Session Aims

1. Practice Safeguarding Adults Leads Network June 2018Dr Dee Hora Named GP Safeguarding AdultsVikki Gray Designated Nurse Safeguarding Adults

2. Session Aims • To support the identification and response to violent extremism and modern slavery in adults • To discuss the role of general practice in adults who are vulnerable to, or experiencing exploitation • To share the slides with practice safeguarding leads to deliver the session to colleagues • An opportunity to meet the CCG leads and for peer support

3. Exploitation • Exploitation is the deliberate maltreatment, manipulation or abuse of power and control over another person. It is taking advantage of another person or situation usually, but not always, for personal gain. • Exploitation comes in many forms, including: • slavery • being coerced and/or controlled by a person or a group • domestic violence and abuse • sexual violence and abuse • human trafficking

4. Modern Slavery & Human Trafficking • Modern Slavery: encompasses slavery, human trafficking, servitude, forced or compulsory labour. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment • HM Government http://www.legislation.gov.uk/ukpga/2015/30/contents/enacted • When we hear the word slavery, we often think of something overseas. But here are the facts; we know that there are 13,000 modern slaves in the UK. They are often hidden in domestic service, in our high streets working in nail bars, food outlets car washes, factories, fields and our shorelines where the fishing industry is active.’ • Hilary Garrett, Deputy Chief Nursing Officer for England

5. Purpose of slavery and trafficking • Forced Labour • Sexual Exploitation • Domestic Servitude • Cannabis Cultivation • Benefit Fraud • Debt Bondage • Organ Harvesting

6. Modern Slavery Act 2015 • Makes prosecuting the traffickers easier by consolidating the existing slavery offences • increases sentences for slavery offences • bans prosecuting victims of slavery for crimes they were forced to commit by their traffickers, such as drug production or petty thefts • introduces child trafficking advocates to better protect trafficked children • makes big UK businesses publically report on how they tackle slavery in their global supply chains • establishes an independent Anti-Slavery Commissioner to overlook the UK’s policies to tackle slavery • The Care Act 2014 recognises Modern Slavery as one of the ten categories of adult abuse and neglect

7. Slavery and Trafficking • Slavery Servitude and Forced labour or Compulsory Labour: • 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 • 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. • Human Trafficking: • To arrange or facilitate the travel of a person with a view to being exploited • It is irrelevant whether P (adult or child) consents to the travel • Travel means entering any country, departing any country, travelling within any country

8. Vulnerabilities • Slavery is due to vulnerability. Poverty alone does not explain slavery. Most slavery victims are poor, but not all poor people are in slavery. • Lack of Awareness of Rights and Risks. Often, people do not know their rights and accept forced labor and exploitation. The schemes of traffickers sound attractive and plausible. The risks of certain acts, like surrendering one’s passport, are not understood. • Absent or Weak Protective Organisations. Poor communities often lack effective local organisations that can serve as protectors and buffers against those perpetrating enslavement. • Absence of Critical Services. People turn to exploitative moneylenders in the absence of a legitimate source of credit. Children not in school are vulnerable to traffickers. A health crisis can drive people into debt and slavery. • Inadequate Legal Protection. Poor and marginalized groups and communities are the least likely to be protected by the law. Weak laws and lack of law enforcement reduce the risk to slave holders and traffickers. • Survivor Vulnerability. The survivors of slavery are often traumatised, have a perceived or real dependence on their traffickers, are impoverished, and are sometimes without marketable skills. They are frequently stigmatized, especially women and girls victimized by sex trafficking. Survivors are at high risk of becoming re-enslaved. • https://www.freetheslaves.net/about-slavery/faqs-glossary/

9. Indicators • Having Discussed indicators you may see in practice – did these come up? • Fearful,anxious or distrustful • Appears malnourished • Shows signs of trauma (physical/psychological) • Suffer injuries • Unfamiliar with local language/context • Control - Allow others to speak for them when addressed directly • Dependenton someone else • Believe they have to paydebt off • Without appropriate ID documents • Do not know home or work address • Do not have any days off • Unable to leave their work environment • Have limited/no social interaction

10. Health indicators

11. Case Studies Case discussion

12. Barriers to Disclosure • Language barriers • Fear of the trafficker, retribution against themselves and their family, and being in an unknown place • Lack of trust, or being suspicious of authority • Perception/prejudice of the UK and treatment they’ll expect to receive: fear of imprisonment, deportation, fines • Lack of knowledge about human trafficking and their rights • Religious/cultural beliefs such as ‘it is normal in my country’ • Feelings of guilt or shame about their situation • Unwilling to be labelled as a victim or stigmatised • Loyalty to trafficker, grooming, “Stockholm Syndrome” • Hopelessness/isolation • Poverty

13. Responding • DO NO HARM– do not put a victim in more danger by trying to assist – be wary of accompaniers • If the victim is under 18 this is child abuse - follow usual child protection procedures • Do not ask anyone accompanying the victim to assist with interpreting • If you think they are controlled by religious, cultural, spiritual beliefs, acknowledge these – this can gain trust • Assistance for adults should proceed via police or local authority on the basis of valid consent unless others are at risk • Adults who lack capacity to consent should be referred via local safeguarding adults procedures applying best interests principles under the Mental capacity Act 2005 • Inform the victim of their rights to assistance and protection – do not make false promises. The National Referral Mechanism is a government programme of holistic support for victims of modern slavery which police and local authority can refer people in to.

14. National Referral Mechanism • The NRM is a national framework where the public bodies work with NGO’s to identify and support potential victims of modern slavery and human trafficking • Accommodation or support and material assistance • Medical treatment and care • Counselling and emotional support • Advice on immigration, legal rights and services • Advice on the criminal justice system • Guidance on education, training, and employment • 45-day reflection period when you cannot be removed

15. If the adult doesn’t want help? • If an adult does not wish to go through the National Referral Mechanism? • Duty to notify needs to be completed – for health this is via a referral to Adult Social Care as we do not yet have the duty directly • Sign post to other relevant support services available nationally and locally (GP intranet) • If an adult does not wish to give evidence or make a statement to the police? • Explain they are still entitled to receive support through the NRM • Explain if they change their mind and wish to give a statement to the police they can engage with police at a later date • If an adult does not wish receive support? • Sign post to services, if in the future they want information or help, particularly give information about walk in services • If an adult wishes to return to their home country? • Immigration can assist with voluntary return – if an individual has a letter from UK Visas and Immigration (UKVI) confirming they a victim of trafficking • International Organisation for Migration – Assisted Voluntary Returns Scheme  • NB: Children and young people under 18 must be referred under local child protection procedures – Social Care will refer to the NRM as required

16. Contact • Police emergency or out of hours: 999 or 101 • Specialist Police: Modern Slavery and Kidnap Unit • TraffickingReferralTeam@met.pnn.police.uk • Call: 0207 587 3546 (office hours) • Camden Children’s Social Care: 0020 7974 331720 7974 3317 • Camden Adult Safeguarding Team: 020 7974 4000 • Help and Advice: Modern Slavery Helpline 0800 0121 700 • Child Trafficking Advice Centre (CTAC): NSPCC 0808 800 5000 • Named GP and Designated Nurse advice and support on GP Intranet safeguarding pages