It is estimated that worldwide 40.3 million people are trapped in modern slavery,1 approximately 11 700 in the UK.2 From January to March 2018, 1631 potential victims of modern slavery were submitted to the UK National Referral Mechanism (NRM): 678 females (>42%), 952 males (58%), one transgender (<1%), 920 (56%) adults and 711 (44%) children.3 NHS England reports one in eight NHS staff think they have seen a victim of trafficking in their clinical practice and one in five victims of modern slavery report coming into contact with healthcare services during the time they were trafficked.4
WHAT IS MODERN SLAVERY?
Modern slavery is a gross infringement of an individual’s human rights and recognised as a crime by the international community. It is an umbrella term which includes slavery, human trafficking, domestic servitude, and labour exploitation. The Modern Slavery Act 2015 states that an offence of slavery, servitude, and forced or compulsory labour has been committed if:
‘(a) the person holds another person in slavery or servitude and the circumstances are such that the person knows or ought to know that the other person is held in slavery or servitude, or (b) the person requires another person to perform forced or compulsory labour and the circumstances are such that the person knows or ought to know that the other person is being required to perform forced or compulsory labour.’5
An individual commits an offence of human trafficking ‘… if the person arranges or facilitates the travel of another person (“V”) with a view to V being exploited.’ 5
Such exploitation includes sexual exploitation, organ harvesting, securing services (for example, domestic servitude, labour exploitation) by force, threats, or deception, and securing services from children and vulnerable persons.5
WHAT IS THE NATIONAL REFERRAL MECHANISM (NRM)?
The NRM is the UK’s framework for identifying victims of modern slavery to ensure they receive appropriate support and the mechanism through which the Modern Slavery Human Trafficking Unit (MSHTU) collects data about victims. The NRM was developed in 2009 after the signing of the Council of Europe Convention on Action against Trafficking in Human Beings. This convention requires potential victims of human trafficking be provided at least 30 days of supported recovery and reflection, which includes accommodation, subsistence, and access to relevant medical and legal services.6,7
HOW CAN VICTIMS OF MODERN SLAVERY PRESENT IN GENERAL PRACTICE?
Individuals may speak poor English, have suspicious looking documents, and not be registered with a GP. They can appear withdrawn and neglected, be afraid to speak, and be accompanied by a controlling companion, who speaks on their behalf. There is often a vague past medical history and lack of clarity about where they live and work, or how injuries occurred. Child victims can be poor school attenders, frequently go missing, and be ambiguous about their age and their relationship with accompanying adults.7
Victims of modern slavery can experience a wide variety of physical symptoms such as injuries (from assault, controlling measures, or inadequate personal protective equipment and health and safety measures), neurological symptoms (for example, headaches, dizziness, and memory loss), dental pain, fatigue, musculoskeletal and abdominal pains, and skin problems. Victims of sexual abuse may present with sexually transmitted infections and late pregnancy bookings. Potential mental health issues include deliberate self-harm, eating disorders, and post-traumatic stress disorder.7,8
WHAT SHOULD I DO IF I SUSPECT A PATIENT IS A VICTIM OF MODERN SLAVERY?
Our key role as GPs is identifying potential victims and making timely referrals. Be interested, ask non-judgemental questions and, if possible, speak to the person in private. Be wise, never make promises you cannot keep, nor raise your concerns in the presence of any accompanying person.7 Be proactive. Ensure the patient receives the required emergency medical treatment. If it is safe, and appropriate to do so, give the person a language-specific information sheet on supporting victims of modern slavery9 and the telephone number for the UK Human Trafficking Centre (UKHTC) 24/7 helpline (0844 778 2406, or visit the UKHTC website)6 or the Red Cross (0344 871 1111). You may wish to share your concerns with a colleague or safeguarding professional before contacting the police (if immediate danger, 999, otherwise, 101) and referring children to social care, if a child is involved or is at risk. Under Section 52 of the Modern Slavery Act 2015, Police and Councils, not GPs, have a statutory ‘duty to notify’ via the NRM, by emailing an MS1 referral form to dutytonotify{at}homeoffice.gsi.gov.uk.
- © British Journal of General Practice 2018
REFERENCES
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The Global Slavery Index.
- 2.↵
(2018) Prevalence, The Global Slavery Index.
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