monitoring by health-care staff and the inadequate recording of such measures. The issue of solitary confinement imposed by judicial decision (“isolamento diurno”) on certain life-sentenced prisoners is also raised in the report. In the Committee’s view, the prolonged and punitive nature of the measure in respect of specific cases raised in the report could be considered as amounting to inhuman and degrading treatment. 51. In the context of ongoing reforms, leading to the closure of judicial psychiatric hospitals (OPGs), the CPT’s report examines the situation of forensic psychiatric patients. While welcoming a number of improvements in treatment and care in the new Residenze per l’esecuzione delle misure di sicurezza (REMS), the report notes several deficiencies at Castiglione delle Stiviere, a former OPG undergoing conversion into a REMS. The CPT sets out the basic principles regarding the use of restraint measures, and recommends that they be the subject of comprehensive protocols in all psychiatric establishments. In their response, the Italian authorities outline the ongoing debate surrounding the use of restraints in psychiatry, an issue which is somewhat complicated by the fact that psychiatric institutions come under the responsibility of the respective region in which they are located. Report and response published in September 2017 (CPT/Inf(2017)23 and CPT/Inf(2017)24) Report on the ad hoc visit to “the former Yugoslav Republic of Macedonia” in December 2016 and response of the authorities of “the former Yugoslav Republic of Macedonia” (prison conditions for persons detained at Idrizovo, Štip and Skopje Prisons) 52. The report recalls that the CPT has repeatedly highlighted certain fundamental structural issues in the prison system, such as a lack of policy on how to manage complex institutions, an inadequate system of reporting and supervision, and the poor management and performance of staff, which calls for an end to the practice of political appointments, and the creation of a truly professional prison management career path. The findings from the December 2016 visit demonstrated that little progress has been made to address these issues across the prison system. Moreover, at Idrizovo Prison, which holds 60% of the country’s prisoners, the provision of health care remains totally inadequate, placing prisoners’ lives at risk; the absence of any appropriate regime means that prisoners have nothing constructive to do; and the conditions of detention in several parts of the prison could be considered as inhuman and degrading. The CPT was also critical of the conditions of detention in the remand section of Skopje Prison and in the closed section of Štip Prison (e.g. confinement in cells for up to 23 hours a day for periods of up to two years at Skopje and extreme overcrowding in certain cells at Štip Prison). 53. The CPT’s report also describes the rampant corruption within the prison system. At Idrizovo Prison in particular, prisoners may purchase their way, for example, to a place in a decent cell, home leave or medication. The CPT recommended that prison staff need to be sufficient in number and receive adequate training and support. In the CPT’s view, this would contribute to addressing a number of persistent problems General Report of the CPT, 2017 ► Page 20