6. Unresolved issues in effective prevention of ill-treatment Inspection authorities are not allowed to peruse medical records social services facilities Issue: For the authorities inspecting the provision of social services to effectively protect the residents’ rights and prevent ill-treatment, they have to be able to access all documents kept by the social services provider. This means they must have the right to peruse documentation on nursing care and make excerpts or copies even without the patient’s consent. The problem is that documentation of nursing care constitutes a part of medical records and the relevant laws do not provide for the inspectors’ access to it. The Ministry of Labour and Social Affairs has not been able so far to secure the necessary legislative changes with the Ministry of Health, which is responsible for this area. It is necessary to amend the Healthcare Services Act and include social services inspectors among entities authorised to peruse medical records even without the patient’s consent. A strategic approach is also lacking in terms of decreasing the need for using means of restraint. psychiatric facilities Issue: The legal regulation of criteria for the use of means of restraint is in conformity with the European standard. Full compliance with the standard, including the principles of necessity and subsidiarity, is prevented by a number of issues persisting in practice. In practice, there is a lack of specific conditions for alternative resolution of dangerous patient behaviour. At certain units, means of restraint are used preventively and is prolonged because of inadequate material equipment and insufficient staff, without this leading to any adjustment in the manner of providing care. Not only patients, but also the personnel are in a danger of injury and trauma. The health-care staff often do not distinguish between treatment and pharmacological restraints. State inspection is sporadic. Because records of the use of means of restraint in the current form, as laid down by the Healthcare Services Act (Section 39 (4)), only provide an irrelevant statistic, effective monitoring and inspection of restraints remains difficult. Potential solution: The use of means of restraint will not decrease without policy of their prevention and alternative means, and without a clear signal from the Government that it will no longer tolerate care relying on the use of restraints. Constant guidance and supervision is also necessary. The attitude to the use of net beds has not changed healthcare services facilities Issue: Although the CPT has regularly recommended since 2002 that the Government of the Czech Republic prohibit this means of restraint, net beds still remain in use. Specifically, although the number of net beds in psychiatric hospitals has decreased, they nevertheless have not been abandoned completely. It is not known how many of them are currently in these or other healthcare facilities. The Government has not yet adopted the necessary steps to implement its 2015 promise to the CPT that it would seek ways to discontinue the use of net beds. Some physicians are concerned that net beds will simply be replaced by other means of restraint. Adopt a strategic approach that would include search for and promotion of effective alternatives to the use, not only of net beds, but of means of restraint in general. 21