The pilot: 

Health and justice outcomes are deeply interconnected, yet policy and delivery have too often treated them as separate systems. A new pilot placing NHS staff within probation appointments reflects a shift towards prevention, early intervention, and whole-person approaches but from a lived experience perspective, it also raises important questions about trust, power, and consent. 

The pilot is being delivered across a small number of probation areas in England with high rates of reoffending and involves NHS clinicians being embedded within probation settings. It aims to identify unmet mental health, substance use, and physical health needs, support access to GP registration, and facilitate referrals into specialist and local services. The scheme is expected to reach up to 4,000 people on probation and forms part of wider cross-government efforts to reduce reoffending by addressing underlying health inequalities. 

Wider reform: 

The proposal aligns with wider Health and Justice reform ambitions to address entrenched health inequalities, improve continuity of care, and reduce avoidable demand on crisis services. People on probation experience significantly poorer physical and mental health than the general population, alongside higher rates of substance dependence, long-term conditions, and unmet need. Integrating health support into probation settings reflects an increasing policy emphasis on tackling the underlying drivers of reoffending rather than responding only to risk or breach. 

From a system perspective, the pilot also offers an opportunity to strengthen place-based and cross-government working, particularly across health, justice, housing, and local authorities. Probation appointments are often one of the most consistent points of contact for people in the community, and using these moments to connect individuals to health support reflects the principle of making every contact count. If implemented well, this could support continuity of care following release from custody and contribute to wider population health goals. 

Lived experience: 

However, lived experience highlights risks that policy design must address. Probation is not a neutral space. It is shaped by power, surveillance, and the risk of sanction. When health support is delivered within this context, there may be concerns about whether engagement is genuinely voluntary, how confidential information is shared, and whether health disclosures could influence compliance, risk assessments, or recall decisions. Without clear safeguards, integrated working risks undermining trust and engagement with key enablers of improved health outcomes. 

This also raises questions about where integrated services are delivered. Co-location does not have to mean probation buildings, and there may be opportunities to deliver joint health and justice support through community or voluntary sector settings. Delivering services in alternative, trusted environments could help mitigate power imbalances and support meaningful engagement. 

There is also a delivery risk if policy ambition is not matched by sustained investment across the system. Identifying health need without sufficient capacity in community services risks raising expectations that cannot be met. Repeated assessments without timely access to care can exacerbate disengagement and compound inequality. For this pilot to support reform objectives, funding must extend beyond identification to ensure clear, accessible pathways into mental health, substance use, primary care, and long-term condition support. 

Joint accountability across government departments will be essential. Integrated care models cannot succeed where responsibility for outcomes is fragmented across health, justice, and local government. Shared objectives aligned performance measures, and collective ownership of outcomes including improved health, reduced reoffending, and continuity of care are needed to move beyond co-location towards genuine system integration. 

The role of the voluntary sector 

The voluntary sector is a critical partner in delivering these ambitions. Community organisations including those whose work begins in custody and continues into the community are often best placed to provide trauma-informed, person-centred support, build trust with people who have experienced exclusion, and bridge gaps between statutory services. Sustainable, cross-departmental funding must recognise this role, rather than relying on short-term pilots or siloed commissioning. 

Conclusion 

Making every contact matter is a central reform ambition. But from both a lived experience and system perspective, success will depend on whether this approach strengthens dignity, choice, and access to care. To ensure this approach reduces rather than reinforces inequality, integrated health and probation models must be underpinned by shared accountability across government, sustainable funding, and a commitment to equitable access to care for all people on probation, regardless of background, need, or circumstance.