16 november 30 :: vol 26 no 13 :: 2011 NURSING STANDARD

Andy Robinson is serving a 13-year sentence at a highsecurity prison for taking part ina plot to smuggle cocaine with astreet value of £4.5 million intoBritain via Heathrow airport.

Jailed last August, the 47-year-old builder may not be anobvious candidate for membershipof a health promotion team. But at HMP High Down in Surrey, he isone of a handful of prisoners whoare helping inmates to protectthemselves from disease and usethe prison’s health services.

Like all inmates at High Down,Mr Robinson spends around 16 outof 24 hours in his cell. But outsidethese ‘bang-up times’ he worksalongside the prison’s nurses.

Every morning he meets 25 orso new prisoners, who arrive fromcourts across the region. His role is to spell out the dangers ofhepatitis B, hepatitis C andsexually transmitted diseases, and encourage prisoners to go to the nurses for vaccinations and screening.

We meet in a side-roomattached to his prison block, athree-storey building housing 200men. Mr Robinson is relaxed, evenjovial, but the interview takesplace under tight security, and

Nursing Standard’s photographerwas not allowed to take a camerainto the building.

‘When you come here, health isthe last thing on your mind,’ saysMr Robinson. ‘Most prisoners donot understand vaccinations andscreening and won’t have givenmuch thought to health before.But I explain that it is important.’

Healthcare jargon and formallanguage does not go down well with this patient group, Mr Robinson explains. ‘We cantalk to other prisoners on a levelthey understand. I ask them “how good is your wood?”. Theycan talk to us, but they may benervous around nurses.’

The category B prison holdsmore than 1,000 men on remandor serving sentences for crimesranging from fraud to sexualassault and manslaughter.

Mr Robinson is one of eight prisoner healthcarerepresentatives selected by nursesand officers to increase vaccination,detection and treatment rates forinfections including hepatitis B andhepatitis C.

The initiative was introduced by prison nurse and primary careclinical lead Hayley Peek inOctober 2010, in response to a

Department of Health target forprisons to increase hepatitis Bvaccination coverage to 80 percent. Ms Peek realised the targetwould be impossible to reachwithin existing budgets unless she recruited prisoners to help.

‘Prisoner representatives werealready working in other areassuch as literacy, so I thought itcould work in health care,’ she says.

In February last year the firsthealthcare representative wasappointed to advocate hepatitis Band chlamydia screening. As uptake rose, hepatitis Cscreening was introduced andthe scheme expanded.

Later in the year arepresentative was selected from each wing to give talks on vaccinations and screening to inmates when they wereadmitted and again when theywere first put on a wing.

The results, says Ms Peek, haveexceeded all expectations (see box).

As well as meeting newprisoners, representatives showthem to treatment rooms, handout appointment slips and fill inpaperwork to help nurses monitorand track patients.

Ms Peek says that one of thescheme’s main advantages is thetime it saves nurses. To cross thesprawling building, prison staffhave to unlock, open and relockdozens of double doors. It can take her 25 minutes to walk from her office in thehealthcare centre to a cell.

Health on the insidePrisoners are taking charge of improving their own health with thehelp of an award-winning nurse-initiated scheme, says Tamsin Snow

Screening success at HMP High Down4Hepatitis B vaccination coverage has increased from a low

of 9.3 per cent to a high of 84 per cent. 4Screening tests for hepatitis C have increased from one per

month to 37 per month. 4Just 13 prisoners under the age of 25 were screened for

chlamydia in April 2010. Monthly chlamydia screens haveincreased to 56.

4Following prisoner demand, chlamydia screening is nowoffered to all prisoners regardless of age.

PEOPLE ASK ME WHY I BOTHERWITH PRISONERS AND SAY

THEY SHOULD GET MINIMAL CARE

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The scheme has increasedhealth awareness generally, but ithas also boosted the self-esteemof the healthcare representatives.

One of the youngest is a 23-year-old man with type 1diabetes. When he arrived at High Down, he had the mostuncontrolled blood sugar levelsnurses there had ever seen. Healso smoked heavily and ate anunhealthy diet.

After being appointed as ahealthcare representative, hegave up smoking and then began working out in the prisongym every day. Unsurprisingly, his blood sugar levels have shown improvements.

This softly spoken young mancan now see a future for himself. ‘I want to train as a gym instructorwhen I leave prison and maybe setup a business with my brother.’

Mr Robinson hopes to work as a counsellor for a drug and alcoholcharity when he is released. He isclearly proud of the contributionhe is making. ‘When I came toHigh Down I had never been to prison before and was reallydown. I spoke to an older guy whohad been here for years and hehelped me get into the routine ofprison. It was a godsend. Now I want to give something back.’

Healthcare representativesreceive £12.50 a week, making it

november 30 :: vol 26 no 13 :: 2011 17NURSING STANDARD

one of the highest paid andmost sought-after jobs

in the prison. Wearingtheir bright orangetee-shirts, they are instantlyrecognisable.Representativesundertake NVQ level 3 training in advice andguidance, and

are also taught torecognise the signs

of self-harm. Staff nurse Kristian

Lane emphasises the carethat has been taken to ensure

healthcare representatives donot abuse the increased accessthey have to other inmates bytrafficking items such as phonesaround the prison. They must stay within their own wing.

‘If prisoner healthcarerepresentatives mess up, it wouldreflect badly on nurses and thescheme,’ says Ms Lane. ‘Thedanger is that security could stopor limit the scheme. But the repsknow that and hopefully want tosee it continue.’

Last month the scheme won a World Health Organization bestpractice award. It is now beingrolled out to three other prisons.

Ultimately the state ofprisoners’ health is a public healthissue, argues Ms Peek. ‘Somepeople ask me why I bother withprisoners and say they should begiven minimum health care. Butmost are going to leave prison at some point, and the healthierthey are when they do so, thebetter for everyone’ NS

Prison nurseHayley Peek, whointroduced thehealthcarerepresentativeinitiative at HMPHigh Down

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Prison nurses at HMPHigh Down in Surrey have recruited healthcare representatives from the inmates to improve uptake of screeningand vaccinations. Thescheme has boosted representatives’ confidenceand developed skills theyhope to use after they are released.

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