Special Report to the Storting Document 4:3 (2018–2019) 74 In the case of inmates held in a security cell or restraint bed, the guide states that the health and care service should provide the inmate with health and care services if the inmate or the Correctional Service so requests.233 This is neither in line with the European Prison Rules nor the UN’s Nelson Mandela Rules.234 It is problematic because medical follow-up of the inmate is dependent on notification of the health service by prison staff. The guide does not take into consideration that the inmate is denied the possibility of contacting the health service directly. We have found examples in several prisons of failure on the part of the health service to look in on an inmate in a security cell or restraint bed to assess the need for medical assistance, in spite of a documented request from the inmate. The vast majority of prison health services lack procedures to ensure that all inmates held in isolation get such supervision at least once a day, regardless of whether this is requested by the prison staff. Medical follow-up of inmates in solitary confinement is ­particularly poor outside the prison health service’s office hours, during evenings and at weekends. We have also seen a failure to carry out systematic health checks of inmates in solitary confinement during the prison health service’s office hours. Lack of checks by medical personnel in connection with the use of security cells was criticised by the European Council’s Committee for the Prevention of Torture after its visit to Norway in 2018. The CPT recommended that steps be taken to ensure that a member of the prison health service always visit persons who are confined to a security cell or restraint bed as soon as possible after being informed of the placement and at least every day until the placement ends. This should be systematic and in no case depend on the opinion of the prison staff. The recommendation was sent to all the prisons visited by the committee, and to other prisons where measures are required.235 75 Lack of medical supervision At Åna Prison, the local accident and emergency unit was responsible for follow-up after 15:00 on weekdays and during weekends. A prison doctor was only available three days a week. The staff could not recall any instance of a doctor from the accident and emergency unit being called to a security cell when such cells were used outside the prison health service’s office hours. A review of the supervision protocols showed that there had been a number of complaints of pains or injuries on the part of inmates, but it was not noted that medical personnel had been called. On the contrary, inmates had been told that they had to wait until the medical personnel were due to work. In some cases, several days passed between visits from medical personnel, including in cases where the inmate clearly suffered from major mental health problems or had notified of physical injuries. In one case, the inmate had repeatedly requested medical attention. No health service visit was noted in the log until the inmate was transferred to another prison six days later. In another case, an inmate was placed in a security cell after having set fire to his own cell. The inmate had respiratory problems after inhaling smoke and fumes from the fire and was checked by the accident and emergency unit. No visits from medical personnel were noted in the log during the following four days after the fire. Those four days coincided with a public holiday. Doctor´s office. 10.4 Need for more knowledge and staff training Many inmates have complex medical issues that require special competence. The municipal authorities are responsible for primary prison health services. In many municipalities, the prison health service does not have a doctor in a permanent position, while others have a doctor in a very limited part-time position or for only a short period. There is currently limited contact between the health services in different prisons, and there is no common platform in the form of a national centre of competence or a professional network to support the exchange of experience and development of the professional quality of these services. The Parliamentary Ombudsman’s visits have shown that there is a need for more knowledge and training of medical personnel employed by the prison health service. This applies to an even greater degree in the case of employees in municipal accident and emergency units, who are ­responsible for following up inmates in solitary ­confinement outside the prison health service’s office hours. Main findings Our findings show widely varying practices between different prisons as regards the prison health ­service’s ­follow-up of inmates who are held in solitary ­confinement, among other things because the ­­organisation of the health service differs. It is important to notify and keep the health service updated as regards inmates in solitary confinement. There are weaknesses in the notification procedures in several prisons. 233 The Directorate of Health (2013). Veileder for helse- og omsorgstjenester til innsatte i fengsel (‘Guide to health and care services for prison inmates’), p. 47. 234 See the Nelson Mandela Rules, Rule 46(1), and the European Prison Rules Rule 42.2. 235 Council of Europe: Committee for the Prevention of Torture (CPT), Report to the Norwegian Government on the visit to Norway 2018,  CPT/Inf (2019) 1, paragraph 107. Highly experienced as well as less experienced prison doctors often agree that there is a need for increased knowledge and competence about the health of prison inmates. This is particularly important as regards the detrimental effects of isolation and the duty of medical personnel to safeguard the health of inmates who are held in solitary confinement. The Norwegian regulatory framework and practice are not in accordance with international human rights standards as regards daily medical supervision of inmates in solitary confinement. We have found a number of instances in which inmates, some suffering from severe health problems, have served in solitary confinement for a long period without being attended to by medical personnel. There is a great need for increased knowledge and training of medical personnel charged with caring for inmates in solitary confinement.