NHS Staff Are Positioned But Not Trained To Identify Trafficking


A survey of National Health Service (NHS) professionals reports that 13% have had contact with a patient they knew or suspected was trafficked.

The figure rises to 20% amongst maternity staff.

It’s clear that certain staff in the UK’s health system are positioned to identify potential victims of human trafficking –for forced labour, domestic servitude or sexual exploitation.

However, this survey also suggests that far too few are trained to manage that interaction.

86.8% of participants reported lacking knowledge of what questions to ask to identify potential victims and 78.3% reported that they had insufficient training to assist trafficked people.

Here in the UK, survivors of human trafficking can access safehouse accommodation, medical treatment and counselling for 45 days under the government’s National Referral Mechanism. In order to access those services a survivor must first be identified and referred into that system by a ‘First Responder’ which include the police, local authorities and a handful of NGOs.

The research carried out for the British Medical Journal suggests that that empowerment to refer has not filtered down to frontline staff. 71% of those asked lacked confidence in making appropriate referrals for men, 67.5% for referral of women and 53.4% who lacked confidence in making an appropriate referral of a child.

This hesitancy seems to be part of a broader lack of awareness. Just like so many other frontline staff trained by Hope for Justice, 95.3% of these NHS respondents were unaware of the scale of human trafficking in the UK, and 76.5% were unaware that calling the police could (in specific circumstance) put patients in more danger.

The call to arms is clear; we must empower more professionals to identify and refer victims.

We know that a perpetrator controlling a sex trafficking victim may well take a sick girl to a medical clinic rather than incur the financial loss of keeping her off the street. In our experience, however, it’s unlikely that many forced labour victims will end up on wards because they are so often prevented from seeking medical help. The occasional victim may; a former client of our charity was very seriously injured in an incident in an unsafe workplace and rushed to A&E whilst still in the trafficking situation. NHS staff are positioned to encounter trafficking victims who may never otherwise be separable from their controllers.

Right now, despite the significant spotlight that came with the passage of the Modern Slavery Act, Hope for Justice receives very few requests to train NHS staff. To date we have delivered only a handful of sessions for healthcare professionals, mainly to sexual health clinics and midwifery teams. However, we were recently approached by the Safeguarding Lead at a major teaching hospitals trust who would like our training rolled out across the hospital. Outside of these instances we’ve encountered very little drive to make training available to NHS staff.

By contrast we’ve seen many organisations and agencies galvanised to offer training to their staff and in only the first six months of 2015, Hope for Justice have trained over 4,000 professionals across the UK.

The challenge we’re encountering is the perception that it’s just too difficult to get staff out of busy wards to attend training.

It’s a challenge we cannot shy from because at Hope for Justice we know training works and victims lives can be at stake. Of the rescues we undertook last year, 64% came about following a referral from someone we’d trained. Without sounding alarmist, victims are clearly out there for us to find and the more proactive the NHS becomes the more opportunities for identification would arise. With their nationwide distribution and privileged access to the confidences of patients, NHS staff well-placed to make life-changing referrals.

Our team has identified ward-based social workers, safeguarding teams, A&E staff, sexual health clinics, midwives and school nurses as prime candidates for training. If opposition to removing staff from wards for even a half day’s critical training is overwhelming, it may be more practical to train ‘champions’ within each team to act a point of reference for other staff. Certainly, something must be done to improve identification rates.

On a half-day training session delivered by Hope for Justice, participants learn about the different types of trafficking, how to identify victims, understand the circumstances that prevent them coming forward for help and how to refer them for assistance. In other words, how to maximise on the brief and unique opportunities presented to professionals to remove an individual from circumstances akin to modern day slavery.

By no means are challenges in the fight against human trafficking confined to the UK.

In her testimony to the US House of Representatives’ Committee on Energy and Commerce, Katherine Chon, Senior Advisor on Trafficking in Persons for the Administration for Children and Families, highlighted very similar findings across America:

“Research has shown that victims of human trafficking often come into contact with the health care and behavioral health systems. Along with law enforcement personnel, health care providers are among the most likely frontline provider who may interact with victims of human trafficking while they are still under conditions of exploitation.

In a 2011 study (1), 50 percent of foreign national survivors of sex and labor trafficking interviewed gave a history of encountering a health care professional while they were in a situation of human trafficking, yet none of them were identified as a victim during these encounters. In a 2014 study (2), almost 88 percent of interviewed survivors of domestic sex trafficking had encountered one or more health care professionals sometime during the period in which they were being trafficked, yet none were identified as a victim during these encounters. As concerning as these statistics are, the lack of research in the area of human trafficking limits our understanding of the health service needs facing this population, and how those needs would best be met.

Victims of human trafficking encounter a variety of health care professionals while still trafficked – this is an often missed opportunity to intercede. In a separate 2014 briefing (3) based on an anonymous nation-wide health care survey of sex and labor trafficking victims, 39 percent of respondents had contact with emergency departments, 29 percent with primary care providers, 17 percent with obstetrician and gynaecologists, 17 percent with dentists, and three percent with paediatricians.”

Having recognised the invaluable positioning of medical staff, Hope for Justice has focussed its US training upon the healthcare community where institutions have been more receptive.

In FY2014/15 we trained 2,790 healthcare professionals across 14 states.

Dr Jeffrey Barrows, D.O., M.A. (Bioethics), Director of U.S. Training at Hope for Justice has had the impact of this training recounted to him again and again;

“After healthcare training sessions, I hear over and over again from participants that they had no idea trafficking was occurring, and many are reminded of past patients who matched the victim profile and key indicators. Healthcare professionals who have been in practice for many years often tell me that they know they have missed victims in the past and are very thankful for the training so they will be able to do something about it in the future.”

The NHS operates within an unenviably complex set of competing priorities but it seems fair to say that anti-trafficking training should rank among them. If NHS bosses from the Health Secretary down are thinking that that’s what any anti-trafficking charity is bound to say then perhaps it is better coming from one of their own; James A. Lemons, M.D. is Hugh McK. Landon Professor of Pediatrics at James W. Riley Hospital for Children in Indianapolis, IN, he says;

I strongly recommend the training provided by the Hope for Justice team.

Their knowledge on how the medical profession interfaces with human trafficking and how we in the medical profession can help end human trafficking is exceptional – every physician, nurse, medic, ER admission secretary should attend their workshop.
It is truly empowering and will save lives – as important as learning CPR.”

1 Baldwin SB, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of human trafficking victims in settings. Health Hum Rights. 2011; 13(1):1-14
2 Lederer L, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in facilities. The Annals of Health Law. 2014; 23(1):61-91.
3 Chisolm-Straker M, Richardson L, Baldwin S, Gaïgbé-Togbé B, Ndukwe N, Johnson P. Trafficking Victims & Health Care: A Survey of Survivors. Power Point. 2014.