Recruiting 'healthcare representatives' from prisoner population

The HCRs designed a prisoner patient information leaflet to outline their service and role that was distributed throughout the jail.

They also sat on a group that reviewed documents to ensure they were accessible to the general prison population and met regularly with prison staff to identify areas of the prison health service that could be improved, for example the reception process for new prisoners, and the outpatient appointment system.

The authors of the article in Primary Health Care say the project has led to improved attendance at outpatient appointments and a fall in the 'did not attend' rate at clinics.

'Prison officers and healthcare staff reported positive benefits from having HCR involvement through more appropriate referrals to services following better signposting by HCRs. It was also suggested that the HCR presence created role models for other prisoners to aspire to, therefore promoting positive behavioural change and pro-social behaviour.

'The working lives of healthcare and disciplinary staff have been affected by the introduction of improved patient and public involvement (PPI) because  prisoners have been reportedly taking more responsibility for their own health care. This has led to fewer demands on staff, freeing up time for them to concentrate on other activities. Healthcare staff and discipline officers are freed up to spend more time with prisoners.'

They said having the prisoners sit on interview panels sent a clear message to existing staff of the value placed on PPI by health care leaders and to new staff it demonstrated an approach that patients were at the centre of healthcare services.

The authors suggest their work in the prison has implications for other healthcare settings, particularly in terms of empowering patients and 'appreciating how the organisational culture and power imbalances between healthcare staff and patients manifest themselves'.