74 The prison officer's contact with the inmates was often limited to the context of exercise. For this reason, inmates ­excluded from the company of others were not routinely seen to by medical ­personnel. The Parliamentary Ombudsman ­expressed concern regarding this lack of follow-up. The visit also identified inadequate ­documentation relating to the use of security cells. The ­documentation gave rise to concern about the prison’s supervision procedures and opportunity to safeguard persons who are placed in a security cell. The documentation did not provide a basis to assess whether inmates in security cells at the prison received proper and satisfactory medical supervision. Although the prison had its own healthcare ­department and a psychiatric outpatient clinic, the de facto availability of health services was ­limited and subject to long waiting times. The ­prison health services was organised in a way that did not sufficiently address ­confidentiality ­between inmates and the health services. This included the prison officers performing ­assessments of medical needs and acting as ­gatekeepers for the health services. The prison ­health services did not engage in outreach a ­ ctivities or preventive work. The medical p ­ ersonnel had limited contact with the inmates and were not responsible for the ­distribution of ­medication. Overall, the ­Parliamentary ­Ombudsman concluded that there was a ­significant risk that inmates in vulnerable ­situations, who did not seek medical assistance on their own initiative, would not be identified before their medical situation became acute. It also came to light that the healthcare ­department found that remand inmates regularly missed their appointments with the specialist health services outside the prison because the police did not come to escort them. The healthcare department did not have a system for registering the cancelled appointments as nonconformities. This represents a clear risk of violation of patients’ right to satisfactory treatment. In all, the health NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2019 services at Oslo Prison appeared to be of an ­inadequate scope to be able to safeguard the health of inmates in a satisfactory manner. Follow-up of the visit Oslo Prison and the healthcare department submitted detailed feedback to the Parliamentary Ombudsman after the visit. The submitted feed­ back showed that some immediate action had been implemented, in addition to more extensive quality-improvement work that will take somewhat longer to implement. Both the prison and the healthcare department emphasised in their feedback that they could not meet certain recommendations, in particular those related to solitary confinement, due to the current staffing, building and resource situation. After the visit, the prison purchased benches with roofs for both exercise yards, and a new, bigger greenhouse for the exercise yard in connection with the section for inmates with extra need for supervision. The prison recognises the need for major improvements, but states that it is uncertain whether the prison is to continue in its current building or whether a new one is to be built. Major improvements will not take place until this has been clarified. After the visit, both the healthcare department and the prison improved the admission ­procedures. A working committee has been appointed to prepare new information material, and the procedures now make it clear that new inmates are to speak to medical personnel within 48 hours. The reply letter from the prison acknowledges that the extensive use of lock-up is undesirable. At the same time, it is underlined that the recommendation of ensuring that inmates spend eight hours outside their cell cannot be realised, due to the current resource situation. After the visit, the prison does however make reference to strengthening measures to compensate for the detrimental effects of solitary confinement and to establishing new measures.