Modern Slavery Awareness: What Care and Healthcare Staff Need to Know

Modern slavery is not a distant crime that happens somewhere else. It happens in ordinary houses, ordinary care homes, and ordinary domiciliary care rounds, often hidden in plain sight behind a job title, a tenancy agreement, or a "helpful" relative. Care and healthcare staff are frequently the only outside professionals who see inside someone's daily life, which puts them in a genuinely powerful position to notice when something is wrong — whether that is a service user being controlled by someone else, or a colleague who arrived in the UK through an international recruitment route and is now trapped by debt, threats, or a visa tied to a single employer. This post explains what modern slavery is, the legal framework behind it, the warning signs to look for, and exactly what to do if you are worried, including how safeguarding vulnerable adults training connects to this duty.

What modern slavery actually covers

"Modern slavery" is an umbrella term for several distinct forms of exploitation, all of which involve one person controlling another for profit or gain. It is not limited to people being physically chained or locked up — control is far more often exercised through debt, fear, isolation, confiscated documents, or manipulation of someone's immigration status.

Forced labour

Someone is made to work, often for little or no pay, under threat of punishment, and cannot leave the situation freely. This can affect people working in care settings themselves, in cleaning, agriculture, construction, or car washes, and sometimes in domestic roles inside private homes that care staff visit.

Domestic servitude

A person is forced to work in a private household — cooking, cleaning, caring for children or an elderly relative — typically living in, isolated from the outside world, with no pay, no time off, and no control over their own passport or documents. This is one of the forms most likely to be encountered by domiciliary care or district nursing staff visiting a private home.

Sexual exploitation

A person is coerced or deceived into sexual activity for someone else's financial gain. Victims may show signs of controlling behaviour by a partner or "boyfriend" figure, unexplained injuries, or reluctance to be alone with the person accompanying them.

Criminal exploitation

A person is forced or manipulated into criminal activity, such as cultivating cannabis, theft, or county lines drug distribution, often under threat to themselves or their family. This increasingly affects both UK nationals (including children) and migrants.

The Modern Slavery Act 2015: the legal framework

The Modern Slavery Act 2015 is the key piece of legislation for England and Wales. It consolidated and strengthened previous offences into two core crimes: slavery, servitude and forced or compulsory labour, and human trafficking. It also introduced Independent Anti-Slavery Commissioner oversight, the Transparency in Supply Chains requirement for large businesses, and statutory defences for victims compelled to commit certain offences as a direct result of their exploitation. Scotland and Northern Ireland have their own broadly equivalent legislation. For care and healthcare employers, the Act sits alongside existing safeguarding duties under the Care Act 2014 (England) and equivalent adult support and protection law elsewhere in the UK — meaning a modern slavery concern about a service user should always also be treated as a safeguarding concern.

Why care and healthcare staff are so well placed to spot it

Care workers, home carers, district nurses and healthcare assistants often get access that no one else does: inside someone's home, alone, on a regular basis, sometimes over months or years. That routine, trusted contact means small changes — a new "lodger" who never leaves the room, a service user who seems frightened of a family member, bruising that doesn't match the explanation given — are far more likely to be noticed by a visiting carer than by anyone else. This is the same underlying skill set covered in training on domestic abuse awareness for care and healthcare staff, and the two issues frequently overlap: coercive control, restricted freedom, and fear of the person supposedly caring for someone are common to both.

Risks among migrant care workers themselves

There is also a second, less obvious group at risk: colleagues recruited from overseas to work in UK social care. Since 2022, international recruitment has become a major route into the sector, and the Care Quality Commission has set out a regulatory policy position on modern slavery and unethical international recruitment, warning that staff shortages and visa arrangements that tie a worker to a single sponsoring employer have increased vulnerability to exploitation. Unseen UK, which runs the national Modern Slavery & Exploitation Helpline, has documented recruitment agents charging workers fees "sometimes exceeding £40,000" against an actual Health and Care Worker visa cost of £284, leaving people in serious debt bondage before they even start work, alongside withheld wages, disproportionate deductions for rent and transport, and threats of deportation used to keep people silent. Unseen's Helpline Annual Assessment recorded a 30% increase in potential exploitation cases in the care sector in 2023 compared with the previous year. Colleagues in this position often cannot simply hand in their notice — sponsorship rules can put their right to remain in the UK at risk if they leave — so they may stay silent about conditions a UK-born colleague would immediately flag.

Recognising the indicators

According to Unseen UK's public guidance, common indicators include a person who:

• Is rarely allowed to travel alone, or is always accompanied and watched closely by the same person
• Appears frightened, avoids eye contact, or is reluctant to talk in front of a particular individual
• Shows signs of physical or psychological abuse, including untreated injuries, malnourishment, or an unkempt appearance
• Has no control of their own money, passport, or identity documents
• Lives in cramped, dirty or overcrowded accommodation, or lives and works at the same address
• Is wearing clothing unsuitable for the work they are doing, or shows signs of exhaustion from excessive hours
• Mentions debts owed to an employer or recruiter, or fear of losing their visa if they complain

No single sign proves exploitation, but a combination should always prompt a safeguarding conversation, ideally away from the person suspected of controlling them.

The National Referral Mechanism and how to refer

The National Referral Mechanism (NRM) is the UK framework for identifying potential victims of modern slavery and connecting them with support. Only designated "first responder" organisations can submit an NRM referral — these include the police, local authorities, the National Crime Agency, the Gangmasters and Labour Abuse Authority, and NGOs such as the Salvation Army and Migrant Help. Most frontline care staff will not be first responders themselves, but your employer's safeguarding lead, the local authority safeguarding adults team, or the police usually are — so your job is to report your concern internally and externally without delay, not to complete the referral form yourself.

What happens for adults

For an adult, informed consent is needed before an NRM referral naming them can be made; the first responder must explain what the process involves and what support is available. If a competent adult declines consent, the organisation still has a legal Duty to Notify the Home Office with anonymised details, so the concern is still recorded nationally even without an identifiable referral. Children never need to consent — anyone concerned about a child must refer, regardless of the child's wishes.

Reporting outside the NRM

You can also report a concern, at any time, to the UK Modern Slavery & Exploitation Helpline on 08000 121 700, free and confidential, 365 days a year, or via Unseen UK's online form. Reporting to the helpline does not itself start an NRM referral but can trigger police or local authority involvement, and it is a good option if you are unsure or want advice before raising a concern with your organisation.

Your safeguarding responsibilities

Every care and healthcare organisation should have a modern slavery policy that sits alongside its wider safeguarding procedures, and every member of staff should know how to raise a concern — about a service user or about a colleague — without fear of it going nowhere or of retaliation. If you are worried about how a concern involving a colleague or manager will be handled, it is worth understanding your organisation's own whistleblowing protections and speak-up culture before you raise it, so you know your rights are protected. Employers, meanwhile, carry direct responsibility for ethical recruitment: verifying that any recruitment agency used for international hires conducts proper checks, never outsourcing that due diligence, and making sure no new employee is left in debt bondage or excessive dependence on the organisation for their visa status, accommodation, or income.

Frequently asked questions

Is modern slavery training mandatory for care staff?

There is no single UK-wide legal mandate naming "modern slavery training" specifically, but it sits firmly within the safeguarding training expected of all care and healthcare staff by regulators such as the CQC, and increasingly within provider policies on ethical international recruitment. Most employers now treat it as a core part of induction and annual refresher training.

What should I do if a service user won't let me speak to them alone?

Treat this as a red flag rather than a coincidence. Note what you observed, raise it with your safeguarding lead or manager the same day, and avoid confronting the person you suspect is controlling them directly — doing so can increase the risk to the victim.

Can I report a concern about a colleague, not just a service user?

Yes. Exploitation of migrant care workers by recruitment agents or, in some cases, employers is a recognised and growing pattern in UK social care. The same reporting routes — your safeguarding lead, the Modern Slavery & Exploitation Helpline, or the CQC — apply whether the person you are worried about is a service user or a colleague.

What is the difference between the NRM and the Duty to Notify?

The NRM is a formal referral, made with the adult's consent, that opens a support pathway and a decision on whether they are a recognised victim. The Duty to Notify is a mandatory, anonymised notification to the Home Office used when an adult potential victim does not consent to a full NRM referral, so that national data still captures the concern.

Modern slavery training gives care and healthcare staff the confidence to notice, name, and report what they are seeing — for the people they support and for the colleagues working alongside them. Learnsignal's CPD training courses for care and healthcare professionals cover this and related safeguarding topics, helping teams build the practical knowledge to protect the people who depend on them.