On the other hand, the Contrôleur général is pleased to note the publication of the interministerial circular of 21st June 2012 from the Ministry of Justice and the Ministry of Health and Social Affairs, concerning the sharing of operational information between health professionals and professionals within the prisons administration and the Judicial youth protection service. This circular makes it possible to establish a list of information which should or may be exchanged between professionals, in order to ensure security in prisons while protecting the medical secrecy guaranteed to persons in custody by article 45 of the Prisons Act of 24th November 2009. However, the Contrôleur général deeply regrets that the issues dealt with in the report for 2011 and recalled above are in no way taken up in the circular, despite the fact that they continue to pose problems in institutions. In addition, he is surprised by the contents of the list of information which “may” be passed on by prison professionals, without therefore any obligation on their part (“non-systematic and non-urgent nature”): it includes information on the family and social background of prisoners, on their behaviour in custody and participation in activities, their personal hygiene and the cleanliness of their cells. Nevertheless, these are essential pieces of information for the provision of high-quality healthcare to prisoners 191. 4.2 Provision of medical services for transsexual prisoners On 30th June 2010, the Contrôleur général published an assessment concerning prisoners suffering from problems of sexual identity. These are persons serving long sentences who report their feeling of belonging to the opposite sex and who encounter difficulties in their conditions of detention and in the medical services provided for them. The observations highlighted in 2010 by the Contrôleur général remain pertinent in 2012: there are still no guiding principles applicable to institutions as a whole, which leads each director to make decisions on a case-by-case basis (authorisation to wear women’s clothing, possibility of buying beauty products in prison shops etc.). Furthermore, imprisoned transsexual persons do not have access to medical care provided outside of institutions and only one of them has had the benefit (and moreover rather belatedly) of routine access to a specialised team within the national public health institution at the remand prison of Fresnes. After being questioned about this issue in June 2012, the Minister of Health and Social Affairs replied in October 2012 that hospitalisation at Fresnes could not constitute a general rule to be applied for dealing with imprisoned transsexual persons, pointing out that: “In view of the geographical location of specialised teams, the prison administration should, in coordination with the medical teams, assess the appropriateness of transferring these persons to prisons near towns that possess such teams, so that appropriate medical care may be provided in the course of their imprisonment”. The Contrôleur général can only be surprised by this reply, which echoes current practices for dealing with transsexual persons that have shown their limits, as recalled in the assessment of 2010. Indeed, it is the absence of structure in the supply of treatment for prisoners that gives rise to difficulties of provision of medical care, slowness in the taking of measures aimed at persons and the heterogeneity thereof according to institutions. Overall structure of this kind (which could be based upon the recommendations of the Haute Autorité de santé Health Authority in its report published in February 2010) indeed comes within the competence of the Ministry of Health and the responsibility of the prisons administration therefore only extends to organising itself in order to allow access to the healthcare considered appropriate by the medical teams. 191 Cf. section 5 of this report. 88