National Preventive Mechanism Ninth Annual Report 2017–18 relatives were, overall, positive about the care, support and treatment they received. No major failings were noted in the administration of the MHA throughout Wales, although recommendations were made for improvements to documentation in some independent settings. Non-compliance action was taken in two independent mental health settings relating to the excessive use of physical restraint and seclusion, and the registration of another independent setting was suspended due to indications of a significant risk to patient safety. The environments of many wards visited were not of the requisite standard, with some environmental issues impacting on patient privacy and dignity, and some on patient safety. Significant concerns about the environment of one unit led to it being found unfit for purpose and not conducive to providing safe care. Recommendations to improve medicines management were made on all inspections. Staff shortages were seen across the sector. RQIA reported concerns about the lack of safe and therapeutic environments in three hospital sites in Northern Ireland. There were also concerns in relation to patient transfers between providers in some mental health inpatient facilities, resulting in a risk to patient and staff safety, and delays in discharge of patients with a learning disability. RQIA noted an increase in the number of admissions of children to adult wards in Northern Ireland, from two in 2016–17 to six in 2017–18. On five occasions the reason for admission was non-availability of beds in the Regional Treatment Centre. 18 20 However, RQIA was satisfied with the safeguarding measures put in place by the provider during each admission. Court custody HMI Prisons and LO reported throughout the year that the physical conditions in the court custody suites inspected and monitored in England and Wales were poor, with many cells dirty and in a state of disrepair. Concerns about identification and management of detainee risk were also identified, which included failures to complete individual risk assessments for detainees, and HMI Prisons noted that handcuffs were often applied without an individual risk assessment. Both HMI Prisons and LO reported that many detainees spent longer than necessary in court custody, even when staff had requested their cases be prioritised. Court custody staff were generally found to be professional and friendly in their dealings with detainees.18 Thematic work on detention issues The NPM as a whole and its members (both individually and jointly) undertake a range of thematic work on detention issues in order to explore areas of concern, gain a greater understanding of particular topics, provide information to policy makers to effect change and strengthen their own working practices. NPM joint thematic work on detention The NPM has completed work on two projects and begun work on a third. For more detailed findings and recommendations see Lay Observers, Annual Report to the Secretary of State for Justice, July 2018, available at https://s3-eu-west-2.amazonaws.com/layobservers-prod-storage-nu2yj19yczbd/uploads/2018/07/ Lay-Observer-Annual-Report-17-18.pdf, accessed 8 August 2018, and HM Chief Inspector of Prisons for England and Wales Annual Report 2017–18, July 2018, available at https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/ sites/4/2018/07/6.4472_HMI-Prisons_AR-2017-18_Content_A4_Final_WEB.pdf, accessed 8 August 2018.