Correctional institutions 2.5.5.3 Determining the need for medical and nursing staff The lack of medical and nursing staff is a national problem. The NPM has repeatedly criticised the lack of specialists in psychiatry and the delays in filling general practitioner positions (see NPM Report 2016, p. 109). Structural weakness The health service in a correctional institution should be able to provide medical and nursing treatment under conditions comparable to those for patients who are at liberty [CPT/Inf/E(2002) 1 – rev. 2010, German, p. 33]. There must be an adequate number of medical personnel to meet this requirement. The NPM raised the questions of which parameters should be used to calculate the need for personnel and what staffing level is needed to provide nursing and medical care to inmates. It became clear that the basis for the decisions and the key figures are lacking. At the end of 2017, the key figures for use in calculating requirements in the medical area were again the subject of intensive internal discussions within the Federal Ministry. According to the Ministry’s own information, it has been working on this question since 2015. Lack of key figures Only the key figures for the deployment of nursing staff have been determined thus far. Three variables were identified for calculating the necessary number of permanent positions in the nursing service for each correctional institution. These three parameters are: “basic care”, “assistance at doctor’s appointments” and “substitution”. Relevant parameters The amount of time the nursing service spends per inmate per year is determined for the parameter “basic care”. For the parameter “assistance at doctor’s appointments”, the average time expended to assist an inmate during doctor’s appointments, including the time used for preparation and follow-up, is calculated. The parameter “substitution” covers the time it takes to administer substitution medications. For each correctional institution, the net time expended for general medical and psychiatric care was surveyed using these three factors. The necessary number of permanent positions was determined on this basis. The results of the calculation show how many full-time equivalents are needed in each correctional institution to cover the tasks performed by the nursing staff there. Need is based on time expended In determining the necessary number of full-time positions, it was also taken into account that the staffing capacity is based on the average annual working hours of an employee who works 42 calendar weeks per year. This is to avoid a situation where absences (e.g. due to vacation) result in personnel shortages. Based on the results of these calculations, it was determined that seven of the 24 correctional institutions have a need for additional nursing staff. This need for additional staff was reported to the recruiting agency for justice supporting staff for 2018. Objective need for nursing staff 123