authorities and service providers, as it would enable fair implementation of contractual requirements and evaluation criteria. Respondents also said that providing suppliers with early information about proposed reasonable steps can help them decide what they need to do in their own supply chains prior to tender publication.

Several framework providers raised that the proposals would place a resource burden on them, arguing the guidance is impracticable. They ask that the guidance shifts responsibility to buyers, where it is more proportionate.

Concerns were flagged about the lack of enforcement mechanisms, and a call for clearer consequences of non-compliance or failure. They highlight the importance of engaging with high-risk suppliers and providing clearer advice on how the NHS should work with suppliers to enhance their capacity to manage risks and comply with standards.

It was noted that there is a need for training programmes to raise awareness and enhance skills in detecting and addressing slavery in the supply chain, particularly among procurement staff who will be responsible for implementing these guidelines.

In terms of the guidance’s practicality, some say it should provide more detailed, actionable instructions for suppliers to follow. They also recommend referring suppliers to resources, such as:

• the Home Office’s updated TISC guidance
• the framework of the Ethical Trading Initiative (ETI)
• a list of NGO contacts that assist in this area

In summary, while respondents generally agree that taking reasonable steps is necessary to mitigate modern slavery risks, there are concerns about the practical implementation of these steps, particularly in terms of enforcement, resource allocation and supplier engagement. Improvements can be made to early market engagement, specific training programmes, and detailed guidance.

Government response

We recognise the importance of ensuring alignment between all legislation, policies and guidance. We strive to ensure these regulations and guidance are fit for purpose and within scope of the powers provided in the Health and Care Act 2006. Beyond the implementation of these regulations, we intend to work across and throughout government to encourage a unified approach to tackling modern slavery in all government supply chains.

There will be a review of the implementation of the regulations, which will seek to assess compliance with the requirements. To avoid creating undue burden on procurement professionals no reporting or accountability requirements have been drafted into the regulations. The regulations, and requirements within, are legally binding; failure to comply could result in challenge and judicial review. DHSC and NHS England are committed to conducting checks on compliance, to support implementation of the requirements. We will develop support to provide clear advice on how the NHS should work with high-risk suppliers to improve their capacity to manage risks.

The importance of early market engagement is recognised with its inclusion in the guidance as a reasonable step at the procurement design stage. Taking this step will support contracting authorities and service providers, to test assumptions and proposed approaches so that providers can take action and prepare tender responses. We will ensure this is stressed in the draft guidance. The guidance on tender documentation will also be reviewed to consider how risk ratings might be noted in a tender notice alongside the intended application of any reasonable steps to support early notification of suppliers.

We recognise the impact these proposals may have on framework providers. Early engagement on the draft regulations flagged the risks of overburdening smaller buyer organisations and indicated framework owners have a responsibility to ensure procurement practices appropriately manage risk for any potential call off contracts.

The NHS spends approximately £30 billion annually, £15 billion of which is through frameworks. Framework owners have a significant role to play in leveraging public body spend. They have a greater power to influence markets at framework level where the combined potential value is greater than the value of individual call off contracts. The guidance supports a proportionate approach to reasonable steps whereby framework operators can set out the reasonable steps to be implemented at a framework level or through a call-off contract.

The draft regulations have been developed with this in mind. Buying organisations are assigned responsibility for assessment, continued reassessment and management of the call-off contract. We will consider where responsibility might be more proportionally assigned between framework owner and buying organisation.

We have responded to requests for training and skills enhancement in our response to feedback received for the question prior in this report relating to section 12ZC. The draft regulations and draft guidance govern public procurement activities. They have been developed for public procurement professionals to increase risk management actions. We recognise the request for more detailed instructions for suppliers and will consider developing supplementary support tools. A link to the TISC guidance will be included in the draft guidance, as applicable guidance to support suppliers when considering how to tackle modern slavery.

As a potential supplier to the health sector, do you see any challenges in implementing the reasonable steps, should modern slavery risk be identified?

Of the 39 respondents:

• 13 (33%) confirmed they could see challenges in implementing the reasonable steps
• 2 (5%) respondents selected ‘no’
• 24 (62%) respondents returned a response score ‘other’
• 16 respondents provided further views, evidence or experience to support their answer

The below are largely the views of supplier representative organisations.

One response stated that advising suppliers to have completed a MSAT in procurement design, requesting declarations from tier 1 supply partners by the supplier during selection criteria, and implementing minimum key performance indicators (KPIs) for staff training on modern slavery are all fair and reasonable.

Opposing respondents set out some challenges in implementing the reasonable steps. One of the primary concerns was resource capacity, particularly for SMEs. The MSAT and undertaking supply chain mapping is seen to be an administrative burden.

Another issue raised was continuity of supply, with respondents suggesting that discussions about alternative routes of supply in cases of identified modern slavery risks should be initiated early in the procurement process to prevent supply disruption.

Providing information could be challenging, particularly for HealthTech products with complex international supply chains.

There were suggestions to ensure KPIs related to modern slavery are proportionate. Respondents called for greater clarity on the goods and services covered by the regulations, as well as clearer guidance on developing effective KPIs. Some suggested that certain themes would be more appropriate as contract terms rather than KPIs.

The importance of ensuring that the new processes align with existing ones such as the Evergreen sustainable supplier assessment process in the NHS was mentioned again. There were also calls for consistency across the NHS system in terms of tools and systems used to measure supplier compliance.

Several respondents emphasised the need for direction to avoid confusion and unnecessary burden. Some also highlighted the importance of considering international standards already in place within industries, as many companies are already committed to these.

Respondents called for more information on the NHS risk assessment tool and more transparency on the data it is based on as well as sector-level risk scores to support companies. They also suggested that suppliers should be kept informed about legal investigations to avoid any conflicts with remedial actions.

In summary, respondents highlighted a range of challenges related to:

• resource capacity
• continuity of supply
• proportionate application of KPIs
• alignment with existing processes
• national direction
• international standards
• data transparency
• collating information
• incident response
• legal investigations

Government response

Respondents provided conflicting views with regard to the proposed reasonable steps, including the use of the MSAT. Where selected to participate in a procurement, suppliers would be required to respond to the MSAT once only, with the same MSAT score used for multiple procurements within a 12-month period. The MSAT platform allows suppliers to manage and update their MSAT responses at any time to maintain a current and accurate report that can be shared with buying organisations.

The MSAT is the only centrally approved tool that is readily available for procurement professionals throughout government. Home Office supports the use of the tool during early procurement activities, as a means to gather information that should inform the approach to modern slavery risk management (not for awarding contracts). DHSC will work closely with both Home Office and Cabinet Office in any future developments of the tool, to share feedback and support improvements.

While full supply chain mapping is a large and complex task, the recommended reasonable steps in the draft guidance apply only to high-risk procurements and suggest mapping to tier 1 at the least and requesting mapping to tier 3. We appreciate this may still present a certain level of complexity for procurement professionals, given the complex nature of some supply chains in the NHS. Early and continued engagement with suppliers throughout procurement and contract activities will enable a collaborative and strategic approach to information sharing.

Continuity of supply should be considered in all procurement activities as best practice. Modern slavery risk assessments will provide an added level of information to identify where continuity of supply may be an issue and to inform early market engagement. Public bodies should consider the Cabinet Office Sourcing Playbook for further guidance.

The recommended KPIs detailed in the draft guidance align with those outlined in PPN 009. There is further and more detailed support for organisations when developing KPIs in the TISC guidance. We will consider the guidance on KPIs provided in the TISC guidance and revise our guidance accordingly.

As previously mentioned, we are keen to ensure alignment with existing policy and guidance where possible, and we recognise the call for consistency across the NHS system. The Evergreen assessment is designed to allow suppliers to align with NHS England’s sustainability ambitions. These regulations and guidance aim to set a baseline best practice for modern slavery risk management.

Feedback requesting additional guidance on the risk assessment has been addressed in our response to the previous question in this report, ‘Do you agree or disagree that the guidance is sufficiently consistent with existing policy set out in PPN 02/23 (now PPN 009): tackling modern slavery in government supply chains?’

There are a number of mechanisms by which the public is made aware of legal investigations. Legal judgments are published publicly following a court ruling. Inquiries established under the Inquiries Act 2005 have a strong emphasis on public access, with hearings livestreamed and records made available online. The Procurement Act 2023 introduces a published debarment list of suppliers that are excluded or excludable from procurement processes. The Procurement Review Unit (PRU) will have responsibility for oversight of the new Procurement Act 2023. The results of a procurement investigation may be published by the PRU or a contracting authority (in accordance with sections 108 to 110 of the Procurement Act 2023).

What more would you like to see from the accompanying guidance which will aid you in adopting processes or complying with these regulations?

Of the 40 participants:

• 34 (85%) provided a response with additional suggestions for the draft regulations or guidance
• 6 (15%) provided no answer

No additional suggestions were made for the draft regulations. The following suggestions were made to improve the modern slavery guidance:

• clear implementation dates should be specified in the guidance to allow suppliers adequate preparation time
• detailed methodology for risk assessments and transparency in the NHS’s approach would significantly aid businesses in determining reasonable steps
• guidance on how a public body can determine whether a framework provider’s risk assessment is an appropriate reflection of the risk
• predefined high-risk sectors beyond the current 5 (surgical instruments, gloves, gowns, uniforms and face masks) should be publicly listed to increase predictability and promote timely compliance
• industry standards should be clearly referenced or provided with examples in the guidance
• flexibility to use local, equivalent tools, terms and conditions and processes to enable alignment with government policies
• suppliers and procurement teams should receive appropriate education and training on modern slavery regulations and best practices
• adequate notification of the risk level for particular frameworks, categories, countries, or supply chains is necessary to enable audits and due diligence
• the guidance should provide a realistic understanding of the dangers associated with modern slavery, with a concise set of vocabulary to make as many possible risks known and understood
• training on credible evidence and meaningful stakeholder engagement (with suppliers and workers) is crucial for impacting vulnerable workers in the supply chain
• a standard ‘gold standard’ audit checklist should be provided that can be easily adapted for each supplier, along with guidance on actions to take if modern slavery risks are identified
• ensure that the guidance covers those that do not have access to the health family e-commercial system. Either access to the system is provided to all framework providers or having the tool available in a way that is compatible with other systems
• artificial intelligence (AI) could potentially support some of the functionality required for this work
• a detailed example risk assessment with evidence demonstrating mitigation of modern slavery practices in the supply chain would be beneficial
• the regulation should include financial incentives or penalties
• the guidance could encourage all NHS bodies to affiliate to Electronics Watch and use that process to understand how best to advance towards greater supply chain transparency for all other high risk NHS supply chain products
• ensure the guidance is updated to reflect the Procurement Act 2023 and the use of the Procurement Specific Questionnaire
• examples should be provided that show how risk assessments affect contracting suppliers, such as through more meetings with trade associations and large suppliers to understand their supply chains better
• the guidance should explain how to spot modern slavery risks and questions to ask during procurement processes, and what to look for in contract management activities

Government response

We will consider the above suggestions and implement where possible. Amendments will be made to the draft guidance and we will consider additional support tools as appropriate (per our responses to feedback in the questions throughout this document).

As per our response to the question ‘Do you agree or disagree that the guidance is sufficiently consistent with the regulations as drafted?’, details of risk categorisation are outlined in PPN 009.

While the draft guidance points to NHS England’s terms and conditions and risk identification tools, it does also allow for the use of alternative and equivalent terms and tools.

We have responded to requests for training and skills enhancement in our response to feedback received for the question prior in this report relating to section 12ZC.

Further information on the risk assessment tool developed for the NHS is covered in the response to the previous question in this report, ‘Do you agree or disagree that the guidance is sufficiently consistent with existing policy set out in PPN 02/23 (now PPN 009): tackling modern slavery in government supply chains?’

Implementation timeframes are subject to the Parliamentary process. We will inform procurement professionals and supply chain partners as soon as possible. In the meantime, reviewing and aligning to the requirements outlined in PPN 009 and using freely available tools such as the MSAT will help organisations to prepare for the regulations.

Are there any other broader impacts of these regulations that should be taken into consideration which have not already been considered within this consultation?

Of the 40 respondents:

• 29 (73%) provided a response with suggestions to be considered
• 4 (10%) indicated no other broader impacts
• 7 (18%) respondents returned blank responses

From the 29 responses provided, the central themes of broader impacts for consideration that emerged were as follows:

• UK government could pass legislation affecting all businesses to prevent, address and remedy any harm to human rights, including labour rights, and the environment in their global supply chains
• additional support and resources are necessary for both NHS procurement and contract management staff and suppliers, including training, central databases, engagement with industry bodies, and assistance for smaller suppliers with due diligence requirements
• the potential impact on public sector resource, particularly in local government, should be a central consideration
• alignment is needed between these regulations, the Procurement Act 2023, relevant PPNs, and any future legislation in the devolved nations to ensure consistency of supply across the UK
• SMEs may struggle with the additional burden placed upon them by the proposed requirements, and provisions for addressing this should be considered
• the operational impact on non-NHS framework authorities should be taken into account
• there is a need for co-ordination with existing national approaches to modern slavery regulations, such as the NHS England Supplier Roadmap and Evergreen Supplier Assessment Process
• the cost of initial and repeated checks required by public bodies may be a concern for industry, particularly SMEs
• there is a risk that different contracting authorities will risk rate the same product and/or market at different levels
• the regulations should consider building in external accreditation bodies for assurance in high-risk categories
• consideration should be given to the impact on social value, as increased focus on modern slavery in NHS tenders may reduce the emphasis on other social value areas
• the impact assessment needs to consider the time and resources required for implementation and ongoing management of the regulations
• there is a need to address labour standards issues beyond modern slavery, such as working hours, discrimination, and health and safety, which this PPN will not focus on
• the regulations should consider the specific challenges faced by high-risk industries like home care workers
• consideration should be given to the costs of additional audits
• the impact assessment should consider the impact on suppliers due to increased administrative workload

Government response

A number of the suggestions made in feedback provided through the consultation will be considered for updates to the draft regulations, and updates to the draft guidance to include clarity where requested.

We will consider the development of supplementary support tools and training following implementation of the regulations as set out in our response to the question prior in this report relating to section 12ZC.  

We will look for opportunities to improve processes set out in the health family’s e-commerce system to support the implementation of the regulations and guidance.

Beyond the implementation of the regulations and guidance we intend to engage across government with the view to encourage a standard approach to tackling modern slavery and human trafficking across all government supply chains.

Feedback received in response to the NHS standard contract 2025 to 2026 consultation has suggested the activities of the independent health sector might be considered. While the scope of the powers in the Health and Care Act is limited, we encourage the independent sector to regard the draft regulations and guidance as best practice and replicate the requirements, where possible. This will be reflected in the final guidance.

Conclusion and next steps

We would like to thank all the respondents for their submissions to this consultation. Your input has been invaluable and has informed amendments to both the regulations and guidance.

With consideration of the wider engagement undertaken throughout consultation, and the responses to this consultation, we conclude that we have achieved broad support for the proposed regulations and intentions to tackle modern slavery in NHS supply chains.

We agree to continue to engage with our stakeholders on the development of this and further guidance before the final version is published. In addition, while our objective in this instance is to discharge the specific legal duty outlined in section 12ZC of the NHS Act 2006, we support wider reform. We will pass on all the recommendations made to:

• Home Office, which leads anti-slavery practices in government
• Cabinet Office, which owns the central public procurement policy
• the Independent Anti-Slavery Commissioner

We support efforts to strengthen the government’s wider response to modern slavery in government supply chains and to create a more harmonised approach.