Identifying modern slavery – The role of the healthcare professional

In September 2017, 11 people were jailed for up to 15 years for exploiting at least 18 victims of modern slavery, including one for 26 years. Men, women, and children are trafficked for exploitation in the UK every year and forced to work in prostitution, domestic roles, or manual labour. Victims are often targeted if they are homeless, alcoholics, have learning disabilities or mental health problems. Coercion can take many forms; from threats against family members, to sexual violence, imprisonment, and having passports taken away. The police have said that modern slavery and human trafficking is far more prevalent than had been previously thought and that there may be tens of thousands of victims.

Inadequate training

12% of health professionals report that they have been in contact with a potential victim of modern slavery within their practice and at the same time 86% of staff do not feel adequately trained to assess and help potential victims of modern slavery.

What can healthcare professionals do?

All healthcare professionals can play a key role in identifying, supporting and caring for victims. One fifth of victims admit to coming into contact with healthcare services during their time in slavery.

The Modern Slavery Act 2015 enables the justice system to ensure that perpetrators are punished and victims receive support. NHS professionals have a very important role to play, as those who present in healthcare settings may have little engagement with any other services. Staff who suspect that a patient may have been trafficked can contact a 24 hour confidential helpline for professional advice and support (0300 303 8151)

In order to help build a picture of modern slavery in the UK and improve the response from all public services, there is a provision in the Modern Slavery Act 2015 for public authorities to notify the Home Office when they encounter a potential victim of modern slavery. Healthcare workers are not bound by this duty but are encouraged to make a voluntary notification. If the victim is an adult who has not consented, any notification must be limited in how much information they divulge so that the victim cannot be identified personally and there is no breach of confidence. The Home office has published guidance on how to notify the Home Office.

The Royal College of Nurses has launched a pocket guide and the Institute of Health Visiting has published a guide to help spot victims of trafficking and to address the lack of modern slavery awareness training in the NHS.

RCN Guide

The RCN guide notes the following key points:-

Signs of trafficking

If the person:

• Is accompanied by someone who appears controlling, who insists on giving information and speaking for them;
• Is withdrawn and submissive, seems afraid to speak to anyone in authority;
• Provides vague and inconsistent explanations of where they live, employment or schooling;
• Has old or serious injuries left untreated;
• Provides vague information, is reluctant to explain how the injury occurred or reluctant to provide a medical history;
• Is not registered with a GP, nursery or school;
• Has experienced being moved locally, regionally, nationally or internationally;
• Appears to be moving location frequently;
• Appearance suggests general physical neglect;
• Struggles to speak English;
• Has no official means of identification or has suspicious looking documents.

Children and young people might show the following signs:-

• Has an unclear relationship with the accompanying adult;
• Goes missing quickly (sometimes within 48 hours of seeking care) and repeatedly from school, home and care;
• Gives inconsistent information about their age;
• Displays an unusual attachment to those around them.

Health issues may include:-

• Long-term multiple injuries;
• Mental, physical and sexual trauma;
• Sexually transmitted infections;
• Pregnant, or a late booking (over 24 weeks);
• Disordered eating or poor nutrition;
• Self-harm, including attempted suicide;
• Dental pain;
• Fatigue;
• Non-specific post-traumatic stress disorder;
• Psychiatric and psychological distress;
• Vague symptoms such as back or stomach pain, skin problems, headaches and dizzy spells.

The role of the healthcare professional:-

• If a person is a victim of modern slavery this is a safeguarding and safety issue. Safeguarding training should include information relating to modern slavery;
• If you have concerns take immediate action to ask further questions and get additional information and support;
• Try to find out more about the situation and if possible speak to the person alone and in private;
• Reassure them that it is safe for them to speak;
• Only ask non-judgmental relevant questions;
• Allow the person time to tell you their experiences and do not make promises you cannot keep;
• Do not let concerns you may have about challenging cultural beliefs stand in the way of making informed assessments about the safety of a child, young person or adult;
• Speak to your manager, colleagues or local safeguarding leads for advice;
• Do not raise your trafficking concerns with anyone accompanying the person

It is vital that healthcare professionals help combat modern slavery and support victims of these appalling crimes. If you need help with training, advice, or drafting a policy for your organisation please contact Claire Bentley, Associate.

Useful resources

• Royal College of Nurses. Modern Slavery Guide for Nurses and Midwives 2017
• Institute of Health Visiting – Working with minority groups: Spotting the signs of an individual in Domestic Slavery 2017
• Identification of Potential Victims of Modern Slavery by Health Professionals
• NHS England – Modern Slavery
• Duty to notify the Home Office of potential victims of modern slavery – October 2015
• Identifying and supporting victims of modern slavery. An interactive learning resource to support all health staff in identifying and supporting victims of modern slavery. NHS Health Education England
• Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking- BMJ Open Journal 2015
• Supporting the mental health of trafficked people – The Lancet 2015
• Home office – Modern slavery strategy 2014