Vera Drake (Imelda Staunton) is devoted to her family, looking after her husband and children, her elderly mother, and a sick neighbour. Her shy daughter, Ethel (Alex Kelly), works in a lightbulb factory, and her son, Sid (Daniel Mays), tailors men's suits. Her husband, Stanley (Phil Davis), is a car mechanic. Although Vera and her family are poor, their strong family bonds hold them together. During her working day as a house cleaner, Vera performs constant small acts of kindness for the many people she encounters.
She is a kindly person who is eager to help others. Unknown to her family, she also works secretly, providing abortions for young women. She receives no money for providing this service because she believes that her help is an act of charity to women in trouble. However, her partner Lily (Ruth Sheen), who also carries on a black-market trade in scarce postwar foodstuffs, charges two guineas (two pounds and two shillings: equivalent to £70 in 2020) for arranging the abortions, without Vera's knowledge.
The film also contains a subplot about an upper-class young woman, Susan (Sally Hawkins), the daughter of one of Vera's employers. Susan is raped by a suitor, becomes pregnant, and asks a friend to put her in contact with a doctor, through whom she can obtain an abortion. The doctor refers her to a psychiatrist, who prompts her to answer questions in a certain way, so that he can legally recommend an abortion on therapeutic psychiatric grounds: that she has a family history of mental illness and that she may commit suicide if not allowed to terminate the pregnancy. The abortion costs her a hundred guineas.
After one of her patients nearly dies, Vera is arrested by the police and taken into custody for questioning. She is held overnight and appears before a magistrate the next morning. Sid is shocked by his mother's secret activities and tells his father that he does not think that he can forgive her. However, in a later conversation with Vera, he expresses fear for what could happen to her in prison, before finally telling Vera that he loves her.
Vera is bailed to appear at the Old Bailey. None of Vera's employers will give her a character reference. Her solicitor thinks she will receive the minimum sentence of 18 months in jail; the judge sentences her to two and a half years imprisonment "as a deterrent to others." This affects all the people who previously depended on Vera's kindness.
While in prison, Vera meets others who have been convicted of performing illegal abortions. They discuss their sentences, explaining that it's not their first time in prison for performing illegal abortions, and that she'll probably only serve half her sentence. Vera tearfully leaves to go to her cell.
Imelda Staunton as Vera Drake
Phil Davis as Stan
Daniel Mays as Sid
Alex Kelly as Ethel
Sandra Voe as Vera's Mother
Eddie Marsan as Reg
Adrian Scarborough as Frank
Heather Craney as Joyce
Sally Hawkins as Susan
Ruth Sheen as Lily
Lesley Sharp as Jessie Barnes
Liz White as Pamela Barnes
Peter Wight as Det. Inspector Webster
Martin Savage as Det. Sergeant Vickers
Jim Broadbent as Judge
Simon Chandler as Mr. Wells
Lesley Manville as Mrs. Wells
Marion Bailey as Mrs. Fowler