CAT/C/IRL/CO/2 (h) Prisoners continue to be handcuffed when transferred between facilities and during external medical examinations. 16. The State party should: (a) Continue to strengthen the measures aimed at further decreasing the number of persons in the prison system and to reduce overcrowding with a view to bringing conditions of detention into line with the international standards enshrined in the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules); (b) Continue efforts aimed at reducing overcrowding and improving material conditions in all places where women are detained, in line with the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules); (c) Consider increasing the use of non-custodial measures and alternatives to detention, in keeping with the United Nations Standard Minimum Rules for Noncustodial Measures (the Tokyo Rules); (d) Ensure the separation of remand prisoners from those who have been sentenced and provide the Committee with information on the number of remand prisoners and how long they stay on remand; (e) Implement the Irish Prison Service Strategic Plan 2016-2018, including for the refurbishment of existing facilities and the construction of new ones; modernize Limerick prison and “Block E” of Portlaoise prison to eliminate the slopping out system completely; and improve in-cell sanitation in all facilities that require it and ensure privacy in the use of toilet facilities and their separation from places where prisoners take meals; (f) Take urgent measures to increase the ratio of guards to prisoners, hire additional medical personnel, including psychiatric personnel and psychologists, and enable the referral of inmates requiring specialized medical care to outside medical facilities without delays due to administrative reasons and lack of escorts from among prison staff; (g) Ensure that solitary confinement remains a measure of last resort, imposed for as short a time as possible, is never applied to juveniles, is under strict supervision and judicial review with clear and specific criteria for its use, and that prolonged and consecutive disciplinary sanctions of solitary confinement are strictly prohibited; (h) Introduce a cell-share risk assessment tool across the prison estate and ensure that prisoners requiring protection are not penalized by their situation and have contact with the outside world, sufficient purposeful activities and out-of-cell exercise and family visits; (i) Urgently undertake an independent, fundamental review of the entire prison health-care system, in keeping with the recommendations of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment; (j) Ensure that prisoners who are transferred between facilities are not injured during transportation and ensure that handcuffing is used only as an exceptional measure, after appropriate risk assessment; (k) Take the necessary steps to ensure that external medical personnel consulted by prisoners respect the principles of medical confidentiality and human dignity. 6