IMPORTANT INFORMATION

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Human Trafficking & Modern Slavery

  • The UK Government signed the Council of Europe Convention on Action against Trafficking in Human Beings on 23 March 2007.
  • The Convention was ratified by the UK on 17 December 2008, and came into force on 1 April 2009. This led to the creation of the UK’s national referral mechanism (NRM) in 2009. 
  • The Convention requires that potential victims of trafficking are provided with a period of a minimum of 30 days recovery and reflection, during which they will receive support, including accommodation, subsistence and access to relevant medical and legal services, and potential eligibility for discretionary leave if they are recognised as a victim. The UK provides this support to potential victims referred to the NRM for a longer period of 45 days. 
  • The NRM is a victim identification and support process. It is designed to make it easier for all the different agencies that could be involved in a trafficking case (for example, the police, Home Office - including Border Force, UK Visas and Immigration and Immigration Enforcement - the National Crime Agency, local authorities, and non-governmental organisations) to co-operate, share information about potential victims and facilitate their access to advice, accommodation and support.

Identifying victims of Human Trafficking & Modern Slavery 

See the Department of Health leaflet: ‘Identifying and supporting victims of human trafficking’ at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/480631/slavery_guidance.pdf 

  • All staff in every health care setting could spot 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 

What is modern slavery? 

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

Who is trafficked? 

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. 

Why are people trafficked? 

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 harvesting 

How might you encounter a victim of modern slavery? 

  • 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 

Signs of trafficking for adults, children and young people include: 

  • A person being accompanied by someone who appears controlling, who insists on giving information and coming to see the healthworker 

The person: 

  • Is withdrawn and submissive, seems afraid to speak to a person in authority and the accompanying person speaks for them
  • Gives a vague and inconsistent explanation of where they live, their employment or schooling
  • Has old or serious injuries left untreated. Has delayed presentation and is vague and 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
  • Their appearance suggests general physical neglect
  • They may struggle to speak English 

In addition: 

Children and young people:

  • 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

Adults:

  • Have no official means of identification or suspicious looking documents

What are the possible health care issues of trafficked people?

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

How might 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 seek out 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 do you do next?

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, but 
  • 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 
  • 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 lead GP for safeguarding or Local CCG Safeguarding Leads for support and advice

If you suspect that your patient may be a victim of modern slavery take the following action:

Children and young people under 18 years

For concerns about a child or young adult follow all child protection guidelines and refer to Sheffield Children and Families Services: Prevention and Assessment Teams

West team: 0114 2734491

East team: 0114 2037463

North team: 0114 2039591

Please note that health professionals have a legal obligation to safeguard children that present to them.

Out of hours, contact Children’s Social Care (0114 2734855 between 5:15pm and 8:45am) or police service, specifically highlighting your concern for child trafficking

Consider referral to the hospital paediatric team for admission for any acute health issues.  This could be undertaken in conjunction with socal care

Adults

If the adult consents, contact the Salvation Army (24 hour referral line - 0300 303 8151) as they are a ‘First Responder’ and it is these First Responders that can refer the victim to the NRM (the adult MUST have given their consent for this referral to be made).  They will complete the ‘NRM Referral Form’ and arrange safe accommodation.

Consider using maternity services to admit pregnant women for observation

Within the Government guidance the terms ‘frontline staff ‘ & ‘First Responders’ are used (often interchangeably).  GP’s and their practice staff are not frontline staff in respect of being First Responders i.e. staff that can refer a person directly to the NRM.

For further information see the above mentioned Department of Health leaflet or the web page: https://www.gov.uk/government/publications/human-trafficking-victims-referral-and-assessment-forms  (Sheffield/South Yorkshire is NOT a pilot area)

Following referral to the NRM there then takes places a process of the case being considered by either the UK Visas and Immigration (UKVI) or the UK Human Trafficking Centre (UKHTC).  Here case managers have 5 days to make ‘reasonable grounds’ decision (stage 1) and then at the end of a 45 day investigation period ‘stage 2’ takes place and a conclusive grounds decision is made regarding victim.

At the end of the initial 5 day period if the result is positive, the Salvation Army collect the adult victim and transport them to a safe house, although in practice the Salvation Army can provide accommodation during this initial 5 day investigation period if the victim is deemed to be destitute.  This is the benefit of using the Salvation Army as the ‘First Responder’ over other First Responders who can’t always provide emergency accommodation. 

Training

Free evidence based training, designed for healthcare professionals, is provided by a voluntary organisation in bespoke 30 minute or one hour sessions at your practice.  Please email tbonvoisin1@sheffield.ac.uk or call 07856590717 to find out more or book a session.

NHS Sheffield Clinical Commissioning Group

Headquarters
722 Prince of Wales Road
Sheffield
S9 4EU

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