Guidance

Identifying and supporting victims of modern slavery: guidance for health staff

Updated 27 November 2015

All staff in every health care setting could identify a victim of modern slavery.

All staff have a duty of care to take appropriate action and legal obligation in the case of children under 18.

All immediately necessary treatment should be provided.

If you suspect that a person is a victim of modern slavery

In all cases, trust and act on your professional instinct that something is not quite right. It is usually a combination of triggers, an inconsistent story and a pattern of symptoms that may cause you to suspect trafficking.

If you have any concerns about a child, young person or adult take immediate action to ask further questions and get additional information and support.

Remember:

• trafficked people may not self-identify as victims of modern slavery
• trafficking victims can be prevented from revealing their experience to health care staff from fear, shame, language barriers and a lack of opportunity to do so. It can take time for a person to feel safe enough to open up
• err on the side of caution regarding age: if a person tells you they are under 18 or if a person says they are an adult, but you suspect they are not, then take action as though they were under 18 years old
• support for victims of human trafficking is available

What you should do next

Try to find out more about the situation and speak to the person in private without anyone who accompanied them.

When speaking to the person reassure them that it is safe for them to speak.

Do not make promises you cannot keep.

Only ask non-judgemental relevant questions.

Allow the person time to tell you their experiences.

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 support and advice.

In all cases for children, young people and adults:

• do not raise your trafficking concerns with anyone accompanying the person
• ensure you address the health needs of the person by continuing to provide care
• ensure the person knows that the health facility is a safe place
• react in a sensitive way that ensures the safety of the person
• think about support and referral

Use an interpreter if translation is necessary

Only use an independent, qualified and police checked interpreter or language line. Do not use anyone accompanying the person as an interpreter. This applies to children, young people and adults.

Children and young people under 18 years

For concerns about a child or young adult follow all child protection guidelines and speak to your designated child protection lead. Please note that health professionals have a legal obligation to safeguard children that present to them.

Out of hours, contact your Local Children’s Social Services or police service, specifically highlighting your concern for child trafficking.

Consider referral to your hospital paediatric team for admission.

Adults

Contact the Salvation Army 24 hour confidential helpline for professional advice and support and referrals on 0300 303 8151 operating 7 days a week.

Only make referrals if the person is able to give consent and has agreed to the referral.

Consider using maternity services to admit pregnant women for observation

Signs of trafficking

The are many signs that could inform you a person is a victim of trafficking. If the person:

• is accompanied by someone who appears controlling, who insists on giving information and coming to see the healthworker
• is withdrawn and submissive, seems afraid to speak to a person in authority and the accompanying person speaks for them
• gives vague and inconsistent explanation of where they live, their employment or schooling
• has old or serious injuries left untreated
• either gives vague information or is reluctant to explain how the injury occurred or to give 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
• have no official means of identification or suspicious looking documents

In addition, children and young people might show the following signs:

• have an unclear relationship with the accompanying adult
• go missing quickly (sometimes within 48 hours of going into care) and repeatedly from school, home and care
• give inconsistent information about their age

Possible health care issues

Victims of modern slavery may only come to your attention when seriously ill or injured or with an injury or illness that has been left untreated for a while. Health care issues may include:

• evidence of long term multiple injuries
• indications of mental, physical and sexual trauma
• sexually transmitted infections
• pregnant, or a late booking over 24 weeks for maternity care
• disordered eating or poor nutrition
• evidence of self-harm
• dental pain
• fatigue
• non-specific symptoms of post-traumatic stress disorder
• symptoms of psychiatric and psychological distress
• back pain, stomach pain, skin problems; headaches and dizzy spells

What modern slavery is

Modern slavery is the illegal trade of human beings for the purpose of commercial sexual exploitation or reproductive slavery, forced labour, or a modern-day form of slavery.

British and foreign nationals can be trafficked into, around and out of the UK. Children, women and men can all be victims of modern slavery.

Children, women and men are trafficked for a wide range of reasons including:

• sexual exploitation
• domestic servitude
• forced labour including in the agricultural, construction, food processing, hospitality industries and in factories
• criminal activity including cannabis cultivation, street crime, forced begging and benefit fraud
• organ haversting

There are several ways you might encounter a victim of modern slavery, these include:

• A person may tell you about their experience
• you detect signs that suggest a person may have been trafficked
• a trafficked person may be referred to you

For further resources and eLearning module on identifying and supporting victims of modern slavery

This guidance has been produced by the Department of Health in collabration with a steering group comprising representatives from: British Association of Sexual Health and HIV, Child Trafficking Advice Centre NSPCC, College of Emergency Medicine, Department of Health, Home Office; UK Human Trafficking Centre Serious Organised Crime Agency, Ministry of Justice, Royal College of General Practitioners, Royal College of Midwives, Royal College of Nursing, Royal College of Paediatric and Child Health, Royal College of Psychiatrists, Salvation Army; Poppy Project, Section for Women’s Health Institute of Psychiatry Kings College London.