Open consultation

Tackling modern slavery in NHS procurement (draft guidance)

Published 21 November 2024

Applies to England

Summary

The Department of Health and Social Care (DHSC) has pledged to put an end to modern slavery in the NHS. As set out in section 12ZC of the National Health Service Act 2006 (the NHS Act 2006) (as inserted by section 81 of the Health and Care Act 2022). DHSC is creating regulations to eradicate the use in the health service of goods and services which are tainted by slavery and human trafficking.

In December 2023, DHSC, supported by NHS England, delivered a review into the risk of modern slavery within NHS supply chains. The review showed a significant amount of commitment from our suppliers to tackling modern slavery in their supply chains and made a recommendation to lay the regulations.

The National Health Service (Procurement, Slavery and Human Trafficking) Regulations 2024 (the regulations) will set out a requirement that all those procuring goods and services for the purposes of the health service in England will be required to assess the risk of modern slavery in their supply chains, and respond by taking reasonable steps to mitigate that risk.

A key component of the changes introduced by the 2022 act - and strongly supported by stakeholders across government, the NHS and local government - is that the new regulations will address modern slavery risk within all points of the commercial lifecycle. The regulations will build in reasonable steps when developing procurements and contracts, during the contract award stage and throughout the contract term.

These regulations are new and signify an important step to ensuring NHS supply chains are free from modern slavery. The regulations will apply to all procurement activities undertaken by a public body (this term being used throughout this guidance as defined within the regulations), regardless of value. The regulations will apply to all procurements and contracts of goods and services for the purposes of the health service, including:

• those procurements covered under the Procurement Act 2023
• those procurements and contracts awarded in scope of the Health Care Services (Provider Selection Regime) Regulations 2023
• any other procurement activity not covered by either of those regimes

The NHS takes a risk-based approach with a focus on due diligence to address modern slavery in healthcare supply chains. Recognising there is no such thing as ‘no risk’ of modern slavery, all covered procurements will be assigned a risk level of low to high and require the pursuit of reasonable steps commensurate to the level of risk. This approach prioritises working collaboratively and constructively with suppliers to support potential victims and improve supplier practices.

The regime is established under section 12ZC of the NHS Act 2006 (as amended) and is set out in the regulations. Regulation 11 specifies that relevant bodies must have regard for this statutory guidance, which has been designed to support organisations to understand and interpret the regulations.

Introduction

Debates regarding amendments tabled for the Health and Care Bill (now act), brought specific attention to suspected forced labour abuses in the Uyghur region in China. Following the introduction of section 81 of the Health and Care Act 2022, and the findings of the NHS review estimating that 20% of the supply chain is at high risk of modern slavery, DHSC and NHS England are introducing the National Health Service (Procurement, Slavery and Human Trafficking) Regulations 2024. Under section 12ZC of the NHS Act 2006, these regulations introduce new statutory duties for public bodies to assess the risk of modern slavery when procuring goods and services to deliver health services and respond to those risks by taking reasonable steps.

Implementing these regulations strengthens the legal duty to manage modern slavery risk within NHS supply chains, as set out in Procurement policy note 02/23: tackling modern slavery in government supply chains (PPN 02/23).  

DHSC has co-developed these regulations with NHS England and draws on the findings and recommendations made within the recent review of risk of modern slavery and human trafficking in the NHS supply chain. The key recommendations relevant to the development of these regulations included:

• under the power in section 12ZC of the NHS Act 2006 (inserted by section 81 of the Health and Care Act 2022), make regulations that set out how to address the risk of modern slavery and human trafficking through the procurement process for the health service aligning to requirements under PPN 02/23
• establish guidance for NHS implementation of the new regulations, taking a risk-based approach to increased supply chain due diligence, monitoring of performance and managing supplier non-compliances
• update modern slavery provisions in the NHS terms and conditions for the procurement of goods and services to address supplier disclosure, monitoring, remediation and consider continuity of supply
• establish robust and consistent risk identification methodology to support a standard approach to product level risk management
• identify opportunities to support a centralised approach to modern slavery risk assessment and mitigation

Each of the recommendations above have driven the development of the regulations and this statutory guidance (the guidance), and have been addressed either through the specific duties within the regulations or within the expectations set out within this guidance. The regulations and this guidance have also been developed by working across government and with affected organisations to understand the progress with implementing modern slavery risk assessment methodologies in accordance with the PPN and determine the support these organisations will need to implement these regulations.

DHSC and NHS England recognise that the implementation of these regulations needs to work compatibly with other areas of legislation including:

• NHS Act 2006
• Equality Act 2010
• Modern Slavery Act 2015
• Public Contracts Regulations 2015 (PCR)
• Subsidy Control Act 2022
• Procurement Act 2023
• Health Care Services (Provider Selection Regime) Regulations 2023

This guidance does not specify how to comply with these other legal obligations. A reference to legislation or a legislative provision is a reference to it as amended, extended or re-enacted from time to time.

Under the new regulations, public bodies are expected to:

• take steps for assessing and addressing the risk of slavery and human trafficking taking place in relation to people involved in health service supply chains
• design procurement procedures and contracts which respond to the level of risk of modern slavery, as proportionate and relevant to the goods or services being procured for the purposes of the health service in England
• make provisions within contracts for goods or services entered into by public bodies for the purposes of the health service in England to ensure supplier compliance with the regulations and this guidance

The regime makes it possible to continue with existing procurements and contracts and will not apply retrospectively. Public bodies in scope of the regulations will still be required to comply with PPN 02/23. Any other public body not in scope of the PPN is recommended to familiarise themselves with the content and apply the risk assessment methodologies and remedial actions documented within the guidance published alongside the PPN. This will enable public bodies to implement these regulations more easily as they commence new procurement activity or enter contracts following enforcement of the regulations.

The regulations are published under section 12ZC of the NHS Act 2006, which requires NHS England to publish guidance about compliance with the requirements imposed by the regulations. This guidance sets out how the regulations should be followed by the public bodies to which they apply. It also details the scope of the regulations and how public bodies should apply them while assessing modern slavery risk and implementing reasonable steps.

Public bodies must apply the regulations and must have regard to this guidance. They are expected to read this guidance alongside its annexes, which give further detail on how to risk assess modern slavery and respond to incidences of modern slavery within their contracts and/or supply chain.

Public bodies should ensure good record keeping practices in relation to modern slavery risk mitigation activities, including documented justification of the decisions regarding the application of relevant and proportionate risk management activities. NHS England may review the implementation of the regulations, and application of this guidance in the future; contracting authorities should be able and ready to report on modern slavery activities where possible.

Scope

The scope is defined within section 12ZC of the NHS Act 2006, and regulations 3 and 11 of the regulations.

This statutory guidance outlines the risk-based approach and minimum due diligence requirements to be conducted for the procurement of goods and services for the health service (NHS procurements) to tackle modern slavery in NHS supply chains. These requirements and approach are aligned with those laid out in PPN 02/23.

Public bodies, as defined within the regulations, must have regard to this guidance in undertaking a risk assessment and in taking reasonable steps to address identified modern slavery risk, as required by the regulations. Public bodies should always consider the impact on the specific nature of the procurement to ensure the reasonable steps applied are proportionate, relevant and do not create unnecessary burdens in the delivery of the contract. Modern slavery risks can be found in contracts and suppliers of all sizes; however, specific attention should be given to the proportionality of the requirements when applying them to small and medium sized enterprises (SMEs) and voluntary, community and social enterprises (VCSEs).

The regulations and this guidance apply to any public body procuring goods or services for the purposes of the health service in England. Public bodies, as defined within the regulations, will include:

• all NHS organisations
• other health bodies including DHSC and its arm’s length bodies
• local authorities
• central purchasing organisations

Broadly, any organisation that is procuring any goods or services that may be used in any aspect of the NHS is in scope. This means, for example, where NHS organisations are listed as organisations able to use a framework established by another organisation, that framework is in scope of these regulations and the requirements outlined within this guidance. This applies even if the framework does not operate only, or principally, for the benefit of NHS customers or call-off authorities. 

For local authorities, this includes:

• when procuring goods and services for the health service as part of their public health functions
• in section 75 partnership arrangements with the NHS
• when working collaboratively with other public sector authorities procuring goods and services for the health service

This means that, for example, services arranged by local authorities focused on substance use, sexual and reproductive health and health visits are in scope. Further, a joint contract established by a local authority to provide community equipment, which may provide goods and services to the health service, is another example of an in-scope procurement.

Where there is any doubt as to whether a procurement is in scope of the regulations, organisations should seek advice to determine the application or treat the procurement as in-scope and comply with the regulations and follow this guidance.

While works are outside the scope of the regulations, this guidance should be followed as best practice for this category of procurement, given the presence of modern slavery risks identified within the construction sector.

For simplicity the term ‘modern slavery’ is used throughout this document in place of ‘slavery and human trafficking’. The term ‘modern slavery risk’ in relation to a good or service means a risk that slavery and human trafficking takes place in relation to any person involved in the supply chain for that good or service (as defined within the regulations).

Modern slavery risk assessments

Regulations 4(1) and 4(2)(a) define the requirements for assessing risk.

Public bodies will be obligated under the regulations to complete a risk assessment when establishing new contracts, frameworks or dynamic markets pertaining to goods and services, following introduction of the regulations. 

To support public bodies to conduct consistent risk assessments of the modern slavery risks in supply chains, a national tool (see annex 2) has been designed for NHS procurement teams to categorise the level of risk as low, medium or high within a procurement. The tool draws on data reflecting the 6 characteristics to help assess modern slavery risk in procurements identified in PPN 02/23, and will be built into the health system’s e-procurement system. For non-NHS bodies procuring for the purposes of the health system, any risk assessment adopted should be developed (or third party provision sourced) on the basis that the assessment reflects risk of the procurement category with regard to the 6 characteristics outlined in PPN 02/23.

When establishing a new contract, the risk assessment must be completed. Where a competitive tendering procedure is being followed, the risk assessment must be completed before the public body publishes a notice for the purpose of inviting suppliers to participate in such a procedure (except where such a contract is established as a call-off from a dynamic market or framework - see further on this below). The risk level assigned to the procurement will define the commercial activities required in the procurement process.

Following the output of the risk level for the procurement, the public body should apply reasonable steps for a procurement of the particular risk level as set out in this document. These steps must address, and where possible eliminate, the risk both when designing the procedure for award and when managing the contract. Public bodies can deviate from the minimum requirements in this guidance only when they have carried out sufficient market engagement to demonstrate and justify a change in approach, and that approach is documented by the procuring public body.

Note, throughout this document the phrase ‘follow the standard procurement process’ is defined as a compliant procurement process in line with the Procurement Act 2023, Public Contracts Regulations 2015 (for procurement over the relevant PCR threshold) and internal policies (for procurements below the relevant PCR threshold), or the NHS Provider Selection Regime (PSR). 

Modern slavery assessment tool

The modern slavery assessment tool (MSAT) is a risk identification and management tool, designed to help public sector organisations and suppliers to work in partnership to improve protections and reduce the risk of worker exploitation within the supply chain. Based on supplier responses, the assessment tool provides bespoke recommendations which provides a foundation for addressing areas of risk and its management. Within the context of the regulations, the collation of recommendations into an improvement plan constitutes one of several ‘reasonable steps’ for medium and high risk procurements within the tendering process and contract management. Providing a full MSAT response early in the procurement process allows organisations to better understand the true nature of modern slavery risk in potential supply chains.

A better understanding of modern slavery risk will enable an appropriately tailored approach to the management of that risk throughout the procurement and contract going forward. Supplier and supply chain information provided via the MSAT may also bolster evidence and justification in relation to the application of relevant mandatory and/or discretionary exclusion grounds by contracting authorities procuring goods and/or services for use in, but not limited to, the health service. For more information, see the following guidance from the Cabinet Office:

• PPN 02/23: tackling modern slavery in government supply chains
• PPN 03/23: standard selection questionnaire (SQ)

How suppliers engage with the MSAT and improvement plan may constitute a component of ongoing reassessment of the contract risk (see the ‘Reassessment of risk’ section). 

Frameworks

Regulations 4(3)(a) and 5 define the requirements to assess risk for frameworks.

Frameworks - owners

To reduce the burden on public bodies calling off from frameworks, the public body proposing to enter into a framework (framework owner) is responsible for completing a risk assessment prior to advertising the opportunity to participate in the framework. Once the level of risk is determined for the sector or framework, follow the reasonable steps outlined in the ‘Reasonable steps’ chapter of this guidance.

Due to the potential length of frameworks, it is recommended that reassessment of modern slavery risk be conducted every 2 years and should make use of the NHS risk assessment tool (or equivalent). The framework owner may want to align reassessment with any other periodic reviews of framework policies, such as renewal periods. See the ‘Reassessment of risk’ section for details of the requirements for reassessment of risk. The framework owner must ensure the date of the latest assessment, or reassessment, is visible to public bodies calling off the framework, alongside confirmation that the assessment has been conducted in line with this guidance.

Any reasonable steps selected by the framework owner should be communicated to all public bodies entitled to award contracts in accordance with the framework within the buying instructions (used to refer to framework documents, buying guides and equivalent documents) of the framework. The framework owner should set out the reasonable steps implemented at a framework level and any identified reasonable steps that will require implementation within any call-off contracts. The framework owner should ensure any reasonable steps which require implementation at a call-off level - those within buying instructions, award procedures and call-off contracts - are proportionate, relevant to the subject matter and level of risk, and do not place a burden on suppliers where individual public bodies may be required to manage the response to the identified risk level. Where a market or sector is reassessed and a risk changes, framework owners would be expected to respond to the change within the context of the procurement laws governing set up and management of these arrangements.

Where a framework establishes a catalogue approach for public bodies to procure goods and/or services, then the framework owner should ensure the reasonable steps implemented throughout the framework term are implemented in a proportionate way, noting the transactional nature of these arrangements.

If supplier meetings are selected as the reasonable step for managing a procurement, then these could be required only for suppliers transacting on a framework. The frequency of supplier meetings should be considered in terms of the context of the framework, value, complexity of the goods or services procured, and the risk level identified.

Frameworks - call-offs

When calling off from a framework, the public body calling off the framework is responsible for confirming a risk assessment has been conducted by the framework owner and is in a manner aligned with this guidance. In the event this risk assessment is not up to date, or the public body is aware of a triggering event for reassessment, the public body must inform the framework owner, who would then be required to undertake a reassessment of modern slavery risk for the framework and respond to that risk in accordance with regulation 10(4).

The public body calling off the framework should have regard for any buying instructions developed by the framework owner when selecting measures for inclusion within their call-off contract. Where it is considered relevant and proportionate, the buying instructions may include reasonable steps for managing risk within the call-off term.

The public body must inform the framework owner in the event a trigger for reassessment arises during the course of contract management (see the ‘Reassessment of risk’ section).

Frameworks - catalogue procurement

There is an expectation that public bodies calling off a framework are required to check that a risk assessment is up to date. Where a catalogue has been established, a public body procuring from the catalogue will need to establish internal procedures to ensure these checks can be completed.

For procurement via the NHS Supply Chain catalogue, the check should be completed at the point a contract is established, an access agreement is signed, or when a demand capture form is complete. For catalogues established for other goods or services, the public body should check a risk assessment is in place prior to the first time the catalogue is accessed, and it is recommended that checks occur within 2 years of any previous check if the catalogue is continually used.

The responsibility for implementing reasonable steps for risk mitigation during contract management should remain with the framework owner for catalogues specifically to ensure a consistent approach and reduce the burden on suppliers.

Dynamic markets

Regulations 4(3)(b) and 6 define the requirements to assess risk for dynamic markets.

Dynamic markets - owners

To reduce the burden on public bodies awarding contracts under a dynamic market, the dynamic market owner is responsible for completing the risk assessment prior to advertising the opportunity and before the first supplier is admitted to a dynamic market. Once the level of risk is determined for the sector or dynamic market, the reasonable steps should be followed as documented within the ‘Reasonable steps’ sections of this guidance.

If supplier meetings are selected as the reasonable step for mitigating modern slavery while the dynamic market is in operation, then this is only required for transacting suppliers. The frequency of supplier meetings should be considered in terms of the context of the dynamic market, value and complexity of the goods or services that are available under it.

Due to the potential duration of dynamic markets, it is recommended that reassessment of modern slavery risk be conducted every 2 years and should make use of the NHS risk assessment tool, or equivalent. The dynamic market owner may want to align reassessment with any other periodic reviews of dynamic market policies. The dynamic market owner must ensure the date of the latest assessment (or reassessment) is visible to public bodies calling off the dynamic market, alongside confirmation that the assessment has been conducted in line with this guidance. The requirements for reassessment of risk are detailed within this guidance in the section ‘Reassessment of risk’. Where a market or sector is reassessed and a risk changes, dynamic market owners would be expected to respond to the change within the context of the procurement laws governing set up and management of these arrangements, noting that the conditions of membership may not be changed once a dynamic market is established.

In some cases, dynamic markets may be set up with suppliers for a specific sector or industry, but the details of which goods and services will be procured under the dynamic market are still to be determined.

Dynamic markets - procurements

In the buying instructions for the dynamic market, the owner should set out the requirements for responding to modern slavery risk within any procurements. This may include the requirement to include certain award criteria or terms within the contract. These instructions should require public bodies conducting the competition to inform the dynamic market owner of the outcome of their procurement, and the details required to support its management of modern slavery risk. Sharing this information will support the dynamic market owner to comply with their duties under regulation 10 in relation to reassessment of risk. In the event that the award under a dynamic market triggers one of the reasons to reassess as documented at regulation 10(3), the owner would then be required to undertake a reassessment of modern slavery risk for their dynamic market and respond to that risk in accordance with regulation 10(4) (see the ‘Reassessment of risk’ section). Where a market or sector is reassessed and a risk changes, dynamic market owners would be expected to respond to the change within the context of the procurement laws governing set up and management of these arrangements, noting that the conditions of membership may not be changed once a dynamic market is established.

The public body awarding contracts under the dynamic market may be required to implement reasonable steps within their procurements, and the dynamic market owner should include any reasonable steps for responding to modern slavery risk within the buying instructions. Where it is considered relevant and proportionate, the buying instructions may include reasonable steps for managing risk within the contract term.

When awarding contracts under a dynamic market, the public body undertaking the procurement is responsible for confirming a risk assessment has been conducted by the dynamic market owner and conducted in a manner aligned with this guidance. In the event this risk assessment is not up to date, or the public body is aware of a triggering event for reassessment, the public body must inform the dynamic market owner, who would then be required to undertake a reassessment of modern slavery risk for the dynamic market and respond to that risk in accordance with regulation 10(4).

The public body must inform the dynamic market owner in the event a trigger for reassessment arises during the course of contract management (see the ‘Reassessment of risk’ section).

Reasonable steps 

Reasonable steps are defined in regulations 7 and 8(1).

The level of modern slavery risk identified for a specific procurement or contract should inform the reasonable steps a public body should take to mitigate the risk when designing the procedure for award, carrying out the procurement and when managing the contract, framework or dynamic market.

Throughout the procurement process, a range of tools can be used to support the mitigation of modern slavery risks, and appropriate tools will depend on the risk categorisation of the procurement. The tools detailed in this guidance support the implementation of reasonable steps as defined within the regulations. Pre-procurement activities provide the earliest opportunities to ensure that modern slavery risks are identified and mitigated throughout the term of a contract, framework or dynamic market.

The following steps should be considered when reviewing the result of the risk assessment, during preparation of the procurement documentation.

Reasonable steps - low risk

Where a low risk of modern slavery is identified in a risk assessment or reassessment, then the public body should follow the standard procurement process relevant to the value and complexity of the subject matter. Public bodies may wish to utilise specific tools to help mitigate the risk of modern slavery in low risk procurements if they deem it necessary, as low risk does not mean ‘no risk’. For all procurements, the standard incident response process set out in annex 1 must be followed where any suspected instances of modern slavery arise.

NHS organisations should ensure their low risk procurements and resulting contracts use the NHS standard terms and conditions, to ensure appropriate modern slavery clauses are included. See:

• NHS standard terms and conditions for the procurement of goods and/or non-clinical services
• the mandated terms of the NHS Standard Contract for use, specifically, by commissioners for all contracts for healthcare services (other than primary care, for which the terms of the GP Contract apply)

For other public bodies, specific schedules relating to modern slavery should be included within the terms and conditions to ensure sufficient cover is provided to public bodies responding to any changes to a risk of modern slavery during the term of a contract, framework or dynamic market - such as clauses which permit variations and/or modifications during the term to respond to a change in risk. For frameworks and dynamic markets, call-off contracts should also include terms which allow a public body to respond to any changes to modern slavery risk during their term.

Reasonable steps - medium and high risk

Procurement design

Table 1: reasonable steps for medium and high risk

Tools	Implementation	Medium risk	High risk
Pre-market engagement	Minimum expectation	Undertake pre-market engagement to understand how supply chains respond to modern slavery risk and incidences, to inform the tender design.	Same as medium risk
Pre-market engagement	How to apply in the process	Variable approaches to market engagement could be used - for example, events, surveys and forums. Include questions within any market engagement to determine how suppliers manage modern slavery risks in their supply chains. Using this intelligence can support the development of specific content within specifications, tender documents and contracts.	Same as medium risk
Tender documentation	Minimum expectation	Ensure modern slavery risks highlighted by the risk assessment and the respective due diligence required are included in tender documentation for supplier awareness.	Same as medium risk
Tender documentation	How to apply in the process	Outline the modern slavery risks and respective due diligence activities required in response to the risk, and ensure these are included within the tender documentation. Ensure the right to reassess risk during the term of a contract, framework or dynamic market is included within the relevant sections of any procurement documentation.	Same as medium risk
Specification	Minimum expectation	Not applicable	Include industry-specific (modern slavery) standards relating to the procurement within the specification.
Specification	How to apply in the process	Not applicable	Utilise pre-market engagement to test for the maturity of the markets’ use of standards relating to the specific procurement category. Include industry-specific standards in the specification in line with the pre-market engagement findings.
Contract conditions	How to apply in the process	Advise suppliers of the requirement to have completed an MSAT within 3 months of contract award as either a condition precedent to commence the contract, or within the contractual terms.	Advise suppliers of the selection criteria - that is, to have completed an MSAT within the last 12 months - or where an MSAT has not been completed, to include it as a condition to bid in the selection criteria.

Selection criteria

When issuing a tender to bidders, you should consider including the reasonable steps detailed in table 2, while also accounting for the requirements laid out in:

• PPN 03/24: standard selection questionnaire (SQ)
• the modern slavery assessment tool (MSAT)

Table 2: reasonable steps for the selection stage of a procurement

Tools	Implementation	Medium risk	High risk
SQ part 1 and 2 declarations	Minimum expectation	Follow the standard procurement process	To be requested from the supplier and its supply chain members required to deliver the contract. At a minimum, the supplier should request its known tier 1 suppliers involved in delivery of the contract that they complete a part 1 and 2 declaration. If a public body wishes to request a declaration from additional supply chain tiers, they should focus efforts on risks in the supply chain as highlighted by the risk assessment, instead of a blanket ask for ‘suppliers in all tiers’.
SQ part 1 and 2 declarations	How to apply in the process	Not applicable	Include in tender documentation the expectation that suppliers will be expected to request part 1 and 2 declarations from tier 1 supply chain members, and state clearly which additional supply chain members will be requested, if applicable.
SQ part 3	Minimum expectation	Ensure the supplier has a modern slavery and human trafficking statement. Section 54 of the Modern Slavery Act 2015 requires suppliers with an annual turnover of £36 million or more to publish a modern slavery statement.	Include a question to ensure the supplier has a modern slavery and human trafficking statement - suppliers out of scope of the Modern Slavery Act 2015 section 54 should provide an equivalent statement, regardless of turnover, as a condition for selection. Where public bodies suspect suppliers may need to draft this document, sufficient time should be provided within the tendering window to allow suppliers to respond.
SQ part 3	How to apply in the process?	Include questions in section 7.11 from SQ part 3. Ensure that the minimum requirements for the statement are tested as part of the scoring criteria (see note 1 below).	Same as medium risk
Modern slavery assessment tool (MSAT)	Minimum expectation	Successful supplier to complete the MSAT as a condition of award within 3 months.	Suppliers to complete MSAT as a requirement to bid.
Modern slavery assessment tool (MSAT)	How to apply in the process	Include in the conditions of award: ‘The successful supplier will complete a MSAT within 3 months of contract award if one has not been completed within the last 12 months, and notify the contract manager of its completion, providing a link to the results’.	Include this question in part 3 of the SQ: ‘Have you completed the MSAT within the last 12 months?’ (Answer options: Yes, No, Exceptional circumstances - give reason. Assessment: Yes, or an acceptable circumstance reason given is a pass. No is a fail.)

Note 1: at the point of publication for this guidance, the selection questionnaire content is currently defined within PPN 03/23: standard selection questionnaire, though all PPNs are subject to refinement and update. Public bodies should refer to the latest PPN for the specific qualification grounds in relation to this requirement.

Award criteria

The evaluation and award criteria for medium and high risk procurements should apply the modern slavery questions and metrics from the Social Value Model, in an effort to further bolster modern slavery risk mitigation activities which are already required pursuant to the regulations.

Guidance on the Social Value Model and the quick reference table can be found alongside PPN 06/20: taking account of social value in the award of central government contracts. Procurement professionals should specifically note Model Award Criteria (MAC) 6.3 (in the Social Value Model on the PPN 06/20 page): “demonstrate action to identify and manage the risks of modern slavery in the delivery of the contract, including in the supply chain”.

Procurement professionals should also have regard for NHS England’s Applying net zero and social value in the procurement of NHS goods and services guidance.

Where a public body is establishing a framework or dynamic market, the reasonable steps set out below should be applied at the most suitable point in the process where the risk identified can be mitigated most effectively. The reasonable steps should be implemented at a point between establishing the framework or dynamic market, or within the buying instructions relevant to that framework or dynamic market, for a public body calling off the agreement to implement where appropriate. Any elements identified within the call-off buying instructions should be proportionate and not create additional administrative or financial burden for either the public body or supplier.

Table 3: reasonable steps for evaluation and award criteria for medium and high-risk procurements

Tools	Implementation	Medium risk	High risk
Terms and conditions	Minimum expectation	Include the modern slavery clause 19 of the NHS standard terms and conditions for procurement (or equivalent) and clauses which permit contract variations to the modern slavery expectations through change control procedures.	Same as medium risk
Terms and conditions	How to apply in the process	Implement terms and conditions which ensure that modern slavery risks and incidences will be monitored, reported and responded to during the term of the contract, framework or dynamic market. Ensure terms include the provision for the public body to vary the modern slavery provisions in the event a risk changes during the term of the contract, framework or dynamic market.	Same as medium risk
Social Value Model	Minimum expectation	As part of the Social Value Model (PDF, 397KB), include MAC 6.3 to ensure weight is given to the supplier’s ability to tackle modern slavery (for NHS organisations, please note this is in addition to the minimum NHS requirement to include a fighting climate change question (or specification), as set out in the NHS social value and net zero guidance).	Same as medium risk
Social Value Model	How to apply in the process	Apply the following social value question and MAC within the social value weighting of the tender: - theme 4: equal opportunity - policy outcome - tackle workforce inequality - model evaluation question: include standard question - MAC 6.3: ‘demonstrate action to identify and manage the risks of modern slavery in the delivery of the contract, including in the supply chain’ Model response guidance for tenderers and evaluators: sub-criteria for MAC 6.3: ‘identifying and managing the risks of modern slavery’. Inclusion of the modern slavery criteria does not negate the inclusion of other social value elements within the procurement as relevant to the subject matter.	Same as medium risk
Key performance indicators (KPIs)	Minimum expectation	KPIs should be included to cover: 1. Participating in the MSAT to monitor supply chains, completing this on an annual basis throughout the life of the contract to measure progress. 2. Agreement to share MSAT recommendations, which can be used to collaboratively develop a contract-specific improvement plan, which will be committed to be delivered within agreed timescales through the contract term. 3. Reporting any suspected modern slavery violations to an executive director (of the supplier) immediately upon detection and investigating the reports within 48 hours. 4. Handling confirmed modern slavery cases successfully within an agreed timeframe and aiding victims immediately upon detection.	At a minimum, KPIs should be included to cover all those KPIs of a medium risk procurement, plus: 1. Requiring commercial staff to complete training on modern slavery due diligence for risk in the supply chain. 2. Completion of supply chain mapping, and when a substantial change in the supply chain occurs (that being a change to any of the characteristics in PPN 02/23) that is proportionate and relevant to the subject matter.
KPIs	How to apply in the process	Include the following, or similar, KPI measures to monitor the respective KPI: 1. MSAT completed within the last 12 months. 2. Percentage of actions within the improvement plan delivered as per agreed timeframes. 3. Number of repeat non-compliances on forced labour from individual business partners in past year. 4. Percentage of corrective actions related to forced labour successfully closed or remedied in agreed timeframe.	KPIs should be monitored to cover all those KPIs of a medium risk, plus: 1. Percentage of commercial staff who have completed annual training on modern slavery. 2. Percentage of relevant supply chain members (to the agreed tier) for which supply chain mapping has been conducted within the last 3 years.

Contract management

Regulations 7 and 9(a), 9(b) and 9(d) define managing modern slavery risks during the term of the contract.

Effective contract management can help manage modern slavery risks and issues. The following tools should be considered when designing contract management requirements in delivery of the procured goods or service.

Framework and dynamic market owners selecting the reasonable steps below should implement those reasonable steps within either the framework or dynamic market terms, or within the contracts. The place for these reasonable steps should make sense for the subject matter and market and should be implemented as not to create unnecessary burden on suppliers during the term of the framework or dynamic market, or any contracts placed during their terms.

The MSAT service and guidance should be noted when reviewing this implementation guidance when including the requirements below within any contract terms and conditions.

Table 4: contract management reasonable steps to manage modern slavery risks and issues

Tools	Implementation	Medium risk	High risk
MSAT	Minimum expectation	Include all contract-relevant MSAT recommendations within a modern slavery improvement plan.	Same as medium risk
MSAT	How to apply in the process	Create a modern slavery improvement plan based on relevant recommendations from the MSAT and agree this with the supplier. Build a standard agenda point into supplier meetings to review the modern slavery improvement plan, including closing off relevant improvement actions.	Same as medium risk
Supply chain mapping	Minimum expectation	Not applicable	The NHS considers a basic supply chain map to be an MSAT, or equivalent, conducted at tier 1 of the supplier’s supply chain for those suppliers relevant to the delivery of the contract. Additional actions can be conducted to improve the quality of the supply chain map or depth by requesting MSATs further into the supply chain. Supply chain mapping should be completed at minimum to the supplier’s tier 1 level, and requested to at least tier 3 level. The supply chain map should be kept up to date by requesting a new mapping every 3 years, and when a substantial change in the supply chain occurs (that being a change to any of the characteristics in PPN 02/23).
Supply chain mapping	How to apply in the process	Not applicable	Include within the conditions of award the following supply chain mapping requirement: “‘Supply chain mapping’, as defined by the ‘Tackling modern slavery in NHS procurement’ guidance, shall be completed within 12 months of the contract award and updated every 3 years, and when a substantial change in the supply chain occurs (for example, introduction of new subcontractors or manufacturers), after its initial completion.”
Incident response process	Minimum expectation	Follow the incident response process in annex 1, for any suspected cases of modern slavery.	Same as medium risk
Incident response process	How to apply in the process	When a case of modern slavery is identified, begin the incident response process within 24 hours.	Same as medium risk
Supplier meetings	Minimum expectation	Follow the standard procurement process. If no regular supplier meeting exists, ensure at least one meeting is conducted annually to review the modern slavery improvement plan, if applicable, based on the MSAT completed by the supplier.	Ensure a regular supplier meeting is conducted every 6 months, including standing agenda topics which at a minimum cover:  - review of KPIs - review of the modern slavery improvement plan, based on the MSAT completed by the supplier - review of whether updates to the supply chain map are required, following a substantial change to the supply chain
Reassessment of risk	Minimum expectation	See the ‘Reassessment of risk’ section below	See the ‘Reassessment of risk’ section below

The contract and supplier relationship management approach should encourage suppliers to be proactive and transparent when reporting risks or incidents of modern slavery. It is important that contracting organisations use these tools to best effect when responding to incidents of modern slavery to avoid causing further harm to those involved. Other than in extreme cases, terminating a contract for reasons linked to modern slavery should only be considered where the issues continue to occur, and the supplier demonstrates a lack of willing to co-operate and change. Legal advice must be sought in these instances. Further guidance is provided in PPN 02/23.

Reassessment of risk

Requirements for reassessment of risk are defined in regulations 9(c) and 10.

Modern slavery risks can change over the lifetime of a contract. Public bodies must have in place mechanisms to ensure a change in risk can be identified and managed during the term of a contract, framework or dynamic market.

Reassessment of risk - frameworks and dynamic markets

The regulations set out detailed requirements regarding the regular reassessment for frameworks and dynamic markets, as arrangements typically span multiple years.

Due to the potential length of frameworks and duration of dynamic markets, it is expected that risk reassessment should occur as standard in line with any other periodic reviews of framework and contract policies, such as renewal periods. It is recommended that this take place no less frequently than every 2 years and should make use of the NHS risk assessment tool, or equivalent.

Framework and dynamic market owners are required to reassess risk in a way that is relevant to the subject matter and proportionate to the risk within the specific market. Where a market or sector is reassessed and a risk changes, dynamic market owners would be expected to respond to the change within the context of the procurement laws governing set up and management of these agreements, noting that the conditions of participation may not be changed once a dynamic market is established.

In addition to the above, regulation 10(3) sets out a statutory requirement to reassess where at least one of the following is true:

• there is reason to suspect that the most recent risk assessment is no longer valid
• there has been a significant change in the contract, framework agreement or dynamic market to which the risk assessment relates
• any steps taken in relation to the management of the framework agreement or dynamic market show it to be necessary

The first of these conditions is considered met when at least one of the following occurs: 

• poor practice is indicated in the relevant sector or its supply chain by one or more media or advisory body
• sector risk assessments are conducted for other procurement activities and a change in the risk factors is identified
• suppliers report a risk in their operations or supply chain

A reassessment must be undertaken as soon as practicable upon any of the regulation 10(3) criteria being identified. This may result in a reassessment being carried out earlier than a planned reassessment in accordance with regulation 10 and this guidance.

Reasonable steps following promotion to a higher risk level following reassessment should take the form of a transition plan and new contract management schedules in line with the new risk level for suppliers transacting on the framework or within the dynamic market. This transition plan may include steps such as:

• instruct affected suppliers to conduct an MSAT within 3 months of being informed of a risk change. If the affected supplier has completed an MSAT within the last 3 months, resubmission should only be instructed where it can be demonstrated that the risk change reflects a recent material change in the supply chain as opposed to improved evidence of risk
• follow KPI development guidance for the new relevant risk level, as defined in the ‘Award criteria’ section under ‘Reasonable steps - medium and high risk’
• conduct an initial supplier meeting no later than 6 months following the supplier being informed of the risk change. From then on, the contract management approach could be followed, as defined in the section ‘Contract management’ (under ‘Reasonable steps - medium and high risk’), for the new relevant risk level

Table 5: a summary of proposed actions following risk change due to reassessment during the contract term

Implementation	Low risk to medium risk	Medium risk to high risk
MSAT	Conduct MSAT within 3 months of being informed of risk change.	Update MSAT within 3 months of being informed of risk change.
Supplier meetings	Supplier meetings within 6 months of being informed of risk change, and meeting frequency dictated by new risk level (see ‘Contract management’ section).	Migrate to high risk meeting frequency, as per the ‘Contract management’ section.
KPIs	KPI requirements according to new risk level, as per the ‘Contract management’ section. Framework or dynamic market owners should direct the use of these KPIs in call-off contracts.	Same as low risk to medium risk
Supply chain mapping	Introduce requirements for supply chain mapping following promotion to high risk, as per the ‘Contract management’ section. Not applicable when promoting to medium risk.	Same as low risk to medium risk

It is recommended that reassessment also takes place as a reasonable step of contract management based on ongoing KPI monitoring. For instance, where the improvement plan indicates substantial action (qualitative or quantitative) be taken to remedy risk, a significant incident is reported, or a supplier is demonstrating poor implementation of the improvement plan, medium risk agreements may be promoted to high risk. This transition could be reflected in the required frequency of supplier meetings, as well as supply chain mapping requirements as per the ‘Contract management’ section.

If sector risk has been ‘downgraded’ following the statutory duty for periodic reassessment, the assessor should use this information in conjunction with the supplier’s ongoing engagement with risk mitigation processes to establish whether protocols of contract management can shift in accordance with a lower risk schedule.

Frequency of supplier meetings may also be reduced where a supplier has demonstrated strong commitment to addressing their MSAT improvement plan and where there is confidence that their current vigilance to risk would precipitate timely communication with the public body in the event of any relevant change in circumstance that might warrant review.

As part of the exit procedures for the framework or dynamic market, the framework or dynamic market owner should progress with the following steps.

For frameworks or dynamic markets which will be renewed, refreshed or reprocured:

• consider whether the management of risk can continue under future iterations of a framework or dynamic market
• communicate the process for managing the reassessment of risk within the sector or market to the public bodies with existing contracts so they are aware they can rely on the risk assessment conducted

For frameworks or dynamic markets which are concluding:

• conduct a final risk assessment at point of closure
• share the outcome of the risk assessment with each public body still in contract
• where reasonable steps for reassessment have been included within the call-off terms and conditions:
  • ensure public bodies are aware ongoing risk mitigation responsibilities lies solely with their contract management activities
  • establish handover protocols for risk mitigation and reasonable steps to affected public bodies

Reassessment of risk - contracts

While there is no statutory requirement to periodically reassess contracts, regulation 9(c) includes reassessment as a reasonable step to be considered for contract management. Triggers for reassessment may be aligned with those for dynamic markets and frameworks, as detailed in regulation 10(3). It is also recommended that periodic reassessment take place as best practice for contracts with a term length of over 2 years. Risk changes should be addressed as per the ‘Reassessment of risk - frameworks and dynamic markets’ section above.

Direct award

Requirement for undertaking a modern slavery risk assessment for contracts not competed is defined at regulation 4(2)(b).

Where a contract has been directly awarded to a supplier, the risk assessment should be carried out as outlined in the ‘Modern slavery risk assessments’ section. However, a flexible and collaborative approach should be taken to implementing the risk mitigations set out for the procurement stages from documentation design through to evaluation and award.

While the statutory duty within these regulations for direct award requires risk assessment completion by the point of contract award, it is expected that reasonable steps to manage contract risk includes building appropriate contract terms and conditions prior to agreeing to appoint a supplier under non-competitive procedures. 

Where the direct award supplier does not meet one or more minimum standards (up to contract award) for the assigned procurement risk level, it is recommended that the supplier relationship manager or commercial lead initially instigate a higher frequency of supplier meetings during contract management. Unmet requirements should be prioritised for action over the course of the agreement, such as completion of the MSAT. Where these have been remedied, meetings may default to the recommended frequency for the assessed risk level. 

It should be noted that direct award procedures refer to those as defined within the Procurement Act 2023 schedule 5, direct award procedures included within the Provider Selection Regime and direct award procedures conducted in accordance with an organisation’s own procurement policy (or equivalent financial rules).

For direct award procedures under a framework, it is expected that any rules for direct award are included within the buying instructions issued by framework owner, and reasonable steps implemented at the point of establishing the framework, rather than at the point of awarding a call-off contract or placing an order through a catalogue.

Training and resources

Modern slavery and exploitation helpline

All NHS staff and the staff of supplier should be aware of the modern slavery and exploitation helpline. Concerns can be reported online or by telephone on 08000 121 700.

National referral mechanism guidance

The national referral mechanism (NRM) is a framework for identifying and referring potential victims of modern slavery and ensuring they receive the appropriate support. The online referral system is to be used by first responder organisations for referrals into the NRM and for duty to notify referrals (DtN).

Training

Public bodies are responsible for ensuring commercial staff involved in letting and managing contracts, including where those staff come into contact with the victims of modern slavery, are given appropriate training.    

Public bodies can utilise a range of training for their staff. NHS staff complete the e-learning titled ‘Tackling modern slavery in supply chains’ on the Government Commercial College. The course will help learners: 

• recognise how modern slavery can manifest in supply chains
• spot modern slavery risks in procurement and critically interrogate the assurances suppliers provide
• drive improvements in modern slavery due diligence to create better outcomes for workers

Resources

Public bodies applying the policy can refer to PPN 02/23: tackling modern slavery in government supply chains for further context and examples of additional measures.

Suppliers can also refer to PPN 02/23 for further context.

For any other questions, NHS England’s Sustainable Procurement team can provide additional support to help both in-scope organisations and suppliers to understand and meet the requirements. Contact england.ccf-sustainability@nhs.net.

Annex 1 - incident response

Responding to modern slavery risk is defined at regulations 8(2)(b) and 8(2)(f).

To ensure the NHS handles all instances of modern slavery and human rights abuses which have been uncovered in the supply chain immediately and in a consistent approach, a standard incident response process is outlined in this document to support public bodies.

Where a potential modern slavery incident has been identified you must: 

• inform the host public body - that is, framework, dynamic market or contract owner
• jointly determine a dedicated lead organisation
• ensure a report to the modern slavery helpline has been made within 48 hours, nominating the supplier in the instance they have reported the incident voluntarily and, if not, the lead organisation
• for bodies designated as first responder organisations, report using the national referral mechanism, with regard to the appropriate guidance
• collaborate with the affected supplier to define corrective actions and timescales in which remediations are expected to be addressed
• ensure that remedial actions taken do not conflict with any legal investigations prompted by referral to the modern slavery helpline or via the NRM
• consider the appropriateness of a third party audit, aligning to audit standards such as Sedex Members Ethical Trade Audit (SMETA). Outputs from this report may feed into actions for a remedial action plan. (A third party audit may be deemed necessary based on the nature and/or scale of the incident, such as being reflective of systemic issues or where suppliers demonstrate resistance to sharing pertinent information for the purposes of remediation)
• where remediations have not been successfully delivered, clauses for contract conclusion may need to be followed in accordance with any identified breach, and a referral to the Procurement Review Unit (PRU) made to progress for potential debarment
• any consideration of contract termination should have regard to the 6 characteristics outlined in PPN 02/23 to establish the likelihood of termination negatively affecting victims. If this is a risk, ongoing work must be undertaken involving relevant non-governmental organisations and local authorities in order to drive victim remediation
• keep a record of the incident locally

Annex 2 - methodology for calculating modern slavery risk

The NHS risk assessment tool will be developed in alignment with the risk drivers approach set out in PPN 02/23.