The inverse care law was proposed 50 years ago in the Lancet, a prestigious medical journal. It claimed that those who are most in need of healthcare, are those least likely to receive it. In other words, the poorer you are, the sicker you’ll become.

This is because healthcare has become a commodity. A product which is sold, rather than a good for all. All commodities tend to follow this pattern. Those most hungry are those with the least access to food. Those most tired are the least able to sleep.

The NHS was set up to combat this commodification of healthcare. To take the market away from what should be a universal right. For this right to be distributed to those who need it most. To relinquish us of the idea that those who are wealthy, will tend to live longer, because they are wealthy.

It worked for a time. But increasing privatisation of NHS services, means this commodification is re-emerging. You may have seen this within the prison system. Aspects of care, which were once delivered by NHS providers, are now delivered by any number of private enterprises. Always going to the lowest bidder, so the quality of service suffers. You know the names. Always with an ironic appeal to a virtue they fail to deliver. Care UK, G4S Health, Sodexo Justice.

You, the patient, don’t buy healthcare, however. You can’t choose an alternate provider within prison, where market forces are conspicuously absent. So how do you influence those providing healthcare to up their game?

There is a concept of the professional patient. The person who has time to research their symptoms online. Who articulately speak the lingo to their GP. They know what buttons to press. They know which levers to pull to get what healthcare they think they deserve. Their sharp elbows flex as they jostle up waiting lists. They are experts at complaining.

I think there exists an inverse complaints law. It feeds into the inverse care law. And I think it is magnified greatly within prisons.

I think that those least able to complain, for whatever reason, are the very people who should complain the most. But they don’t, and so suffer poor health outcomes. With healthcare stripped back to the bones, no one is looking out for these people. No one will come to save them.

Those in prison, are often unable to complain. This could be through fear of retribution – it’s hard to complain about those who run your daily life. It could be through illiteracy. One can’t be expected to fill out forms with entry level 1 English. But more likely, it is because they aren’t adequately informed that they can, or should complain. Their standards beaten so low by a society which neglects them, they expect nothing, and demand nothing.

It's these people the regulators should be most interested in. It’s from these people that a realistic view of healthcare performance within prisons could be gleaned. But the regulators show little interest in capturing these people’s opinions. So, they remain ignorant, and wonder why patient safety incidents and deaths in custody keep increasing.

You might not even know who these regulators are. This isn’t your fault. I asked two medical staff regulators, the General Medical Council (GMC), and the Nursing and Midwifery Council (NMC), whether they sent information in to prisons. Whether they felt the need to empower prisoners with the ability to raise concerns.

Neither of them did. This shows a shameful ignorance on behalf of these regulators, with little concept of the very places they should be regulating. They should make it easy to complain. But they don’t. So valid complaints will be lost, through lack of information.

Likewise, there is little information entering prisons from the Care Quality Commission (CQC). They regulate the healthcare providers within prisons. You may see a small purple poster of their rating of the provider stuck up somewhere in healthcare. Yet if you ask someone to visit the CQC website, to try and find the healthcare provider in your prison, they won’t be able to find this information very easily. It is all woefully out of date. And again, valid complaints will be lost through misinformation.

Despite the lack of desire from regulators, you can complain to them. And you should. Here’s how.

Always start with a local complaint, within your prison. Even if you don’t think it will succeed, you need to show these bodies that you have tried resolving things internally, and so need external help. Go through the official complaints system within the prison. I urge you to use it, but I fully understand why you might choose not to.

The next stage is the ombudsman. You have two options; The Parliamentary and Health Service Ombudsman, or the Prisons and Probation Ombudsman. The former has more teeth in the healthcare world, but the latter is perhaps more used to issues relating to prison healthcare. I suggest trying one, then if still unsatisfied, try the other. You can also appeal their final decisions.

Finally, there are other people you can write to, outside of the complaints process per se. In many ways, complaining is about finding someone influential to put your words in front of, who can then act upon them.

Healthcare professionals are regulated by bodies such as the GMC for doctors, and the NMC for nurses. If your issue relates to a staff member specifically, you should consider contacting these bodies. This likely won’t solve any issues surrounding your treatment, where you need to contact those funding, regulating, or designing the healthcare department.

Your prison healthcare is commissioned (paid for) by a local NHS trust. So, write to your local NHS trust. Let them know the issues you face receiving healthcare. Your words are powerful testimony, and they will be listened to, as it’s unusual for them to receive letters from prisoners.

You can send the CQC similar information. Again however, as a regulator, this won’t have a direct bearing on your treatment.

If your issue relates to an external healthcare appointment, you can write to the Patient Liason and Advice Service (PALS) located within that hospital. Or, you could even write directly to the medical director, or chief executive of that hospital.

Finally, write to your MP. Ask them to raise your issues with the Health and Social Care Secretary or the Department of Health and Social Care. They are duty bound to reply.

In all instances, keep your complaints civil, and to the point. Tell them what happened, how it made you feel, and what should have happened, or how they can remedy the situation. Try and explain the bigger picture, that incidents are symptomatic of bigger issues. That you want to stop errors impacting on others. Selflessness is appealing.

If in doubt, err on the side of complaining. Even trivial things can add up to disaster. Missed appointments, missed doses, unfair treatment. These things need no longer be part and parcel of prison life. Through your complaints, the system will be forced to improve.