Exclusive: Nurses at forefront of fight against modern slavery

Hundreds of victims of modern slavery have come into contact with health services since 2015 and experts say this is only the tip of the iceberg, but commitment to tackle it varies greatly among NHS organisations

Hundreds of victims of modern slavery have come into contact with health services since 2015 and experts say this is only the tip of the iceberg, but commitment to tackle it varies greatly among NHS organisations

  • Modern slavery includes compulsory labour, sexual exploitation and forced criminality
  • One nurse treating a victim of forced sex helped police jail the gang responsible
  • Pocket guides are being issued to nurses and midwives but more awareness is needed

Picture: iStock

Hundreds of modern slavery victims have come into contact with NHS health services in UK cities since 2015, a Nursing Standard investigation reveals.

A total of 464 suspected or confirmed modern slavery victims were identified at 29 trusts and health boards over the past two years.

But experts say the figures are only the tip of the iceberg, as many NHS organisations do not yet have systems in place to record potential victims.

‘Those working in healthcare are our eyes and ears’

Anti-slavery commissioner Kevin Hyland

Compulsory labour, sexual exploitation, human trafficking and forced criminality are all examples of modern slavery.

In the past year alone, organisations including NHS England, the RCN and the Institute of Health Visiting have highlighted the importance of the role of nurses and other healthcare professionals role in identifying victims of modern slavery.

Slavery statistics

Nursing Standard’s survey of 68 NHS organisations delivering acute, community and mental health services in cities with populations of 350,000 and over found:

  • Fourteen organisations (21%) do not record data on modern slavery and therefore do not know whether they have seen victims or not.
  • Four organisations (6%) refused to give specific numbers for fear of identifying victims, but said they had recorded between one and five victims every year since 2015.
  • Eight organisations (12%) recorded zero cases.
  • Just under half, or 29 organisations (43%), recorded a total of 464 victims.

NHS England director of nursing and deputy chief nursing officer Hilary Garratt says NHS staff, working with other organisations, have a ‘significant role’ to play in the prevention of modern slavery.

‘They will regularly come into contact with vulnerable people,’ Ms Garratt says.


men, women and children are estimated have been trafficked for exploitation in the UK and trapped in prostitution, domestic roles or forced labour

Source: UK government

‘It is therefore vital that we recognise how modern slaves may present in our services – including showing signs of coercion, slavery and abuse – and provide appropriate support.

‘I encourage all those who deliver care to seek advice, and where possible training, if they suspect an individual is a victim.’

There is a duty for police forces and local authorities to notify the Home Office of potential victims of modern slavery, but this does not apply to the NHS at present.

Anti-slavery commissioner Kevin Hyland told Nursing Standard: ‘There is a lack of consistency in the approach to tackling modern slavery in the health service, which needs to be addressed.

‘People need to understand this is a serious organised crime and it is trading in human lives.’


The Modern Slavery Act was passed in this year, giving law enforcement better tools to fight modern slavery and punish the criminals behind it

Mr Hyland says other safeguarding processes for issues such as domestic violence are well established and standardised across NHS services, but modern slavery is not yet at that point.

‘While there may be good local training processes, this issue needs to be in the actual structures of the NHS to reach an entire organisation, rather than pieces of it.

‘Those working in healthcare are our eyes and ears.’

Vigilant emergency nurse

Mr Hyland gave the example of a London emergency nurse who contacted police about a patient with injuries consistent with forced sex and who was accompanied by threatening men.

‘As a result of that call, a large organised crime group from across Eastern Europe was jailed,’ he says.

‘That all started from a vigilant nurse who had benefited from training that had been delivered.’

Nurse who was honoured for raising awareness

Louise Cahill was highly commended in the RCNi Nurse Awards 2017 for her work training students and qualified professionals and raising awareness of the growing but often unseen problem of modern slavery and human trafficking.

Louise Cahill. Picture: Tim George

Ms Cahill, who completed her studies at the University of Hertfordshire earlier this year, was instrumental in developing a tool that helps health professionals identify and respond to victims of modern slavery and human trafficking.
She wrote a training session for nursing students at the university, and has made presentations at universities across the country.

‘My goal is to ensure all nurses know the signs of modern slavery and how to respond,’ she says.

Variation in training

Most organisations include modern slavery within their mandatory safeguarding training, but beyond that any commitment to tackling the subject varies greatly.

Nursing Standard's research shows some organisations have held or sent representatives to conferences on modern slavery or held awareness campaigns, but others have no plans to do so as yet.

RCN professional lead for midwifery and women's health Carmel Bagness leads the college’s work on modern slavery and developed guidance to nurses on spotting the signs of it.

Ms Bagness says 10,000 pocket guides on modern slavery have been distributed to nurses and midwives in the past six months, but awareness still needs to increase.

1 in 8

healthcare workers have come into contact with modern slavery victims

Source: King’s College London research

‘Our major concern is a lack of good quality data due to a lack of recording systems, and so not all cases are being recorded,’ she explains.

Putting systems in place

Ms Bagness says of Nursing Standard's data: ‘I imagine this is just the tip of the iceberg. We need to push for better quality data. If there isn’t a system to do anything about it what is the point of recording it?

Ms Bagness says there should be an established reporting system across health and social care to ensure victims gain access to help as soon as possible.

However, she says progress is being made thanks to ongoing work by a range of agencies, organisations and services.

‘We are in a much better place than we were three or four years ago, but it will take time to make sure adequate systems and processes are in place.'

Work of Glasgow support service

The Trafficking Awareness Raising Alliance (TARA) in Glasgow supports women over 18 who have been trafficked for sexual exploitation.

The government-funded service, which covers Scotland, had 72 referrals last year and has about 40 active cases at any one time.

Help includes crisis accommodation, care planning and legal advice.

Lured with false job offer

Jaroslava, a Slovakian woman rescued by TARA, was forced into prostitution after being lured to the UK with the false offer of a job in a sandwich factory.

'My trafficker told me surely I must have known I was going to work in a brothel.

'I started to cry and became very scared. I was still saying I wouldn't do it when he slapped me and raped me saying that this was what I deserved.’

Jaroslava was forced to have sex with up to six men every day.

Resilience and survival

‘I learned to take myself away in my head, I learned to smile at the men and to pretend that it was all okay – life was easier and less painful that way.’

TARA’s service manager Carolann Nesbitt, a nurse, says working alongside health, social care and other services has been key to its success.

She adds: ‘Abuse takes time to recover from, but often the women are really resilient and have come through and survived – some are now at university or college, working or have had a family.’

The signs of trafficking

The RCN modern slavery guide says signs of trafficking include an individual:

  • Being accompanied by someone who appears controlling, or who insists on giving information and speaking for them.
  • Appearing withdrawn and submissive, or seeming afraid to speak to anyone in authority.
  • Providing vague and inconsistent explanations of where they live, work or go to school.
  • Having old or serious injuries left untreated.
  • Providing vague information, or being reluctant to explain how an injury occurred.
  • Not being registered with a GP, nursery or school.
  • Having no official means of identification or suspicious-looking documents.

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