Four stories from the NHS frontlines

A young girl presents at a sexual health clinic

A girl of 16 attended a sexual health clinic with another woman who she called “Auntie.” The girl had extremely poor English, was very fearful and not allowed to speak. The “Auntie” spoke on her behalf. The Auntie said the girl had recently moved to the UK and they were living together at a local address.

The staff at the sexual health clinic were extremely concerned about the girl. They managed to see the girl on her own and she opened up a bit more – her spoken English was better than they had been led to believe.

The nurses spoke to the NHS Safeguarding team and together they made a referral to the Police and Social Care colleagues. The address was known to the Police - there had been past concerns about sexual exploitation at the House of Multiple Occupancy. The different statutory organisations worked together to devise a plan so they could see the girl again and explain how they could help and support her escape the situation she was in. They made a pseudo appointment at the sexual health clinic and arranged for a translator to be present. Unfortunately, the girl did not return.

A young man comes into the Emergency Department

A young man arrived at A&E with an unpleasant compound fracture which he had received while working on a building site. He was brought in by a “work colleague.” He seemed incredibly fearful. After receiving pain relief, he became very chatty and shared that he was frightened about where he was living and working. Staff accessed the internal safeguarding team and the Hospital intranet to discuss and get some information. They contacted the Modern Slavery and Exploitation Helpline and found a translator so they could communicate more easily. They provided the patient with information and the offer of support including the opportunity to have a referral to the Police Modern Slavery team. Unfortunately as the pain relief wore off, he clammed up and stopped communicating freely. He refused to share any more information and didn’t return for his outpatients appointment.

A young girl in labour

A young girl of 15 turned up in hospital while in labour. She was accompanied by an “Auntie.” They spoke no English but through Google Translate the staff found out that she was Romanian and had travelled to the country with her “Uncle.” The Auntie herself had also just given birth to a baby in the last two weeks.

The staff managed to “keep” the girl in hospital for five days and during this time they were able to find out more about her accommodation. Her supposed “Mum” and “Dad” arrived from London to take her “home.” The team talked to Children Social Care Services and the Police who had different views about the risk levels. The child and baby were discharged into the care of the “parents” but the hospital team were able to share her information with the Police and midwifery services in London. They hoped she would seek support and that there would be further opportunities to connect with her in London. The young Mum was aware there are people in the health service who can help in the future is she needs this.

A man living on a farm

A man required a leg amputation due to untreated diabetes. He lived in a caravan on a farm with no water and electricity. He wasn’t paid for his work but was provided with food in the farmhouse and access to showers. The NHS staff were concerned about his situation and sought advice from the safeguarding team. After further investigation, it turned out that the man was working for his ex-girlfriend whose business was struggling and that he was willingly working for free. The medical team had rightly seen the red flags and the couple did need help and support but he wasn’t a victim of modern slavery.

What can we learn from these stories?

These stories demonstrate some of the complexities surrounding supporting potential victims of modern slavery. There is lots to learn:

• Healthcare settings provide a window of opportunity to take action – in each story, the staff recognised warning signs and used the time in the healthcare setting or hospital to investigate further. A stay in hospital or a health appointment can give staff time to speak to other statutory agencies and build a better picture of what is going on as well as come up with an action plan.
• Healthcare settings can provide a safe space or moment where people are able to escape their situation for a short while and potentially open up and ask for help. A healthcare setting can allow people some ‘confidential/ private time’ when they can be asked if they feel safe. Healthcare staff are encouraged to see people alone and trained to ask this question of all patients. It is also possible to access translation services so that potential victims can tell their story.
• Healthcare teams are used to working with other agencies such as the Police, Social Care and Local Authority and multi-agency working is critical when working out how to safeguard patients and build a fuller picture of what is going on.
• Warning signs can be fairly obvious within a healthcare setting – injuries, overbearing “relatives” and fearfulness can all be tell-tale signs of modern slavery. NHS Staff are taught to ‘spot the signs’
• It is extremely challenging and complex to get victims of modern slavery the help they deserve – often victims won’t seek support, respond to the offer of support or return for follow up appointments. They may disappear into the shadows. However, if they turn up in another healthcare setting in the future, their notes will alert other healthcare professionals to the potential situation. NHS Staff are also encouraged to question why someone does not turn up for appointments and to work in a trauma-informed way.
• You may have one piece of the puzzle but by working with other statutory agencies, a better picture may emerge that means action can be taken.
• It is OK to be wrong - the final story about the amputee shows that it is better to raise concerns and then be proven wrong than to remain quiet. In this situation, the team were still able to provide safeguarding support and address some of the issues that were not right but it didn’t meet the threshold for modern slavery.

All NHS employees receive safeguarding training to ensure they are aware of and able to respond to incidents of Modern Slavery within care settings. This training varies according to the day-to-day work that staff undertake.

More specialist training can be provided by organisations such as VITA Training. Vita has recently launched new training for NHS Safeguarding Leads (see poster below)

If you know someone who works in the NHS, why not forward them this article? It is essential that we keep the issue of modern slavery and exploitation front of mind.

If you need advice or support on a modern slavery issue or are worried about someone you know, then you can call the Modern Slavery Helpline on 08000 121 700. It operates 24 hour a day, 365 days a year. You can also seek guidance or ask questions through their website.