90 health care Secure rooms in emergency care units As in previous years, the Ombudsman felt it was important to visit the emergency care units of somatic hospitals, which use secure rooms for the seclusion of patients brought to emergency care services who, for example because they are aggressive or confused, cannot be placed with other emergency patients. This situation is a problem because there is no legislation on seclusion in somatic health care. However, secluding a patient may sometimes be justified under emergency or self-defence provisions. Such situations tend to involve an emergency, during which it is necessary to restrict the patient’s freedom in order to protect either his or her own health or safety, or those of other persons. The Ombudsman has required in his legal practice that the legal provisions and ethical norms governing the actions of doctors and other health care professionals must also be taken into account in these situations, and, as a result, the application of two parallel sets of standards. Furthermore, the procedure may not violate the patient’s human dignity. Having appropriate equipment in the seclusion room is of major importance when assessing whether a patient’s seclusion has, as a whole, been implemented in a manner that qualifies as dignified treatment and high-quality health and medical care. The criteria laid down in the Mental Health Act for the seclusion of a psychiatric patient are also applicable as minimum requirements for secure rooms in somatic hospitals. A patient placed in a secure room must be continuously monitored. This means that the patient must be monitored by visiting the seclusion room in person and observing the patient through a video link with image and audio. Appropriate records must be kept of the monitoring at all times. The different emergency care units have numerous security rooms, which are regularly used. Regardless of this, patients rarely complain to the Ombudsman about their placement in a secure room, or their treatment while in seclusion. Attention is also paid to the privacy of the patient in urgent-care facilities. The Ombudsman has stressed the importance of ensuring, by various means including spatial design, that patients’ details are not disclosed to third parties in the hectic environment of an emergency room. The Ombudsman finds it important that the protection of privacy is raised as a topic in staff training and that due attention is paid to the matter in the execution of daily duties. The NPM visited the urgent care unit of two central hospitals in 2017. All visits were made unannounced and during the evening. An external expert participated in the visits. Prisoners’ health care Health care for prisoners was transferred to the administrative branch of the Ministry of Social Affairs and Health at the beginning of 2016. Health Care Services for Prisoners (VTH) operates in connection with the National Institute for Health and Welfare (THL). At the same time, the powers of Valvira and the Regional State Administrative Agencies were expanded to cover the prisoners’ health care organisation. In practice, the supervision has been centralised in AVI Northern Finland, which conducts guidance and assessment visits to the outpatient clinics and hospitals of the Prisoners’ Health Care Unit on its own, or together with Valvira. By the end of the year, 13 of these units had been visited. The objective is that AVI will have visited all of the VTH units by the end of 2018. The NPM visited the Vantaa unit of VTH in 2017. Because the visit was combined with the inspection visit to Vantaa Prison, the inspection team had the opportunity, before inspecting the clinic, to interview prisoners on the health care they had received. In